Natural history models combine the expected benefits of improvements in multiple indicators to yield a single, composite measure, the quality-adjusted life-year. Such metrics could fairly express, in terms of survival and complications prevention, relatively disparate DM programs' benefits. Measuring and comparing health care costs requires data validation and appropriate case-mix adjustment.
Comparing value across programs may provide more accurate assessments of performance, enhance quality improvement efforts within systems, and contribute generalizable knowledge on the utility of DM approaches. Conference attendees recommended pilot projects to further explore use of natural history models for measuring and reporting the value of DM. Pregnancy is a delicate balance of angiogenic factors. Adverse pregnancy outcomes in the form of placental insufficiency occur when antiangiogenic factors predominate, which manifests as maternal-placental syndrome MPS.
Women with rheumatic disease are at increased risk of MPS. Endothelial damage from circulating antiangiogenic factors and other inflammatory molecules in combination with preexisting maternal vascular risk factors is the likely underlying pathophysiological process for MPS. It is likely that these changes persist, and additional "insults" from ongoing inflammation, medications, and disease damage contribute to the development of accelerated cardiovascular disease seen in young women with rheumatic disease.
Periodontal disease and adverse birth outcomes : a study from Pakistan. Periodontal disease may increase the risk of adverse birth outcomes ; however, results have been mixed. Few studies have examined periodontal disease in developing countries.
We describe the relationship between periodontal disease and birth outcomes in a community setting in Pakistan. This was a prospective cohort study. Enrollment occurred at weeks of gestation. A study dentist performed the periodontal examination to assess probing depth, clinical attachment level, gingival index, and plaque index. Outcomes included stillbirth, neonatal death, perinatal death, disease severity by quartiles. As the measures of periodontal disease increased from the 1st to 4th quartile, stillbirth and neonatal and perinatal death also increased, with relative risks of approximately 1.
Early preterm birth increased, but the results were not significant. Late preterm birth and low birthweight were not related to measures of periodontal disease. Pregnant Pakistani women have high levels of moderate-to-severe dental disease. Stillbirth and neonatal and perinatal deaths increased with the severity of periodontal disease. Survival outcomes for patients with liver disease who suffer an intracranial hemorrhage ICH have not been thoroughly investigated.
We retrospectively reviewed hospital charts from March through February of patients with liver disease and an ICH evaluated by the neurosurgery service at a single academic medical center. The primary outcome was survival. We included a total of 53 patients in this study. Of those patients with an admission diagnosis of liver disease , 27 patients also had ESLD.
There were 11 ESLD patients on the liver transplant waitlist. ICH in the setting of liver disease carries a grave prognosis. Also, a survival advantage for surgical hematoma evacuation in ESLD patients is not clear. To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied.
Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes. Two reviewers independently conducted a comprehensive literature search. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. Sixteen articles met the inclusion criteria with moderate to high risk of bias.
There was no article with low risk of bias. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes. Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes.
Published by Elsevier Inc. The cholesteryl ester transfer protein inhibitor evacetrapib substantially raises the high-density lipoprotein HDL cholesterol level, reduces the low-density lipoprotein LDL cholesterol level, and enhances cellular cholesterol efflux capacity. We sought to determine the effect of evacetrapib on major adverse cardiovascular outcomes in patients with high-risk vascular disease. In a multicenter, randomized, double-blind, placebo-controlled phase 3 trial, we enrolled 12, patients who had at least one of the following conditions: an acute coronary syndrome within the previous 30 to days, cerebrovascular atherosclerotic disease , peripheral vascular arterial disease , or diabetes mellitus with coronary artery disease.
Patients were randomly assigned to receive either evacetrapib at a dose of mg or matching placebo, administered daily, in addition to standard medical therapy. The primary efficacy end point was the first occurrence of any component of the composite of death from cardiovascular causes, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina.
At 3 months, a After of the planned primary end-point events had occurred, the data and safety monitoring board recommended that the trial be terminated early because of a lack of efficacy. After a median of 26 months of evacetrapib or placebo, a primary end-point event occurred in Although the cholesteryl ester transfer protein inhibitor evacetrapib had favorable effects on established lipid biomarkers, treatment with evacetrapib did not result in a lower rate of.
Systematic review: has disease outcome in Crohn's disease changed during the last four decades? Disease outcome in Crohn's disease might have changed during the last four decades. Disease outcome measurement in Crohn's disease has methodological difficulties because of patient selection and lack of proper definition of diagnostic and outcome measurement criteria.
