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PubMed1997

Long-term follow-up of initially successful trabeculectomy.

OBJECTIVE: The purpose was to study the long-term outcomes of primary trabeculectomies that were successful at 1 year. DESIGN: A retrospective study of patients with various types of glaucoma who had trabeculectomies that were successful at 1 year and who had a follow-up of at least 10 years. PARTICIPANTS: There were 40 patients (40 eyes) who had primary trabeculectomies that were successful at 1 year and who had a follow-up range of 10 to 21 years. INTERVENTION: Control of intraocular pressure (IOP) and disease progression was evaluated at 5, 10, and 15 years and at the last obtainable follow-up. MAIN OUTCOME MEASURES: Successful control of IOP was defined as IOP less than 21 mmHg or a reduction of 33% if preoperative IOP was less than 21 mmHg. Successful control of disease progression was defined as stable cup-disc ratios determined by examination, or color photographs or both, as well as stable visual fields. RESULTS: If an eye was considered successful by IOP at 1 year, the probability of successful control of IOP was 82% at 5 years and 67% at 10 and 15 years. If an eye was considered successful by IOP at 1 year, the probability of successful control of disease progression at 5 years was 77%, at 10 years 61%, and at 15 years 48%. If an eye did not require further glaucoma surgery at 1 year, the probability that it still would not need further surgery at 5 years was 90%, at 10 years 75%, and at 15 years 67%. Forty percent of eyes had cataract extraction by the time of last follow-up examination. CONCLUSIONS: Loss of IOP control and progression of glaucomatous damage occurs over time despite initial success at 1 year.

Adolescent↗

PubMed1996

Influence of procedural success on immediate and long-term clinical outcome of patients undergoing percutaneous revascularization of occluded coronary artery bypass vein grafts.

OBJECTIVES: This study sought to determine whether successful recanalization of an occluded vein graft is associated with improvement in long-term clinical outcome. BACKGROUND: Coronary angioplasty of occluded vein grafts is associated with a lower initial success rate and a higher complication rate than angioplasty of vein grafts with subtotal stenoses and native coronary arteries. Whether successful angioplasty improves clinical outcome is unknown. METHODS: We analyzed 77 consecutive patients who underwent angioplasty of an occluded saphenous vein coronary artery bypass graft between August 1983 and June 1994. Patients with a myocardial infarction in the previous 24 h were excluded from the study. RESULTS: The mean age of the study cohort was 65 years; the mean (+/- SD) age of the treated grafts was 7.5 +/- 3.9 years. As an adjunct to balloon angioplasty, stents were used in 9% of procedures, laser in 30%, and atherectomy in 16%, and thrombolytic therapy was administered in 23% of patients. The angioplasty success rate was 71%. Major complications within 30 days of the procedure included death in 5.2% of patients, Q wave myocardial infarction in 1.3% and repeat bypass surgery in 7.8%; these events occurred with similar frequency in patients in whom angiographic success was and was not achieved. Kaplan-meier analysis comparing patients in whom angioplasty was successful (n = 55) and not successful (n = 22) revealed no differences in survival or occurrence of myocardial infarction or recurrent severe angina between the two groups in the 3 years after the procedure. Univariate analysis identified the age of the graft and use of newer interventional devices as predictors of death or myocardial infarction during this time period; procedural success was not associated with freedom from these adverse events after adjusting for these variables. CONCLUSIONS: Angioplasty of occluded vein grafts is associated with a low initial success rate and a high complication rate. Successful angioplasty does not appear to reduce the occurrence of adverse events in the 3 years after the procedure.

Aged↗

PubMed1998

Intubation success rates improve for an air medical program after implementing the use of neuromuscular blocking agents.

