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PubMed2001

An outcome study of severe traumatic head injury using the "Lund therapy" with low-dose prostacyclin.

BACKGROUND: There are two independent head injury outcome studies using the "Lund concept", and both showed a mortality rate of about 10%, and a favourable outcome (Glasgow outcome scale, GOS 4 and 5) of about 70%. The Lund concept aims at controlling intracranial pressure, and improving microcirculation around contusions. Intracranial pressure is controlled by maintaining a normal colloid osmotic pressure and reducing the hydrostatic capillary pressure. Microcirculation is improved by ensuring strict normovolaemia and reducing sympathetic discharge. The endogenous substance prostacyclin with its antiaggregatory/antiadhesive effects may further improve microcirculation, which finds support from a microdialysis-based clinical study and an experimental brain trauma study. The present clinical outcome study aims at evaluating whether the previously obtained good outcome with the Lund therapy can be reproduced, and whether the addition of prostacyclin has any adverse side-effects. METHODS: All 31 consecutive patients with severe head injury, Glasgow coma scale (GCS) < or = 8, admitted to the University Hospital of Umeå during 1998 were included. The Lund therapy including prostacyclin infusion for the first three days at a dose of 0.5 ng kg(-1) min(-1). Outcome was evaluated according to the GOS >10 months after the injury. RESULTS: One patient died, another suffered vegetative state and 7 severe disability. Of the 22 patients with favourable outcome, 19 showed good recovery and 3 moderate disability. No adverse side-effects of prostacyclin were observed. CONCLUSION: The outcome results from previous studies using the Lund therapy were reproduced, and no adverse side-effects of low-dose prostacyclin were observed.

Adolescent↗
PubMed1996

Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies.

This study examined the relationships between clients' reasons for depression and the process and outcome of a cognitive therapy (CT) and a behavioral activation (BA) treatment for major depression. Reason giving was conceptualized as the tendency to offer multiple explanations for a problem. Different reasons for depression were also thought to match or mismatch the theoretical model underlying each treatment. Reasons for depression were assessed pretreatment with a previously developed questionnaire. Process variables including homework compliance and perceived treatment helpfulness were measured early in treatment. Results demonstrated that perceived helpfulness of the treatment was associated with positive outcomes in BA. Reason giving was associated with worse outcomes in BA. Specific reasons also predicted differential outcome in the 2 treatments. Clients who endorsed existential reasons for depression had better outcomes in CT and worse outcomes in BA. Relationship-oriented reasons were consistently associated with negative process and outcome in CT. Results are discussed in terms of the function of reason giving and the role of specific explanations for depression in treatment process and outcome.

Adult↗
PubMed2001

Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder.

The relationship between therapists and treatment outcome was examined in 14 highly trained therapists who participated in the Multicenter Collaborative Study for the Treatment of Panic Disorder. Overall, therapists yielded positive outcomes in their caseloads; yet, therapists significantly differed in the magnitude of change among caseloads. Effect sizes for therapist impact on outcome measures varied from 0% to 18%. Overall experience in conducting psychotherapy was related to outcome on some measures, whereas age, gender, gender match, and experience with cognitive-behavioral therapy (CBT) were not. Therapists with above- and below-average outcomes were rated similarly on measures of adherence and competency. The results suggest that therapists make a contribution to outcome in CBT for panic disorder, even when patients are relatively uniform, treatment is structured, and outcome is positive. Implications for future clinical outcome studies and for training clinicians are discussed.

Adult↗
PubMed2000

Measurements for horizontal extraocular muscle surgery from the suture site: outcome and influencing factors.