To assess possible changes in disease outcome in Crohn's disease during the last four decades. Articles and abstracts were selected according to stringent inclusion criteria. Forty articles and nine abstracts complied with the inclusion criteria. Seven studies with a median follow-up time between One study with Sixteen publications applied in the disease recurrence category. This structured literature review provides no hard evidence for change in disease outcome in Crohn's disease during the last four decades.
Copyright Blackwell Publishing Ltd. Genetically determined height and coronary artery disease. The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease CAD are unclear.
We used a genetic approach to investigate the association between height and CAD, using height-associated genetic variants. We tested the association between a change in genetically determined height of 1 SD 6. Using individual-level genotype data from 18, persons, we also examined the risk of CAD associated with the presence of various numbers of height-associated alleles.
To identify putative mechanisms, we analyzed whether genetically determined height was associated with known cardiovascular risk factors and performed a pathway analysis of the height-associated genes. We observed a relative increase of There was a graded relationship between the presence of an increased number of height-raising variants and a reduced risk of CAD odds ratio for height quartile 4 versus quartile 1, 0. Shared biologic processes that determine achieved height and the development of atherosclerosis may explain some of the association.
Funded by the British Heart Foundation and others. Common diseases as determinants of menopausal age. None of the other diseases examined were significantly associated with ANM. Information from the questionnaire was self-reported, making recall possible, but it is unlikely that any bias was different in the strata of different factors considered. Misclassification could also have occurred in cases where the diagnoses of common diseases were close to age at last follow-up.
In addition, observational studies cannot establish that the associations identified represent cause-and-effect relationships. Our study is the first in examining multiple common diseases simultaneously as determinants of ANM. Contrary to previous reports, we did not find any significant accelerating effect of hypertension, cardiovascular disease and diabetes on ANM.
The authors declare that there is no conflict of interest regarding the publication of this paper. For permissions, please e-mail: journals. Adult outcomes of childhood-onset rheumatic diseases. A number of studies published over the past 10 years have examined the long-term health, functional and quality of life outcomes of adults with childhood-onset rheumatic diseases such as juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis and localized scleroderma.
As increasing numbers of patients with these conditions survive into adulthood, understanding the adult outcomes of these pediatric conditions has become ever-more important. Identifying modifiable risk factors for poor outcomes is vital to improving care for these patients. In addition, as these conditions and their treatments can affect cardiovascular health, bone health and fertility, particular attention needs to be paid to these outcomes. Preparing patients and their families for a successful transition from pediatric to adult rheumatology care is an important first-step in the long-term management strategy for this expanding patient population.
Illness beliefs and psychological outcome in people with Parkinson's disease. Illness beliefs are important predictors of psychological outcome in people with chronic illness and evidence suggests these could also be significant in furthering our understanding of psychological functioning in people with Parkinson's disease. Illness beliefs are specific, dynamic representations of an illness and cover dimensions such as cause, identity, consequences and controllability.
Eighty-one people with Parkinson's disease completed a series of questionnaires to provide demographic, clinical and psychosocial data, which were then used to assess the relative impact of illness beliefs on their psychological functioning. Psychological functioning was assessed by measuring levels of depression, anxiety, stress, positive affect and emotional well-being.
Hierarchical block regression indicated that illness beliefs were important independent predictors across some but not all outcomes and the results emphasised the importance of testing new predictors against more established predictors of outcome such as physical functioning and self-esteem.
The illness beliefs most important in psychological outcome in people with PD were causal beliefs particularly in psychosocial causes and illness coherence the level of understanding of the illness. The therapeutic potential of psychosocial variables was discussed given that these can be modified during therapy and this change can positively influence psychological outcome.
Hospital admissions among patients with congestive heart failure CHF are a major contributor to health care costs. A comprehensive disease management program for CHF was developed for private and statutory health insurance companies in order to improve health outcomes and reduce rehospitalization rates and costs. The program comprises care calls, written training material, telemetric monitoring, and health reports.
Currently, members from six insurance companies are enrolled. Routine evaluation, based on medical data warehouse software, demonstrates benefits in terms of improved health outcomes and processes of care. Nonadherence in dialysis patients: prevalence, measurement, outcome , and psychological determinants. Estimates of nonadherence vary with assessment method. Whilst readily available and free from report bias, physiological proxies-frequently used as measures of adherence-are often confounded by clinical factors including residual kidney function and dialysis adequacy.
