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At least 37 records · Page 2Linked to original sources
PubMed2003

Halothane enhances gamma-aminobutyric acid receptor type A function but does not change overall inhibition in inspiratory premotor neurons in a decerebrate dog model.

BACKGROUND: Inspiratory premotor neurons in the caudal ventral medulla relay excitatory drive to phrenic and inspiratory intercostal motoneurons in the spinal cord. These neurons are subject to tonic gamma-aminobutyric acid type A (GABA(A))-mediated (GABA(A)ergic) inhibition. In a previous study, 1 minimum alveolar concentration (MAC) halothane depressed overall glutamatergic excitatory drive but did not change overall inhibitory drive to the neurons. This study investigated in further detail the effects of halothane on GABA(A)ergic inhibition by examining postsynaptic GABA(A) receptor activity in these neurons. METHODS: Studies were performed in decerebrate, vagotomized, paralyzed, and mechanically ventilated dogs during hypercapnic hyperoxia. The effect of 1 MAC halothane on extracellularly recorded neuronal activity was measured during localized picoejection of the GABA(A) receptor antagonist bicuculline and the GABA(A) agonist muscimol. Complete blockade of GABAergic inhibition by bicuculline allowed estimation of the prevailing overall inhibition of the neuron. The neuronal response to muscimol was used to assess the anesthetic effect on the postsynaptic GABA(A) receptor function. RESULTS: One minimum alveolar concentration halothane depressed the spontaneous activity of 19 inspiratory premotor neurons by 22.9 +/- 29.1% (mean +/- SD; P < 0.01). Overall excitatory drive was depressed 23.6 +/- 16.9% (P < 0.001). Overall GABAergic inhibition was not changed (+8.7 +/- 27.5%; P = 0.295), but the postsynaptic GABA(A) receptor function was increased by 110.3 +/- 97.5% (P < 0.001). CONCLUSION: One minimum alveolar concentration halothane greatly enhanced GABA(A) receptor function on inspiratory premotor neurons but did not change overall synaptic inhibition, indicating that the presynaptic inhibitory input was reduced. Therefore, the anesthetic depression of spontaneous inspiratory premotor neuronal activity in the intact brainstem respiratory network is mainly due to a decrease in overall glutamatergic excitation.

Anesthetics, Inhalation↗
PubMed2005

Sevoflurane enhances gamma-aminobutyric acid type A receptor function and overall inhibition of inspiratory premotor neurons in a decerebrate dog model.

BACKGROUND: Inspiratory premotor neurons in the caudal ventral medulla relay excitatory drive to phrenic and inspiratory intercostal motoneurons in the spinal cord. These neurons are subject to tonic gamma-aminobutyric acid type A (GABAA)ergic inhibition. In a previous study, 1 minimum alveolar concentration (MAC) sevoflurane depressed overall glutamatergic excitatory drive and enhanced overall GABAAergic inhibitory drive to the neurons. This study investigated in further detail the effects of sevoflurane on GABAAergic inhibition by examining postsynaptic GABAA receptor activity in these neurons. METHODS: Studies were performed in decerebrate, vagotomized, paralyzed, and mechanically ventilated dogs during hypercapnic hyperoxia. The effect of 1 MAC sevoflurane on extracellularly recorded neuronal activity was measured during localized picoejection of the GABAA receptor antagonist bicuculline and the GABAA agonist muscimol. Complete blockade of GABAAergic inhibition by bicuculline allowed estimation of the prevailing overall inhibition of the neuron. The neuronal response to muscimol was used to assess the anesthetic effect on the postsynaptic GABAA receptor function. RESULTS: One MAC sevoflurane depressed the spontaneous activity of 21 inspiratory premotor neurons by (mean +/- SD) 32.6 +/- 20.5% (P < 0.001). Overall excitatory drive was depressed 17.9 +/- 19.8% (P < 0.01). Overall GABAAergic inhibition was enhanced by 18.5 +/- 18.2% (P < 0.001), and the postsynaptic GABAA receptor function was increased by 184.4 +/- 121.8% (n = 20; P < 0.001). CONCLUSION: One MAC sevoflurane greatly enhanced GABAA receptor function on inspiratory premotor neurons and increased overall synaptic inhibition but to a smaller extent, indicating that the presynaptic inhibitory input was also reduced. Therefore, the anesthetic depression of spontaneous inspiratory premotor neuronal activity by 1 MAC sevoflurane in vivo is due to a combined effect on the two major ionotropic synaptic neurotransmitter systems with a decrease in overall glutamatergic excitation and a strong enhancement of postsynaptic GABAA receptor function.