BACKGROUND: Measurement of recession in strabismus surgery is performed either from the limbus or from the muscle insertion. These measurement methods may result in inaccuracies that may influence the outcome of the procedure. We prospectively evaluated the outcome of recessions measured from the extraocular muscle suture site to its insertion in an incidence cohort. METHODS: Thirty-six consecutive surgical procedures for infantile esotropia and 23 for constant exotropia were performed in which measurements were performed from the suture site. A successful surgery for esotropia was defined as an orthophoria of up to +10 prism dioptres of deviation for non-accommodative targets at a distance of 20 feet, measured by cover and prism test. A successful surgery for exotropia was defined as a residual deviation between -10 and +10 prism dioptres. The statistical significance of the outcome influencing factors was assessed by chi-square test. RESULTS: Six weeks following surgery, 28 procedures (78%) for infantile and non-accommodative esotropia and 19 procedures (83%) for exotropia were successful. At the end of the follow-up period (mean 13.7 months +/- 9.4 for esotropia and 11.6 months +/- 12.8 for exotropia), the success rate was 77% for esotropia and 75% for exotropia. Prematurity and mental retardation in esotropia, exotropia with pre-operative deviations larger than -45 prism dioptres and amblyopia in exotropia were related to unfavourable outcome (p < 0.05). CONCLUSIONS: Measurement for muscle recession can be performed from the suture site. The outcome is comparable to the outcome when measurements are performed from the limbus or the insertion, probably due to the incidence cohort. Refinement of the technique and defining other factors influencing the outcome of strabismus surgery may improve the outcome.

Adolescent↗
PubMed1996

Retrospective analysis of long-term surgical results in acromegaly: preoperative and postoperative factors predicting outcome.

OBJECTIVE: Sixty-one of 83 patients with acromegaly treated between 1969 and 1993 were analysed retrospectively to clarify which early postoperative factors were significant predictors of a successful long-term outcome and which preoperative factors significantly influenced the early postoperative results. PATIENTS: Of the 61 patients, 30 were operated on before 1987 and 31 afterwards. A successful long-term surgical outcome was defined as a long-term mean basal GH level < 6 mU/l (comparable to < 3 micrograms/l), a normal IGF-I level, and normal GH dynamics. RESULTS: Overall, 59% of patients (37% before 1987 and 81% after) had an early postoperative mean basal GH level < 6 mU/l, and 56% (29% before 1987 and 77% after) met all three of the specified criteria for a successful long-term surgical outcome. Statistical analysis confirmed that GH dynamics and postoperative mean basal GH level < 6 mU/l were significant predictors of the long-term surgical outcome, whereas the postoperative IGF-I level alone was not. On the other hand, abnormal preoperative GH dynamics were normalized in all patients with a postoperative mean basal level < 6 mU/l. In addition, there were no patients showing an unsuccessful long-term outcome in those associated with both the early postoperative mean basal GH level < 6 mU/l and normalization of the IGF-I level. Therefore, measurement of the early postoperative mean basal GH level and the IGF-I level may be an economical and simple guide to predict the long-term surgical outcome. Moreover, multivariate analysis indicated that cavernous sinus invasion was an independent significant factor influencing the early postoperative outcome. CONCLUSIONS: Successful long-term surgical outcome may be predicted if early postoperative mean basal GH level is reduced to < 6 mU/l (< 3 micrograms/l) and IGF-I level becomes normal. This study also confirms that early diagnosis and treatment by an experienced endocrinologist and neurosurgeon can improve the operative results in patients with acromegaly.

Acromegaly↗
PubMed1998

Service support to people in Wales with severe intellectual disability and the most severe challenging behaviours: processes, outcomes and costs.

A survey of people with severe intellectual disability and the most severe challenging behaviour in Wales identified five adults living in family homes, 17 in new specialist community housing and 19 in traditional services. With the omission of two people from the latter group and with a restricted collection of data for people living in the family home, the present study explored service input, outcome and costs across the three setting types. Process and outcome indicators for the family home group, who received little service input, were better than those for the traditional service group, although less good than those for the community house group. The specialist community home model produced significant gains over the traditional services in virtually all areas. Across the residential data set as a whole, there was no association between staff:resident ratios and severity of disability or between costs and severity of disability. This was largely true of the service types separately. There was a relationship between costs and service quality. However, this association was underpinned by gross differences between community houses and traditional settings. Costs, processes and outcomes ceased to be related when the two residential types were considered separately. Although higher costs of new community services compared to traditional services may be set against improved outcomes, high costs within the former could not be related to benefit. Outcome indicators were generally related to each other, suggesting that high quality in one sense was matched by high quality in other senses. Outcome was significantly associated with the ability of residents. Outcome indicators also tended to be related to observed staff performance, which was independent of resident ability. Therefore, outcome may be considered as dually determined by differences in resident ability and in what staff did.

