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PubMed1995

External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost.

BACKGROUND: External dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, with success rates consistently above 90%. This study reviews the demographics, success, cost, efficiency, and patient satisfaction in external DCR. This information will be useful as comparison criteria for evaluating new surgical techniques. METHODS: Records of 169 external DCR procedures performed over an 8.7-year period were reviewed. All patients had preoperative symptoms of tearing and/or dacryocystitis with a component of nasolacrimal obstruction. Patient demographics, history, examination findings, surgical and anesthesia information, postoperative success, complications, and follow-up course were recorded. Patient satisfaction and long-term success were evaluated by telephone survey. RESULTS: External DCR often required middle turbinectomy (17%), exposure of ethmoid sinuses (17%), and removal of dacryoliths (14%). Most patients (90%) underwent silicone intubation, with the tubes removed at an average of 3.7 weeks after surgery. A patent system was established in 95% of procedures, whereas 92% remained asymptomatic. Postoperative complications included hemorrhage (3.9%) and scarring (2.6%). Of the surveyed patients, 87% denied continued or recurrent symptoms; 97% rated their incision "good" to "excellent" in appearance; and all patients stated they would recommend the procedure to others. CONCLUSION: External DCR is highly successful, requires limited follow-up, and is a cost-effective procedure. Complications are uncommon, and patient satisfaction is high. New lacrimal surgical techniques must be evaluated against the long-proven success of the external approach.

Adolescent↗
PubMed1999

Effect of application of force to self-adhesive defibrillator pads on transthoracic electrical impedance and countershock success.

STUDY OBJECTIVE: To examine the effect of the application of force to self-adhesive defibrillator pads on transthoracic electrical impedance and countershock success. METHODS: A prospective, randomized, controlled pilot study was carried out in an experimental animal laboratory, involving 32 mixed-breed swine weighing 36.5 to 55.7 kg each. Ventricular fibrillation (VF) was induced, and the animals were randomly allocated to 1 of 4 groups, with 8 animals per group. Animals in groups I and II remained in VF for 30 seconds; those in groups III and IV remained in VF for 5 minutes. At the end of the VF period, up to 3 countershocks were given. In groups I and III, countershocks were delivered through the self-adhesive defibrillator pads alone; in groups II and IV, they were delivered through the defibrillator pads with 25 lb of applied force. Any animal without return of spontaneous circulation after 3 countershocks was given epinephrine after 1 minute of CPR, followed by 1 additional minute of CPR and 1 additional countershock if required. RESULTS: The main measurements included baseline and countershock transthoracic impedance, cumulative countershock success rate, and 30-minute survival rate. Application of 25 lb of force to the defibrillator pads significantly decreased transthoracic impedance, compared with baseline values (group II, 15. 1% decrease; group IV, 16.1% decrease). The first-shock success rate was higher when force was applied during the countershock (87.5% versus 50% for groups II and I, respectively; 62.5% and 37.5% for groups IV and III, respectively). In the animals who experienced 5 minutes of VF, there were greater rates of success after the second, third, and fourth countershocks when force was applied (group IV) than when no force was applied (group III). Groups I and II (VF for 30 seconds) demonstrated 100% survival at 30 minutes. Group IV had a higher 30-minute survival rate (3/8 animals) than did group III (1/8). However, the rates of countershock success and 30-minute survival were not statistically different among the groups. CONCLUSION: Application of force to self-adhesive defibrillator pads decreases transthoracic impedance during countershock. This effect may contribute to improving the countershock success rate.

Animals↗
PubMed2001

Locating study subjects: predictors and successful search strategies with inmates released from a U.S. county jail.

