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PubMedDate not supplied

Predictors of clinical outcome in patients receiving local intra-arterial thrombolysis without subsequent symptomatic intracranial hemorrhage against acute middle cerebral artery occlusion.

BACKGROUND AND PURPOSE: The factors that predict favorable outcome after local intra-arterial thrombolysis (LIT) remain unknown. We aimed to clarify these factors in patients with middle cerebral artery occlusion treated by LIT. METHODS: We performed LIT in 26 consecutive patients who had middle cerebral artery occlusion with a modified Rankin scale (mRS) score or=3). RESULTS: The duration from symptom onset to hospital admission was 0.96 +/- 0.87 (mean +/- SD) hour and from onset of stroke to LIT was 3.78 +/- 1.17 hours. No patients developed symptomatic intracerebral hemorrhage or died. Thirteen patients achieved good outcomes. No significant differences existed between the two groups in baseline National Institutes of Health Stroke Scale (NIHSS) scores, time from stroke onset to LIT, blood pressure, early CT signs, or subsequent hemorrhagic transformation shown by CT. However, univariate analysis showed that patients with good outcomes were younger, more often had absence of hypertension history, had better collaterals shown by angiography, and had better recanalization rates than those with poor outcomes. NIHSS scores after LIT were lower in patients with good outcomes than in patients with poor outcomes. Logistic regression analysis indicated improvement of the NIHSS scores by >or=2 immediately after LIT was independently associated with good outcome. CONCLUSION: Improvement of the NIHSS score by >or=2 immediately after LIT is a useful predictor of patient outcome at discharge.

Aged↗
PubMed2004

Factors influencing the outcome in symptomatic Chiari I malformation.

BACKGROUND: To study the clinico-radiological determinants of outcome in patients with Chiari I malformation (CIM). MATERIALS AND METHODS: The disability assessment of 48 patients with C I M who underwent posterior decompression was done by modified Klekamp and Samii scoring system. The outcome was regarded as good when the patient was ambulant without any aid with an improvement in the disability score; and, poor when (a) there was postoperative deterioration or lack of improvement; (b) the patient was non-ambulant without aid, irrespective of the improvement in the clinical score; or, (c) there was a perioperative mortality. Patients with hydrocephalus; those who underwent syringo-subarachnoid or syringo-peritoneal shunt as the primary procedure; and, patients with atlanto-axial dislocation were excluded from the study. STATISTICAL METHODS USED: Categorical data were expressed in proportions and analyzed with Chi square test. Analysis of factors predicting clinical outcome at 6 months was done utilizing logistic regression analysis. RESULTS: The outcome assessed at six months showed that 30 patients (62.5%) had good outcome while 18 patients (37.5%; including two perioperative mortalities) had a poor outcome. CONCLUSIONS: Significant predictors of outcome in patients with CIM include the duration of symptoms (P value=0.006), respiratory distress (P value=0.001), and basilar invagination (P value=0.048). The effect of syringomyelia in predicting the clinical outcome could not be determined due to the differences in the number of patients in the groups with or without syringomyelia.

Adolescent↗
PubMed2005

Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial.

The reported relationships between nerve conduction studies (NCS) and outcome measures in carpal tunnel syndrome (CTS) are weak to moderate. However, selection of patients may have confounded nonrandomized studies. NCS have potentially great value in selecting patients for a specific treatment and in objectively assessing the efficacy of treatments in CTS, especially if they correlate significantly with clinical outcome measures. To investigate the relationship between clinical outcome measures for the severity of complaints and NCS in patients treated for CTS, data were obtained from a multicenter randomized controlled trial on the efficacy of splinting versus surgery for CTS. At baseline and 12 months after randomization, clinical outcome measures were assessed and NCS were performed. In total, 138 patients completed the questionnaires and underwent repeated NCS. Relationships were analyzed with Spearman rank correlation coefficients and Pearson correlation coefficients. All NCS parameters showed highly significant improvement compared with baseline (P < 0.001). Modest correlations (< 0.4) were found between the neurophysiologic and clinical outcome measures after 12 months, and between the changes in these different categories of outcome measures. This study confirms that the parameters of NCS improve significantly after treatment for CTS, but the modest correlations between neurophysiologic and clinical outcome measures do not support that NCS are routinely performed in clinical practice to evaluate treatment effects. However, studies investigating the effects of treatment for CTS should incorporate both clinical outcome measures and NCS, because they are complementary. Furthermore, NCS can provide additional information to the clinician when treatment effects are unsatisfactory.

