Month Outcomes (month + outcome)

Distribution by Scientific Domains

Selected Abstracts

OCDS Craving Scores Predict 24-Month Outcome in Alcoholic Outpatients

Michael Soyka MD
This study was conducted to replicate previous findings on the predictive value of a German version of the Obsessive Compulsive Drinking Scale (OCDS) by investigating 24-month treatment outcome in an outpatient setting. This was a prospective, observational study with 92 alcohol-dependent patients. The OCDS was used to assess craving at the end of treatment, and at the 6-, 12-, and 24-month follow-ups. Univariate and logistic regression analyses were performed. Of the 67 patients interviewed at the 24-month follow-up, 58% were abstinent and 79% improved. OCDS scores were higher in patients with a less favorable outcome. In line with previous findings, our results showed that the intensity of craving as measured by the OCDS may predict outcome in outpatient alcoholics.,(Am J Addict 2010;19:264,269) [source]

(217) Selective Nerve Root Injections Can Accurately Predict Level of Nerve Impairment and Outcome for Surgical Decompression: A Retrospective Analysis

PAIN MEDICINE, Issue 3 2001
Kevin Macadaeg
There remains significant controversy regarding the use of a vertebral selective nerve root injection (SNI) as a diagnostic and therapeutic tool. In addition, the frequency of use of such procedures in patients with radiculopathy has increased dramatically in the last few years. Based on a Medline review there has been no studies combining cervical and lumbar SNI results and comparing preoperative diagnosis to surgical findings and outcome. The purpose of this paper is to retrospectively examine and compare the sensitivity, specificity and predictive value of a good surgical outcome in patients who had an SNI and subsequent surgical intervention. 101 patients from a 1996 thru 1999 database, who were referred to 10 spine surgeons (2 orthopedic and 8 neurosurgeon) for either cervical or lumbar radiculopathy, and had SNI and various imagery studies and subsequent surgery. Patients receive SNIs at our institution if there is a discrepancy between physical exam and radiologic imagery or to confirm a putative pain generator in multilevel pathology. These patients were then retrospectively analyzed with regard to correlation to surgical level and surgical outcome. SNIs were performed by one of three pain specialists in our clinic. Approximation of the appropriate nerve root sleeve was performed using fluoroscopic imagery, a nerve stimulator and contrast. After nerve root stimulation and neurography, 0.5,0.75 cc of lidocaine 2% was injected. Pre- and post-procedural visual analog scale (VAS) pain scores were obtained from the non-sedated patient. A SNI was considered positive or negative if the patient had immediate appendicular pain relief of greater or less then ninety percent respectively. The study was designed to include only those patients that had a SNI, regardless of result, and subsequently had surgical decompression in an attempt to treat the pain that initially prompted the SNI. A statistical analysis was then performed comparing preoperative data to surgical findings and outcome. Overall, 101 patients had SNIs who subsequently underwent surgical decompression. Average duration of symptoms prior to SNI was 1.5,12 months (4 months mean). Fifteen patients presented with cervical and 86 with lumbar radiculopathy. There were a total of 110 procedures performed on these patients. VAS scores of <2 and overall pain reduction openface> 90% with respect to their pre-procedural appendicular were used to determine if a SNI was positive, negative or indeterminate. All of these patients had an MRI or CT with or without a myelogram and all went to surgery. The results yield that SNIs are able to predict surgical findings with 94% and 90% sensitivity and specificity, respectively. A good surgical outcome was determined if the patient would do the surgery again, if they were satisfied or very satisfied and had a VAS of <3 at 6- and 12-month intervals. Our data revealed that a positive SNI was able to predict a good 6-month outcome with 95% and 64% sensitivity and specificity, respectively. At 12-months, similar results were obtained of 95% and 56%. Preoperative MRI results were also evaluated and revealed a 92% sensitivity in predicting surgical findings. We had 24 false positive MRI results and 0 true negatives. Interestingly we had 8 diabetic (IDDM or NIDDM) patients or nearly 8% of our total. The odds ratio of a diabetic having a bad outcome at 12 months was 5.4 to 1. Diabetics had a 50% likelihood of having a bad 12-month outcome versus 16% for non-diabetics with a p value of 0.066. We also looked at gender, smoking history and presence of cardiovascular disease and found no significant relationship with outcomes. Our data indicate that SNIs, when performed under rigorous method, is a highly valuable tool that can accurately determine level of nerve root impairment and outcome in patients being considered for surgical decompression. With a sensitivity of 94% and a specificity of 90%, SNIs offer a major advantage over other diagnostic modalities in patients with difficult-to-diagnose radiculopathies. [source]

Bayes' Theorem to estimate population prevalence from Alcohol Use Disorders Identification Test (AUDIT) scores

ADDICTION, Issue 7 2009
David R. Foxcroft
ABSTRACT Aim The aim in this methodological paper is to demonstrate, using Bayes' Theorem, an approach to estimating the difference in prevalence of a disorder in two groups whose test scores are obtained, illustrated with data from a college student trial where 12-month outcomes are reported for the Alcohol Use Disorders Identification Test (AUDIT). Method Using known population prevalence as a background probability and diagnostic accuracy information for the AUDIT scale, we calculated the post-test probability of alcohol abuse or dependence for study participants. The difference in post-test probability between the study intervention and control groups indicates the effectiveness of the intervention to reduce alcohol use disorder rates. Findings In the illustrative analysis, at 12-month follow-up there was a mean AUDIT score difference of 2.2 points between the intervention and control groups: an effect size of unclear policy relevance. Using Bayes' Theorem, the post-test probability mean difference between the two groups was 9% (95% confidence interval 3,14%). Interpreted as a prevalence reduction, this is evaluated more easily by policy makers and clinicians. Conclusion Important information on the probable differences in real world prevalence and impact of prevention and treatment programmes can be produced by applying Bayes' Theorem to studies where diagnostic outcome measures are used. However, the usefulness of this approach relies upon good information on the accuracy of such diagnostic measures for target conditions. [source]

Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy

ADDICTION, Issue 3 2009
Frances J. Kay-Lambkin
ABSTRACT Aims To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems. Design Randomized controlled trial. Setting Community-based participants in the Hunter Region of New South Wales, Australia. Participants Ninety-seven people with comorbid major depression and alcohol/cannabis misuse. Intervention All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment ,live' (i.e. delivered by a psychologist) or via a computer-based program (with brief weekly input from a psychologist). Measurements Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post-baseline assessment. Findings (i) Depression responded better to intensive MI/CBT compared to BI alone, with ,live' treatment demonstrating a strong short-term beneficial effect which was matched by computer-based treatment at 12-month follow-up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer-based therapy showing the largest treatment effect. Conclusions Computer-based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12-month outcomes relative to a ,live' intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer-based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress. [source]

Treatment of Palmaz-Schatz In-stent Restenosis: 6,Month Clinical Follow-up

To identify predictors of Palmaz-Schatz in-stent restenosis and determine outcomes of treatment, we assessed 6,month outcomes in 402 patients who had coronary intervention with stent placement; 60 (15%) developed angiographic and clinical evidence of restenosis. Predictors of restenosis included family history of cardiovascular disease, prior bypass surgery, nonelective stenting, stenting of a vein graft, and multiple stents. Of 60 patients with stent restenosis, 47 had repeat percutaneous intervention and 10 had bypass surgery; only 1 of these 10 patients developed symptoms requiring repeat revascularization. Of the 47 with repeat percutaneous intervention, 32 (68%) had conventional balloon angioplasty; the others had perfusion balloon catheters, laser ablation, and repeat coronary stenting. During follow-up, 22 (47%) of these 47 patients suffered recurrent angina, myocardial infarction, or death. A third revascularization procedure was performed in 14 (30%), including 5 referred for bypass. This study shows the limitations of percutaneous modalities for patients with Palmaz-Schatz in-stem restenosis. Such patients are likely to have recurrent symptoms and to undergo repeat target-vessel revascularization. [source]

Long-Term Outcomes of a Telephone Intervention After an ICD

Background: The purpose of this study was to determine the long-term benefits of participating in a structured, 8-week educational telephone intervention delivered by expert cardiovascular nurses post-ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self-efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post-ICD. This article reports on the 6- and 12-month outcomes of the nursing intervention trial. Methods and Results: A two-group (N = 168) randomized control group design was used to evaluate intervention efficacy with persons receiving an ICD for the secondary prevention of sudden cardiac arrest. Measures were obtained at baseline, 6 and 12 months post hospitalization. Outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI], Centers for Epidemiologic Studies,Depression [CES-D], fear of dying), (3) self-efficacy (Sudden Cardiac Arrest,Self-Efficacy [SCA-SE], Sudden Cardiac Arrest,Behavior [SCA-B], Sudden Cardiac Arrest,Knowledge [SCA-K]), and (4) health care utilization (emergency room [ER] visits, outpatient visits, hospitalizations). Using repeated measures ANOVA, the 6- and 12-month benefits of the intervention over usual care were in reductions in physical concerns (P = 0.006), anxiety (P = 0.04), and fear of dying (P = 0.01), with enhanced self-confidence (P = 0.04) and knowledge (P = 0.001) to manage ICD recovery. There were no statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months. Conclusion: A structured 8-week post-hospital telephone nursing intervention after an ICD had sustained 12-month improvements on patient concerns, anxiety, fear of dying, self-efficacy, and knowledge. Results may not apply to individuals with congestive heart failure who receive an ICD for primary prevention of sudden cardiac arrest. [source]

Comparison of drug-eluting stents with bare metal stents in unselected patients with acute myocardial infarction

L. Iri Kupferwasser MD
Abstract Objectives: The aim of this study was to compare the procedural characteristics and outcomes of patients with acute myocardial infarction treated with drug-eluting stents (DES) vs. bare metal stents (BMS). Background: DES have been shown to reduce the incidence of restenosis and target vessel revascularization (TVR) in clinical randomized studies when compared with BMS in patients undergoing elective percutaneous intervention. Limited data are available with the use of DES in patients with acute ST-segment elevation myocardial infarction. Methods: Two hundred and sixty-one consecutive patients who presented with myocardial infarction between 7/2001 and 8/2005 were studied. The procedural characteristics, 30-day and 12-month outcomes of 131 patients treated with DES were compared with 130 patients treated with BMS. Results: At 12-months follow-up DES therapy was associated with a substantial decrease in major adverse cardiovascular events (MACE) (HR 0.33; P =0.002), TVR (HR 0.19; P =0.002), and recurrent myocardial infarction (HR 0.23; P =0.051) vs. BMS therapy. Coronary interventions utilizing DES were characterized by a marked increase in the number of stent per target vessel (DES: 1.9 0.9 vs. BMS: 1.38 0.6, P < 0.0001), treatment of bifurcation (DES: 21% vs. BMS: 5%, P =0.0004), and multivessel intervention (DES: 22% vs. BMS: 8%, P =0.003). Conclusion: The routine use of DES in acute myocardial infarction is associated with reduced rates of MACE at 12 months vs BMS, despite a higher rate of complex procedures in the DES treated patients. In addition to its anti-restenosis effect, the improved outcome of patients treated with DES may be linked to a more complete revascularization in association with prolonged clopidogrel therapy. 2007 Wiley-Liss, Inc. [source]