Animals↗
PubMed2006

Validation of a 7-point Global Overall Symptom scale to measure the severity of dyspepsia symptoms in clinical trials.

BACKGROUND: Currently there is no consensus on the optimal method to measure the severity of dyspepsia symptoms in clinical trials. AIM: To validate the 7-point Global Overall Symptom scale. METHODS: The Global Overall Symptom scale uses a 7-point Likert scale ranging from 1 = no problem to 7 = a very severe problem. Validation was performed in two randomized-controlled trials (n = 1121 and 512). Construct validity: Global Overall Symptom was compared with the Quality of Life in Reflux And Dyspepsia, Gastrointestinal Symptom Rating Scale, Reflux Disease Questionnaire and 10 specific symptoms using Spearman correlation coefficients. Test-retest reliability: The Intraclass Correlation Coefficient was calculated for patients with stable dyspepsia defined by no change in Overall Treatment Effect score over two visits. Responsiveness: effect size and standardized response mean were also calculated. RESULTS: Construct validity: Change in Global Overall Symptom score correlated significantly with Quality of Life for Reflux And Dyspepsia, Gastrointestinal Symptom Rating Scale, Reflux Disease Questionnaire and specific symptoms (all P < 0.0002). Reliability: The Intraclass Correlation Coefficient was 0.62 (n = 205) and 0.42 (n = 270). Responsiveness: There was a positive correlation between change in Global Overall Symptom and change in symptom severity. The effect size and standardized response mean were 1.1 and 2.1, respectively. CONCLUSION: The Global Overall Symptom scale is a simple, valid outcome measure for dyspepsia treatment trials.

Adolescent↗
PubMed1984

The contribution of brain injury to the overall injury severity of brain-injured patients.

Several recent population-based studies of the incidence of head injury have identified cases by screening hospitalized patients. This method assumes a close relationship between severity of head injury and overall injury severity, since it is the latter that determines hospital admission. Thus, a patient whose overall injury severity is high will be admitted to the hospital regardless of the degree of his head injury. Similarly, since a patient's outcome status after treatment depends on his response to all his injuries, studies of the prognosis of various types of head injury also assume a close relationship between head injury severity and overall injury severity. The present study examines the relationship between brain injury severity and overall injury severity in a series of hospitalized head-injured patients with evidence of actual or probable brain trauma. Among these patients, brain injury severity was closely related to overall injury severity. Head injury severity and head and neck injury severity were also closely related to overall injury severity. For all other body regions, injury severity was not closely related to overall injury severity in this group of patients.

Adolescent↗
PubMed2000

Correlation of clinical picture (event free survival and overall survival) in childhood acute leukemia patients with immunophenotype and chromosomal abnormalities.