Adult↗
PubMed2005

The use of outcomes instruments in the assessment of patients with idiopathic scoliosis.

Outcomes research is becoming an increasingly vital aspect of modern medicine. With current cost containment measures, the need for effective and reproducible treatment options is essential. The methodology associated with these outcomes studies is varied. Studies involving radiographic assessment can be effective with respect to instrumentation performance. However, studies that use physical parameters for outcomes do not include the patient's perception of outcome. For surgical outcome to be considered successful, patient satisfaction must be taken into account. The tools and methods used to assess patient satisfaction are complicated, as these outcomes measures must stratify the various aspects of daily living, personal perception, and overall well-being. The interpretation and analysis of these patient-perceived data can prove challenging because the variability within a group can be large based on human factors. Nonetheless, patient satisfaction should be of prime importance and should be addressed in any outcome study. An overview of the parameters and terms associated with outcomes research in the assessment of patients with scoliosis is important in order to improve existing care or aid in the evaluation of new standards of care.

Humans↗
PubMed2005

Adverse pregnancy outcomes after a false-positive second trimester serum screen for Down syndrome in Thai pregnant women.

OBJECTIVE: To determine whether a false-positive second trimester serum screen for Down syndrome in Thai pregnant women is predictive of adverse pregnancy outcomes. MATERIAL AND METHOD: The relationship between adverse pregnancy outcomes in women and a false-positive screening for Down syndrome was investigated in a case-control study. The Double-marker maternal serum screening for Down syndrome (alpha-fetoprotein and free beta-hCG) was performed on Thai pregnant women between 14 and 21 weeks 'gestation at Charoenkrung Pracharuk Hospital from March 1998 to August 2002. The pregnancy outcomes of 165 women having false positive serum screening (risk ratio at least 1.270; study group) were compared to the outcomes of 165 control patients having negative serum screening results (control group). The outcome indices analyzed were preterm delivery, low birth weight newborn, small-for-gestational age newborn, preeclampsia, placenta previa, and fetal death. RESULTS: The incidence of adverse pregnancy outcomes was 18.2% in the study group and 15.2% in the control group (odds ratio = 1.244; 95% confidence interval = 0.696, 2.225; p = 0.46). Women in the study group delivered at a significantly lower birth weight of newborns than women in the control group did (3088.1 +/- 543.9 versus 3229.1 +/- 454.6 g, respectively; p = 0.011). No significant differences in adverse outcomes was discovered after the comparisons between the study group and the control group. preterm delivery 11 of 165 (6.6%) versus 5 of 165 (3%), p = 0.124; low birth weight newborn 11 of 165 (6.6%) versus 6 of 165 (3.6%), p = 0.213; small for gestational age newborn 4 of 165 (2.4%) versus 0 of 165 (0%), p = 0.123; preeclampsia 16 of 165 (9.7%) versus 12 of 165 (7.3%), p = 0.429; placenta previa 4 of 165 (2.4%) versus 4 of 165 (2.4%), p=1; fetal death 1 of 165 (0.6%) versus 0 of 165 (0%), p=1. CONCLUSION: The present findings revealed no apparent increase in the adverse pregnancy outcomes analyzed in women with false positive Down syndrome screening test.

Adult↗
PubMed2005

Cardiovascular risk factors and diseases strongly predict hemodialysis treatment outcome in maintenance hemodialysis patients.

