Home About us Contact
|
Home About us Contact | ||
|
|
||
Important Outcome (important + outcome)
Terms modified by Important Outcome Selected AbstractsPrice and Volatility Transmission across BordersFINANCIAL MARKETS, INSTITUTIONS & INSTRUMENTS, Issue 3 2006Louis Gagnon Over the past forty years, financial markets throughout the world have steadily become more open to foreign investors. With open markets, asset prices are determined globally. A vast literature on portfolio choice and asset pricing has evolved to study the importance of global factors as well as local factors as determinants of portfolio choice and of expected returns on risky assets. There is growing evidence that risk premia are increasingly determined globally. An important outcome of this force of globalization is increased comovement in asset prices across markets. This survey study examines the literature on the dynamics of comovements in asset prices and volatility across markets around the world. The literature began in the 1970s in conjunction with early theoretical developments on international asset pricing models, but it blossomed in the late 1980s and early 1990s with the availability of comprehensive international stock market databases and the development of econometric methodology to model these dynamics. [source] Correlation between coping style and quality of life among hemodialysis patients from a low-income area in BrazilHEMODIALYSIS INTERNATIONAL, Issue 3 2010Paulo Roberto SANTOS Abstract Quality of life (QOL) is an important outcome among end-stage renal disease patients and can be associated with modifiable behaviors. We analyzed the correlation between coping style and QOL among hemodialysis patients. We studied 166 end-stage renal disease patients undergoing hemodialysis. They were older than 18 years, under hemodialysis for at least 3 months, and had never received a transplant. Quality of life was assessed by SF-36 and coping style was scored by the Jalowiec Coping Scale. Emotion-oriented coping and problem-oriented coping scores were compared according to sex, comorbidity, and socioeconomic status by the Mann-Whitney test. Correlations between QOL and 2 coping styles (emotion-oriented coping and problem-oriented coping) were adjusted for age, time on dialysis, hemoglobin, creatinine, albumin, calcium,phosphorus product, and Kt/V by backward stepwise linear regression. There was no difference between coping scores according to sex, comorbidity, and socioeconomic status. Emotion-oriented coping was independently and negatively associated with 4 QOL dimensions: physical functioning, role-physical, role-emotional, and mental health. Our results indicate that patients with high emotion-oriented coping scores should be seen at risk for poor QOL. Patient education in coping skills may be used to change the risk of poor QOL. [source] Capitalising on learning: an exploration of the MBA as a vehicle for developing career competenciesINTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 1 2003Jane Sturges This article reports the findings of a study of Canadian MBA graduates that explores the skills, knowledge and capabilities which they gained from the programme within the context of a career-competency framework. It concludes that the development of knowing-why career competencies (relating to career values, meanings and motivations) were the most important outcome of the course for the graduates. Knowing-how career competencies (relating to skills and job-related knowledge) were also valued highly. Increased self-confidence was a valuable form of career capital for the graduates, although the antecedents and consequences of this appear to be somewhat different for men and women. [source] Overall self-rated health: a new quality indicator for primary careJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007James E. Rohrer PhD Abstract Rationale, aims and objectives, Patient ,empowerment' gives patients choices about their own care and about the outcomes they would most prefer. Many patients can be presumed to regard overall self-rated health as an important outcome. Therefore, overall self-rated health can be considered a relevant and important outcome measure for a patient-centred medical clinic. The purpose of this study was to use this new outcome measure as a dependent variable and to test the hypothesis that patients who are confident about their ability to manage their health will have better health, in comparison to more dependent patients. Methods, We conducted a randomized cross-sectional postal survey of 500 veteran patients from the Panhandle of Texas and the surrounding areas; and 302 participated in the study. Multiple logistic regression analysis was used to test the hypothesis that health confidence is positively related to self-rated health, controlling for obesity, cigarette smoking and participation in recreational activities. Results, Veterans who strongly disagreed with the statement that they usually could overcome illnesses on their own were less likely to report good, very good or excellent self-rated health (adjusted odds ratio = 0.25). Conclusions, Overall self-rated health as measured by a single question proved to be significantly related to behavioural risk factors in this sample of primary care patients, attesting to its validity as an outcome indicator. Furthermore, health confidence was associated with better health. Most primary providers believe that they can, through good communication and providing self-care tools, increase healthy behaviours in their patients. If we are indeed able to increase health confidence in our patients, this study would suggest that self-rated health would improve. [source] Newborn screening in Fragile X syndromeJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2008F. Tassone