In a group of 102 children with different immunological subtypes of acute leukemia, both lymphoblastic and nonlymphoblastic, the clinical parameters - event free survival and overall survival were correlated with numerical and structural chromosomal abnormalities. In a group of 80 ALL patients genetic abnormalities were observed in 40 patients, from those 19 of numerical type, 17 of structural type and 4 with both, numerical and structural anomalies. From the whole ALL group observed 23 patients (28.75%) died. In 10 died patients genetic abnormalities were found and in 6 cases less mature T-phenotype ALL has been documented. It seems, therefore, that immature T-phenotype with pathological karyotypes of all types of genetic anomalies presents the most risk group of patients of which all children died. ALL patients, as a whole, with pathological karyotype have shown significantly lower event free survival rate, comparing to the group of ALL patients with normal karyotype. Overall survival rate was also lower in the first group, but statistically not significant. In T-ALL patients, in both groups, with and without pathological karyotype, event free survival rate and overall survival rate were also lower in the first group, but statistically not significant. In B-ALL patients with pathological karyotypes vs. normal ones overall survival rate was lower in the first group, but statistically not significant. There was no difference in overall survival rate in these patients between pathological and normal karyotypes. In ANNL group of patients pathological karyotype was observed in 14 of them, with numerical anomalies in 6 patients, structural in 4 patients and both of them - numerical + structural in 4 children. From the whole ANLL group observed 11 (50%) patients died during the follow-up period (9 in relapse and 2 of treatment complications). From 11 died patients in 81.8% pathological karyotype was present. The prevalence of pathological karyotypes was observed in less mature M0-M2 ANLL subtype (71.4%). ANLL patients with pathological karyotype have shown significantly lower event free survival rate (in one of the two statistical log-rank analyses), comparing to the group of ANLL patients with normal karyotype. Overall survival rate was also lower in the first group, but statistically not significant. The presence/absence of CD34 marker expression in blast cells of our group of acute leukemia patients did not show any difference in event free survival and overall survival rates.

Adolescent↗
PubMed2006

POSSUM predicts decreased overall survival in curative resection for colorectal cancer.

PURPOSE: Poor condition at operation determined by the physiologic POSSUM score is related to postoperative mortality and morbidity of colorectal cancer surgery. This study was designed to analyze the relationship between condition of patients with colorectal cancer at operation and long-term overall survival. METHODS: A total of 542 patients survived a radical resection for Stages I, II, or III colorectal cancer. Physiologic POSSUM score at surgery, exclusive of age, was calculated for all patients. Mean physiologic POSSUM score was used as cutoff point to determine low-risk and high-risk group patients. A Cox proportional hazard analysis was performed to study the effect of low-risk and high-risk group on overall survival and to identify independent risk factors. RESULTS: Five-year overall survival was significantly higher in low-risk group patients than in high-risk group patients (low-risk group 66.6 percent vs. high-risk group 48.5 percent; P < 0.001). Differences in overall survival also were found when patients in Stages I, II, and III were analyzed separately. Risk factors for overall survival were advanced stage of disease, poor tumor differentiation, mucinous adenocarcinoma, older than age 70 years, and poor condition of the patient at time of operation. CONCLUSIONS: Poor condition at operation, as determined by physiologic POSSUM score, is a risk indicator for long-term overall survival in colorectal cancer patients.

Adenocarcinoma↗
PubMed1990

The effect of overall treatment time on local control in patients with adenocarcinoma of the prostate treated with radiation therapy.