AIM: To identify independent predictors of hemodialysis treatment outcome among major cardiovascular risk factors and pre-existent cardiovascular diseases in maintenance hemodialysis patients with the end-stage renal disease. METHODS: A total of 144 prevalent patients on maintenance hemodialysis at Rijeka University Hospital between 1998 and 2003 were included in the prospective clinical study. Pre-existent cardiovascular risk factors and diseases were identified, as well as their relation to hemodialysis treatment outcome. Primary outcome measure was death, and secondary outcome measure was the length of time from the beginning of patient's hemodialysis treatment to the end of follow-up, ie, end of the study or patient's death. The independent variables on hemodialysis treatment outcome were identified with the multiple linear regressions. RESULTS: Cardiovascular diseases were the major cause of death in 40 (60.6%) patients. Acute myocardial infarction in 15 (22.7%) patients was the major single cause of death. Among risk factors, hyperglycemia (P<0.001), low delivered dialysis dose (P<0.001), use of semi-synthetic dialysis membrane (P<0.001), and anemia (P=0.041) were independent predictors of hemodialysis treatment outcome. Hypertensive heart disease (P<0.001), ischemic heart disease (P<0.001), and dilated cardiomyopathy (P=0.016) were independent predictors of the hemodialysis treatment outcome. CONCLUSIONS: Cardiovascular diseases were the leading cause of death in hemodialysis patients. There was also high prevalence of cardiovascular risk factors and pre-existent cardiovascular diseases. Several of them were independent predictors of the hemodialysis treatment outcome.

Adult↗
PubMedDate not supplied

Racial disparities in birth outcomes increase with maternal age: recent data from North Carolina.

BACKGROUND: Racial disparities in birth outcomes persist in North Carolina and the United States. We examined patterns of birth outcomes and womens health measures in North Carolina by race and age to portray the largest disparities. We wanted to see if our data were consistent with the "weathering hypothesis," which holds that the health of African American women may begin to deteriorate in early adulthood, with negative effects on birth outcomes. METHODS: We conducted a descriptive analysis of 1999-2003 North Carolina live birth and infant death records and 2001-2003 Behavioral Risk Factor Surveillance System survey data. Birth outcome measures examined were low birth weight, very low birth weight, infant mortality neonatal mortality and postneonatal mortality. Womens health measures examined were obesity self-reported health status, high blood pressure, high cholesterol, current smoking, and smoking during pregnancy. Rates for whites and African Americans were compared for each of three age groups. RESULTS: Racial disparities in birth outcomes increase with increasing maternal age. African American teens often experience better birth outcomes than older African American women. Racial disparities in measures of womens health also increase with increasing age. CONCLUSIONS: Health problems among older African American women of reproductive age may contribute substantially to racial disparities in birth outcomes. Improving the health of older African American women may be an effective strategy to reduce the overall racial disparities in birth outcomes.

Adolescent↗
PubMed2006

Poor and good health outcomes in rheumatoid arthritis: the role of comorbidity.

OBJECTIVE: To assess the predictive value of selected sociodemographic characteristics, rheumatoid arthritis (RA)-specific clinical factors, and comorbidity with respect to patient-reported health outcomes, i.e., pain, disability, and health-related quality of life, among patients with RA. METHODS: Data were collected between 1997 and 2002 among 882 patients with RA of varying disease duration using questionnaires and clinical examinations. Health outcomes were evaluated over 5 years as a function of disease duration by means of random intercept linear regression. Then we selected the 10% of patients with the poorest and best health outcomes during the 5 years of followup compared to others with equal disease duration. Separate multivariate logistic regression analyses were conducted to identify factors associated with poor and good outcomes. RESULTS: Sociodemographic characteristics seemed to be less important in the prediction of health outcomes. After RA-specific clinical factors, comorbidity appeared to be a major predictive factor for health outcomes. In particular, psychological comorbidity, i.e., depressive symptomatology, was a consistent predictive factor with respect to all health outcomes. CONCLUSION: Assessment of comorbidity needs to be incorporated into the management of RA in order to prevent poor outcomes and to adapt therapies to the specific situation of individual patients. Periodic routine screening for and monitoring of somatic and psychological comorbidity should be included in clinical practice.

Adolescent↗
PubMed1995

[Japan coma scale in the prediction of outcome after early surgery for aneurysmal subarachnoid hemorrhage].