Minimizing loss to follow-up in longitudinal studies is critical. The purpose of this study was to examine the ability to locate subjects recently released from jail, identify predictors of being able to find a subject, and describe effective search strategies for this unique population. The sample for this cohort study included study subjects who were sought for interview after release from jail. Inmates in the San Francisco City and County Jail were enrolled in a randomized trial of incentives to improve follow-up for tuberculosis therapy after release from jail. Sociodemographic, health-related, and extensive locating information was collected during baseline interviews in jail. The main outcome was successful location of the subject. Study personnel recorded data on the number and nature of attempts made to find subjects in order to describe successful search strategies. Of 254 persons sought for the postrelease interview, 188 (74.0%) were found. Primary English speakers were more likely than Spanish speakers to be found (relative risk: 3.2, 95% confidence interval: 1.5-6.7, p = 0.002). Nearly one quarter of subjects (24%) were found back in jail, and the remainder were found in the community. Phone calls and letters to the subjects, and personal contacts to family and friends were successful strategies for 53% of the subjects. Seeking persons in programs, such as shelters and drug and alcohol programs, was successful in finding 18% of English-speaking subjects. Outreach efforts in sections of the city where Latinos spent time, including popular restaurants and community gathering places, were successful in finding 13% of Spanish-speaking subjects. We conclude that study subjects released from jails can be successfully located using well-defined search protocols tailored to the ethnicity of the sample and including a variety of strategies. Employment of bilingual personnel is important when a large proportion of subjects is monolingual and non-English speaking.

Adult↗
PubMed2002

Body weight is a predictor of biphasic shock success for low energy transthoracic defibrillation.

BACKGROUND: Transthoracic impedance and current flow are determinants of defibrillation success with monophasic shocks. Whether transthoracic impedance, either independently or via its association with body weight, is a determinant of biphasic waveform shock success has not been determined. METHODS AND RESULTS: We studied 22 swine, weighing 18-41 kg. After 15 s of ventricular fibrillation, each pig received transthoracic truncated exponential biphasic shocks (5/5 ms), 70-360 J. Shock success was strongly associated individually with body weight, leading-edge transthoracic impedance and current at low energy levels (70 and 100 J, all P<0.001). Multiple logistic regression analysis showed a significant association of body weight with shock success after adjusting for the effect of leading-edge impedance (odds ratio of success for 1 kg decrease in weight at 70 J was 1.29, 95% CI: 1.05-1.59, P=0.02; and at 100 J was 1.30, 95% CI: 1.14-1.49, P<0.0001). The same result was observed after adjusting for the effect of leading-edge current. At 150 J or higher energy levels, no significant association was observed. CONCLUSIONS: Body weight is a determinant of shock success with biphasic waveforms at low energy levels in this swine model.

Animals↗
PubMed2000

Significance of success rate of external cephalic versions and vaginal breech deliveries in counseling women with breech presentation at term.

OBJECTIVE: To appreciate the role of success rates of external cephalic versions and breech deliveries, in order to assess the risk reduction in women with breech presentation at term. STUDY DESIGN: We reviewed the patient files of all women with breech presentation whom had an attempt of external cephalic version (ECV) at term. Most of the ECVs were performed under intravenous ritodrine infusion. All women had a trial of labor (TOL) as long as they did not meet one or more of the exclusion criteria of vaginal delivery. Success rates of ECV and TOL were assessed, and statistical analysis was performed by using the student t-test for continuous data, and the Chi-square and Fisher's exact tests for categorical data. Statistically significant differences required a P value of <0.05. RESULTS: Of all women with breech presentation at term and not in labor, who had no contraindication for an ECV, 164 consented and were included in the study. The success rate of ECV was 30% (22/74) and 67% (60/90) for nulliparae and multiparae, respectively. Multiparity was the only significant positive predicting variable for ECV success (OR=4.73, 95% CI 4.19-5.27, P=0.00001). Of all the women that underwent a successful ECV, 18/22 primiparae (82%), and 52/60 multiparae (87%) had a vaginal delivery, compared to only 52% of the primiparae and 63% of the multiparae that reached labor with a breech presentation. There were no significant perinatal complications except for one case of mild placental abruption. In the primiparous women, ECV decreased the chance of cesarean delivery by only 9% (P=0.2), compared to a 16% decrease in the multiparae (P=0.019). CONCLUSIONS: When counseling women with breech presentation at term, complete information is needed for consent, and should take into account the success rate of ECVs and of vaginal breech deliveries in the specific center.

Breech Presentation↗
PubMed1988

Predictors of success for coronary angioplasty performed for acute myocardial infarction.