To determine whether the success rate for endotracheal intubation improves after implementing the use of neuromuscular blocking (NMB) agents in an air medical program, this retrospective study analyzed all patients requiring endotracheal intubation at two air medical programs (nurse/paramedic crews) over a 5-year period. Air medical program A, the control group, had employed NMB agents throughout the entire study period. Air medical program B, which did not use NMB agents from July 1, 1989 through June 30, 1992, implemented their use starting July 1, 1992. For program A, the overall intubation success rate was 93.5% (202 successful intubations in 216 patients) and the successful intubations/total attempts ratio was 0.67 (202 of 301). For program B, the overall intubation success rate improved from 66.7% (46 successful intubations in 69 patients) before NMB agent use to 90.5% (57 in 63) after NMB agent use (P = .001). The successful intubations/total attempts ratio increased from 0.36 (51 of 141) prior to NMB agent use to 0.48 (63 of 132) after NMB agent use (P = NS). In comparing the 92 patients who did not receive NMB agents to the 40 patients who did, the intubation success rate increased from 69.6% (64 of 92) to 97.5% (39 of 40) (P < .001) and the successful intubation/total attempts ratio increased from 0.36 (73 of 202) to 0.58 (41 of 71) (P = .007). With the use of NMB agents, program B's overall intubation success rate increased significantly, matching the results of program A.

Adjuvants, Anesthesia↗

PubMed2006

Successful aging in Shanghai, China: definition, distribution and related factors.

OBJECTIVE: There are few studies of successful aging in China. This study was designed to investigate the distribution, and related factors, of successful aging in an elderly Chinese population. METHODS: A cross-sectional, community-dwelling elderly population was surveyed in Shanghai, China. We defined successful aging based on a multi-dimensional model. Correlates of successful aging were explored through the Shanghai Successful Aging Project Questionnaire, which includes sociodemographic questions, and a battery of standardized instruments, including the Chinese version of the Mini-mental State Examination, activities of daily living, and the Life Satisfaction Index A (LSIA). RESULTS: The rate of successful aging was 46.2% [95% confidence interval (CI) 43.6-48.7] among people aged 65 or above, and the rate for males was higher than that for females. The rate was much lower for those aged 85 years or over (9.4%). Logistic regression analysis suggested that female gender and older age were unfavorable factors for successful aging. A higher score on the LSIA, more leisure activities and being currently married related to successful aging. CONCLUSION: The rate of successful aging in Shanghai, China is similar to that found in studies from western countries. There are some potentially modifiable factors that may relate to successful aging.

Activities of Daily Living↗

PubMedDate not supplied

An analysis of Michigan EMT licensure examination results as a predictor of paramedic licensure examination success.

INTRODUCTION: Predicting paramedic candidate performance on the written licensure examination is of considerable importance to educators, students, employers, and state regulators. There has been little investigation of the available statistical data regarding examinee pass rate and examination score. No studies have measured an examinee's sequential success pattern on the basic emergency medical technician (EMT) or paramedic examinations. There has been no analysis of the relationship between the number of examinations required for successful paramedic licensure and examination score. OBJECTIVE: The purpose of this study was to determine the frequency with which paramedic licensure examinees successfully pass the State of Michigan written examination on the first or subsequent attempts; to determine the frequency with which the paramedic examinees pass the prerequisite basic EMT licensure examination; to determine whether the frequency of paramedic examination attempts is related to examination score; and to determine whether there is a relationship between successfully passing the basic EMT examination and successfully passing the paramedic examination. METHODS: A retrospective study of Michigan paramedic licensure examination results for 1994 was done on the basis of a review of reports prepared for Michigan Department of Public Health Emergency Medical Services (MDPH-EMS) by Professional Examination Services. Analysis of paramedic examination score and the number of examination attempts is correlated to EMT score and number of attempts required to pass. Success in the first or subsequent paramedic examinations is correlated to paramedic score, and success in passing the first or subsequent EMT examination is then related to success in passing the paramedic examination. RESULTS: Paramedic examinees (n = 869) generated a 72.1% pass rate in 1994 (mean score = 82.2%). The minimum passing score is 80%. The average score for examinees who passed (n = 627) was 86.2% (95% confidence interval [CI] = 85.8-86.6%); those who failed (n = 242) averaged 71.9% (95% CI = 71.1-72.6%). Paramedic examinees successful on the first attempt (n = 500) had higher average scores (mean = 87.1%; 95% CI = 86.7-87.5%) than did those who required multiple attempts (mean = 82.8%; 95% CI = 82.3-83.3%; n = 127). A total of 702 (90.5%) paramedic examinees passed the EMT examination on the first attempt. Examinees who passed the EMT examination the first time averaged fewer attempts on the paramedic examination (mean 1.5; 95% CI = 1.4-1.6) than did those who required multiple EMT examinations (mean 2.3; 95% CI = 2.0-2.6). Paramedic examinees passing the EMT examination in one attempt had higher average paramedic scores (82.6%; 95% CI = 82.1-83.2%) than those needing multiple EMT attempts (75.5%; 95% CI = 73.4-77.5%). CONCLUSION: Paramedic examinees who pass their EMT licensure examination on the first attempt have a significantly better chance of passing the paramedic licensure examination. Paramedic licensure examinees who pass the paramedic examination on the first attempt score significantly higher than do examinees who require additional attempts. Paramedic programs should incorporate EMT examination performance into their student selection criteria. Further study of variables predictive of success is needed.

