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At least 1,423 records · Page 79Linked to original sources
PubMed1997

Impact on clinical outcome of secondary brain insults during the neurointensive care of patients with subarachnoid haemorrhage: a pilot study.

OBJECTIVE: To analyse the occurrence and influence on outcome of secondary brain insults during neurointensive care of patients with subarachnoid haemorrhage. METHODS: Sixty one seriously ill patients with subarachnoid haemorrhage with a poor neurological grade, acute hydrocephalus, or intraventricular and/or intracerebral haemorrhages, who were referred as emergency cases to the neurosurgical intensive care unit during 1990 and 1991, comprised the study patients. RESULTS: The follow up performed according to the Glasgow outcome scale 14 months (median) later showed 23 patients with good recovery (38%), 11 with moderate disability (18%), seven with severe disability (11%), and two in a vegetative state (3%); 18 patients had died (30%). Clinical outcome was significantly related to the CT modified Hunt and Hess grade (P = 0.006). In total, 164 secondary brain insults (potentially avoidable factors) of various types were seen at the unit during the first seven days after the haemorrhage. Patients with a favourable outcome had significantly fewer secondary insults than patients with an unfavourable outcome (P = 0.0008). The occurrence of insults in each patient was related to the neurological grade (CT modified Hunt and Hess grade, P = 0.05). Multivariate analysis with the CT modified Hunt and Hess grade and the number of secondary brain insults during the first week as explanatory variables and favourable outcome as the dependent variable, showed that the number of complications was a significant independent predictor of favourable outcome (beta = -0.38, SE(beta) = 0.17, P = 0.03), whereas the CT modified Hunt and Hess grade did not reach significance (beta = -1.2, SE(beta) = 0.81, P = 0.14). CONCLUSIONS: The clinical outcome after subarachnoid haemorrhage is at least partly determined by the number of secondary insults. Therefore, vigorous attempts should be made to avoid all events that may potentially increase the risk of secondary cerebral ischaemia. Prospective studies must be initiated to define the role of "priming" of the brain and the impact of specific individual secondary insults in patients with subarachnoid haemorrhage.

Adult↗
PubMed1999

Glasgow head injury outcome prediction program: an independent assessment.

Using an independent data set, the utility of the Glasgow Head Injury Outcome Prediction Program was investigated in terms of possible frequency of use and reliability of outcome prediction in patients with severe head injury, or haematoma requiring evacuation, or coma lasting 6 hours or more, in whom outcome had been reliably assessed at 6 to 24 months after injury. Predictions were calculated on admission, before evacuation of a haematoma, or 24 hours, 3 days, and 7 days after onset of coma lasting 6 hours or more. Three hundred and twenty four patients provided 426 predictions which were possible in 76%, 97%, 19%, 34%, and 53% of patients on admission, before operation, 24 hours, 3 days, and 7 days respectively. Major reasons for non-feasible predictions were that patients were paralysed/ventilated as part of resuscitation or management. Overall, 75.8% of predictions were correct, 14.6% were pessimistic (outcome better than predicted), and 9.6% optimistic (outcome worse than predicted). Of 197 patients (267 predictions) whose eventual outcome was good or moderate, 84.3% of predictions were correct. For death or vegetative survival (96 patients with 110 predictions), 83.6% of predictions were correct but for severe disability (31 patients with 49 predictions), only 12.2% were correctly predicted. The utility of the Glasgow Head Injury Outcome Prediction Program compares favourably with other outcome prediction algorithms for patients with head injury.

Adolescent↗
PubMed1997

Pulmonary emphysema: comparison of preoperative quantitative CT and physiologic index values with clinical outcome after lung-volume reduction surgery.