Background: Screening for the FMR1 mutations has been a topic of considerable discussion since the FMR1 gene was identified. However, Fragile X has not been recommended for newborn screening mainly because of the lack of an accurate screening test and of data on potential benefits. We have recently developed an improved Polymerase Chain Reaction (PCR) method for the identification of premutation and full mutation alleles for the FMR1 gene. Method: The method is inexpensive, accurate and quick and can be performed on a number of sample templates including, importantly, blood spots. We have applied this method for international screening. Specifically, we have screened 5267 anonymous blood spot samples from newborn males from the centre-northwest region of Spain. We have also used this technology to a pilot ,high risk' screening program of individuals with autism and/or intellectual disabilities and family members of a proband with fragile X initiated in Guatemala. This project is a prototype for future screening endeavours. Results: One important outcome from this study is that the frequency of premutation alleles (1 per 250) appears to be higher than previously reported. This is of importance, especially in view of the different phenotypic involvement observed in carriers of premutation alleles, including neurological problems such as FXTAS. Here, we present data on the frequency of premutation/full alleles found in this population and their size distribution. Conclusion: This project is a prototype for future screening endeavours. Results from our pilot program in both Spain and Guatemala will lend strong support for implementing this technology for rapid screening to a much larger scale population screening. [source] Organizational Routines as Sources of Connections and UnderstandingsJOURNAL OF MANAGEMENT STUDIES, Issue 3 2002Martha S. Feldman Organizational routines are increasingly identified as an aspect of organizations that allows them to achieve the balance between adaptability and stability. We contribute to this discussion by showing that the connections that organizational routines make between people contribute to both stability and the ability to adapt. We argue that the connections between people that are formed as they engage together in organizational routines are important for developing understandings about both what needs to be done in a specific instance of performing a routine and about the goals of the organization that routines presumably help accomplish. Together the two sets of understandings influence organizational performance by affecting the ability of organizations to adapt to changing circumstances. These arguments lead to a general recognition of the importance to organizations of connections and the suggestion that the connections, themselves, may be an important outcome of organizational routines. [source] Has the time come to control hepatitis A globally?JOURNAL OF VIRAL HEPATITIS, Issue 2008Matching prevention to the changing epidemiology Summary., For the first time a global meeting on hepatitis A virus (HAV) infection as vaccine preventable disease was organized at the end of 2007. More than 200 experts from 46 countries gathered to investigate the changing global HAV epidemiology reflecting the increasing numbers of persons at risk for severe clinical disease and mortality from HAV infection. The benefits of childhood and adult hepatitis A (HepA) vaccination strategies and the data needed by individual countries and international health organizations to assess current HepA prevention strategies were discussed. New approaches in preventing HAV infection including universal HepA vaccination were considered. This introductory paper summarizes the major findings of the meeting and describes the changing epidemiology of HAV infections and the impact of HepA vaccination strategies in various countries. Implementation of HepA vaccination strategies should take into account the level of endemicity, the level of the socio-economic development and sanitation, and the risk of outbreaks. A stepwise strategy for introduction of HepA universal immunisation of children was recommended. This strategy should be based on accurate surveillance of cases and qualitative documentation of outbreaks and their control, secure political support on the basis of high-quality results, and comprehensive cost-effectiveness studies. The recognition of the need for increased global attention towards HepA prevention is an important outcome of this meeting. [source] Methodological issues in papers on IFN therapy: time for reappraisalJOURNAL OF VIRAL HEPATITIS, Issue 3 2000Kondili We conducted an analytical review of 194 full papers on interferon (IFN) therapy for chronic hepatitis C to evaluate current methodology (i.e. study design, criteria for evaluating the efficacy of therapy and predictors of response). Of the papers evaluated, 64 were randomized controlled trials (RCT), 40 were non-randomized controlled trials (NRCT) and 90 were observational studies (OS). The methodological analysis was focused mainly on clinical trials. The number of patients enrolled in RCT was higher compared with the number enrolled in NRCT. Uniform enrolment criteria were used in less than 50% of the trials. Only 20% of RCT and 2.5% of NRCT used criteria for defining sample size. The response rate was calculated on an intention-to-treat basis in 36 of the RCT and in 14 of the NRCT. The outcome of treatment and the criteria employed to define the response to treatment were found to be far from standardized. In 51.5% of the RCT and 42.5% of the NRCT, normalization of alanine aminotransferase (ALT) level at the end of follow-up was the only marker of response studied. Only 57.6% of the trials