Despite variation in estimates of its prevalence, it is clear that suboptimal adherence to dialysis prescriptions, medication and diet can lead to adverse clinical outcomes. Several factors can help explain nonadherence in ESKD including mood, self-efficacy, social support, illness, and treatment perceptions. Psychological interventions have been shown to improve ESKD adherence, yet achieving long-term behavior change remains challenging. Identifying individuals who struggle to adhere to aspects of the dialysis regime, and tailoring theory-led interventions to improve and support adherence is a clear clinical need requiring further empirical enquiry.
Early life environment and social determinants of cardiac health in children with congenital heart disease. Congenital heart disease is a significant cause of infant mortality. Epidemiology and social context play a crucial role in conditioning disease burden and modulating outcomes , while diagnosis and treatment remain resource intensive.
This review will address the role of social demographics, environmental exposure, epigenetics and nutrition in the aetiology of congenital heart disease. We then discuss the determinant effect of social factors on the provision and outcomes of care for congenital heart disease and implications for practice. It is our hope that enhanced knowledge of the intersection of social determinants of health and congenital heart disease will facilitate effective preventative strategies at the individual and population levels to optimize heart health outcomes across the life course.
Outcomes in mothers with rheumatic diseases and their offspring workshop. This conference report describes six presentations that were given during a Canadian Institutes for Health Research-funded workshop. The goal of the workshop was to discuss key knowledge gaps in the study of outcomes in mothers with rheumatic diseases and their offspring.
Presentations focused on epidemiological and methodological issues associated with the reproductive and perinatal health of women with rheumatic diseases. Discussions of relevant recent research allowed for discovery of potential data sources that could facilitate interdisciplinary research and created the opportunity for future collaborations.
Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review. To assess the clinical and economic effects of disease management in patients with chronic diseases. Electronic databases were searched for English-language articles from to Articles were included if they used a systematic approach to care and evaluated patients with chronic disease , reported objective measurements of the processes or outcomes of care, and employed acceptable experimental or quasi-experimental study designs as defined by the Cochrane Effective Practice and Organization of Care Group.
Two reviewers evaluated 16, titles and identified studies that met the inclusion criteria. Identified studies represented 11 chronic conditions: depression, diabetes, rheumatoid arthritis, chronic pain, coronary artery disease , asthma, heart failure, back pain, chronic obstructive pulmonary disease , hypertension, and hyperlipidemia.
Disease management programs were associated with marked improvements in many different processes and outcomes of care. Few studies demonstrated a notable reduction in costs. Further research is needed to understand how disease management can most effectively improve the quality and cost of care for patients with chronic diseases.
Incident chronic kidney disease : trends in management and outcomes. Management trends in early chronic kidney disease CKD and their associations with clinical outcomes have not previously been reported. We evaluated incident Stage G3A CKD patients from an integrated health care system in , and to determine adjusted trends in screening urinary protein quantification , treatment [prescription for angiotensin-converting enzyme inhibitor ACEI or angiotensin receptor blocker ARB , and statin] and nephrology referral.
For the same time periods, adjusted rates for mortality, progression to Stage G4 CKD and hospitalization for myocardial infarction or heart failure were calculated and compared across time periods. There were , and patients with incident CKD in , and , respectively. In this integrated health care system, management of incident CKD over the past decade has intensified.
Multiyear evaluation of participants in voluntary, opt-out DM programs. Patient-centered programs, administered by 3 regional contractors, provide phone-based consultations with a care manager, educational materials, and newsletters. The study sample consisted of 23, asthma, CHF, and 29, diabetes patients with at least 6 months' tenure in the program. Medical claims were analyzed to quantify program effect on healthcare utilization, medical costs, and clinical outcomes.
Multivariate regression analysis with an historical control group was used to predict patient outcomes in the absence of DM. The difference between actual and predicted DM patient outcomes was attributed to the program. A patient survey collected data on program satisfaction and perceived usefulness of program information and services. Modest improvements in patient outcomes included reduced inpatient days and medical costs, and with few exceptions increased percentages of patients receiving appropriate medications and tests.
Findings suggest that the DM programs more than pay for themselves, in addition to improving patient health and quality of life. Lessons learned in program design, implementation, effectiveness, and evaluation may benefit employers contemplating DM, DM providers, and evaluators of DM programs.
Determinants of outcomes in patients with simple gastroschisis. We analyzed the determinants of outcomes in simple gastroschisis GS not complicated by intestinal atresia, perforation, or necrosis. All simple GS patients enrolled in a national prospective registry from to were studied.