PURPOSE: To compare quantitative computed tomographic (CT) and preoperative physiologic values in emphysema with outcome after lung-volume reduction surgery. MATERIALS AND METHODS: In 46 patients, emphysema was quantified by measuring lung attenuation on preoperative CT scans. Quantitative CT and preoperative physiologic values and postoperative outcomes (1-second forced expiratory volume, PaO2, and 6-minute walk distance) were compared. RESULTS: Moderately strong correlations were found between several quantitative CT and preoperative physiologic values (magnitude of r = .29-.58, P < .05) and several quantitative CT and outcome measures (magnitude of r = .31-.47, P < .05). With stratification, postoperative outcome was better with mean lung attenuation greater than -900 HU; 75% or greater of upper lung below -900 HU (emphysema index); greater than 25% of lung below -960 HU (severe emphysema index); ratio of upper- and lower-lung emphysema indexes 1.5 or greater; volume of normally attenuated lung (-850 to -701 HU) greater than 1 L; and full width at half maximum of attenuation-frequency distribution 80 HU or less. Differences in outcome measures between groups stratified with quantitative CT values were often two- to threefold; patients with greater numbers of favorable quantitative CT values had better outcome. Correlations between preoperative physiologic measures and outcome were few. CONCLUSION: In emphysema, quantitative CT values correlate with outcome. Quantitative assessment of emphysema in candidates for lung-volume reduction surgery is potentially useful.

Adult↗
PubMed2005

The psychological outcome of constitutional delay of growth and puberty.

Does being of short stature (SS) matter? Growth studies are important because endocrinologists need to be able to give not only diagnostic but also prognostic indication to those of SS, and give advice for or against treatment. Studies on body height may give significant insight into the behavioural-hypothalamic-pituitary axis underlying the surface effect on social behaviour. This research presents adult follow-up studies of 49 males who attended at a growth clinic as children and who were diagnosed as having the condition of maturational delay short stature (MDSS). From the psychological perspective, the elements of diagnosis and prognosis, attitudinal influences both social and individual, treatment, and psychological issues which could have bearing on SS are drawn together. Where there is a poor psychosocial outcome finding, the MDSS patients seem to be more like those with growth hormone (GH) deficiency. With GH deficiency (GHD), a poor psychosocial outcome of SS has been demonstrated with greater certainty. The current situation is that there remains divergence between previous SS outcome studies. Differing research SS psychosocial outcomes are analysed and a methodological explanation of past divergent outcomes is presented, being: (1) differences in sensitivity between psychological assessment tools; (2) Invalidation by confounding the psychological with sociological outcomes, and (3) confounding of results by failure to control for psychological states. An innovative new approach of changing the methodology of past SS research from the biological to the psychological perspective is employed: previous SS research has appointed height status as the independent variable, with psychosocial outcome as the dependent variable. The innovative approach in this research is to reverse that order and psychological status has been made the independent variable for both the MDSS and for a predetermined psychologically and physically healthy (PPH) comparison group of males. The results of the follow-up studies in this research indicate that there is an association between psychological distress and attained height which supports other studies where the findings indicate a poor psychological outcome associated with SS. It can therefore be concluded that the psychological status of children should be determined when they attend a growth clinic with concerns of SS.

Adult↗
PubMed2004

Cerebral venous flow velocity predicts poor outcome in subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Predictors of clinical outcome in aneurysmal subarachnoid hemorrhage (SAH) vary in reliability. Measurement of cerebral venous hemodynamics by transcranial color-coded duplexsonography (TCCS) has become of increasing interest lately, and correlation with intracranial pressure (ICP) seems to be high. The aim of the presented study was to assess changes of cerebral venous hemodynamics in SAH and evaluate its relationship with clinical outcome. METHODS: We performed sequential TCCS of venous peak flow velocities (vp-FVs) in the transversal sinus in 28 consecutive patients with aneurysmal SAH (Hunt and Hess scale 1 to 5). Measurement was initiated at onset of arterial vasospasm up to 5 days after SAH. All patients had a continuous ICP monitoring. Clinical outcome was evaluated with the modified ranking scale (MRS) 30 days after SAH. Patients were divided according to outcome: group I good recovery (MRS 0-III) and group II poor outcome (death or MRS IV-V). Maximum vp-FV, time-averaged vp-FV (mv-FV), and ICP were compared between groups. RESULTS: Vp-FV and mv-FV as well as ICP of group II exceeded values of group I (P<0.001 for all 3 parameters). Vp-FV showed a positive correlation with ICP (r=0.63; P<0.001). A vp-FV exceeding 35.4 cm/s (sensitivity 100%; specificity 90.9%), an mv-FV exceeding 27.3 cm/s (sensitivity 94.1%; specificity 81.8%), and an ICP exceeding 24 mm Hg (sensitivity 87.5%; specificity 81.8%) predicted poor outcome (receiver operating characteristic analysis). CONCLUSIONS: Increased ICP values correlate with increased venous flow velocities. In SAH, increased ICP and increased venous flow velocities are associated with poor outcome. Flow velocity of the transversal sinus is a highly sensitive, reliable, and early predictor of outcome in SAH.