To evaluate the predictors and likelihood of success for coronary angioplasty performed in the setting of acute myocardial infarction, 300 consecutive patients with 321 coronary stenoses were studied retrospectively. Success was defined as final diameter stenosis less than 70% and Thrombolysis in Myocardial Infarction (TIMI) flow grade greater than or equal to 2. Nine clinical variables and 15 angiographic variables were assessed. Seventy-nine percent of patients were men; the mean age was 56 +/- 11 years, and 54% of patients also received thrombolytic therapy. The mean left ventricular ejection fraction was 46 +/- 11%, and 18 patients (6%) were in cardiogenic shock. Angioplasty success in the infarct-related artery was achieved in 240 patients (80%). In 177 total occlusions (TIMI flow grade less than or equal to 1), the success rate was 75.7% and success was independently predicted by 1) an ejection fraction greater than 30% (p = 0.001); 2) no arterial bend greater than or equal to 45 degrees at the site of angioplasty (p = 0.008); and 3) no triple vessel disease (p = 0.014). In 144 subtotal occlusions (TIMI flow grade greater than or equal to 2), procedural success was achieved in 84.7% and was predicted by 1) absence of thrombus greater than 5 mm (p = 0.023), and 2) absence of other stenoses greater than or equal to 50% in the same artery (p = 0.043), whereas patency without further emergency intervention was achieved in 71.7% and was predicted only by patient age less than or equal to 60 years and absence of cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1999

Effect of transient abrupt vessel closure during otherwise successful angioplasty for unstable angina on clinical outcome at six months. Hirulog Angioplasty Study Investigators.

OBJECTIVES: The objective of this study was to identify predictors of major adverse cardiac events after successful coronary angioplasty. BACKGROUND: The acute complications of angioplasty are related to baseline clinical and angiographic variables, and early complications adversely affect long-term outcome. However, the predictors of enduring success after uncomplicated angioplasty are less well defined. METHODS: Of 4,098 patients undergoing angioplasty in the Hirulog Angioplasty Study, 3,899 (95%) had a successful procedure without in-hospital death, emergent bypass surgery or clinical evidence of myocardial infarction. Baseline and procedural variables for these 3,899 patients were examined. RESULTS: Major adverse cardiac events occurred in 22% of the patients with initially successful procedures at 6 months: death in 1%, myocardial infarction in 2% and repeat revascularization in 21%. Univariable predictors of increased events included successful salvage from abrupt vessel closure (p < 0.001), emergency stenting (p < 0.001), multilesion angioplasty (p < 0.001), diabetes (p=0.02), target lesion in the left anterior descending artery (p=0.02), unstable angina (p=0.03) and smaller final luminal diameter (p=0.04). There was a trend toward increased events among patients with prior angioplasty (p=0.08), but asymptomatic elevation of the creatine kinase was not predictive (p=0.5). In a multivariable model, abrupt vessel closure was the strongest independent predictor of major adverse cardiac events at 6 months (p < 0.001; odds ratio [95% confidence interval]=3.6 [2.5 to 5.1]), while multivessel angioplasty, target lesion in the left anterior descending artery and diabetes also remained independent predictors (all p < or = 0.02). CONCLUSIONS: This analysis suggests that "uncomplicated" abrupt vessel closure is a powerful predictor of adverse clinical outcome following successful angioplasty. Improved techniques to reduce abrupt closure during angioplasty are thus urgently needed, and patients who experience "uncomplicated" closure require closer surveillance during follow-up.

Aged↗
PubMed1994

Chemostratigraphy of predominantly siliciclastic Neoproterozoic successions: a case study of the Pocatello Formation and Lower Brigham Group, Idaho, USA