Studies of patients treated with radiation therapy for squamous cell carcinoma of the head and neck have demonstrated that when all other variables are constant, protraction of the overall treatment time leads to a decreased probability of local control. Few data exist on the effect of overall treatment time on local control following irradiation of tumors that are generally thought to be slowly proliferating, such as adenocarcinoma of the prostate. This analysis was undertaken to determine the time-dose relationships for local control of prostatic adenocarcinoma at the University of Florida. All patients were treated at least 5 years prior to the date of analysis. For patients with Stage A2 disease, a tumor dose of 6500 cGy in 7 to 7.5 weeks to 7000 cGy in 8 weeks resulted in local control in 17/17 patients (100%). For patients with Stage B1 disease, the local control rate was 14/16 (88%) with an overall treatment time of less than or equal to 8 weeks versus 1/3 in patients who received split-course treatment in greater than 8 weeks (p = .097). For patients with Stage B2, C1, and C2 disease who received greater than or equal to 6500 cGy, the 5-year rate of local control was lower when overall treatment time was protracted beyond 8 weeks. Results were as follows: B2 (62 patients), less than or equal to 8 weeks, 88%, versus greater than 8 weeks, 55%, p = .002; C1 (87 patients), less than or equal to 8 weeks, 88%, versus greater than 8 weeks, 73%, p = .052; Cs (33 patients), less than or equal to 8 weeks, 81%, versus greater than 8 weeks, 65%, p = .056. Stratification by tumor grade of patients with Stage B1, B2, C1, and C2 disease who received greater than or equal to 6500 cGy demonstrated significantly lower local control rates for all grade categories when the overall treatment time was protracted beyond 8 weeks. Five-year local control rates (life-table method) for overall treatment time less than or equal to 8 weeks versus greater than 8 weeks were as follows: well differentiated, 93% versus 73% (p = .003); moderately differentiated, 86% versus 69% (p = .017); and poorly differentiated, 75% versus 59% (p = .046). These data suggest that tumor repopulation during excessively protracted treatment may be a clinically significant factor in patients with adenocarcinoma of the prostate.

Adenocarcinoma↗
PubMed2004

Both pretreatment prostate-specific antigen level and posttreatment biochemical failure are independent predictors of overall survival after radiotherapy for prostate cancer.

PURPOSE: To assess the impact of pretreatment prognostic factors plus subsequent biochemical failure on overall survival after radiotherapy for prostate cancer. METHODS AND MATERIALS: We analyzed the prostate-specific antigen (PSA) and survival records of 1571 men with clinically localized prostate cancer treated with external beam radiotherapy monotherapy at the former Queensland Radium Institute between 1990 and 1997. The pretreatment PSA level, biopsy Gleason score, clinical stage, patient age, and the development of biochemical failure were assessed in relationship to overall survival and cause-specific survival, using fixed, as well as time-dependent, statistics. RESULTS: The median follow-up was 88.1 months (95 months for those still alive). The actuarial overall survival, cause-specific survival, and biochemical failure-free survival rate at 10 years was 61.1%, 80.9%, and 25.9% respectively. Cause-specific survival was independently influenced by the pretreatment PSA level, Gleason score, clinical stage, and the development of biochemical failure (relative risk, 19.1). Using the overall survival endpoint, multivariate analysis showed age, pretreatment PSA level, Gleason score, and biochemical failure (relative risk 1.27) to be statistically significant variables. CONCLUSION: In addition to previously identified factors, the pretreatment PSA level and occurrence of biochemical failure after radiotherapy for prostate cancer are associated with an increased overall mortality risk. Both pretreatment PSA level and posttreatment biochemical failure are independent predictors of overall survival after radiotherapy for prostate cancer.

Adult↗
PubMed2005

Impact of short course hormonal therapy on overall and cancer specific survival after permanent prostate brachytherapy.

PURPOSE: To review the impact of prior hormonal therapy on 10-year overall and prostate cancer specific survival after primary brachytherapy. METHODS AND MATERIALS: A retrospective review was performed on the Arizona Oncology Services tumor registry for 2,378 consecutive permanent prostate brachytherapy cases from 1988 through 2001. Hormonal therapy was administered before the implant in 464 patients for downsizing of the prostate or at the discretion of the referring physician. All deceased patients with known clinical recurrence were considered to have died of prostate cancer, irrespective of the immediate cause of death. Risk groups were defined, with 1,135 favorable (prostate-specific antigen [PSA] < 10, Gleason < 7, Stage T1-T2a), 787 intermediate (single adverse feature), and 456 unfavorable (two or more adverse features) patients. Kaplan-Meier actuarial survival curves were generated for both overall and cause-specific survival from the time of treatment. Multivariate analysis was performed to assess the impact of hormonal intervention in comparison with known risk factors of grade, PSA, and age. RESULTS: With follow-up ranging up to 12.6 years and a median of 4.1 year, a total of 474 patients died, with 67 recorded as due to prostate cancer. Overall and cause-specific 10-year survival rates are 43% and 88%, respectively. Overall survival is 44% for the hormone naive patients, compared with 20% for the hormone-treated cohort (p = 0.02). The cancer-specific survival is 89% vs. 81% for the same groups (p = 0.133). Multivariate analysis confirms the significance of age > 70 years (p = 0.0013), Gleason score >/= 7 (p = 0.0005), and prior hormone use (p = 0.0065) on overall survival. CONCLUSIONS: At 10 years, in prostate cancer patients receiving brachytherapy, overall survival is worse in men receiving neoadjuvant hormonal therapy, compared with hormone naive patients. This does not appear to be due to other known risk factors for survival (i.e., stage, grade, PSA, age) on multivariate analysis. The leading causes of death were cardiovascular, prostate cancer, and other cancers with no obvious discrepancy between the two groups. This finding is unexpected and requires confirmation from other centers.