Adult↗
PubMed2000

A predictive risk model for outcomes of ischemic stroke.

BACKGROUND AND PURPOSE: The great variability of outcome seen in stroke patients has led to an interest in identifying predictors of outcome. The combination of clinical and imaging variables as predictors of stroke outcome in a multivariable risk adjustment model may be more powerful than either alone. The purpose of this study was to determine the multivariable relationship between infarct volume, 6 clinical variables, and 3-month outcomes in ischemic stroke patients. METHODS: Included in the study were 256 eligible patients from the Randomized Trial of Tirilazad Mesylate in Acute Stroke (RANTTAS). Six clinical variables and 1-week infarct volume were the prespecified predictor variables. The National Institutes of Health Stroke Scale, Barthel Index, and Glasgow Outcome Scale were the outcomes. Multivariable logistic regression techniques were used to develop the model equations, and bootstrap techniques were used for internal validation. Predictive performance of the models was assessed for discrimination with receiver operator characteristic (ROC) curves and for calibration with calibration curves. RESULTS: The predictive models had areas under the ROC curve of 0.79 to 0.88 and demonstrated nearly ideal calibration curves. The areas under the ROC curves were statistically greater (P<0.001) with both clinical and imaging information combined than with either alone for predicting excellent recovery and death or severe disability. CONCLUSIONS: Combined clinical and imaging variables are predictive of 3-month outcome in ischemic stroke patients. Demonstration of this relationship with acute clinical variables and 1-week infarct information supports future attempts to predict 3-month outcome with all acute variables.

Aged↗
PubMed2006

An empirical analysis of cost outcomes of the Texas Medication Algorithm Project.

OBJECTIVE: Disease management systems that incorporate medication algorithms have been proposed as cost-effective means to offer optimal treatment for patients with severe and chronic mental illnesses. The Texas Medication Algorithm Project was designed to compare health care costs and clinical outcomes between patients who received algorithm-guided medication management or usual care in 19 public mental health clinics. METHODS: This longitudinal cohort study for patients with major depression (N=350), bipolar disorder (N=267), and schizophrenia (N=309) applied a multi-part declining-effects cost model. Outcomes were assessed by the Inventory of Depressive Symptomatology and the Brief Psychiatric Rating Scale. RESULTS: Compared with patients in usual care, patients in algorithm-based care incurred higher medication costs and had more frequent physician visits, although these differences often became smaller with time. For major depression, algorithm-based care achieved better outcomes sustainable with time but at higher agency and non-agency costs (mixed cost-effective). For bipolar disorder, patients in algorithm-based management achieved better outcomes at lower agency costs (cost-effective). For schizophrenia, patients in algorithm-based care achieved better outcomes that diminished with time, with no detectable difference in health care costs (cost-effective). CONCLUSIONS: Cost outcomes of algorithm-based care and usual care varied by disorder and over time. For bipolar disorder and schizophrenia, algorithm-based care improved outcomes without higher costs for health care services. For major depression, substantively better and sustained outcomes were obtained but at greater costs.

Algorithms↗
PubMed1994

Early outcome determination of low-birth-weight infants using the Neurodevelopmental Risk Examination.