Clinical Competence↗

PubMed2001

Success in the toxoplasma dye test.

OBJECTIVES: To compare the success rate of the toxoplasma dye test using different accessory factors (human serum as a source of complement) and different batches of tachyzoites produced in vivo and in vitro. METHODS: Twenty-five accessory factors were used in the dye test to assess both types of tachyzoite. Batches of tachyzoites were produced in vivo (n = 49) and in vitro (n = 23) and their performance assessed against panels of accessory factors. Performance was recorded as success or failure (incorrect results, total killing or no killing). RESULTS: With in vivo tachyzoites 21/25 accessory factors were successful in P > or = 1 dye test runs, whereas with in vitro tachyzoites all 25 were successful. One or more failure was recorded for 19/25 and 12/25 accessory factors using in vivo and in vitro tachyzoites, respectively (P < 0.05). The number of successful dye test runs was less for in vivo (92/141, 65%) than in vitro (140/163, 86%) tachyzoites (P < 0.001). This was due to a higher success rate in citrated accessory factors used for in vitro tachyzoites compared to the corresponding uncitrated accessory factors used for in vivo tachyzoites (P < 0.001). Success in the dye test was recorded for 48/49 and 23/23 batches of in vivo and in vitro tachyzoites, respectively. The number of successful dye test runs was lower with in vivo (156/234, 67%) than in vitro (116/142, 82%) tachyzoites (P < 0.01). CONCLUSIONS: Success in the dye test may be due to the accessory factor, tachyzoites, or a combination of both. Problems due to the accessory factor can be minimized by careful quality control or use of modification procedures. Tachyzoites produced in vitro may also increase success in the dye test. Careful selection of accessory factor/tachyzoite combination makes it possible to use the dye test in a district general hospital.

Animals↗

PubMed2002

[Medical dissertation: differences between successful and aborted research projects].

BACKGROUND AND OBJECTIVE: To obtain the title "Doctor medicinae" in Germany a dissertation is required. There are no data currently available to compare successful and unsuccessful student research projects. This study's aim was to determine observational differences between the two groups of successful and unsuccessful dissertations pursued by medical students. METHODS: All medical students of the 11 (th) to 14 (th) terms of study at the Charité Hospital in Berlin (n = 1036; 560 females [54.1 %] and 476 males [45.9 %]) received a questionnaire, which invited them to describe the current and/or up to two aborted dissertations. The returned questionnaires were classified into "successful" and "unsuccessful" dissertations. RESULTS: 324 (31 %) students responded, describing 348 dissertation projects at the Charité. Of these, 72 were identified as successful and 65 as unsuccessful. Successful dissertations were significantly better supervised (the supervisor was available more often [64 % vs. 29 %]; the supervisor was more often helpful [57 % vs. 9 %]). Further, planning of successful projects was significantly better (dissertation faithful to agreed-on specifications [42 % vs. 5 %]; financially supported [39 % vs. 8 %]). In addition, efforts to attract the student as a future research partner were significantly more frequent when the dissertation was successful (50 % vs. 17 %). CONCLUSION: Successful dissertations are clearly the result of better preparation and continuous close supervision. To improve the chances of success, better planning and supervision are essential. Moreover, financial support and proper preparation for scientific work, e. g., by special courses, maybe promising instruments to increase the fraction of successful dissertations.

Academic Dissertations as Topic↗

PubMed2003

The effect of birth weight on vaginal birth after cesarean delivery success rates.