considered histological evidence as an important outcome. Among the clinical trials, 71.1% evaluated predictors of good response to IFN therapy. In 51% of the OS, ALT normalization by the end of follow-up was the only criterion for defining response. In conclusion, to ensure a high level of reliability in comparing or combining the results of different studies, some basic general requirements must be followed when planning trials on antiviral therapy. [source] The role of narrative in understanding digital video: An exploratory analysisPROCEEDINGS OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE & TECHNOLOGY (ELECTRONIC), Issue 1 2003Todd Wilkens Narrative is perhaps the oldest and most widely used form for organizing information and human experience, thus, it is not surprising that there is a significant body of research concerning narrative and its importance to comprehension and understanding. One important outcome of this research is the concept of narrative intelligence, the human tendency to fit experience into narrative form. This research is extremely relevant to information seeking in general and sense-making, in particular. This paper outlines the basic principles and research supporting the concept of narrative intelligence and its applicability to the ways in which people make sense of digital video. We explore relevant theory and research in sense-making, surrogates, narrative, and narrative intelligence and then present the preliminary results of two research studies. The first clarifies and operationalizes the concept of narrative as it relates to video. The second demonstrates how narrativity can have significant effects on information seeking and sense-making in digital video. Results from these studies have implications for how syntactic form can be used as a means of indexing digital video. [source] Examining the Nature and Significance of Leadership in Government OrganizationsPUBLIC ADMINISTRATION REVIEW, Issue 2 2008Tracey Trottier Though the mainstream organizational literature has advanced in the last 20 years with the integration of transformational and distributed leadership theories, as well as genuine attempts at comprehensive models, the public sector literature has lagged, especially in utilizing large-scale empirical studies. This study takes advantage of a very large government data set to test the utility of one of the best known theories, the "full range" leadership theory of Bernard Bass. It addresses three important research questions: How inclusive is Bass's operational definition of leadership? How much of an impact do Bass's leadership competencies have on follower satisfaction? Finally, how important is transformational leadership compared to transactional leadership in government settings? The results indicate that Bass's broad definition of leadership comes quite close to capturing what federal employees perceive to be effective leadership. The relationship between good leadership in an organization and follower satisfaction is also presented as an important outcome in the federal government. Finally, both transactional and transformational leadership are perceived as important in the federal government, although transformational leadership is considered slightly more important even after shifting one important factor, individualized consideration, back to the transactional model. [source] A Win,Win Model for an Academic Nursing Center: Community Partnership Faculty PracticePUBLIC HEALTH NURSING, Issue 2 2002Stella Shiber Ph.D. A number of schools of nursing have established community nursing centers to provide faculty practice sites, student learning experiences, and a service to the community, most often to a poor underserved population. The current literature concludes that these centers provide a quality clinical service and improve access to health care, and they also provide an avenue for research, training, and faculty practice. Acquiring necessary financial support and the ability to achieve financial independence appear to be the most common difficulties for these centers. Most of the current literature includes an examination of issues relating to funding. The model presented in this article focuses on organizational variables that include both the center and its placement in relationship to other functions and programs in the school and a broadening of the meaning of fiscal responsibility to include an awareness of the broad spectrum of benefits that the community nursing center brings to the entire school. Efforts to coordinate and integrate the needs and functions of several groups are described. Establishing goals and priorities that simultaneously meet the needs of all or most of these groups has been an important outcome. The activities of the center have become an integral part of the everyday life of the school. Achieving financial independence and being fiscally aware and responsible is not the same thing. [source] Can rational prescribing be improved by an outcome-based educational approach?THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 1 2010A randomized trial completed in Iran Abstract Introduction: An outcome-based education approach has been proposed to develop more effective continuing medical education (CME) programs. We have used this approach in developing an outcome-based educational intervention for general physicians working in primary care (GPs) and evaluated its effectiveness compared with a concurrent CME program in the field of rational prescribing. Methods: A cluster randomized controlled design was used. All 159 GPs working in 6 cities, in 2 regions in East Azerbaijan province in Iran, were invited to participate. The cities were matched and randomly divided into an intervention arm, for an outcome-based