The value of the 10-grade Japan Coma Scale (JCS) as a means of evaluating patients undergoing early aneurysm surgery was assessed in terms of its relationship to surgical outcome. The 13-grade Glasgow Coma Scale (GCS) was also assessed, and comparisons were made between the two. A series of 765 patients who underwent aneurysm surgery within 7 days after hemorrhage were evaluated both by JCS and GCS immediately prior to surgery, and outcome was assessed by the Glasgow Outcome Scale (GOS) 6 months postoperatively. Both the JCS and GCS scores were significantly correlated with surgical outcome (JCS vs GOS: rs = 0.586, GCS vs GOS: rs = 0.615, p < 0.001). There was no significant difference between the correlation coefficients for outcome of the JCS and GCS. In general, the better the JCS or GCS score was, the better the surgical outcome was, however, outcome among those with a JCS score of 3 was poorer than among those with a score of 10, 20, or 30. The results of this study indicate that both JCS and GCS are useful in predicting surgical outcome, but the GCS may be better than the JCS because of the problem with the score of 3 in the latter.

Acute Disease↗
PubMed1995

Sample size calculations in scleroderma: a rational approach to choosing outcome measurements in scleroderma trials.

Subjects with both diffuse and limited scleroderma were studied to calculate the baseline characteristics of several commonly used outcome measurements in order to provide parameters for sample size calculations for scleroderma clinical trials. From these estimates, outcome measurements were chosen as potentially responsive to change in clinical trials if their sample sizes were not prohibitively large. Forty-five patients with scleroderma were systematically assessed to determine the means and standard deviations whereby sample size calculations can be performed using this information. Examples of sample sizes were determined for the entire group, and for 2 subsets: those with diffuse scleroderma and those with diffuse disease of recent onset. Many baseline characteristics were significantly different in patients with diffuse compared to limited systemic sclerosis. The baseline values were different for the Health Assessment Questionnaire (HAQ) disability score, Functional Index, grip strength, oral aperture, finger-to-palm distance, skin score, and physician global assessment. Sample sizes can vary widely depending upon the outcome measurement chosen and the range of deltas used within the different scleroderma subsets. Sample size requirements for many outcome measures are extremely large due to marked variability in the baseline measures. Primary outcome measures in scleroderma trials should be chosen which have adequate power to detect a minimal clinically relevant change in the primary outcome measurements at the sample sizes employed. All other outcome measures should be ranked as secondary. Skin scores, global assessments, and grip strength measurements require smaller sample sizes than the other outcome measurements which were studied. Sample sizes in future trials will vary depending upon the proportion of patients with diffuse and limited scleroderma who are included.

Female↗
PubMed1994

Outcomes evaluation in TBI Rehabilitation. Part I: overview and system principles.

Questions of how to measure outcomes are commonly heard in rehabilitation today. In this supplement we review the current state of the art of outcomes measurement in traumatic brain injury rehabilitation, discuss key issues, and identify steps that need to be taken. The underlying question is not simply that of outcomes measurement but how to infer effective and cost-effective treatment. The validity of such inferences rests on multiple features of the entire clinical information system. Requirements for valid, feasible, outcome-oriented clinical data systems are described. Effectiveness is inferred from variations in outcomes experienced by similar persons who received differing interventions. Outcome data systems need large sample sizes and technically adequate severity adjusters. A nationwide TBI data system is needed to identify reasonably homogeneous subgroups in different programs whose outcomes can be meaningfully compared. In alliance with payors and persons with disabilities, rehabilitation professionals can create outcome data systems that will provide the knowledge necessary to improve the effectiveness and cost-effectiveness of rehabilitation programs.

Activities of Daily Living↗
PubMed1994

Patient outcomes following tricompartmental total knee replacement. A meta-analysis.