Adult↗
PubMed2001

An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction.

CONTEXT: A fundamental premise of medical education is that faculty should educate trainees, that is, students and residents, to provide high quality patient care. Yet, there is little research on the effect of medical education on patient outcomes. OBJECTIVE: A content analysis of leading medical education journals was performed to determine the primary foci of medical education research, using a three- dimensional outcomes research framework based on the paradigm of health services outcomes research. DATA SOURCES: All articles in three medical education journals (Academic Medicine, Medical Education, and Teaching and Learning in Medicine) from 1996 to 1998 were reviewed. Papers presented at the Research in Medical Education conference at the Association of American Medical Colleges annual meeting during the same period, and published as Academic Medicine supplements, were also analysed. STUDY SELECTION: Only data-driven articles were selected for analysis; thus editorials and abstracts were excluded. DATA EXTRACTION: Each article was categorized according to primary participant (i.e. trainee, faculty, provider and patient), outcome (performance, satisfaction, professionalism and cost), and level of analysis (geographic, system, institution and individual(s)). DATA SYNTHESIS: A total of 599 articles were analysed. Trainees were the most frequent participants studied (68.9%), followed by faculty (19.4%), providers (8.1%) and patients (3.5%). Performance was the most common outcome measured (49.4%), followed by satisfaction (34.1%). Cost was the focus of only 2.3% of articles and patient outcomes accounted for only 0.7% of articles. CONCLUSIONS: Medical education research is dominated by assessment of trainee performance followed by trainee satisfaction. Leading journals in medical education contain little information concerning the cost and products of medical education, that is, provider performance and patient outcomes. The study of these medical education outcomes represents an important challenge to medical education researchers.

Clinical Competence↗
PubMed2002

Outcomes in lower respiratory tract infections and the impact of antimicrobial drug resistance.

Numerous published studies have documented the rapid rise in antimicrobial drug resistance among common respiratory pathogens, particularly Streptococcus pneumoniae. Yet, surprisingly few studies have evaluated the impact of these in vitro findings on clinical outcomes. Outcomes research is the measurement of the impact of illness and the effect of treatment on clinically relevant end-points. Studies of patients with community-acquired pneumonia have established certain expected rates of outcomes, including mortality, clinical complications, and time to resolution of symptoms. Recent studies have identified specific processes of care and treatment choices that have an impact upon these outcomes. However, there are no well-controlled studies that provide definitive estimates of the magnitude of the impact of antimicrobial therapy on these outcomes for patients with community-acquired pneumonia or other respiratory tract infections, such as acute exacerbations of chronic bronchitis. Most studies of the impact of drug resistance on outcomes for patients with respiratory tract infections have focused on the impact of beta-lactam drug resistance on outcomes for patients with community-acquired pneumococcal pneumonia. In general, these studies have demonstrated that outcomes are not affected by current levels of drug resistance, but most studies are hampered by small sample size, inability to control adequately for severity of illness and concordance of therapy, and inclusion of few subjects with high-level drug resistance. Additional studies are urgently needed to assess better whether the current empiric treatment guidelines are adequate or will need to be adjusted as patterns of resistance continue to evolve.

Bronchitis, Chronic↗
PubMed2001

Ductus venosus studies in fetuses at high risk for chromosomal or heart abnormalities: relationship with nuchal translucency measurement and fetal outcome.