OBJECTIVE: The purpose of this study was to evaluate the effect of increasing birth weight on the success rates for a trial of labor in women with one previous cesarean delivery. STUDY DESIGN: To evaluate the effect of increasing birth weight for women who undergo a trial of labor, the medical records of women who had attempted a vaginal birth after cesarean delivery (VBAC) from 1995 through 1999 in 16 community and university hospitals were reviewed retrospectively by trained abstractors. Information was collected about demographics, medical history, obstetric history, neonatal birth weight, complications, treatment, and outcome of the index pregnancy. The analysis was limited to women with singleton gestations with a history of 1 previous cesarean delivery. Because women with previous vaginal deliveries have higher vaginal birth after cesarean delivery success rates, the women were divided into four risk groups on the basis of their birth history. Groups were defined as women with no previous vaginal deliveries (group 1), women with a history of a previous vaginal birth after cesarean delivery (group 2), women with a history of a vaginal delivery before their cesarean delivery (group 3), and a group of women with a vaginal delivery both before and after the previous cesarean delivery (group 4). RESULTS: There were 9960 women with a singleton gestation and a history of one previous cesarean delivery. The overall vaginal birth after cesarean delivery success rate for the cohort was 74%. The overall vaginal birth after cesarean delivery success rates for groups 1, 2, 3, and 4 were 65%, 94%, 83%, and 93%, respectively. An analysis of neonatal birth weights of <4000 g, 4000 to 4249 g, 4250 to 4500 g, and >4500 g in group 1 showed a reduction in vaginal birth after cesarean delivery success rates from 68%, 52%, 45%, and 38%, respectively. In the remaining groups, there was no success rate below 63% for any of the birth weight strata. For group 1, vaginal birth after cesarean delivery success rates were decreased when the indication for the previous cesarean delivery was cephalopelvic disproportion or failure to progress or when the treatment was either an induction or augmentation of labor. The uterine rupture rate was higher in women for group 1 with birth weights of > or =4000 g (relative risk, 2.3; P <.001). CONCLUSION: Women with macrosomic fetuses and a history of a previous vaginal delivery should be informed of the favorable vaginal birth after cesarean delivery success rates. Given the risks of vaginal birth after cesarean delivery, those women with no history of a vaginal delivery should be counseled that the success rates may be <50% when the neonatal birth weight exceeds 4000 g and that the success rates may be even lower if the indication for the previous cesarean delivery was cephalopelvic disproportion or failure to progress or if the treatment requires either induction or augmentation of labor. The uterine rupture rate was 3.6% in women for group 1 with a birth weight > or =4000 g.

Adult↗

PubMed2005

Successful thyroid tissue ablation as defined by a negative whole-body scan or an undetectable thyroglobulin: a comparative study.

BACKGROUND: Successful thyroid tissue ablation of patients with well-differentiated thyroid cancer can be defined by a negative whole-body scan (WBS) and/or an undetectable thyroglobulin (Tg). Variables associated with success are poorly understood. Tg measurement, although more sensitive than WBS, has not been firmly established as the sole monitoring method. In a previous study, we retrospectively evaluated the variables associated with scintigraphic success. Ablation dose (AD) was the only variable associated with success (odds ratio (OR): 1.96 per 1.85 GBq increment; 95% confidence interval (CI)=1.11-3.46). OBJECTIVES: (1) To determine if the variables associated with success are the same using Tg. (2) To determine whether Tg measurement can become the sole method for assessing ablation success. METHODS: We performed the analysis using a Tg level <2 ng.ml-1 as a criterion for completed ablation. Data were available from 109 patients. RESULTS: Univariate analysis showed an effect of stage (OR=0.05; 95% CI=0.01-0.23) and female sex (OR=2.8; 95% CI=1.14-6.89). Multivariate analysis demonstrated only stage to be a significant predictor of success. Ablation was successful by both methods in 62/109 patients and it failed by both in 10/109. There were 21 WBS- Tg+ and 16 WBS+ Tg- patients. CONCLUSIONS: Investigation of the variables associated with successful ablation yields different results depending on the definition of success. There was a significant incidence of WBS+ Tg- cases after initial ablation. Until it is firmly established that such patients have a benign course both monitoring methods should be used.

Adult↗

PubMed2005

Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery.