OBJECTIVE: To provide estimates of patient outcomes following tricompartmental knee replacement and to examine variation in outcomes due to patient and prosthesis characteristics. DATA SOURCES: English-language articles identified through a computerized literature search and bibliography review. STUDY SELECTION: Studies were included if they enrolled 10 or more patients at the time of initial knee replacement and measured patient outcomes using a global knee-rating scale. DATA EXTRACTION: Each study was subjected to a blinded qualitative assessment and unblinded abstraction of patient characteristics, surgical techniques, and outcomes. DATA SYNTHESIS: A total of 130 studies reporting patient outcomes on 154 cohorts satisfied inclusion criteria. The total number of enrolled patients was 9879 with a mean enrollment of 64.1 patients. The mean follow-up was 4.1 years. The mean patient age was 65.0 years, 71.7% of patients were women, 62.6% had osteoarthritis, and 26.6% underwent bilateral knee replacement. Global rating scale scores improved by 100% for the typical enrolled patient, and 89.3% of patients reported good or excellent outcomes. Anatomic classification of the prosthesis, percentage of enrolled patients with osteoarthritis, publication year, and number of enrolled patients explained 27% of the variation in reported mean postoperative global rating scale scores. The weighted mean complication rate was 18.1%, and the mean mortality rate per year of follow-up was 1.5%. The overall rate of revision during 4.1 years was 3.8%. CONCLUSIONS: Tricompartmental knee replacement was a safe and effective procedure for the patients reported in these studies. The knee pathology and the type of prosthesis were significant predictors of outcomes. Limitations in the reporting style of these articles severely constrain the ability to explore variation in outcomes due to study, patient, or prosthesis characteristics and restrict their generalizability.

Aged↗
PubMed1995

Dynamic patient data bases: the foundation of an integrated approach to outcome measures for the healthcare professionals.

In recent years there has been a tremendous need among healthcare professionals to assess the effectiveness, efficiency, and appropriateness of the patient care services being provided through criteria-based outcome and program evaluation. Although the need for a tool which could evaluate the effectiveness of patient care is widely recognized, such an undertaking has been severely limited due to the lack of any automated means to collect and analyze patient data on a routine, continuous basis within a clinical setting. We have developed and implemented at Mineral Springs Hospital, Banff, Alberta an integrated and automated hospital information system that not only continuously collects administrative, financial, and patient data, but also contains an intelligent component for automated outcome measure and program evaluation. The system collects various non-duplicated data elements from each routine work process within the facility on a continuous basis. Through the creation of a dynamic patient database, data is transformed into information--a powerful decision support tool. The system provides flexible user-defined reports in patient-specific resource utilization, direct and/or indirect specific financial costs, result reporting of each intervention, service provided and user-defined criteria-based outcome, and program evaluation. The system design incorporates expert rules, dynamic data entry forms, quantitative models, and user-defined access control. Using information derived from the dynamic common database, managers and front-line clinicians can easily evaluate and modify management decisions or careplans on a macro or micro level. An external review is planned to evaluate whether the system has helped the assessment of effectiveness, efficiency and appropriateness of healthcare services being provided at the hospital. The fundamental concept behind the system design is that the patient is the center of activity for data collection. The system provides the answers to the 5 W's (who, what, where, when, and why) together with intervention and service result reports. A dynamic common patient database is the center of the system and is accessible to all with proper authorization. Common data elements are collected from routine work flow without extra data entry and this information is subsequently shared. Data collection is a continuous process. We believe that every process is the outcome of another sub-process or event. The design of the dynamic patient database incorporates patient-specific costing and outcome evaluation, user-defined flexible data entry forms, user-defined access control, outcome evaluation rules and information semantic rules. Such a patient database would provide the flexibility needed to accommodate diverse methodologies to evaluate outcomes whether it they be medical, cost, access and/or other combination of measures. The system was developed on a PC-based Network technology, using FOXPRO (XBase) as the database development tool incorporating advanced technology such as distributed processing and fault tolerant computing. We chose PC-based technology because it is economical, having relatively low maintenance costs and requires no major dependency on vendors. The developed system produces patient-specific reports with many dimensions. The reports are user-defined. The system reports general data, CMG, RGN, LOS, Expected LOS, and other user-defined demographic data. Resource utilization, financial costs, and result reportings are produced together with rule-based outcome assessments of any type of measures, including, but not limited to, pre-set functional/health goals, user satisfaction, clinicianUs text or codified comments etc. It provides the framework for continually capturing data at a practical, work-flow level. The incorporation of a dynamic patient database as the driving forece of an integrated, rule-based administration, financial and patient data system will provdie the tools for healthcar

Databases, Factual↗
PubMed1996

Use of risk-adjusted outcome data for quality improvement by public hospitals.