Patients below the median for total parenteral nutrition TPN duration 26days and hospital stay 34days were compared to those above. Univariate and multivariate logistic and linear regression analyses were employed using maternal, patient, postnatal, and treatment variables. Of patients with simple GS, representing TPN was used in Hospital stay for Univariate analysis revealed significant differences in several patient, treatment, and postnatal factors.
On multivariate analysis, prenatal sonographic bowel dilation, older age at closure, necrotizing enterocolitis, longer mechanical ventilation, and central-line associated blood stream infection CLABSI were independently associated with longer TPN duration and hospital stay, with CLABSI being the strongest predictor. Prenatal bowel dilation is associated with increased morbidity in simple GS.
Bowel matting is not an independent risk factor. There is strong evidence that race, ethnicity and social determinants of health significantly influence outcomes for patients with diabetes. A better understanding of the mechanisms of these relationships or associations would improve development of cost-effective, culturally tailored programs for patients with diabetes.
This article reviews the current state of the literature on the influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes for diabetes, with particular emphasis on the rural South to give an overview of the state of the literature. The literature review shows that racial or ethnic differences in the clinical outcomes for diabetes, including glycemic, blood pressure BP and lipid control, continue to persist.
In addition, the literature review shows that the role of social determinants of health on outcomes , and the possible role these determinants play in disparities have largely been ignored. Psychosocial factors, such as self-efficacy, depression, social support and perceived stress, show consistent associations with self-care, quality of life and glycemic control. Neighborhood factors, such as food insecurity, social cohesion and neighborhood esthetics have been associated with glycemic control.
Perceived discrimination has also been associated with self-care and the psychological component of quality of life. Healthcare professionals need to be skilled in assessing social determinants of health and taking them into consideration in clinical care. In addition, more research is needed to identify the separate and combined influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes in diabetes, especially in the South, where the burden of disease is particularly high.
Analysis of surgical outcomes of diverticular disease of the colon. We analyzed retrospectively the surgical outcomes of diverticular diseases of the colon at the surgical division of Fukuyama Medical Center. Data were collected from 39 patients who underwent surgery for diverticular disease at Fukuyama Medical Center.
Thirty-nine patients were admitted between and The mean age of the 39 patients was The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into 2 groups, Elective vs. Emergent group, right vs. Multivariate analysis of the logistic model of morbidity revealed a significantly higher rate in the left colon and the Cox proportional hazards model clearly showed fewer postoperative hospital days with the laparoscopic approach.
Surgical procedures should be decided in reference to the particular clinical and pathological features of diverticular disease to gain an acceptable morbidity and mortality rates. Objective The benefit of deep brain stimulation DBS for Parkinson disease PD may depend on connectivity between the stimulation site and other brain regions, but which regions and whether connectivity can predict outcome in patients remain unknown.
Here, we identify the structural and functional connectivity profile of effective DBS to the subthalamic nucleus STN and test its ability to predict outcome in an independent cohort. This connectivity profile was then used to predict outcome in an independent cohort of 44 patients from a different center.
Results In the training dataset, connectivity between the DBS electrode and a distributed network of brain regions correlated with clinical response including structural connectivity to supplementary motor area and functional anticorrelation to primary motor cortex p disease matched to our DBS patients. This prediction does not require specialized imaging in PD patients themselves. Remote health monitoring: predicting outcome success based on contextual features for cardiovascular disease.
Current studies have produced a plethora of remote health monitoring RHM systems designed to enhance the care of patients with chronic diseases. Many RHM systems are designed to improve patient risk factors for cardiovascular disease , including physiological parameters such as body mass index BMI and waist circumference, and lipid profiles such as low density lipoprotein LDL and high density lipoprotein HDL.
There are several patient characteristics that could be determining factors for a patient's RHM outcome success, but these characteristics have been largely unidentified. In this paper, we analyze results from an RHM system deployed in a six month Women's Heart Health study of 90 patients, and apply advanced feature selection and machine learning algorithms to identify patients' key baseline contextual features and build effective prediction models that help determine RHM outcome success.
We introduce Wanda-CVD, a smartphone-based RHM system designed to help participants with cardiovascular disease risk factors by motivating participants through wireless coaching using feedback and prompts as social support. We analyze key contextual features that secure positive patient outcomes in both physiological parameters and lipid profiles. Results from the Women's Heart Health study show that health threat of heart disease , quality of life, family history, stress factors, social support, and anxiety at baseline all help predict patient RHM outcome success.