OBJECTIVE: To investigate, in a high-risk group of fetuses, the role of ductus venosus Doppler velocimetry as a prognostic factor, in addition to nuchal translucency measurement, for predicting chromosomal anomalies and, where the karyotype was normal, for predicting fetal outcome. METHODS: Nuchal translucency was measured and ductus venosus pulsatility index and late diastolic flow (a-wave) were recorded in 186 fetuses at a median gestational age of 12.6 weeks (range, 10-17). Fetal karyotype, the presence of structural anomalies, pregnancy outcome, neonatal examination at birth and postnatal follow up were the outcome values. RESULTS: Nuchal translucency measurement was increased in 112 fetuses. The outcome of pregnancy was normal in 130 fetuses. Fifty-six fetuses had an adverse outcome (46 chromosomal anomalies, three intrauterine deaths, six structural anomalies and one developmental disorder). The sensitivity of an abnormal ductus venosus pulsatility index or of absent or reversed flow during the a-wave was 65% for chromosomal anomalies and 68% for an adverse outcome. The specificity was 79%. There was a significant correlation between nuchal translucency and ductus venosus pulsatility index. In chromosomally normal fetuses with an enlarged nuchal translucency an abnormal ductus venosus flow was associated with a nearly nine-fold increase in adverse outcome (odds ratio 11.7). CONCLUSION: Ductus venosus Doppler velocimetry can be used in addition to nuchal translucency measurement as a predictor of chromosomal anomalies. However, as the ductus venosus blood flow pattern is correlated with nuchal translucency measurement it cannot be used as an independent variable to reduce the indication for fetal karyotyping. Ductus venosus Doppler velocimetry may have a role in the counseling of parents in the case of an enlarged nuchal translucency and normal karyotype by identifying those fetuses in need of an intensive follow up due to an increased risk of adverse outcome.

Adult↗
PubMedDate not supplied

Improving hemodialysis patient outcomes: a step-by-step approach.

Hemodialysis patient outcomes are often suboptimal, with one-sixth of patients receiving an inadequate dialysis dose, one-fourth using catheters for vascular access, and more than one-half being malnourished. This review describes a four-step approach for improving dialysis patient outcomes. First, select an outcome to improve. This can be a global outcome such as mortality, morbidity, quality of life, or health care costs or an intermediate outcome (such as dialysis dose) that has a demonstrated link with a global outcome. Second, determine barriers to optimal outcomes. Both patient factors (such as noncompliance) and provider factors (such as the process of care) may act as barriers. Third, intervene on specific barriers. Interventions may involve providing medical or surgical treatment, changing patient or provider behavior, or modifying the system of care. Fourth, disseminate the intervention to other settings. "Early adopters" (those who quickly adopt an innovation) and "opinion leaders" (well-respected local physicians) are especially influential in determining the rate of dissemination. By using this approach, physicians can move from helping an individual patient to improving the outcomes of many patients.

Humans↗
PubMed1997

Internal medicine residency training and outcomes.

OBJECTIVE: To review the impact of the clinical education of internal medicine residents on patients' outcomes. DATA SOURCES AND STUDY SELECTION: English-language studies of the relation between internal medicine housestaff training and patients' outcomes were systematically identified by a MEDLINE search and from bibliographies and reference lists of recently published articles. MAIN RESULTS: We hypothesized that the primary impact of internal medicine residency training on patients' outcomes would be the result of: (1) the inexperience of the residents; (2) the heavy workload these inexperienced residents are expected to manage: or (3) some structural feature of the internal medicine teaching services, such as the discontinuity of patient care inherent in night float systems and the fact that residents rotate to different services each month. We also hypothesized that residents may in may ways provide superior care, and many actually improve certain patient outcomes. Housestaff inexperience, workload, and structural features that promote discontinuity have been shown to affect especially outcomes of resource utilization, length of stay, and patient satisfaction. No study has demonstrated that internal medicine residents contribute to excess patient morbidity or mortality. However, the published studies in this area are for the most part retrospective and were conducted 10 to 15 years ago. The full extent of the untoward (or the beneficial) effects of internal medicine residency training on patients' outcomes is unknown. CONCLUSIONS: Multisite, prospective studies would remedy the deficiencies in the published research in this area and would yield the most valid insight into the range and extent of the effects of housestaff training on patients' outcomes. In the absence of such studies and in a rapidly changing managed care environment, academic medical centers and departments of medicine need to be aware of those aspects of the clinical education of residents that are most likely to affect patients' outcomes.

Clinical Competence↗
PubMed2001

Seizure outcome after temporal lobectomy: current research practice and findings.