In 1993 the California Office of Statewide Health Planning and Development (OSHPD) began public release of risk-adjusted monitoring of outcomes (RAMO) under the California Hospital Outcomes Project. We studied how 17 acute are public hospitals in California used these RAMO data for quality improvement purposes following their initial distribution, first by analyzing the outcome data for San Francisco General Hospital Medical Center as recommended by OSHPD and, second, by querying the departments at the other 16 public hospitals to determine how their own analyses compared. We found that the hospitals generally did minimal analyses of the OSHPD RAMO data and considered the data of little value to them. Only 3 hospitals initiated quality improvement activities based on their data review. The major reasons given by the hospitals for not using the RAMO data were that their outcomes were adequate, as verified by a comparison of their observed outcomes and those expected after risk-adjustment; that the hospitals had too few patients in the diagnostic categories; that they had too few resources; and that they were not concerned with the data's public release. Other possible explanations were that awareness of the California Hospital Outcomes Project was not widespread at the time of the study, that the RAMO data were not distributed in a way that encouraged their use, and that public hospitals were not inclined to use the outcome data because the project was imposed on them. Whatever the explanation, our study suggests that the California Hospital Outcomes Project has had little effect on quality improvement in public hospitals.

California↗
PubMed1996

Pregnancy outcomes in a prospective matched control study of pregnancy and renal disease.

OBJECTIVE: Assessment and comparison of pregnancy outcomes in women with renal disease and women with high risk pregnancies due to medical illness without renal disease. DESIGN: A prospective, matched controlled study. SETTING: The High Risk Obstetrical Clinics of Magee Women's Hospital, a primary and referral center where approximately 9,500 deliveries occur per year. PATIENTS: Two groups of pregnant women, all identified in the first trimester. The study group included 43 pregnancies in 40 women with renal disease as defined by: 1) known renal disease antedating pregnancy, 2) prepregnant proteinuria > or = 150 mg/24 hours, or 3) first trimester serum creatinine > or = 0.8 mg/dl or proteinuria > or = 300 mg/24 hours. The 43 controls included women with medical problems other than renal disease that placed them at high obstetrical risk. Control women were matched to study women for parity, advanced maternal age, race, and insulin-dependent diabetes mellitus. MEASUREMENTS: For all patients, blood pressure was recorded once at approximately 10, 20, and 30 weeks gestation. For study patients, serum creatinine, 24-hour urinary protein, and creatinine clearance were obtained at least once in each trimester. Pregnancy outcomes were recorded as favorable if gestation was > or = 36 weeks and without evidence of intrauterine growth retardation. Adverse pregnancy outcomes included prematurity, intrauterine growth retardation, intrauterine fetal death, spontaneous abortion, or neonatal death. RESULTS: Forty-two percent of study and control patients were diabetic. First trimester renal function was normal (creatinine < 0.8 mg/dl) in 12 study patients, mildly impaired in 24 (creatinine 0.8-1.4 mg/dl) and moderately impaired in 5 (creatinine > or = 1.4 mg/dl). Compared with controls, first and third trimester hypertension was more prevalent in the study patients (p = 0.003, p = 0.012); overall mean blood pressure was also higher in study patients (92 +/- 11 mmHg vs 85 +/- 8 mmHg, p = 0.002). The mean gestational age was shorter in the study patients (33.4 +/- 6.9 weeks vs 37.2 +/- 4 weeks, p = 0.001). Overall pregnancy loss was more common in the study patients (14/43 vs 3/43, p = 0.003) with spontaneous abortion contributing half of those pregnancy losses (7/14). Hypertension in any trimester was associated with adverse pregnancy outcome in study but not control patients. In the subset of study patients, adverse fetal outcome was directly associated with degree of renal dysfunction and proteinuria. CONCLUSIONS: Pregnancy outcome in women with renal disease was significantly worse than in the control group and showed no improvement over retrospective reports from the 1970's and 1980's. Specifically, fetal deaths were more common in women with renal disease and were predicted by proteinuria and the degree of renal dysfunction. The uncommonly low number of spontaneous abortions in the control group may have contributed to the worse fetal outcome in the study patients compared with controls. Women with diabetes mellitus and hypertension are at particularly high risk for relatively poor pregnancy outcome. These higher risks should be discussed when counseling women with renal disease who contemplate pregnancy.