education on rational prescribing, and a control arm for a traditional CME program on the same topic. GPs' prescribing behavior was assessed 9 months before, and 3 months after the CME programs. Results: In total, 112 GPs participated. The GPs in the intervention arm significantly reduced the total number of prescribed drugs and the number of injections per prescription. The GPs in the intervention arm also increased their compliance with specific requirements for a correct prescription, such as explanation of specific time and manner of intake and precautions necessary when using drugs, with significant intervention effects of 13, 36, and 42 percentage units, respectively. Compared with the control arm, there was no significant improvement when prescribing antibiotics and anti-inflammatory agents. Discussion: Rational prescribing improved in some of the important outcome-based indicators, but several indicators were still suboptimal. The introduction of an outcome-based approach in CME seems promising when creating programs to improve GPs' prescribing behavior. [source] Characterisation of dic(9;20)(p11,13;q11) in childhood B-cell precursor acute lymphoblastic leukaemia by tiling resolution array-based comparative genomic hybridisation reveals clustered breakpoints at 9p13.2 and 20q11.2BRITISH JOURNAL OF HAEMATOLOGY, Issue 4 2006Jacqueline Schoumans Summary Although the dic(9;20)(p11,13;q11) is a recurrent chromosomal abnormality in paediatric B-cell precursor acute lymphoblastic leukaemia (BCP ALL), occurring in approximately 2% of the cases, its molecular genetic consequences have not been elucidated. In the present study, high-resolution genome-wide array-based comparative genomic hybridisation (array-CGH) and fluorescence in situ hybridisation (FISH) were used to characterise the 9p and 20q breakpoints (BPs) in seven childhood BCP ALLs with dic(9;20), which was shown to be unbalanced in all of them, resulting in loss of 9p13.2-pter. Five of the cases had loss of 20q11.2-qter, whereas two displayed gain of 20cen-pter. All BPs on 9p clustered in a 1.5 Mb segment of the sub-band 9p13.2; in three of the cases, the 20q BPs mapped to three adjacent clones covering a distance of 350 kb at 20q11.2. Thus, the aberration should be designated dic(9;20)(p13.2;q11.2). One of the ALLs, shown to have a complex dic(9;20), was further investigated by FISH, revealing a rearrangement of the haemapoietic cell kinase isoform p61 (HCK) gene at 20q11. The disruption of HCK may result in a fusion gene or in loss of function. Unfortunately, lack of material precluded further analyses of HCK. Thus, it remains to be elucidated whether dic(9;20)(p13.2;q11.2) leads to a chimaeric gene or whether the functionally important outcome is loss of 9p and 20q material. [source] Health-related quality of life assessment after breast reconstruction,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2009S. Potter Background: Health-related quality of life (HRQL) is an important outcome following breast reconstruction. This study evaluated current methods of HRQL assessment in patients undergoing latissimus dorsi breast reconstruction, hypothesizing that early surgical morbidity would be reflected by poorer HRQL scores. Methods: Patients completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and breast module (QLQ-BR23), the Functional Assessment of Cancer Therapy (FACT) general measure, and breast module and arm subscale (FACT-B + 4), and the Body Image Scale and Hospital Anxiety and Depression Scale (HADS) 3 months after surgery. They also reported additional HRQL problems not included in the questionnaires. HRQL scores were compared between patients with and without early surgical morbidity. Results: Sixty women completed the questionnaires, of whom 25 (42 per cent) experienced complications. All EORTC and FACT subscale and HADS scores were similar in patients with or without morbidity. Women with complications were twice as likely to report feeling less feminine and dissatisfied with the appearance of their scar than those without problems. Thirty-two women (53 per cent) complained of problems not covered by the questionnaires, most commonly donor-site morbidity. Conclusion: Existing HRQL instruments are not sufficiently sensitive to detect clinically relevant problems following breast reconstruction. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Determinants of quality of life in patients with cancerCANCER, Issue 5 2005A South American study Abstract BACKGROUND Because health-related quality of life (QOL) is an important outcome in cancer management, the authors sought to better understand its determinants. To address this subject, they analyzed QOL, as measured with the Functional Assessment of Cancer Therapy-General questionnaire (FACT-G), Spanish Version 4, and depicted the complex relations among physical, psychological, social, and cultural factors, including spirituality. METHODS A cross-sectional study design was used with a sample of 309 patients with cancer. The influence of several possible determinants was first studied by univariate regression analysis. Variables showing an association were included in a forward stepwise multivariate regression model. RESULTS Five regression models were studied, for the FACT-G total score and its four subscales. Five variables explained 32.1% of the variance of the FACT-G total score: tumor stage, spiritual well-being, income, mood disorders, and mode of questionnaire administration. The type and relevance of the explanatory variables differed among the various dimensions of QOL. CONCLUSIONS The authors underlined the entwining of biologic, psychosocial, and spiritual factors as determinants of the QOL of patients with cancer, thus supporting the multidimensional definition and