Age Factors↗
PubMed2004

Risk factors for overall and persistent diarrhoea in infancy in Antalya, Turkey: a cohort study.

The aim of this study was to identify factors that influence the incidence of diarrhoea in infancy. The study was a prospective cohort study conducted in two primary healthcare unit areas in Antalya, Turkey. A total of 204 infants were followed until they were aged 1 year. Morbidity surveillance and anthropometric measurements were carried out by home visits every 2 months. The average incidences were found to be 2.76 episodes per child-year for overall diarrhoea and 18.56 episodes per 100 child-years for persistent diarrhoea. Relative risks, confidence intervals and logistic regression analyses were used to assess the associations. For both overall diarrhoea and persistent episodes, increased risks were associated with having an uneducated mother (RR=1.89 and 5.33, respectively) and a self-employed father (RR=1.89 and 3.77, respectively). Among environmental factors, living in a slum was associated with both overall (RR=1.68) and persistent (RR=2.69) diarrhoea, whereas living in a crowded house (RR=1.70), having no kitchen (RR=2.27) or having an unhygienic toilet (RR=1.93) were found to be significant for overall episodes alone. Factors related to the infant were preterm birth (RR=1.64), low birth weight (RR=2.05), and first breastfeed given more than 1 h after birth (RR=1.64). Nutritional status was also associated with overall or persistent diarrhoea: underweight children (RR=2.15, persistent diarrhoea only), stunted children (RR=1.67 and 2.14, respectively) or wasted children (RR=1.54 and 3.20, respectively). By logistic regression analysis, both overall and persistent diarrhoea were found to be associated with mother's education.

Diarrhea, Infantile↗
PubMed1999

Biochemical failure does not predict overall survival after radical prostatectomy for localized prostate cancer: 10-year results.

OBJECTIVES: To compare rates of overall survival in men with biochemical failure (bF) to those with no bF after radical prostatectomy for localized prostate cancer. METHODS: Radical prostatectomy was performed in 1132 consecutive patients between June 1986 and September 1998, and bF (prostate-specific antigen [PSA] 0.2 ng/mL or greater) was documented in 213 patients (19%), with a mean follow-up of 56 months (range 1 to 125). Ninety-nine patients were treated with androgen ablation and/or radiation therapy at the time of bF. Kaplan-Meier estimates of bF, metastasis-free survival, and overall survival were generated and compared using the log-rank test. RESULTS: The 10-year overall survival rates for patients with bF (88%) versus no bF (93%) were similar (P = 0.94). The survival rates of patients with bF were not statistically different than those of patients without bF when compared by age older than 65 years, preoperative PSA greater than 10 ng/mL, biopsy or specimen Gleason score 7 or greater, clinical Stage T2b-3, presence of extracapsular extension, positive surgical margins, and seminal vesicle invasion. Patients who received second-line treatment also had a similar 10-year overall survival rate (86%, P = 0.97). For the 213 patients with bF, the metastasis-free survival rate at 10 years was 74%. The overall survival rate for patients with distant metastasis (56%) was markedly lower (P <0.001) than for those without distant metastasis. CONCLUSIONS: At 10 years, patients with a PSA recurrence after radical prostatectomy for localized disease have an excellent overall survival equivalent to those without a detectable PSA. Within this period, the clinical significance of a detectable PSA needs to be further evaluated.