OBJECTIVE: To estimate whether excessive weight gain or obesity are risk factors affecting success for vaginal birth after cesarean (VBAC). METHODS: Patients attempting VBAC were identified by the International Classification of Diseases, 9th Revision, codes "VBAC" and "non-primary C-section" and by reviewing logbooks on labor and delivery. A chart review identified patients attempting VBAC who were eligible for inclusion. Exclusion criteria included multiple gestation, more than one previous cesarean delivery, previous classical uterine scar, delivery at less than 36 weeks of gestation, and incomplete information. Patients were divided into the following categories: underweight (body mass index [BMI] < 19.8), normal weight (BMI 19.8-26), overweight (BMI 26.1-29), and obese (BMI > 29). Excessive weight gain was defined as a weight gain of more than 40 lb. Variables of interest included diabetes, previous successful vaginal delivery or VBAC, and presence of recurrent indication for cesarean delivery. RESULTS: We identified 1,213 patients who met inclusion criteria. Overall, the VBAC success rate was 77.2%. The success rates for BMI less than 19.8, 19.8-26, 26.1-29, and greater than 29 were 83.1%, 79.9%, 69.3%, and 68.2%, respectively, P < .001. Obese patients were almost 50% less likely to have a successful VBAC when compared to underweight patients, odds ratio 0.53, 95% confidence interval 0.29-0.98, P = .043. Similarly, patients who gained more than 40 lb were almost 40% less likely to be successful at VBAC than those who gained less than that amount, odds ratio 0.63, 95% confidence interval 0.42-0.97, P = .034. They had a VBAC success rate of 66.8%, whereas patients who gained less than 40 lb were successful 79.1% of the time, P < .001. CONCLUSION: Excessive weight gain during pregnancy and obesity both decrease VBAC success. Proper patient selection will help increase the likelihood of successful VBAC.

Adult↗

PubMed2004

Human factors impact successful lay person automated external defibrillator use during simulated cardiac arrest.

OBJECTIVE: With the dissemination of automated external defibrillators in the community, there is increasing lay person use, along with less formal automated external defibrillator training and retraining. Therefore, the "ease of use" factors related to the human-device interface may be vital for successful use. We sought to determine whether human factor differences would result in differences in parameters of successful or safe use by lay persons in the setting of simulated cardiac arrest. METHODS: We measured parameters of successful and safe use with two automated external defibrillator devices among two groups of volunteers, those trained with a brief video tape and those without any training (completely naive). Both devices (the Philips FR2 or the HS1) are used in public access defibrillator settings. Volunteers entered a mock cardiac arrest scenario after randomization to either the naive (untrained) group or to a video-trained group. RESULTS: Both the FR2 and HS1 were found to be completely safe when used by video-trained and by naive groups of participants, with no adverse events observed (total, n = 256). For both devices, video-trained participants demonstrated high rates of successful defibrillation in the simulated testing (86% for FR2 and 89% for HS1). With the FR2, video-trained participants were significantly more successful compared with naive, untrained participants (86% vs. 48% successful use; p < .001). However, for the HS1, there was no significant difference in success rates for the video-trained vs. naive, untrained groups (89% vs. 87%; p = .79). CONCLUSIONS: Both devices are safe with either video-trained or naive users. The successful use of each device is high when participants view the training videotape designed for the device. An important difference in successful use was observed for naive users where the HS1 showed improved successful use compared with the FR2. Because defibrillation in the community may increasingly be attempted by lay persons whose training is remote or who have not been trained at all, the "naive" scenario may be increasingly relevant to automated external defibrillator use. Collectively, these data support the notion that human factors associated with ease of use may play a critical factor in survival rates achieved by specific devices.

Adult↗

PubMed2006

Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies.

OBJECTIVE: There is no consensual definition of "successful aging." Our aim was to review the literature on proportions of subjects meeting criteria and individual components of definitions of successful aging as well as correlates of these definitions. METHODS: We conducted a literature search for published English-language peer-reviewed reports of data-based studies of adults over age 60 that included an operationalized definition of successful aging. The authors categorized the components of these definitions and independent variables examined in relation to successful aging (e.g., gender, education, and social contacts). RESULTS: The authors identified 28 studies with 29 different definitions that met our criteria. Most investigations used large samples of community-dwelling older adults. The mean reported proportion of successful agers was 35.8% (standard deviation: 19.8) but varied widely (interquartile range: 31%). Multiple components of these definitions were identified, although 26 of 29 included disability/physical functioning. The most frequent significant correlates of the various definitions of successful aging were age (young-old), nonsmoking, and absence of disability, arthritis, and diabetes. Moderate support was found for greater physical activity, more social contacts, better self-rated health, absence of depression and cognitive impairment, and fewer medical conditions. Gender, income, education, and marital status generally did not relate to successful aging. CONCLUSION: Despite variability among definitions, approximately one-third of elderly individuals were classified as aging successfully. The majority of these definitions were based on the absence of disability with lesser inclusion of psychosocial variables. Predictors of successful aging varied yet point to several potentially modifiable targets for increasing the likelihood of successful aging.