modeling of the construct. Cancer 2005. © 2005 American Cancer Society. [source] Verbund-Simulation , Strategic Planning and Optimization of Integrated Production NetworksCHEMICAL ENGINEERING & TECHNOLOGY (CET), Issue 4 2010T. Viere Abstract Strategic analysis and optimization of highly integrated production networks is an essential requirement for cost-effective and resource-efficient production. This paper presents a comprehensive software-based concept for modeling, simulation, optimization, and visualization of an integrated silicone production network of Wacker Chemie AG. A Verbund-Model was implemented in a step-by-step approach, starting with primary material streams in one business unit up to the modeling of all energy, waste, and cost streams in several business units. The system's flexibility enables different levels of detail for modeling processes and parts of the network: from simple input-output relations to complex, nonlinear equations and specifications. The proactive implementation of technical measures and projects based on the assessment of future scenarios is an important outcome of the Verbund-simulation. [source] Emergency Department Overcrowding: Analysis of the Factors of Renege RateACADEMIC EMERGENCY MEDICINE, Issue 2 2007Phillip V. Asaro MD Background Reneging (i.e., leaving without being seen) is an important outcome of emergency department (ED) overcrowding. The input-throughput-output conceptualization of ED patient flow is helpful in understanding and measuring the impact of various factors on this outcome. Objectives To quantify the impact of input and output factors on ED renege rate. Methods The authors used patient-level and system-level data from multiple sources in their institution to build logistic regression models, with reneging as the dependent variable. This approach provides the impact of each input and output factor on renege rate expressed as an odds ratio (OR). Results The OR for reneging attributable to the difference between the 80th and 20th percentile values for inpatient bed utilization is 1.05. Comparing 80th and 20th percentile values for boarded ED admits as of 7 am, the OR is 1.73; for daily ED arrivals, the OR is 2.00; and for admission percentage, the OR is 1.12. The OR for evening versus morning patient arrival time is 3.9 and for patient arrival on a Monday versus a Sunday is 2.7. The OR for reneging for a patient presenting on Monday evening versus Sunday morning is 10.5. Conclusions The effects of ED input and output factors on renege rate are significant and quantifiable. At least some of the variation in these factors and subsequently their effects are predictable, suggesting that further refinement in the management of ED and inpatient resources could affect improvement in ED renege rate. Continued efforts at quantifying the effects are warranted. [source] Patient personality predicts postoperative stay after colorectal cancer resectionCOLORECTAL DISEASE, Issue 2 2008A. Sharma Abstract Objective, Postoperative length of stay (LOS) is an important outcome after colorectal cancer surgery. The aim of this study was to evaluate the putative effects of personality, mood, coping and quality of life on LOS. Method, A consecutive series of 110 eligible patients undergoing elective resection for colorectal cancer were invited to participate in the study. A battery of psychometric questionnaires including the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy (colorectal), the Courtauld Emotional Control Scale, the Positive and Negative Affectivity Scale and the Eysenck Personality Questionnaire (EPQ) were administered 5,12 days before surgery. Nonparametric correlations were computed for psychometric scores, demographic variables and the LOS. Factors found to be significantly correlated on this analysis were entered into a multiple regression model to determine the independent predictors of LOS. Results, One hundred and four patients with colorectal cancer participated. Seventy were male (67%) and the mean age was 68 years (range 39,86). The median LOS was 10 days (range 4,108). LOS was negatively correlated with pre- and postoperative albumin levels, PANAS +ve affect, Functional Assessment of Cancer Therapy questionnaire with the colorectal module functional well-being score and EPQ extroversion score. LOS was strongly positively correlated with postoperative morbidity. LOS was positively correlated with CECS anger score, age and being male. Postoperative morbidity (, = 0.379, P = 0.007) and extroversion (, = ,0.318, P = 0.05) were independent predictors of LOS. Conclusion, Personality as measured by EPQ predicts postoperative LOS in patients with colorectal cancer. Extroverts have a higher pain threshold and this may be part of the explanation. [source] Supporting a diverse workforce: What type of support is most meaningful for lesbian and gay employees?HUMAN RESOURCE MANAGEMENT, Issue 2 2008Ann H. Huffman We examine differences in type of support (i.e., supervisor, coworker, organizational) received by lesbian, gay, and bisexual (LGB) employees and the relationship between type of support and relevant outcomes (job and life satisfaction, outness of sexual orientation). Surveys were administered to 99 LGB individuals, and results indicate that support is best viewed as a multi-dimensional construct composed of supervisor, coworker, and organizational support for LGB employees. Overall, supervisor support was related to job satisfaction, coworker support was related to life satisfaction, and organizational support for LGB employees was related to outness.Thus, support for LGB employees isrelated to important outcomes. Practical suggestions for increasing organizational support for LGB employees are offered. © 2008 Wiley Periodicals, Inc. [source] Guidelines