PURPOSE: The literature regarding seizure outcome and prognostic factors for outcome after temporal lobectomy is often contradictory. This is problematic, as these data are the basis on which surgical decisions and counseling are founded. We sought to clarify inconsistencies in the literature by critically examining the methods and findings of recent research. METHODS: A systematic review of the 126 articles concerning temporal lobectomy outcome published from 1991 was conducted. RESULTS: Major methodologic issues in the literature were heterogeneous definitions of seizure outcome, a predominance of cross-sectional analyses (83% of studies), and relatively short follow-up in many studies. The range of seizure freedom was wide (33-93%; median, 70%); there was a tendency for better outcome in more recent studies. Of 63 factors analyzed, good outcome appeared to be associated with several factors including preoperative hippocampal sclerosis, anterior temporal localization of interictal epileptiform activity, absence of preoperative generalized seizures, and absence of seizures in the first postoperative week. A number of factors had no association with outcome (e.g., age at onset, preoperative seizure frequency, and extent of lateral resection). CONCLUSIONS: Apparently conflicting results in the literature may be explained by the methodologic issues identified here (e.g., sample size, selection criteria and method of analysis). To obtain a better understanding of patterns of long-term outcome, increased emphasis on longitudinal analytic methods is required. The systematic review of possible risk factors for seizure recurrence provides a basis for planning further research.

Electroencephalography↗
PubMed2002

Preliminary results on pregnancy outcomes in women using lamotrigine.

PURPOSE: In 1992, the International Lamotrigine Pregnancy Registry was initiated to enroll prospectively and to monitor pregnancies exposed to lamotrigine (LTG) for the occurrence of major birth defects. This study presents results as of September 2001 on 168 outcomes exposed to LTG monotherapy and 166 outcomes after pregnancies exposed to LTG polytherapy during the first trimester. METHODS: LTG pregnancy exposures are voluntarily reported to the registry by health care providers before they are aware of each pregnancy outcome. Pregnancy-outcome ascertainment is obtained through subsequent follow-up with the reporting health care provider, and each reported birth defect is reviewed by an expert pediatrician. The percentage with major birth defects in pregnancies with known birth defect status was calculated for LTG monotherapy and for polytherapy stratified by trimester of exposure. RESULTS: The registry identified 334 first-trimester LTG pregnancy outcomes exposed to LTG monotherapy or polytherapy during the first trimester and involving either a live birth with or without a major birth defect or an abortion with a major birth defect. After exposure to LTG monotherapy, the percentage with major birth defects exposed to LTG monotherapy was three (1.8%) of 168 [95% confidence interval (CI), 0.5-5.5%]. There were five (10%) major birth defects observed in 50 outcomes after LTG polytherapy involving valproic acid (VPA; 95% CI, 3.7-22.6%) during the first trimester. The observed proportion of major defects after LTG polytherapy without VPA during the first trimester was five (4.3%) of 116 (95% CI, 1.6-10.3%). No specific patterns of major birth defects in any subgroup or within the registry as a whole were observed. CONCLUSIONS: The sample sizes for individual regimens are too small to rule out small increases in frequency of all major birth defects or even large increases in frequency of rare major birth defects. However, the percentage of outcomes with major birth defects after LTG monotherapy in this study and in another similar pregnancy registry in the United Kingdom did not differ from that reported in the recent literature for women with epilepsy receiving antiepileptic drug monotherapy (4%). The frequency of major malformations after exposures of LTG-VPA is higher than that after the LTG monotherapy or LTG polytherapy regimens without VPA. Although there are published data on frequency of major malformations after VPA exposures in pregnancy, between-study differences in methods and source populations and the wide confidence intervals around the estimate for LTG and VPA limit the utility of comparison with such data, and no conclusions are made at this time about this combination. The continued registration of exposed pregnancies to an exposure registry as early as possible in the pregnancy before any knowledge of the outcome, and before any prenatal testing, will enhance the power of such data.

Abnormalities, Drug-Induced↗
PubMed2000

Is there a positive volume-outcome relationship in peripheral vascular surgery? Results of a systematic review.