Sickle cell disease is a risk factor for cerebrovascular accidents in the pediatric population. This risk is compounded by hypoxemia. Cyanotic congenital heart disease can expose patients to prolonged hypoxemia. To our knowledge, the long-term outcome of patients who have combined sickle cell and cyanotic congenital heart disease has not been reported.
We retrospectively reviewed patient records at our institution and identified 5 patients 3 girls and 2 boys who had both conditions. Their outcomes were uniformly poor: 4 died age range, 12 mo yr ; 3 had documented cerebrovascular accidents; and 3 developed ventricular dysfunction. The surviving patient had developmental delays. On the basis of this series, we suggest mitigating hypoxemia, and thus the risk of stroke, in patients who have sickle cell disease and cyanotic congenital heart disease.
Potential therapies include chronic blood transfusions, hydroxyurea, earlier surgical correction to reduce the duration of hypoxemia, and heart or bone marrow transplantation. This results in the systemic accumulation of its glycosphingolipid substrates in body fluids and organs, including the kidney.
Fabry nephropathy can lead to end-stage renal disease requiring kidney transplantation. Little is known about its long-term outcomes and the overall patient survival after kidney transplantation. Here, we report 17 Fabry patients 15 males, 2 females who received kidney transplants and their long-term treatment and follow-up at 4 specialized Fabry centers. The posttransplant follow-up ranged to 25 years, with a median of Graft survival was similar and death-censored graft survival was superior to matched controls.
Fabry patients died with functioning kidneys, mostly from cardiac causes. In 2 males 14 and 23 years posttransplant, the grafts had a few typical FD lamellar inclusions, presumably originating from invading host macrophages and vascular endothelial cells.
We conclude that kidney transplantation has an excellent long-term outcome in Fabry disease. Determining the non-inferiority margin for patient reported outcomes. One of the cornerstones of any non-inferiority trial is the choice of the non-inferiority margin delta. This threshold of clinical relevance is very difficult to determine , and in practice, delta is often "negotiated" between the sponsor of the trial and the regulatory agencies.
However, for patient reported, or more precisely patient observed outcomes , the patients' minimal clinically important difference MCID can be determined empirically by relating the treatment effect, for example, a change on a mm visual analogue scale, to the patient's satisfaction with the change.
This MCID can then be used to define delta. We used an anchor-based approach with non-parametric discriminant analysis and ROC analysis and a distribution-based approach with Norman's half standard deviation rule to determine delta in three examples endometriosis-related pelvic pain measured on a mm visual analogue scale, facial acne measured by lesion counts, and hot flush counts.
For each of these examples, all three methods yielded quite similar results. In two of the cases, the empirically derived MCIDs were smaller or similar of deltas used before in non-inferiority trials, and in the third case, the empirically derived MCID was used to derive a responder definition that was accepted by the FDA. In conclusion, for patient-observed endpoints, the delta can be derived empirically. Implementation and outcomes of commercial disease management programs in the United States: the disease management outcomes consolidation survey.
Despite widespread adoption of disease management DM programs by US health plans, gaps remain in the evidence for their benefit. The Disease Management Outcomes Consolidation Survey was designed to gather data on DM programs for commercial health plans, to assess program success and DM effectiveness. The questionnaire was mailed to appropriate health plan contacts; 26 plans covering more than 14 million commercial members completed and returned the survey.
Respondents reported that DM plays a significant and increasing role in their organizations. Key reasons for adopting DM were improving clinical outcomes , reducing medical costs and utilization, and improving member satisfaction. Detailed results were analyzed for 57 DM programs with over , enrollees.
Most responding plans offered DM programs for diabetes and asthma, with return on investment ROI ranging from 0. Most but not all respondents reported reduced hospital admissions, increasing rates of preventive care, and improved clinical measures. Few respondents provided detailed information about DM programs for other medical conditions, but most that did reported positive outcomes.
Lack of standardized methodology was identified as a major barrier to in-house program evaluation. Although low response rate precluded drawing many general conclusions, a clear need emerged for more rigorous evaluation methods and greater standardization of outcomes measurement. Characteristics and outcome of autoimmune liver disease in Asian children.
At final review [median range duration of follow-up 4. Of the two who underwent liver transplantation LT; 6. A delay in seeking treatment adversely affected the final outcome [survival with native liver vs. Malaria is a major public health problem in Tripura and focal disease outbreaks are of frequent occurrence.