Aged↗
PubMed1999

Patterns of failure and overall survival in patients with completely resected T3 N0 M0 non-small cell lung cancer.

BACKGROUND: Previous studies of patients with surgically resected non-small cell lung cancer and chest wall invasion have shown conflicting results with respect to prognosis. Whether high-risk subsets of the T3 N0 M0 population exist with respect to patterns of failure and overall survival has been difficult to ascertain, owing to small numbers of patients in most series. METHODS AND MATERIALS: A retrospective review was performed to determine patterns of failure and overall survival for patients with completely resected T3 N0 M0 non-small cell lung cancer. From 1979 to 1993, 92 evaluable patients underwent complete resection for T3 N0 M0 non-small cell lung cancer. The following potential prognostic factors were recorded from the history: tumor size, location, grade, histology, patient age, use of adjuvant radiation therapy (18 of 92 patients), and type of surgical procedure (chest wall or extrapleural resection). RESULTS: The actuarial 2- and 4-year overall survival rates for the entire cohort were 48% and 35%, respectively. The actuarial local control at 4 years was 94%. Neither the type of surgical procedure performed nor the addition of thoracic radiation therapy impacted local control or overall survival. CONCLUSION: Patients with completely resected T3 N0 M0 non-small cell lung cancer have similar local control and overall survival irrespective of primary location, type of surgery performed, or use of adjuvant radiation therapy. Additionally, the tumor recurrence rate and overall survival found in this study support the placement of this group of patients in Stage IIB of the 1997 AJCC lung staging classification.

Carcinoma, Non-Small-Cell Lung↗
PubMed2000

A method for quantifying overall satisfaction of complete denture patients.

Reproducible and quantitative evaluation of patient satisfaction with their complete dentures is of great importance for preoperative diagnosis, treatment planning and assessment of complete denture treatment outcome. This study attempted (1) to clarify the degree of contribution of various factors to overall satisfaction, and (2) to develop a method for quantitative assessment of overall satisfaction with complete dentures. Twelve satisfaction factors and a three-grade scale were used to assess 302 complete denture patients. The contribution of each grade of the 12 factors to the overall satisfaction level was determined by multiple regression analysis. Seven factors were highly correlated to the overall satisfaction. Based on the level of contribution by these seven significant factors, a scoring method for satisfaction was established. Category scores for these factors were calculated and the sum of the category scores was converted to an integer between 0 and 100. The resulting quantification score was closely correlated with overall satisfaction. A protocol for scoring overall satisfaction was developed based on the scientifically analysed contribution of each satisfaction factor.

Aged↗
PubMedDate not supplied

An ultraviolet spectrophotometric method as an alternative test for determining overall migration from aromatic polyester packaging materials into fatty food oils.

The generic test method developed by the European Committee for Standardization (CEN) Sub Committee 1 (SC1), CEN ENV 1186, for determining overall migration from plastics into fat simulants is complex, time consuming and the test precision is poor. An ultraviolet (UV) spectrophotometric test method that utilizes the first derivative of absorbance (d[A]/d[lambda]) has been developed for determining overall migration into oil from polyethylene terephthalate (PET) and other aromatic polyester packaging materials which correlates with overall migration values obtained by the CEN method. The UV method can be used as a control method instead of the CEN method for overall migration testing in most instances and may require only about 10% of the time needed to conduct the CEN test. For modified polyester packaging materials such as foamed articles, the UV test method is a better test for overall migration. In addition to the overall migration information, the UV data also indicate if additional testing for the specific migration of terephthalic acid (TPA) into the fat simulant is required. HB 307 oil is the preferred fatty food simulant but olive oil can also be used.