OBJECTIVES: to examine the evidence for the existence, or otherwise, of a positive volume-outcome relationship in the area of peripheral vascular surgery. DESIGN: systematic overview of prospective or retrospective volume-outcome studies. DATA SOURCES: seven bibliographic databases were searched for English-language articles published between 1986 and 1998. STUDY SELECTION: thirty-six articles published in peer-reviewed journals; excluding editorials, letters or abstracts; and addressing volume and outcome in peripheral vascular surgery. Criteria were applied and agreed by consensus between two of the authors. DATA EXTRACTION: the articles identified were independently assessed by two of the authors. Studies were categorised into three distinct areas - carotid endarterectomy- (17 studies), abdominal aortic aneurysm repair (16 studies) and other vascular interventions (four studies). Within each category studies were further classified according to full adjustment, partial adjustment or no adjustment for case mix. Where discrepancies arose, decisions were referred to a third author for arbitration. DATA SYNTHESIS: findings for carotid endarterectomy identified a positive volume-outcome relationship for both mortality and stroke at the physician level. There was less support for a positive relationship for mortality at the hospital level, and no evidence of benefits for stroke in higher volume hospitals. If only studies making a full adjustment for case mix are included, there is no clear support from statistically significant evidence for or against a positive volume-outcome relationship. For repair of unruptured abdominal aortic aneurysms there is evidence of a positive volume-outcome relationship at both the physician and hospital level, with evidence being particularly strong at the level of the hospital. For ruptured aneurysms the evidence is suggestive of there not being a positive volume-outcome relationship at the hospital level, while for physicians the evidence is more balanced with no clear support either way. For other vascular interventions there were insufficient studies (n=4) from which to draw meaningful conclusions. CONCLUSIONS: our results show that evidence of a relationship between volume and outcome in peripheral vascular surgery may be attributable to factors such as lack of adjustment for case-mix, different definitions of volume and poor quality of studies, especially those of retrospective design. Future studies should address these deficiencies by making full adjustment for case mix and by being prospective in design.

Aortic Aneurysm, Abdominal↗
PubMed2000

Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years.

Twenty-five sedentary, low-demand patients older than 60 years were retrospectively evaluated for function and radiographic results following nonoperative treatment of displaced distal radius fractures. The mean age was 72 years and the average follow-up period was 34 months. All patients had radiographic and functional evaluations. The radiographic assessment included a scoring system based on measurements of the final dorsal angle, loss of radial length, and the final radial inclination. The development of radiocarpal and distal radioulnar joint arthrosis was also investigated. The functional assessment included subjective and objective criteria. Overall satisfaction, ability to return to previous activity level or occupation, concern over wrist appearance, and a functional task questionnaire were part of the subjective assessment. Objective assessment included neuromuscular evaluation and measurements of range of motion and grip strength. The final radiographic scores revealed that 6 patients (24%) had excellent results, 11 (44%) had good results, 2 (8%) had fair results, and 6 (24%) had poor results. Six of 10 patients with intra-articular fractures developed progressive wrist arthrosis. Two of 6 patients with radiographic arthrosis had unsatisfactory functional outcome. Five of 8 patients with intra-articular fractures that healed with a residual stepoff >/=2 mm had satisfactory functional outcome; 3 of these 8 patients had unsatisfactory functional outcome. The functional assessment revealed that 22 patients (88%) had excellent or good results and 3 (12%) had fair or poor results. The radiographic outcome did not correlate with the functional outcome. Twenty-three of 25 patients (92%) were satisfied with the overall outcome of the treatment and 22 (88%) were able to return to their previous activity level or occupation. Despite an obvious clinical deformity in over half of the patients, none were unhappy with the clinical appearance of the wrist. According to the functional task questionnaire, jar opening was by far the most difficult task to perform after fracture healing. Functional outcome was satisfactory in most cases; a high level of personal satisfaction and return to previous activity level was observed, regardless of the radiographic result. Nonoperative treatment of distal radius fractures yields satisfactory outcome, especially in those with low functional demands. It also is indicated in poor operative candidates. (J Hand Surg 2000; 25A:19-28.

Activities of Daily Living↗
PubMed2003

New radiographic-based surrogate outcome measures for osteoarthritis of the knee.