The state is co-endemic for both Plasmodium falciparum and P. The present study was aimed to review data on disease distribution to prioritize high-risk districts, and to study seasonal prevalence of disease vectors and their bionomical characteristics to help formulate vector species-specific interventions for malaria control. Data on malaria morbidity in the State were reviewed retrospectively for understanding disease distribution and transmission dynamics. Cross-sectional mass blood surveys were conducted in malaria endemic villages of South Tripura district to ascertain the prevalence of malaria and proportions of parasite species.
Mosquito collections were made in human dwellings of malaria endemic villages aiming at vector incrimination and to study relative abundance, resting and feeding preferences, and their present susceptibility status to DDT. The study showed that malaria was widely prevalent and P. The disease distribution, however, was uneven with large concentration of cases in districts of South Tripura and Dhalai coinciding with vast forest cover and tribal populations.
Both Anopheles minimus s. Of these, An. Multidisciplinary COPD disease management program: impact on clinical outcomes. We hypothesized performance improvement interventions would improve COPD guideline-recommended care and decrease COPD exacerbations in primary care clinic practices.
We initiated a performance improvement project in 12 clinics to improve COPD outcomes incorporating physician education, case management, web-based decision support CareManager TM , and performance feedback. We collected baseline and one-year follow up data on patients who had COPD with acute exacerbations. We analyzed data by two methods. First, the 12 clinics were cluster randomized to 4 intervention patients and 8 control patients clinics which all had access to CareManager TM but only intervention clinic physicians received case management, academic detailing, and decision support assistance.
Exacerbation rates and guideline adherence were compared. Second, data from all 12 clinics were pooled in a quasi-experimental design comparing baseline and post-implementation of CareManager TM to determine the value of system-wide performance improvement during the study period. In the randomized analysis, baseline demographics were similar. Cryptococcus neoformans and C. These fungi commonly enter their host via inhalation into the lungs where they encounter resident phagocytes, including macrophages and dendritic cells, whose response has a pronounced impact on the outcome of disease.
Cryptococcus has complex interactions with the resident and infiltrating innate immune cells that, ideally, result in destruction of the yeast. These phagocytic cells have pattern recognition receptors that allow recognition of specific cryptococcal cell wall and capsule components. However, Cryptococcus possesses several virulence factors including a polysaccharide capsule, melanin production and secretion of various enzymes that aid in evasion of the immune system or enhance its ability to thrive within the phagocyte.
This review focuses on the intricate interactions between the cryptococci and innate phagocytic cells including discussion of manipulation and evasion strategies used by Cryptococcus, anti-cryptococcal responses by the phagocytes and approaches for targeting phagocytes for the development of novel immunotherapeutics. Outcomes that matter in chronic illness: a taxonomy informed by self- determination and adult-learning theory.
The inability to cure disease or reverse dysfunction results in chronic illness. With it, patients, their families, and society face a unique set of needs and challenges. Surprisingly, health outcomes of greatest importance to this population remain poorly described and researched. A new taxonomy is presented that uses insights from Self Determination Theory and Adult Learning Theory to expand the scope of recognized health outcomes by including what the authors call " outcomes that matter.
Neonatal management and outcome in alloimmune hemolytic disease. Hemolytic disease of the fetus and newborn HDFN occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia.
Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome.
Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics.
Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis. Outcome of Alzheimer's disease : potential impact of cholinesterase inhibitors. Alzheimer's disease is fast becoming a major public health concern with serious economic consequences.
The cholinesterase inhibitors CEIs offer some benefit in the symptomatic treatment of the disease. This study aims to investigate the effect of CEIs on three clinically relevant domains rapid cognitive decline, institutionalization, and weight loss in patients with Alzheimer's disease.
A prospective observational study was performed in which a population of Alzheimer's disease patients were recruited and followed up for at least 1 year between and Patients were reevaluated at 6 monthly intervals using standardized neurocognitive and geriatric evaluations in addition to complete clinical examination, standard paraclinical investigations, and recording of treatment received.
Health literacy and patient outcomes in chronic kidney disease : a systematic review. By disproportionately affecting people with low socio-economic status and non-white ethnicity, limited health literacy may promote health inequity. We performed a systematic review of quantitative studies of health literacy and clinical outcomes among adults with CKD. A total of 29 studies 13 articles; 16 conference abstracts were included.