Isotopic chemostratigraphy has proven successful in the correlation of carbonate-rich Neoproterozoic successions. In successions dominated by siliciclastic rocks, chemostratigraphy can be problematic, but if thin carbonates punctuate siliciclastic strata, useful isotopic data may be obtained. The upper Pocatello Formation and lower Brigham Group of southeastern Idaho provide an opportunity to assess the potential and limitations of isotopic chemostratigraphy in overwhelmingly siliciclastic successions. The 5000 m thick succession consists predominantly of siliciclastic lithologies, with only three intervals that contain thin intercalated carbonates. Its depositional age is only broadly constrained by existing biostratigraphic, sequence stratigraphic and geochronometric data. The lowermost carbonates include a cap dolomite atop diamictites and volcanic rocks of the Pocatello Formation. The delta 13C values of these carbonates are distintly negative (-5 to -3), similar to carbonates that overlie Neoproterozoic glaciogenic rocks worldwide. Stratigraphically higher carbonates record a major positive delta 13C excursion to values as high as +8.8 within the carbonate member of the Caddy Canyon Quartzite. The magnitude of this excusion is consistent with post-Sturtian secular variation recorded elsewhere in the North American Cordillera, Australia, Svalbard, Brazil and Nambia, and exceeds the magnitude of any post-Varanger delta 13C excursion documented to date. In most samples, Sr-isotopic abundances have been altered by diagenesis and greenschist facies metamorphism, but a least-altered value of approximately 0.7076 supports a post-Sturtian and pre-Marinoan/Varanger age for upper Pocatello and lower Brigham rocks that lie above the Pocatello diamictite. Thus, even though available chemostratigraphic data are limited, they corroborate correlations of Pocatello Formation diamictites and overlying units with Sturtian glaciogenic rocks and immediately post-Sturtian successions in western North America and elsewhere.

Calcium Carbonate↗
PubMed1995

Analysis of migration success of Onchocera lienalis microfilariae in the haemocoel of Simulium vittatum.

Migration success (i.e. the proportion of worms that reach the thorax) of Onchocerca lienalis microfilariae (mf) in the haemocoel of Simulium vittatum was studied by inoculating mf into the posterior abdomen, and recording their distribution in the blackfly body at predetermined time points. Mf arrive into the thorax by active locomotion rather than by drifting in haemolymph currents. Migration into the thorax was completed by 12 h post inoculation (pi) but was not continuous throughout this period. Migration proceeded in two phases; the first occurred 0-2 h pi and the second at 6-12 h pi. Overall, migration success 12-24 h pi was only 36%, indicating that a substantial number of mf failed to reach the thorax, either because they were eliminated by the fly's defensive response or because they remained in the abdomen. Migration success was density independent. Mf that arrive into the thorax within 2 h pi did not differ in their migration potential from mf that remained in the abdomen at this time. In flies where more mf migrated successfully there was lower mf loss, indicating that migration success was linked to mf loss. Moreover, the proportion of mf in the thorax was not correlated with mf loss, suggesting that mf loss affected the number of mf that migrated successfully, rather than the reverse causal relationship.

Abdomen↗
PubMed1995

Comparative effects of mites and lice on the reproductive success of rock doves (Columba livia).

We report experimental data comparing the effects of Mesostigmatid mites and Ischnoceran lice on the reproductive performance of a single group of captive rock doves (Columba livia). Several components of host reproductive success were compared for the two groups, including number of eggs laid, hatching success, nestling growth rates, fledging success, post-fledging body mass and survival. Adult body mass and survival were also compared. There was a dramatic difference in the effects of the mites and lice. The former drove host reproductive success to zero, mainly by agitating adults and causing them to incubate eggs less faithfully. Nestling growth rates and post-fledging survival were also significantly reduced by mites. Lice showed no effect on reproductive success whatsoever, even though the feather damage they cause is known to have energetic consequences (Booth, Clayton & Block, 1993). Neither parasite had a significant effect on adult birds. Although Ischnocera are found on most species of birds, our results for lice constitute the first experimental test of the impact of Ischnocera on avian reproductive success (preliminary report by Clayton & Tompkins, 1994). We discuss reasons for the different effects of mites and lice, including the relationship of horizontal (mites) and vertical (lice) transmission to the evolution of virulence.

Animals↗
PubMed1998

How Excellent Teachers Are Made: Reflecting on Success to Improve Teaching.