A neonatal neurodevelopmental assessment, the Neurodevelopmental Risk Examination (NRE), was developed, through adaptation of the scoring of the Allen/Capute neonatal neurodevelopmental examination, for screening the development of low-birth-weight (LBW) infants in the newborn period. A pilot study was conducted of the NRE and its ability to predict motor and cognitive outcome in LBW infants. The NRE was performed on 92 LBW infants (mean birth weight 1,192 g; mean gestational age 29 weeks) at or near term and included assessments of sensory/behavioral response, axial tone, extremity tone, deep tendon reflexes, and primitive reflexes. Developmental outcome was assessed at a mean age of 13.7 months by neuromotor examination and by the mental scale of the Bayley Scales of Infant Development. The NRE total risk score, reflecting overall neurodevelopmental status, correlated well with motor and cognitive outcomes (r = .50, P = .0001; and r = -.38, P = .0001, respectively). When infants were clustered into risk groups based upon NRE score (69 infants were deemed low-risk, 20 moderate-risk, and three high-risk), a strong relationship to outcome was maintained (motor outcome: chi 2 = 43.6, P < .0001; cognitive outcome: analysis of variance (ANOVA) F = 6.78, df(2.89), P = .002). All subcategories of the examination, except primitive reflexes, were associated with outcome. Therefore, by using a simple method of scoring and interpretation, the NRE can validly predict motor and cognitive outcome in LBW infants.

Cognition↗
PubMed1995

ERP indices and neuropsychological performance as predictors of functional outcome in dementia.

We compared the relative value of neuropsychological and event-related potentials (ERPs) obtained during both passive and active auditory oddball paradigm measures for determining functional outcome in dementia 4 years following initial assessment. Functional outcome was assessed by structured interview of family members of 29 patients with dementia, and patients' functional status was rated in seven areas: mortality, incontinence, institutionalization, ADL dependence, verbal responsiveness, recognition of family members, and capacity for social interaction. A total functional outcome score (ADLTOTAL) was obtained by summing across these individual outcome measures. Many of the neuropsychological measures correlated strongly with overall functional outcome, whereas P3 amplitude and latency on the active ERP condition were the only ERP indices to predict functional outcome. When ERP and neuropsychological measures were considered simultaneously using stepwise multiple regression analyses, the neuropsychological measures were better predictors of most functional outcomes, although P3 latency was the best predictor of mortality. However, neuropsychological performance and ERPs appear to be sensitive to different functional outcomes. Therefore, evaluation of both ERPs and neuropsychological performance may ultimately have prognostic utility in the assessment of patients with dementia.

Aged↗
PubMed2003

Children's classroom peer relationships and subsequent educational outcomes.

Used children's peer relationships (social preference, aggression, and withdrawal) to predict educational outcomes in a 10-year longitudinal study of 524 students in Grades 3 to 5. Consistent with prior research, lower social preference and elevated aggression and withdrawal were each associated with lower graduation rates; however, only aggression uniquely predicted outcomes. Ethnicity and socioeconomic status (SES) predicted educational outcomes and moderated the association between peer acceptance and outcomes. Social preference predicted educational outcomes of Caucasian and middle SES students but not African American and low SES students; when ethnicity and SES were included in the same model, only the moderating effect of SES was a significant predictor of educational outcome. Ethnicity also interacted with social withdrawal such that withdrawal predicted more negative educational outcomes for African American but not Caucasian students. When academic achievement scores and being over-age for grade were included in our model, only peer-rated aggression significantly added to the prediction of educational outcomes.

Child↗
PubMed2005

Social isolation and outcomes post stroke.

OBJECTIVE: To assess the relationship between social isolation and stroke outcomes in a multiethnic cohort. METHODS: As part of the Northern Manhattan Stroke Study, the authors prospectively followed a cohort of patients with stroke for 5 years. Baseline data including social isolation were collected. At follow-up, the authors documented outcome events as defined by the first occurrence of myocardial infarction (MI), stroke recurrence, or death. Cox hazard models were used to calculate the hazard ratio (HR, 95% CI) for prestroke predictors of post stroke outcomes. RESULTS: The authors followed 655 ischemic stroke cases for a mean of 5 years. The cohort was 55% women; 17% white, 27% African American, 54% Hispanic; mean age 69 +/- 12 years. There were 265 first outcome events. In univariate analysis, coronary artery disease (OR 1.3, 1.0 to 1.7), age > 70 years (OR 1.9, 1.5 to 2.5), atrial fibrillation (AF) (OR 1.8, 1.3 to 2.5), race-ethnicity (white vs Hispanic) (OR 1.7, 1.1 to 2.9), physical inactivity (OR 1.3, 1.1 to 2.6), help at home (OR 1.8, 1.4 to 2.4), and social isolation (OR 1.4, 1.2 to 1.6) were associated with increased risk of an outcome event. No association was seen for hypertension, diabetes, education, sex, insurance, occupation, marital status, or primary care physician. In the multivariable model controlling for age, AF (OR 1.9, 1.5 to 2.5), help at home (OR 1.5, 1.1 to 2.0), and social isolation (OR 1.4, 1.1 to 1.8) predicted outcome events. CONCLUSION: Prestroke social isolation is a predictor of outcome events post stroke. Lack of social support may contribute to poorer outcomes due to poor compliance, depression, and stress.