One included non-USA patients. Of the 29 studies, 5 were cohort studies and 24 were cross-sectional. Six health literacy measures were used. Limited health literacy was significantly, independently associated with hospitalizations, emergency department use, missed dialysis sessions, cardiovascular events and mortality in cohort studies.
Study quality was high 1 study , moderate 3 studies and poor 25 studies , limited by sampling methods, variable adjustment for confounders and reduced methodological detail given in conference abstracts. There is limited robust evidence of the causal effects of health literacy on patient outcomes in CKD.
Available evidence suggests associations with adverse clinical events, increased healthcare use and mortality. Prospective studies are required to determine the causal effects of health literacy on outcomes in CKD patients, and examine the relationships between socio-economic status, comorbidity, health literacy and CKD outcomes. Intervention development and evaluation will determine whether health literacy is a modifiable determinant of. Being unmarried is associated with decreased survival in the general population.
Whether married, divorced, separated, widowed, or never-married status affects outcomes in patients with cardiovascular disease has not been well characterized. The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. Compared with married participants, being unmarried was associated with higher risk of all-cause mortality hazard ratio [HR]: 1.
Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated HR: 1. The findings persisted after adjustment for medications and other socioeconomic factors. Marital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease , with higher mortality in the unmarried population.
The mechanisms responsible for this increased risk require further study. Published on. Short-term outcomes following implementation of a dedicated young adult congenital heart disease transition program. Transition from pediatric to adult care is a critical time for patients with congenital heart disease.
Lapses in care can lead to poor outcomes , including increased mortality. Formal transition clinics have been implemented to improve success of transferring care from pediatric to adult providers; however, data regarding outcomes remain limited. We sought to evaluate outcomes of transfer within a dedicated transition clinic for young adult patients with congenital heart disease.
We performed a retrospective analysis of all 73 patients seen in a dedicated young adult congenital heart disease transition clinic from January to December within a single academic institution that delivered pediatric and adult care at separate children's and adult hospitals, respectively. Demographic characteristics including congenital heart disease severity, gender, age, presence of comorbidities, presence of cardiac implantable electronic devices, and type of insurance were correlated to success of transfer.
Rate of successful transfer was evaluated, and multivariate analysis was performed to determine which demographic variables were favorably associated with transfer. Thirty-nine percent of patients successfully transferred from pediatric to adult services during the study period. Severe congenital heart disease OR 4. Trends favoring successful transfer with presence of comorbidities and private insurance were also noted. Despite a dedicated transition clinic, successful transfer rates remained relatively low though comparable to previously published rates.
Severity of disease and presence of implantable devices correlated with successful transfer. Other obstacles to transfer remain and require combined efforts from pediatric and adult care systems, insurance carriers, and policy makers to improve transfer outcomes. Program outcomes? What measures will be used to determine NEW Program outcomes? Each grantee must develop its own ACF will Outcomes of transconjunctival sutureless gauge vitrectomy for vitreoretinal diseases.
To evaluate the safety and efficacy profile of gauge 27G pars plana vitrectomy PPV for the treatment of various vitreoretinal diseases. The clinical outcomes of 61 eyes 58 patients with various vitreoretinal diseases following 27G PPV were retrospectively reviewed. The mean follow-up was When learning to perform 27G PPV, surgeons may encounter a learning curve and should gradually expand surgical indications from easy to pathologically complicated cases.
Cat-scratch disease : ocular manifestations and treatment outcome. To characterize cat-scratch disease CSD ocular manifestations and visual outcome and evaluate the effect of systemic antibiotics and corticosteroids on final visual acuity VA.
Multicentre retrospective cohort study. Medical records of 86 patients with ocular disease eyes of patients identified in a national CSD surveillance study were reviewed. Mean age was Hypoalbuminaemia predicts outcome in adult patients with congenital heart disease. Background In patients with acquired heart failure, hypoalbuminaemia is associated with increased risk of death. The prevalence of hypoproteinaemia and hypoalbuminaemia and their relation to outcome in adult patients with congenital heart disease ACHD remains, however, unknown.
The relation between laboratory, clinical or demographic parameters at baseline and mortality was assessed using Cox proportional hazards regression analysis. Median plasma albumin concentration was Conclusions Hypoalbuminaemia is common in patients with ACHD and is associated with a threefold increased risk of risk of death. Hypoalbuminaemia, therefore, should be included in risk-stratification algorithms as it may assist management decisions and timing of interventions in the growing ACHD population.