Activities of Daily Living↗

PubMed2006

A distinguishable observation between survival and success rate outcome of hydroxyapatite-coated implants in 5-10 years in function.

PURPOSE: To differentiate between the survival and success definitions of functional hydroxyapatite (HA)-coated implant prosthesis. METHODS: A total of 248 implants (62 patients), 5-10 years in function, were evaluated. The implant distribution length was 8 mm (6.5%), 10 mm (29.4%), 13 mm (30.2%) and 15 mm (33.9%). The diameter was 3.25 mm (60.1%) and 4 mm (39.9%). Probing depth (PD), gingival index (GI), height of keratinized mucosa (KM) and recession (REC) were measured. Periapical radiographs were taken to estimate the amount of crestal bone resorption (BL), mesially and distally, with the aid of a millimetric-scaled magnifying glass (x 8). Only implants that fulfilled the success rate criteria were considered as successful. All other functional implants were assigned to the non-successful group. All functional implant prostheses were defined as survival ones. RESULTS: The accumulative survival rate after 5 and 10 years was 94.4% and 92.8%, respectively. Accumulative success rates were 89.9% and 54%, respectively. Implants 13 and 15 mm in length (97.9% and 96.4%, respectively) had the highest survival rate, which was higher over implants 8 and 10 mm in length (75%, P<0.01 and 88.2%, respectively). The survival rate of 4 mm diameter implants compared with 3.25 mm was 96.5% and 90.3%, respectively (P=0.019). The average BL was 1.7, 0.92 and 2.79 mm for the survival, successful and non-successful defined implant groups. PD was 3.26, 2.79 and 4 mm and GI was 0.96, 0.75 and 1.57, respectively. These measurements were statistically different between implant groups. KM and REC measurements showed similar scoring for all groups. A correlation was shown between successful and non-successful implants on the score of GI and PD (P<0.001 in both). CONCLUSION: A distinguishable observation between survival and success rate was noted particularly in long-term observations. Implant length and diameter have an influence on the survival rate. Clinical parameter scores expressed an influence on the defined implant status.

Adult↗

PubMed1991

Electrogram patterns predictive of successful catheter ablation of accessory pathways. Value of unipolar recording mode.

BACKGROUND: Transcatheter electrical ablation has been used in the treatment of arrhythmias, and most experience has been obtained by ablating the normal atrioventricular conduction system. Less information is available on ablation of atrioventricular accessory pathways. METHODS AND RESULTS: Catheter ablation of overt accessory pathways was attempted in 135 patients with 142 distinct pathways, including 21 right parietal or anteroseptal, 47 posteroseptal, and 74 left lateral pathways. We sought to identify the type and value of electrophysiological parameters associated with successful ablation outcome. For this purpose, the unipolar recording mode was used in addition to bipolar anterograde and retrograde parameters. With a mean follow-up of 16 +/- 6 (mean +/- SD) months, fulguration was successful in eliminating preexcitation in 129 patients (96%), including all seven with two distinct accessory pathways. The first ablation attempt was successful in 110 patients, and two or more attempts were performed in 25 patients. Bipolar electrograms associated with success of fulguration showed a shorter atrioventricular conduction time (40 +/- 13 versus 53 +/- 17 msec, p less than 0.0001) and an earlier main ventricular deflection relative to delta wave onset (-1.7 +/- 10 versus 5 +/- 7 msec, p less than 0.001) than electrograms associated with unsuccessful outcome. The only parameter dealing with retrograde conduction (i.e., ventriculoatrial conduction time during reciprocating tachycardia) was not predictive (86 +/- 17 versus 93 +/- 17 msec). Neither was the atrial to ventricular electrogram amplitude ratio. Two unipolar parameters were found to be predictive of successful outcome: 1) The three different patterns PQS, P-QS, P-rS of unipolar waves recorded at the annulus were associated with respective success rates of 97%, 78%, and 55% (p less than 0.001). 2) Intrinsic deflection timing occurred -4 +/- 8 and 6 +/- 7 msec relative to delta wave onset in successful attempts and in failures, respectively (p less than 0.001). Logistic regression analysis revealed a single independent factor predictive of success, the unipolar pattern (p = 0.03), with an odds ratio of 7:1 (PQS pattern versus P-rS pattern). In the group of 18 patients who underwent a first unsuccessful but second successful attempt, comparison of electrograms revealed no difference in the ventriculoatrial conduction time but a significant improvement in anterograde parameters and unipolar pattern distribution. CONCLUSIONS: Some distinctive electrogram patterns concerning anterograde conduction are associated with success of accessory pathway fulguration. The unfiltered unipolar recording mode (PQS pattern) contributes significantly to optimizing the accuracy of accessory pathway localization.