Age Factors↗
PubMed1992

Outcome analysis in 654 surgically treated lumbar disc herniations.

This article reports the outcomes of 654 consecutive patients treated during a 4.5-year period. Patients had a microdiscectomy, a laminectomy plus microdiscectomy, or a decompressive laminectomy with a microdiscectomy. The causes of ruptured discs were lifting (31.4%), falls (10.2%), and sports (10.0%). Almost all patients had complained of leg pain (99%), and 79% had radicular pain in a dermatomal distribution. Thirty-three percent of the patients had been involved in industrial accidents, and 6% had legal claims pending during the surgical period. Almost 11% of the patients had complications, and there was one death caused by abdominal arterial bleeding. Patients were also rated according to the Prolo Functional-Economic Outcome Rating Scale to improve the ability to compare series in the future. Almost 80% of the patients had good outcomes as defined by scores on this scale of 8 (16.2%), 9 (33.2%), and 10 (26.9%). Several conclusions can be drawn from the results of this series: 1) most patients had good outcomes; 2) patients with nonindustrial injuries had better outcomes than did patients with industrial injuries; 3) professionals with legal concerns and laborers with industrial insurance had good outcomes; and 4) the Functional-Economic Outcome Rating Scale appears to be a useful tool for comparing different procedures more objectively and for comparing the outcomes across series.

Adolescent↗
PubMed2006

Child outcomes and family characteristics 1 year after severe inflicted or noninflicted traumatic brain injury.

OBJECTIVE: To assess outcomes 1 year after severe traumatic brain injury (TBI) among young children and to compare outcomes between children with inflicted versus noninflicted injuries. STUDY DESIGN: Prospective cohort study. METHODS: All North Carolina-resident children who were hospitalized between January 2000 and December 2001 in any of the state's 9 PICUs and who survived a severe TBI that occurred on or before their second birthday were eligible to participate. Child health status, child use of ancillary medical resources, and family characteristics were determined through maternal caregiver interviews approximately 1 year after injury. Comparisons were made between family characteristics and child outcomes according to injury type. RESULTS: Seventy-two interviews of maternal caregivers were completed among 112 survivors (64.3%). Children with inflicted injuries (n = 41) had worse outcomes than did children with noninflicted injuries (n = 31), as measured with the Pediatric Outcome Performance Category and Stein-Jessup Functional Status II (Revised) tools. However, approximately 50% of children with inflicted injuries had only mild deficits or better. Children with inflicted injuries had a higher use of ancillary medical resources. Families caring for the children did not differ substantively, with a large proportion of single, working, minority mothers. CONCLUSIONS: Children with inflicted TBIs had worse outcomes than did children with other TBIs 1 year after injury. However, outcomes for these children were better than those reported previously. Many families caring for children after severe TBI are socially disadvantaged. Interventions to improve child outcomes may include enhanced family support.

Brain Injuries↗
PubMed2006

Cerebral oxygenation and electrical activity after birth asphyxia: their relation to outcome.