for assessing the suitability of spatial climate data setsINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 6 2006Christopher Daly Abstract Spatial climate data are often key drivers of computer models and statistical analyses, which form the basis for scientific conclusions, management decisions, and other important outcomes. The recent availability of very high-resolution climate data sets raises important questions about the tendency to equate resolution with realism. This paper discusses the relationship between scale and spatial climate-forcing factors, and provides background and advice on assessing the suitability of data sets. Spatial climate patterns are most affected by terrain and water bodies, primarily through the direct effects of elevation, terrain-induced climate transitions, cold air drainage and inversions, and coastal effects. The importance of these factors is generally lowest at scales of 100 km and greater, and becomes greatest at less than 10 km. Except in densely populated regions of developed countries, typical station spacing is on the order of 100 km. Regions without major terrain features and which are at least 100 km from climatically important coastlines can be handled adequately by most interpolation techniques. Situations characterized by significant terrain features, but with no climatically important coastlines, no rain shadows, and a well-mixed atmosphere can be reasonably handled by methods that explicitly account for elevation effects. Regions having significant terrain features, and also significant coastal effects, rain shadows, or cold air drainage and inversions are best handled by sophisticated systems that are configured and evaluated by experienced climatologists. There is no one satisfactory method for quantitatively estimating errors in spatial climate data sets, because the field that is being estimated is unknown between data points. Perhaps the best overall way to assess errors is to use a combination of approaches, involve data that are as independent from those used in the analysis as possible, and use common sense in the interpretation of results. Data set developers are encouraged to conduct expert reviews of their draft data sets, which is probably the single most effective way to improve data set quality. Copyright © 2006 Royal Meteorological Society. [source] Guidelines Abstracted from the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Stroke RehabilitationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2006Miriam Rodin MD OBJECTIVES: To assist facilities in identifying those evidence-based processes of poststroke care that enhance measurable patient outcomes. The guideline(s) should be used by facilities (hospitals, subacute-care units and providers of long-term care) to implement a structured approach to improve rehabilitative practices and by clinicians to determine best interventions to achieve improved patient outcomes. OPTIONS: The guideline considers five elements of poststroke rehabilitation care: interdisciplinary teams; use of standardized assessments; intensity, timing, and duration of therapy; involvement of patients' families and caregivers in decision-making; and educational interventions for patients, families, and caregivers. Evidence, benefits, harms, and recommendations for each of the five designated elements and specific annotated recommendations for poststroke managements are presented separately. OUTCOMES: The overall guideline considers improvement in functional status measures as the primary outcome. Achieving community-dwelling status and preventing complications, death, and rehospitalization are also important outcomes. Costs are not specifically addressed. PARTICIPANTS: The Department of Veterans Affairs/Department of Defense (VA/DoD) Stroke Rehabilitation Working Group consisted of 28, largely VA and military hospital, representatives of medical and allied professions concerned with stroke diagnosis, management, and rehabilitation. Nine additional members with similar credentials served as the editorial committee. Technical consultation was contracted from ACS Federal Health Care, Inc., and the Center for Evidence-Based Practice, State University of New York,Upstate Medical University, Department of Family Medicine conducted evidence appraisal. Consensus was achieved over several years of facilitated group discussion and iterative evaluation of draft documents and supporting evidence. SPONSOR: The guideline was prepared under the auspices of the VA/DoD. No other source of support was identified in the document, or supporting documents. [source] The role of diet in the management of gout: a comparison of knowledge and attitudes to current evidenceJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2009P. Shulten Abstract Background:, Evidence supports dietary modifications in the management of gout. Despite this, the degree of implementation of this evidence by nutrition professionals and rheumatologists and those affected by gout is unknown. The present study aimed to compare usual dietary practices of patients with gout to evidence for dietary management of gout and to investigate whether the knowledge and attitudes of nutrition professionals and rheumatologists reflects current evidence. Methods:, A food frequency questionnaire was used to determine usual dietary intake of patients with gout, a separate questionnaire examined gout-related dietary modifications (n = 29). Online questionnaires to examine attitudes towards dietary management of gout were completed by nutrition professionals and rheumatologists. Results:, Proportions of participants whose reported intakes were inconsistent with current evidence for the dietary management of gout were: alcohol, n = 14 (48%); beer, n = 18 (62%); seafood, n = 29 (100%); meat, n = 7 (24%); beef/pork/lamb, n = 24 (83%); dairy products, n = 12 (41%); vitamin C supplementation, n = 29 (100%). Of the 61 rheumatologists and 231 nutrition professionals who completed the online survey, the majority considered that weight loss and decreased alcohol intake were important or very important outcomes. Proportions were lower for decreased purine intake. Thirty-four (56%) rheumatologists do not refer patients with gout to dietetic services and, of those who do, the majority refer less than half. Conclusions:, Overall, patients with gout in the present study were not implementing evidence for dietary management of their condition and complex dietary issues were evident. [source] Outcomes generated by patients with rheumatoid arthritis: how important are they?MUSCULOSKELETAL CARE, Issue 3 2005Sarah Hewlett PhD MA RGN Arc Senior Lecturer Abstract Background: It has been shown previously that patients with rheumatoid arthritis (RA) can generate a wide range of outcomes that they consider important in treatment. It is not known if these outcomes are generally important in the wider RA patient community. Objectives: (1) To examine whether recent patient-generated outcomes are generalizable within a wider RA population; (2) to assess the relative importance of each outcome; and(3) to explore whether any important outcomes have been omitted. Methods: A questionnaire, listing 23 outcomes previously generated by RA patients, was distributed through three rheumatology centres in the UK. Patients gave an importance score to each outcome (0,3), selected their top three most important outcomes, and then listed any outcomes of personal importance that were missing. Results: 323 questionnaires were returned (65%). All outcomes were deemed important. Independence, pain, and mobility were most frequently selected by patients in their top three outcomes but were not chosen by 61,66% of patients. The next most commonly chosen outcomes related to feeling well and fatigue. Factor analysis revealed six reasonably distinct groupings: general well-being (11.9% explained variance), day-to-day functioning(10.6%), emotional and psychological well-being (10.6%), social role and confidence (10%), physical symptoms (9.5%) and medication issues (7.9%). Conclusion: Outcomes generated by patients as important in RA, are generalizable and inclusive. The most important (independence, pain and mobility) are routinely treated and measured. The next most important (feeling well, fatigue) are infrequently addressed and deserve urgent consideration for measurement, treatment and research. Copyright © 2005 John Wiley & Sons, Ltd. [source] Review article: Patient-level outcomes: the missing linkNEPHROLOGY, Issue 4 2009DENISE V O'SHAUGHNESSY SUMMARY Treatment of chronic kidney disease (CKD) may be life-saving, but can disrupt every aspect of a patient's life and the lives of family members. Many patients with CKD are elderly with significant comorbidities and sometimes therapies to improve survival may be less important than those that improve or maintain quality of life. In this setting, patient-level benefits become particularly important goals of therapy. Randomized controlled trials (RCT) are also essential to justify expensive therapies, such as medications used in the treatment of CKD mineral and bone disorders. Surprisingly, data to support the efficacy of these drugs for patient-level outcomes remains limited. In fact, fewer RCT are conducted in renal medicine than in any other medical specialty and reliance is often placed on association data and the assessment of intermediate and biochemical end-points. While some of these may prove to be valid surrogates for clinically important outcomes, some may not. Inclusion of patient-level outcomes in clinical research provides a missing link that can inform a more comprehensive approach to clinical practice and patient care. Incorporating measures of health-related quality of life into clinical trials can make outcomes more relevant and may be relatively simple. This paper provides examples of reliable, validated instruments to measure health-related quality of life domains and functional status, together with practical instructions for their use. Most could be incorporated into RCT of CKD mineral and bone disorder treatments. Inclusion of outcomes that are perceived by patients to be significant should become standard practice in renal medicine and in clinical renal research. [source] Determinants of internet auction success and closing price: An exploratory studyPSYCHOLOGY & MARKETING, Issue 6 2003James H. Gilkeson Although auctions have been examined extensively in economics, and to some degree in marketing, on-line auctions are only beginning to receive research attention. Further, in both economics and marketing the research on auctions has relied primarily on rational, economic theories. This article investigates how particular on-line auction features impact two important outcomes: auction success and final closing price. Traditional economic theories as well as theories from marketing and psychology are employed to provide a broader picture of on-line auctions. Specifically, several key factors related to auction success and closing price for four types of sterling flatware in an on-line auction site (eBay) are examined. The findings show that, across all four piece types, a reserve auction format, the relative opening price, and the number of bids unexplained by a low or high opening price are associated with both auction success and final closing price. © 2003 Wiley Periodicals, Inc. [source] SBIRT in Emergency Care Settings: Are We Ready to Take it to Scale?ACADEMIC EMERGENCY MEDICINE, Issue 11 2009Edward Bernstein MD Abstract This article