Adolescent↗

PubMed2006

Local anesthetic and stylet styles: factors associated with resident lumbar puncture success.

OBJECTIVE: To assess the effects of procedural techniques, local anesthetic use, and postgraduate training level on lumbar puncture (LP) success rates. METHODS: In this prospective observational study, medical students and residents ("trainees") reported techniques used for infant LPs in an urban teaching emergency department. Data on postgraduate year, patient position, draping, total and trainee numbers of attempts, local anesthetic use, and timing of stylet removal were collected. Logistic regression analysis was used to identify predictors of successful LP, with success defined as the trainee obtaining cerebrospinal fluid with <1000 red blood cells per mm3. RESULTS: We collected data on 428 (72%) of 594 infant LPs performed during the study period. Of 377 performed by trainees, 279 (74%) were successful. Local anesthesia was used for 280 (74%), and 225 (60%) were performed with early stylet removal. Controlling for the total number of attempts, LPs were 3 times more likely to be successful among infants >12 weeks of age than among younger infants (odds ratio [OR]: 3.1; 95% confidence interval [CI]: 1.2-8.5). Controlling for attempts and age, LPs performed with local anesthetic were twice as likely to be successful (OR: 2.2; 95% CI: 1.04-4.6). For infants < or =12 weeks of age, early stylet removal improved success rates (OR: 2.4; 95% CI: 1.1-5.2). Position, drape use, and year of training were not significant predictors of success. CONCLUSIONS: Patient age, use of local anesthetic, and trainee stylet techniques were associated with LP success rates. This offers an additional rationale for pain control. Predictors identified in this study should be considered in the training of physicians, to maximize their success with this important procedure.

Anesthesia, Local↗

PubMed2006

Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects.

OBJECTIVE: Endotracheal intubation of newborn infants is a mandatory competence for many pediatric trainees. The Neonatal Resuscitation Program recommends a 20-second limit for intubation attempts. Intubation attempts by junior doctors are frequently unsuccessful, and many infants are intubated between 20 and 30 seconds without apparent adverse effect. Little is known about the proficiency of more senior medical staff, the time taken to determine endotracheal tube (ETT) position, or the effects of attempted intubation on infants' heart rate (HR) and oxygen saturation (Spo2) in the delivery room (DR). The objectives of this study were to determine (1) the success rates and duration of intubation attempts during DR resuscitation, (2) whether experience is associated with greater success rates and shorter time taken to intubate, (3) the time taken to identify ETT position after intubation, and (4) the frequency with which infants deteriorated during intubation attempts and the time at which this occurred. METHODS: We reviewed videos of DR resuscitations; identified whether intubation was attempted; and, when attempted, whether intubation was attempted by a resident, a fellow, or a consultant. We defined the duration of an intubation attempt as the time from the introduction of the laryngoscope blade to the mouth to its removal, regardless of whether an ETT was introduced. We determined the time from removal of the laryngoscope to the clinicians' decision as to whether the intubation was successful and noted the basis on which this decision was made (clinical assessment, flow signals, or exhaled carbon dioxide [ETCO2] detection). We determined success according to clinical signs in all cases and used flow signals that were obtained during ventilation via the ETT or ETCO2 when available. When neither was available, the chest radiograph on admission to the NICU was reviewed. For infants who were monitored with pulse oximetry, we determined their HR and Spo2 before the intubation attempt. We then determined whether either or both fell by > or =10% during the attempt and, if so, at what time it occurred. RESULTS: We reviewed 122 video recordings in which orotracheal intubation was attempted 60 times in 31 infants. We secondarily verified ETT position using flow signals, ETCO2, or chest radiographs after 94% of attempts in which an ETT was introduced. Thirty-seven (62%) attempts were successful. Success rates and mean (SD) time to intubate successfully by group were as follows: residents: 24%, 49 seconds (13 seconds); fellows: 78%, 32 seconds (13 seconds); and consultants: 86%, 25 seconds (17 seconds). Of the 23 unsuccessful attempts, 13 were abandoned without an attempt to pass an ETT and 10 were placed incorrectly. The time to determine ETT position in the DR was longer when clinical assessment alone was used. Infants who were monitored with oximetry deteriorated during nearly half of the intubation attempts. Deterioration seemed more likely when HR and Spo2 were low before the attempt. CONCLUSIONS: Intubation attempts often are unsuccessful, and successful attempts frequently take >30 seconds. Greater experience is associated with greater success rates and shorter duration of successful attempts. Flow signals and ETCO2 may be useful in determining ETT position more quickly than clinical assessment alone. Infants frequently deteriorate during intubation attempts. Improved monitoring of infants who are resuscitated in the DR is desirable.