Diffusion↗
PubMed2005

Pretreatment serum interleukin-6 concentration as a prognostic factor of overall survival in metastatic malignant melanoma patients treated with biochemotherapy: a retrospective study.

Biological response parameters during biochemotherapy, including chemotherapy with immune modulating agents, have been studied extensively. Of these parameters, interleukin-6 (IL-6) has been implicated in advanced stage disease and tumour recurrence. However, there is limited information available about the significance of IL-6 in metastatic malignant melanoma (MMM). In this study, we evaluated the possible relationship between serum IL-6 level and overall survival. This retrospective study included 125 patients with MMM. Pretreatment serum IL-6 levels were determined using a highly sensitive enzyme-linked immunosorbent assay (ELISA) test. Kaplan-Meier survival curves were constructed and compared using the log-rank test. Cox proportional analysis was performed to assess the predictors of overall survival, which was calculated from the beginning of biochemotherapy until death. In order to establish the possible relationship between IL-6 level and overall survival, patients were divided into two groups according to a cut-off of 5 pg/ml, corresponding to the first quartile obtained by descriptive statistics of the pretreatment IL-6 level in all patients. Thirty-five patients were in the low IL-6 group and 76 patients were in the high IL-6 group. Based on this stratification, overall survival was shown to be affected by IL-6 serum level: it was higher (24.6 months) in the low IL-6 group when compared with the high IL-6 group (9.7 months) (P=0.0006). Furthermore, Cox multivariate analysis including standard melanoma prognostic factors showed that IL-6, as a variable, lactate dehydrogenase (LDH) and tumour burden were significant prognostic factors for overall survival. On the basis of this evidence, the pretreatment serum IL-6 level is a predictive factor of overall survival in MMM.

Adolescent↗
PubMedDate not supplied

The effect of nursing care on overall patient satisfaction and its predictive value on return-to-provider behavior: a survey study.

OBJECTIVES: To determine the extent of patient satisfaction with care provided at the hospital at all levels and to correlate patients' satisfaction with nursing care, in particular, with their overall satisfaction. Also, to assess the predictive value of patient satisfaction on subsequent return to the hospital. DESIGN: A survey study of a random sample of 420 inpatients to determine the extent of their satisfaction with the overall care provided at the hospital. SETTING: A 110-bed private hospital in Kuwait, January 1-March 31, 2004. RESULTS: The extent of overall patient satisfaction with the quality of care provided at the hospital was found to be quite high (Excellent, 74.7%; Very good, 23.7%). Individually, nursing care received the maximum patient satisfaction ratings (Excellent, 91.9%; Very good, 3.9%). A positive correlation (r = 0.31, P = .01) was noted between patients' perception of nursing care and their overall satisfaction with the health care provided at the hospital. Significant positive correlation (r = 0.36, P = .01) was also found between overall patient satisfaction and their reported intentions of returning and recommending the hospital to others. CONCLUSIONS: Patient satisfaction surveys can be of great value to health care providers not only in recognizing and improving the quality of care, but also as predictors of return-to-provider behavior of the patients. Overall patient satisfaction is linked with quality nursing care, which, in turn, depends on the quality of leadership practiced at the institution. Transformational leadership behavior promotes nurse satisfaction, which adds to their work effectiveness and motivates them to provide quality patient care.

Clinical Competence↗
PubMed2006

Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment.