OBJECTIVE: To determine the value of regional cerebral oxygen saturation (rSo2), fractional cerebral tissue oxygen extraction (FTOE) measured by near-infrared spectroscopy (NIRS), and amplitude integrated electroencephalogram (aEEG) after birth asphyxia in relation to neurodevelopmental outcome. METHODS: NIRS measured rSo2, FTOE, and aEEG were monitored simultaneously, together with arterial oxygen saturation (Sao2) and blood pressure during the first 48 hours after severe birth asphyxia in 18 term infants. FTOE was calculated as [Sao2-rSo2]/Sao2. Neurodevelopmental outcome was assessed at 3, 9, and 18 months and 3 and 5 years of age. At the time points 6, 12, 18, 24, 30, 36, 42, and 48 hours after birth, the mean values of Sao2, rSo2, FTOE, and mean arterial blood pressure were calculated over a 1-hour period. A stepwise-regression model was used to investigate the relative contribution of rSo2, FTOE, or aEEG to developmental outcome. RESULTS: Nine Infants died during the neonatal period as a result of neurologic deterioration, and 8 infants had a normal outcome at 5 years of age. One child developed learning disabilities and a mild diplegia. The rSo2 and FTOE remained stable in infants with a normal outcome. The rSo2 increased and the FTOE decreased after 24 hours in the infants with an adverse outcome. (rSo2: 65% vs 84% at 12 and 48 hours, respectively; FTOE: 0.32 vs 0.12 at 12 and 48 hours, respectively). aEEG showed the closest relationship with outcome, but also rSo2 showed a significant correlation 24 hours after birth. CONCLUSIONS: rSo2 and FTOE seem to reflect secondary energy failure. aEEG showed the closest relationship with outcome after severe birth asphyxia.

Asphyxia Neonatorum↗
PubMed2000

Outcomes and experiential education.

Outcomes-based assessment in education involves continuous use of assessment measures to provide feedback about the efficacy of the curricular structure, content, and teaching methods. This process is initiated by establishing educational outcome statements for the Doctor of Pharmacy curriculum, selecting assessment methods that most appropriately measure the educational outcomes, and establishing a learning environment that is congruent with both the outcomes and assessment methods. To ensure a successful continuous outcomes-based assessment process, a systematic assessment plan should be prepared that focuses the process by identifying only the most essential hypotheses, uses a practical yet appropriate methodology, ensures efficient data collection, includes data analyses that link the educational outcomes to the learning environment, and promotes timely development and implementation of an action plan. An overview of outcomes-based education and the use of outcomes-based practice experiences in pharmacy education is presented.

Accreditation↗
PubMed2001

Comparison of childhood problem behaviors in boys with subsequent schizophrenic, antisocial, and good adult outcomes.

Childhood problem behaviors for 145 boys seen in child guidance clinics were used to compare four adult outcome groups: antisocial men, schizophrenic subjects with good outcomes, schizophrenic subjects with poor outcomes, and subjects with good outcomes. Delinquent and aggressive factor scale scores distinguished the antisocial outcomes from the other groups. A preschizophrenic factor along with lower IQ separated schizophrenics with poor outcome from the others. Subjects with good outcomes had lower scores on factor scales, higher IQ, and less disturbed families. Schizophrenics with good outcomes were the most difficult to identify correctly.

Adult↗
PubMed2003

Outcome-based education.

The move to outcome-based education has been one of the most important trends in health-profession education in recent years. This paper defines outcomes and outcome-based education, describes the development of outcome-based education, identifies several different ways that outcomes have been presented, and discusses the advantages and disadvantages of the outcome-based educational approach. The implementation of outcome-based education at the University of Dundee medical school, Scotland, UK is described as a case study for curriculum planners in veterinary medical education. The lessons learned in Dundee from six years' experience with outcome-based education are identified to aid veterinary medical educators wishing to implement the approach.

Animals↗
PubMed2000

Do women fare worse? A metaanalysis of gender differences in outcome after traumatic brain injury.

The purpose of this metaanalysis was to investigate possible gender differences in TBI sequelae. The case fatality rates in patients after TBI have previously been shown to be significantly higher in women as compared with men. A quantitative review of published studies of TBI outcome revealed eight studies (20 outcome variables) of TBI in which outcome was reported separately for men and women. Outcome was worse in women than in men for 85% of the measured variables, with an average effect size of -0.15. Although clinical opinion is often that women tend to experience better outcomes than do men after TBI, the opposite pattern was suggested in the results of this metaanalysis. However, this conclusion is limited by the fact that in only a small percentage of the total published reports on TBI outcome was outcome described separately for each sex. A careful, prospective study of sex differences in TBI outcome is clearly needed.

Brain↗