summarizes a panel discussion on "SBIRT in the emergency care setting: are we ready to take it to scale?" Dr. Edward Bernstein commented on the historical developments of emergency department (ED) screening, brief intervention (BI), and referral to treatment (SBIRT) research, practice, and knowledge translation. Dr. Jack Stein addressed SBIRT grant program progress to date, the reimbursement stream, SBIRT lessons learned, and unanswered questions. Dr. Richard Saitz reviewed the limitations of the evidence for alcohol and drug ED screening and BI and cautioned on the danger of proceeding to practice and broad dissemination without evidenced based on randomized controlled trials with sufficient sample size and clinically important outcomes. [source] RESPONSIBILITY FOR CONTROL; ETHICS OF PATIENT PREPARATION FOR SELF-MANAGEMENT OF CHRONIC DISEASEBIOETHICS, Issue 5 2007BARBARA K. REDMAN ABSTRACT Patient self-management (SM) of chronic disease is an evolving movement, with some forms documented as yielding important outcomes. Potential benefits from proper preparation and maintenance of patient SM skills include quality care tailored to the patient's preferences and life goals, and increase in skills in problem solving, confidence and success, generalizable to other parts of the patient's life. Four central ethical issues can be identified: 1) insufficient patient/family access to preparation that will optimize their competence to SM without harm to themselves, 2) lack of acknowledgement that an ethos of patient empowerment can mask transfer of responsibility beyond patient/family competency to handle that responsibility, 3) prevailing assumptions that preparation for SM cannot result in harm and that its main purpose is to deliver physician instructions, and 4) lack of standards for patient selection, which has the potential to exclude individuals who could benefit from learning to SM. Technology assessment offers one framework through which to examine available data about efficacy of patient SM and to answer the central question of what conditions must be put in place to optimize the benefits of SM while assuring that potential harms are controlled. [source] Impact of a Triage Liaison Physician on Emergency Department Overcrowding and Throughput: A Randomized Controlled TrialACADEMIC EMERGENCY MEDICINE, Issue 8 2007Brian R. Holroyd MD BackgroundTriage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear. ObjectivesTo evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting. MethodsA six-week TLP clinical research project was conducted between December 9, 2005, and February 9, 2006. A TLP was deployed for nine hours (11 am to 8 pm) daily to initiate patient management, assist triage nurses, answer all medical consult or transfer calls, and manage ED administrative matters. The study was divided into three two-week blocks; within each block, seven days were randomized to TLP shifts and the other seven to control shifts. Outcomes included patient length of stay, proportion of patients who left without complete assessment, staff satisfaction, and episodes of ambulance diversion. ResultsTLPs assessed a median of 14 patients per shift (interquartile range, 13,17), received 15 telephone calls per shift (interquartile range, 14,20), and spent 17,81 minutes per shift consulting on the telephone. The number of patients and their age, gender, and triage score during the TLP and control shifts were similar. Overall, length of stay was decreased by 36 minutes compared with control days (4:21 vs. 4:57; p = 0.001). Left without complete assessment cases decreased from 6.6% to 5.4% (a 20% relative decrease) during the TLP coverage. The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days. ConclusionsA TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs. [source] Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analysesCLINICAL ENDOCRINOLOGY, Issue 1 2010Mohamed B. Elamin Summary Objective, To summarize the available evidence on the cardiovascular effects of cross-sex steroid use in transsexuals. Methods, We searched relevant electronic databases and sought additional references from experts. Eligible studies reported on cardiovascular events, venous thromboembolism, blood pressure and fasting serum lipids. Data were extracted in duplicate. We used the random-effects model to estimate the pooled weighted mean difference (WMD) and 95% confidence intervals (CIs). Results, We found 16 eligible studies, mostly uncontrolled cohorts of varied follow-up durations (1471 male-to-female (MF) and 651 female-to-male (FM) individuals). In the MF individuals, cross-sex hormone use was associated with a statistically significant increase in fasting serum triglycerides without changes in the other parameters (WMD = 23·39 mg/dl; 95% CI = 4·82,41·95). In the FM individuals, there was a similar increase of triglycerides (WMD = 31·35 mg/dl; 95% CI = 7·53,55·17) and a reduction of high density lipoprotein (HDL)-cholesterol (WMD = ,6·09 mg/dl; 95% CI = ,11·44 to ,0·73). There was a statistically significant but clinically trivial increase in systolic blood pressure (WMD = 1·74 mmHg; 95% CI = 0·21,3·27). Analyses were associated with significant heterogeneity across studies. There were very few reported cardiovascular events (deaths, strokes, myocardial infarctions or venous thromboembolism), more commonly among MF individuals. Conclusions, Very low quality evidence, downgraded due to methodological limitations of included studies, imprecision and heterogeneity, suggests that cross-sex hormone therapies increase serum triglycerides in MF and FM and have a trivial effect on HDL-cholesterol and systolic blood pressure in FM. Data about patient important outcomes are sparse and inconclusive. [source] | ||||||||||||||||||||||||||||