The authors surveyed forty-eight distinguished teachers from clinical departments regarding the role of instructional successes in learning to teach. Using qualitative content analysis of comments, the authors identified nine common successes in clinical teaching associated with planning, teaching, and reflection. In anticipatory reflection used for planning, common successes occurred by involving learners, continuously innovating, creating a positive atmosphere for learning, considering the learners, engaging the learners, preparing adequately, and limiting content. When reflecting-in-action, the success experience most commonly mentioned was maintaining flexibility in action. Reflecting-on-action after a successful teaching event, they commented on the importance of thoughtful analysis and choosing an appropriate strategy. These teachers incorporated reflective practice into their teaching as an essential component of professional development and incrementally improved their teaching based upon successful instructional experiences.

Journal Article↗
PubMed2003

A preliminary empirical test of a culturally-relevant theoretical framework for the study of successful aging.

This article aims to shed preliminary empirical light on the assumptions underpinning a culturally relevant theoretical framework for the study of successful aging. On the basis of the Kluckhohnian theory of cultural variation, this framework suggests that congruence exists between value orientations concerned with man-nature, time, activity, and relationships, and the manner in which the construct of successful aging is understood. Methodologically speaking, the research project upon which this article is based started out by adapting and further developing the vignette-based instrument that Kluckhohn and Strodtbeck designed to test the theory of cultural variation. Vignette-based interviews were then conducted with 30 Iranian immigrants to Sweden as a preliminary test of the hypothesis of congruence. The results presented in this article suggest that, as posed in the framework in question, there is a relationship between the value orientations that people prefer and the various understandings of successful aging that they uphold. The results suggest also that there is a variety of ways in which the construct of successful aging can be understood, and that variety encompasses other ways of thinking about successful aging besides the master nature, future, productivity, and individuality-oriented views that characterize the gerontological debate. Although further research is necessary, these preliminary results do infer that this framework might offer a theoretically interesting approach to the study of individual, generational, and cross-cultural understandings of successful aging.

Adult↗
PubMed2000

Needle design does not affect the success rate of spinal anaesthesia or the incidence of postpuncture complications in children.

BACKGROUND: In adults, pencil-point spinal needles are believed to be less traumatic and therefore to be superior compared to cutting-point needles with respect to success rate and postpuncture complications. The aim of this randomised, parallel groups and prospective study was to record the success rate and to evaluate the incidence of complications following spinal anaesthesia with the two types of needles in children. METHODS: We studied 215 children aged 1 to 18 years. A 25-gauge needle was used in children up to 7 years (n=96) and a 27-gauge needle in older children (n=119). During lumbar puncture with either a cutting-point (n=109) or a pencil-point (n=106) spinal needle, we recorded puncture characteristics and the success of cerebrospinal fluid (CSF) aspiration. Hyperbaric bupivacaine 5 mg ml(-1) at a dose of 0.3-0.4 mg kg(-1) was used for the spinal anaesthesia. The incidence of postdural puncture complications was recorded from diaries completed by the children and parents one week after the lumbar puncture. RESULTS: The success rate of the spinal anaesthesia was 97% without difference between the needles. The success rate was higher when the aspiration of CSF was easy compared to if it was difficult (98% vs. 88%, P=0.02). Two hundred and seven diaries were returned (97%). Twenty-four children developed a headache, 8 of which were classified as a postdural puncture headache (PDPH), 6 with the cutting-point needle and 2 with the pencil-point needle (n.s.). Nine children developed signs of transient radicular irritation with no difference between the needles. CONCLUSION: Both types of spinal needles can be used in children, and a free aspiration of CSF results in a high success rate of the spinal block. Postpuncture complications are as common in children as in adults.

Adolescent↗
PubMed1996

A life span model of successful aging.

To lay the foundation for our model, we first describe existing conceptions of successful aging, underlying assumptions of development, and criteria for success. The model presented extends the discourse on this topic in three directions: (a) It frames the discussion of successful aging in the broader context of life course development; (b) it accounts for both normative and nonnormative (i.e., exceptional) success; and (c) it integrates motivational processes into a theory of successful aging. Successful aging is equated with the development and maintenance of primary control throughout the life course, which is achieved through control-related processes that optimize selection and failure compensation functions. Selection processes regulate the choice of action goals so that diversity is maintained and positive and negative trade-offs between performance domains and life stages are taken into account. Compensation mechanisms serve to maintain, enhance, and remediate competencies and motivational resources after failure experiences. Both compensation and selection processes are motivated by desires for primary control and can be characterized in terms of primary and secondary control processes.