Presentation and outcomes of indigenous Australians with peripheral artery disease. The risk factors for peripheral artery disease PAD are more common in Indigenous than non-Indigenous Australians, however the presentation and outcome of PAD in Indigenous Australians has not been previously investigated. The aim of this prospective cohort study was to compare the presenting characteristics and clinical outcome of Indigenous and non-Indigenous Australians with PAD.
PAD patients were prospectively recruited and followed-up since from an outpatient vascular clinic in Townsville, Australia. Kaplan Meier survival analysis and Cox proportional hazard analysis were used to compare the incidence of myocardial infarction MI , stroke or death major cardiovascular events among Indigenous and non-Indigenous patients. Four hundred and one PAD patients were recruited, of which 16 were Indigenous and were non-Indigenous Australians.
Indigenous Australians were younger at entry median age During a median follow-up of 2. These findings suggest that Indigenous Australians with PAD present at a younger age, have higher rates of smoking and insulin-treated diabetes, and poorer clinical outcomes compared to non-Indigenous Australians. To describe preschool neurodevelopmental outcomes of children with complex congenital heart disease CHD , who were evaluated as part of a longitudinal cardiac neurodevelopmental follow-up program, as recommended by the American Heart Association and the American Academy of Pediatrics, and identify predictors of neurodevelopmental outcomes in these children.
Testing included standardized neuropsychological measures. Parents completed measures of child functioning. Data on patients were analyzed. Neurodevelopmental scores did not differ based on cardiac anatomy 1V vs 2V ; both groups scored lower than norms on fine motor and adaptive behavior skills, but were within 1 SD of norms. Patients with genetic conditions scored significantly worse than 1V and 2V groups and test norms on most measures. Children with CHD and genetic conditions are at greatest neurodevelopmental risk.
Deficits in children with CHD without genetic conditions were mild and may not be detected without formal longitudinal testing. Parents and providers need additional education regarding the importance of developmental follow-up for children with CHD.
Health literacy and health outcomes in chronic obstructive pulmonary disease. Education determines a nation's health, but what determines educational outcomes? A cross-national comparative analysis. This study is premised on the notion that public health policy should address not only health itself, but also primary determinants of health. We examined the effect of national policies on educational outcomes , in particular, on adolescent reading literacy ARL. We compared the effect of traditional policy indicators--national income and educational spending--with income inequality, a measure of redistributive policies.
We used Organization for Economic Cooperation and Development OECD data that provide a rare opportunity to test policy effects after accounting for competing individual-, school-, and country-level explanations. Our sample consisted of , students, schools, and 24 countries. Among the wealthy nations in OECD, additional economic prosperity and educational spending is trumped by distribution of income for its effect on ARL.
Our study yielded a striking result about education, a major determinant of health. Not only is income inequality a significant determinant of ARL scores, but direct spending on education and overall national economic prosperity are not.
Purpose: Ependymoma is less commonly found in the supratentorial brain and has known clinical and molecular features that are unique. Our single-institution series provides valuable information about disease control for supratentorial ependymoma and the complications of supratentorial irradiation in children.
Methods and Materials: A total of 50 children with newly diagnosed supratentorial ependymoma were treated with adjuvant radiation therapy RT ; conformal methods were used in 36 after The median age at RT was 6. The conformal RT group was prospectively evaluated for neurologic, endocrine, and cognitive effects.
Results: With a median follow-up time of 9. None of the evaluated factors was prognostic for disease control. Local and distant failures were evenly divided among the 16 patients who experienced progression. Eleven patients died of disease , and 1 of central nervous system necrosis. Seizure disorders were present in 17 patients, and 4 were considered to be clinically disabled. Clinically significant cognitive effects were limited to children with difficult-to-control seizures.
The average values for intelligence quotient and academic achievement reading, spelling, and math were within the range of normal through 10 years of follow-up. Central hypothyroidism was the most commonly treated endocrinopathy. Conclusion: RT may be administered with acceptable risks for complications in children with supratentorial ependymoma. These results suggest that outcomes for these children are improving and that complications may be limited by use of focal irradiation methods.
National databases are used with increasing frequency in spine surgery literature to evaluate patient outcomes. The differences between individual databases in relationship to outcomes of lumbar fusion are not known. Patient demographics, comorbidities including obesity , length of stay LOS , in-hospital mortality, and complications such as urinary tract infection, deep venous thrombosis, pulmonary embolism, myocardial infarction, durotomy, and surgical site infection were collected using specific International Classification of Diseases , Ninth Revision codes.
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