STUDY DESIGN: A retrospective study of patients who underwent 1-3-level kyphoplasty procedures at a single institute. OBJECTIVE: To examine and compare the effects of single and multilevel kyphoplasty procedures on local versus overall sagittal alignment of the spine. SUMMARY OF BACKGROUND DATA: Cement augmentation has been a safe and effective method in the treatment of symptomatic vertebral compression fractures (VCFs). In addition to providing rapid pain relief, balloon tamp kyphoplasty has reduced acute fractures, allowed controlled cement placement under lower pressure, and resulted in improvement of deformity. The restoration of normal overall spinal sagittal alignment in the elderly patient with a VCF and kyphotic deformity has obvious benefits. Although significant correction of local kyphosis (fractured vertebra) has been reported in the literature, to our knowledge, there have been no reports on whether this leads to an improved overall sagittal alignment. METHODS: A total of 65 consecutive patients with symptomatic VCFs who underwent 1-3-level kyphoplasty procedures were included in the study. Preoperative and postoperative radiographs were analyzed to quantify local and overall spinal sagittal alignment correction. Preoperative and postoperative vertebral heights at the fractured levels were also measured and categorized into anterior, middle, or posterior vertebral heights. RESULTS: Measurements revealed that kyphoplasty reduced local kyphotic deformity at the fractured vertebra by an average of 7.3 degrees (63% of preoperative kyphosis). This result did not translate to similar correction in overall sagittal alignment. In fact, angular correction decreased to 2.4 degrees (20% of preoperative kyphosis at fractured level) when measured 1 level above and below. The angular correction further decreased to 1.5 degrees and 1.0 degrees (13% and 8% of preoperative kyphosis at fractured level), respectively, at spans of 2 and 3 levels above and below. Average height gain was highest in the middle of the vertebral body (39% increase) compared to the anterior or posterior edges (19% and 3% increases, respectively). With multilevel kyphoplasty procedures, higher angular gains were seen over more vertebrae compared to the 7.3 degrees for a single-level kyphoplasty: 7.8 degrees over 2 levels and 7.7 degrees over 3 levels for 2 and 3-level kyphoplasty procedures, respectively. Kyphoplasty was able to achieve higher angular reduction in thoracic versus lumbar fractures (8.5 vs. 6.4 degrees, P < 0.01). The angular correction was also better maintained over adjacent segments in the thoracic spine. CONCLUSION: The majority of kyphosis correction by kyphoplasty is limited to the vertebral body treated. The majority of height gained after kyphoplasty occurs in the midbody. Higher correction over longer spans of the spine can be achieved with multilevel kyphoplasty procedures, in proportion to the number of levels addressed. Notwithstanding its well-published clinical efficacy, it is unrealistic to expect a 1 or 2-level kyphoplasty to improve significantly the overall sagittal alignment after VCFs.

Aged↗
PubMed2006

Prostate-specific antigen failure within 2 years of radical prostatectomy predicts overall survival.

OBJECTIVE: This study attempts to determine whether prostate-specific antigen (PSA) failure following radical retropubic prostatectomy (RRP) affects patients' long-term overall survival. METHODS: This study examined 155 men diagnosed as clinical stages T1b-T3a who received RRP as primary therapy. To evaluate whether PSA failure following RRP affects overall survival, the patients were grouped into those who experienced PSA failure within 2 years and those who did not. Clinical failure-free survival, prostate cancer-specific survival and overall survival were used as endpoints. Comparisons of survival curves were performed using the log-rank test. Logistic regression analysis was performed to determine the variable most predictive of PSA failure within 2 years of surgery. RESULTS: At 10 years, the PSA failure-free survival rate, clinical failure-free survival rate, prostate cancer specific survival rate and overall survival rate of the 155 patients were 40.1%, 83.1%, 94.9% and 84.2%, respectively. The overall survival curve for patients with PSA failure within 2 years of surgery was significantly lower than for patients with no PSA failure within 2 years of surgery (P = 0.042). The multivariate logistic regression analysis demonstrated that PSA greater than 20 ng/mL and poor differentiation of the tumor were significant independent predictors of PSA failure within 2 years of surgery. CONCLUSION: These results imply that prospective studies should be conducted to detect patients at high risk for PSA recurrence in whom metastasis may occur early and to investigate postoperative treatments for these high-risk patients to improve overall survival.

Aged↗