Activities of Daily Living↗
PubMed1978

Drug choice as a self-handicapping strategy in response to noncontingent success.

In two closely related experiments, college student subjects were instructed to choose between a drug that allegedly interfered with performance and a drug that allegedly enhanced performance. This choice was the main dependent measure of the experiment. The drug choice intervened between work on soluble or insoluble problems and a promised retest on similar problems. In Experiment 1, all subjects received success feedback after their initial problem-solving attempts, thus creating one condition in which the success appeared to be accidental (noncontingent on performance) and one in which the success appeared to be contingent on appropriate knowledge. Males in the noncontingent-success condition were alone in preferring the performance-inhibiting drug, presumably because they wished to externalize probable failure on the retest. The predicted effect, however, did not hold for female subjects. Experiment 2 replicated the unique preference shown by males after noncontingent success and showed the critical importance of success feedback.

Achievement↗
PubMed1985

Depression and preference for self-focusing stimuli after success and failure.

Depressed individuals, who tend to have large perceived-self/ideal-self discrepancies, have been shown to be particularly high in private self-consciousness. On the bases of this finding and of several converging theoretical perspectives, we hypothesized that depressives, unlike nondepressives, do not find self-focus more aversive after failure than after success, and thus either (a) show no differential preference for self-focusing stimuli after success versus after failure (weak hypothesis), or (b) prefer self-focusing stimuli after failure over self-focusing stimuli after success (strong hypothesis). Depressed and nondepressed college students succeeded or failed on a supposed test of verbal intelligence, and then worked on two sets of puzzles, one in the presence and one in the absence of a self-focusing stimulus (mirror). Whereas nondepressed subjects liked the mirror-associated puzzle more after success than after failure, depressed subjects did not; depressed subjects tended to like the mirror-associated puzzle more after failure than after success. Nondepressed subjects also exhibited a self-serving pattern of attributions, viewing the test as less valid and luck as more responsible for their performance after failure than after success; depressed subjects showed no such differences. In consistency with their failure to use defensive strategies, depressed subjects showed a decrease in self-esteem after failure; nondepressed subjects showed no such change.

Attention↗
PubMed2006

Learning from successful and failed experience: the moderating role of kind of after-event review.

The claim that appropriate "after-event review (AER)" may increase the relative value of drawing lessons from successes, as compared with failures, was examined in the present study. The study was a laboratory experiment in which the effect of type of AER (failure-focused, success-focused, failure- and success-focused, and no AER review) on performance improvement and causal attributions was tested under conditions of earlier success and earlier failure. In general, 2 results were demonstrated: (a) Drawing lessons from successful experience is feasible, and its effectiveness is contingent upon the type of AER. More specifically, after successful events, the most effective review is that of wrong actions, whereas after failed events, any kind of event review (correct or wrong actions) is effective. (b) AERs elicit more internal (as opposed to external) and specific (as opposed to general) attributions. These 2 classifications moderate the effect of AERs on task performance.

Adult↗
PubMed2005

Snatching defeat from the jaws of victory: self-esteem differences in the experience and anticipation of success.

Successes--defined broadly as meeting important standards or receiving positive evaluations--are widely assumed to be enjoyed equally by people with high self-esteem (HSEs) and low self-esteem (LSEs). Three studies examined the contradictory hypothesis that HSEs react more favorably to success than do LSEs and that success brings about certain unfavorable consequences for LSEs. Undergraduate participants reacted to a laboratory-manipulated success (Studies 1 and 2) or imagined highly positive events in the future (Study 3). Self-esteem differences emerged in anxiety, thoughts about the self, and (in Study 3) thoughts about non-self-related aspects of the event. LSEs were more anxious than HSEs after succeeding, success improved HSEs' self-relevant thoughts but not LSEs', and LSEs focused more on success's negative aspects.

Achievement↗