Adult↗
PubMed1997

Sexually transmitted diseases and adverse outcomes of pregnancy.

We emphasize again that the prevalence of maternal infections may vary in different populations, and others might arrive at different estimates about the percentage of infants colonized and, concerning those infants colonized, about the percentage with adverse outcomes. Additionally, many women are colonized or infected simultaneously with several of the organisms discussed in this review, and this may result in different projections of morbidity and mortality rates than those presented here. We realize also that new information is generated continually describing the relationship between various maternal colonizations and preterm birth, and that screening and treatment protocols for several diseases may reduce the prevalence of adverse outcomes reported here. Therefore, we emphasize that the prevalences of various adverse pregnancy outcomes, as presented in this article, are only approximations and may change as new information becomes available. Nevertheless, we believe it is reasonable to estimate the relative effect of various maternal sexually transmitted diseases on adverse pregnancy outcome as we have done in this article. By comparing the effect of direct transmission of sexually transmitted organisms on adverse outcomes with the effect on overall outcome through an increase in the rate of preterm births, we should be able to use this type of analysis to establish some basis for allocation of resources to future research as well as intervention programs aimed at reducing sexually transmitted disease-related adverse outcomes of pregnancy. Finally, the appreciation of the effect of bacterial vaginosis on outcomes of pregnancy associated with preterm birth gives bacterial vaginosis a greater public health importance than has been attributed to it in the past as the subject of sexually transmitted disease research and prevention.

Female↗
PubMedDate not supplied

Outcomes research in chiropractic: the state of the art and recommendations for the chiropractic research agenda.

OBJECTIVE: To examine and document the state of the art in outcomes research in chiropractic, including the limitations of available data, and to make recommendations for further progress in this area. METHODOLOGY: An extensive search of the literature from 1990 through 1994 was undertaken using electronic databases (Medline, Index to Chiropractic Literature, EMBASE, and ERIC) and hand searches were conducted for relevant studies published in 1995. Publication in English, publication in a peer-reviewed journal, weight of evidence (study design) and measurement of patient-relevant outcomes were primary inclusion criteria. We prepared a draft with recommendation, rationale, actions required, responsible parties and expected outcomes for each seed statement. An outcomes workgroup, convened at the Research Agenda Work shop, added its perspective to the seed recommendations and actions required. Finally, the white paper authors prepared the final recommendations for outcomes research in chiropractic. RESULTS: This white paper presents six recommendations, emphasizing four general areas in which to develop the outcomes research agenda in chiropractic: research culture, infrastructure, opportunities and topics in outcomes research. CONCLUSION: The long-term goals of the chiropractic research agenda must be to advance the profession and to better meet the health needs of the public. Our final recommendations serve as a foundation for the development of proposals for future strategy with outcomes research a priority.

Case-Control Studies↗
PubMed1997

Advanced practice nurse as outcomes manager.

Outcomes management as a patient management system has been designed to impact and improve select outcomes. Central to the development and implementation of best practice senario identified throughout outcomes management is the advanced practice nurse. SLEH has been in the forefront of development and implementation of an outcomes management program. This article describes the outcomes management position and shares the job description and performance evaluation used at this institution. The tools allow for measuring and quantifying the impact of the outcomes manager position on improving patient outcomes. The improvement of outcomes has increased the value of the advanced practice nurse and provided the institution with a solid future necessary for survival in a managed care market.

Benchmarking↗