			Home About us Contact

Poor Treatment Outcome (poor + treatment_outcome)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Breast Cancer in Nigeria: Is Non-Adherence to Chemotherapy Schedules a Major Factor in the Reported Poor Treatment Outcome?

THE BREAST JOURNAL, Issue 2 2010
Adewale O. Adisa MBChB, FWACS
No abstract is available for this article. [source]

Pretreatment Psychosocial Variables as Predictors of Outcomes Following Lumbar Surgery and Spinal Cord Stimulation: A Systematic Review and Literature Synthesis

PAIN MEDICINE, Issue 4 2009
James Celestin MD
ABSTRACT Background., In the multimodal treatment approach to chronic back pain, interventional back procedures are often reserved for those who do not improve after more conservative management. Psychological screening prior to lumbar surgery or spinal cord stimulation (SCS) has been widely recommended to help identify suitable candidates and to predict possible complications or poor outcome from treatment. However, it remains unclear which, if any, variables are most predictive of pain-related treatment outcomes. Objective., The intent of this article is to perform a systematic review to examine the relationship between presurgical predictor variables and treatment outcomes, to review the existing evidence for the benefit of psychological screening prior to lumbar surgery or SCS, and to make treatment recommendations for the use of psychological screening. Results., Out of 753 study titles, 25 studies were identified, of which none were randomized controlled trials and only four SCS studies met inclusion criteria. The methodological quality of the studies varied and some important shortcomings were identified. A positive relationship was found between one or more psychological factors and poor treatment outcome in 92.0% of the studies reviewed. In particular, presurgical somatization, depression, anxiety, and poor coping were most useful in helping to predict poor response (i.e., less treatment-related benefit) to lumbar surgery and SCS. Older age and longer pain duration were also predictive of poorer outcome in some studies, while pretreatment physical findings, activity interference, and presurgical pain intensity were minimally predictive. Conclusions., At present, while there is insufficient empirical evidence that psychological screening before surgery or device implantation helps to improve treatment outcomes, the current literature suggests that psychological factors such as somatization, depression, anxiety, and poor coping, are important predictors of poor outcome. More research is needed to show if early identification and treatment of these factors through psychological screening will enhance treatment outcome. [source]

Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience

ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2005
D. Schmidt
Purpose,,, We reviewed the impact of planned discontinuation of antiepileptic drugs (AEDs) in seizure-free patients on seizure recurrence and the seizure outcome of reinstituted treatment. Methods,,, A literature review was performed yielding 14 clinical observations of seizure recurrence after discontinuation and its treatment outcome. Results,,, Seizure recurrence rate after AED discontinuation ranged between 12 and 66% (mean 34%, 95%CI: 27,43) in the 13 reviewed studies (no data in one study). Reinstitution of AEDs after recurrence was efficacious between 64,91% (mean of 14 studies, 80%, 95%CI: 75,85%) at follow-up. Mean follow-up ranged from 1,9 years. Seizure outcome of resumed treatment was not different for series in children and adolescents (84%, mean of 4 studies, 95%CI: 75,93) or in adults only (80%, mean of 9 studies, 95%CI: 74,86). Although seizure control was regained within approximately one year in half of the cases becoming seizure free, it took some patients as many as 5,12 years. In addition, in 19% (mean of 14 studies, 95%CI: 15,24%), resuming medication did not control the epilepsy as before, and chronic drug-resistant epilepsy with many seizures over as many as five years was seen in up to 23% of patients with a recurrence. Factors associated with poor treatment outcome of treating recurrences were symptomatic etiology, partial epilepsy and cognitive deficits. Conclusions,,, These serious and substantial risks weigh against discontinuation of AEDs in seizure-free patients, except perhaps for selected patients with idiopathic epilepsy syndromes of childhood or patients with rare seizures. [source]

Extent of extracapsular spread

CANCER, Issue 6 2003
A critical prognosticator in oral tongue cancer
Abstract BACKGROUND Extracapsular spread (ECS) of metastatic squamous cell carcinoma of the head and neck to regional lymph nodes is the most reliable predictor of poor treatment outcomes. Recently, the authors have shown that ECS is significantly associated with higher rates of locoregional recurrence, distant metastasis, and decreased survival in patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this review was to determine if the degree of ECS impacts distant metastasis rates and survival. METHODS Two hundred sixty-six patients treated for SCCOT with surgery +/, adjuvant radiotherapy from 1980,1995 were reviewed. The setting was a tertiary referral center. The extent of ECS on histopathologic review of involved lymph nodes was measured from the capsular margin to the farthest perinodal extension in mm. Extent of ECS and the number of pathologic lymph nodes with or without ECS were analyzed for disease-free interval, survival rates, and distant metastases. RESULTS No differences in the survival of patients with ECS of , 2 mm or > 2 mm was found (P = 0.92). Patients with both ECS and multiple positive lymph nodes had decreased overall survival (P = 0.0003), disease-specific survival (P = 0.0005), and a shorter disease-free interval (P = 0.019) when compared with those with a single positive lymph node with ECS. Those with multiple ECS+ lymph nodes had the worst prognosis (P = 0.001). CONCLUSIONS Based on these findings, the authors recommended that all patients with SCCOT with ECS or multiple positive lymph nodes with or without ECS on pathologic review be considered for clinical trials that intensify regional and systemic adjuvant therapy. Cancer 2003;97:1464,70. © 2003 American Cancer Society. DOI 10.1002/cncr.11202 [source]