Clinical Competence↗

PubMed2000

Factors influencing success of monovision contact lens fitting: survey of contact lens diplomates.

BACKGROUND: Contact lenses are frequently fitted so that one eye is focused for distance and the other for near (monovision) in order to reduce the dependence of presbyopic patients on bifocal spectacle correction. METHODS: We surveyed Diplomates in the Cornea and Contact Lens section of the American Academy of Optometry (N = 179) regarding their estimates of success with monovision fitting and factors influencing their perception of success. Results were statistically analyzed to determine the fitting philosophies of responders estimating that they achieve high success rates (HSRs) and low success rates (LSRs), respectively. RESULTS: Completed surveys were returned by 98 Diplomates (54.8%), who estimated an overall success rate of approximately 71.7% with monovision; 50.5% "totally successful" (wear monovision correction full-time without problems or need for additional correction) and 21.2% "successful" (wear monovision full-time, but experience some symptoms of blur or other discomfort, may wear over-correction at times for driving or detailed near work). Sighting dominance was the most frequently used method to determine the distant eye, followed by the plus-lens test. The HSR group tended to be more likely to take occupational factors into account when deciding which eye to use for the distance lens, and they used more flexibility in determining the near-add power. The LSR group discontinued monovision sooner than the HSR group, who continued treatment for longer than 4 weeks during the adaptation period much more often for all add ranges. CONCLUSIONS: Practitioners who regard monovision treatment as very successful have somewhat different fitting philosophies than those who regard monovision as unsuccessful. Implementation of highly successful practitioners' fitting techniques may increase success with monovision contact lens fitting.

Adaptation, Ocular↗

PubMed2004

Success that lasts.

Pursuing success can feel like shooting in a landscape of moving targets: Every time you hit one, five more pop up from another direction. We are under constant pressure to do more, get more, be more. But is that really what success is all about? Laura Nash and Howard Stevenson interviewed and surveyed hundreds of professionals to study the assumptions behind the idea of success. They then built a practical framework for a new way of thinking about success--a way that leads to personal and professional fulfillment instead of feelings of anxiety and stress. The authors' research uncovered four irreducible components of success: happiness (feelings of pleasure or contentment about your life); achievement (accomplishments that compare favorably against similar goals others have strived for); significance (the sense that you've made a positive impact on people you care about); and legacy (a way to establish your values or accomplishments so as to help others find future success). Unless you hit on all four categories with regularity, any one win will fail to satisfy. People who achieve lasting success, the authors learned, tend to rely on a kaleidoscope strategy to structure their aspirations and activities. This article explains how to build your own kaleidoscope framework. The process can help you determine which tasks you should undertake to fulfill the different components of success and uncover areas where there are holes. It can also help you make better choices about what you spend your time on and the level of energy you put into each activity. According to Nash and Stevenson, successful people who experience real satisfaction achieve it through the deliberate imposition of limits. Cultivating your sense of "just enough" can help you set reachable goals, tally up more true wins, and enjoy lasting success.

Achievement↗