OBJECTIVE: Minimum joint space width (mJSW) between the femoral condyle and tibial plateau is currently the principal radiographic outcome measure for knee osteoarthritis (OA). While mJSW measurement has been proven effective, there is a need for quantitative measures with greater sensitivity to OA so studies of disease modifying trials can be performed more quickly and with fewer subjects. Also, mJSW is a single outcome measure that does not reflect all disease changes. Here we present a study of new radiograph-based outcome measures to quantify OA progression. DESIGN: Our goal is made possible by a software algorithm that delineates both the edge of the tibial plateau and the femoral condyle on digitized knee radiographs. We also developed a new coordinate system based on anatomical landmarks to facilitate measurement of the outcome measures. We studied measurements of joint space width (JSW) and average JSW at fixed locations along the joint interface. The outcome measures were tested using duplicate acquisitions made from 16 OA and 18 normal knees. Reproducibility was quantified by the root-mean square standard deviation and the coefficient of variation. RESULTS: We found that the reproducibility for all outcome measures was better than or similar to that for mJSW. Despite a slightly higher reproducibility error for some new outcome measures compared to mJSW, they are potentially valuable since they reflect independent disease changes. CONCLUSION: We have demonstrated new reproducible radiographic outcome measures to quantify OA progression with the potential to be an improvement over standard minimum joint space width.

Adult↗
PubMed1999

Value of inferior vena cava Doppler waveform analysis for prediction of neonatal outcome.

The objective of this article is to determine the value of the inferior vena cava preload index (IVC) to predict neonatal outcome and compare it to other biophysical methods of antenatal surveillance. A clinical outcome study of patients referred to the author's institution for Doppler velocity blood flow studies was undertaken by comparing the ability of three antenatal surveillance tests: the nonstress test (NST); umbilical artery S/D ratio (UA); and the ratio of the middle cerebral artery to umbilical artery S/D ratios (MCUA) to predict poor neonatal outcome to the ability of the IVC to predict poor outcome. Patients were followed serially and neonatal outcome data was tabulated. Those patients that delivered within 10 days of their last study were included in the analysis. Seventy patients met the inclusion criterion. Neonatal outcome based on the results of the IVC as compared with outcome based on the results of the NST, UA, and MCUA tests. Odds ratios (with 95% confidence limits) for significant neonatal morbidity predicted by each test were: NST: 2.6 (0.14-14.6); UA: 5.7 (1.7-18.8); MCUA: 3.6 (1.1-13.1); and IVC: 4.1 (1.3-13.2). Logistic regression analysis indicated that the combination of MCUA and IVC was the best method of predicting poor neonatal outcome. This study of the utility of fetal IVC suggests that this noninvasive method of antenatal surveillance may provide an additional sensitive method of evaluating the status of the high-risk fetus.

Blood Flow Velocity↗
PubMed2005

[Individual therapists in inpatient psychotherapy -- a pilot study on their importance for therapeutic outcome].

OBJECTIVE: How much does the individual psychotherapist influence therapy outcome in a multimodal inpatient setting with several therapeutic relationships and the additional influence of group processes. METHODS: We studied the outcome of n = 293 psychotherapy inpatients (mean treatment duration: 11 weeks) who were treated in an integrated inpatient concept by 9 mostly psychodynamically oriented psychotherapists (professional experience 0.5 to 7 yrs, 13 to 56 patients per therapist). Patients had an extensive evaluation of process and outcome variables (e. g. SCL 90R, IIP, Global outcome rating, Helping Alliance Questionnaire - HAQ). Differences in outcome between patients of different therapists were calculated. RESULTS: Patients assigned to the participating therapists did not differ in their basic clinical characteristics, except in the clinical severity rating carried out by therapists themselves. Outcome in the SCL90R - GSI residual score and global rating differed significantly between the therapists (d (SCL-pooled SD) = 0.43 to 1.10, explained variance: 10 %). The same holds true for the therapeutic alliance (HAQ, explained variance: 45 %). Assessment of therapeutic relationship shows good correlation between patients and therapists, outcome assessment does not. Therapists differed in the degree of matching between their own and their patients' evaluations. CONCLUSIONS: We found significant therapist differences in outcome and alliance. Despite the multifaceted inpatient setting the individual therapist is an important determinant of therapeutic success.

Adult↗