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Specific Outcomes (specific + outcome)

Distribution by Scientific Domains

Medical Sciences	85%

Selected Abstracts

What works for whom in a computer-mediated communication intervention in community psychiatry?

ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2008
Moderators of outcome in a cluster randomized trial
Objective:, An intervention to structure patient,key worker communication has been tested in a randomized controlled trial. The aim of this paper was to investigate effectiveness of the intervention in terms of moderators of effectiveness. Method:, A total of 507 patients with schizophrenia were included. Moderators of effectiveness were investigated using two-way anovas. Results:, Patients with a better relationship with their key worker and a shorter duration of illness at baseline benefited more from the intervention in terms of quality of life. Patients who received the intervention who were in competitive employment or had a shorter duration of illness showed greater reduction of unmet needs. Older patients receiving the intervention had better treatment satisfaction. Conclusion:, Outcome of the intervention was moderated by patient characteristics. Moreover, the moderating characteristics varied depending on the specific outcome. Evidence on moderators is very limited, even though, they are significant for understanding, targeting and implementing complex interventions. [source]

The Elements of Rationality and Chance in the Choice of Human Action

JOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 4 2004
ERNEST KRAUSZ
The focus in this paper is on deliberate human action. The central questions addressed are: whether purely rational choice is possible; whether choices may be induced by chance alone; or whether there is always a mixture of rationality and chance, as well as other factors such as habit, emotion, imitation and irrationality. The approach is a factualist one, upholding the view that, although human action can be explained by its antecedents, this is not incompatible with the notion of "free choice". It is the actual choosing process that determines the final choice of action. Whatever the sources of the elements involved in the choosing process, the choice of action is a specific outcome created by the acting agent. It is in this choosing process and decision making that both rationality and chance enter. The conclusion is that rationality is the element which links intentionality with goal seeking and attainment, but that the actual choice is determined by a complex interactive process in which both logic and chance play a part. [source]

Predictive models of toxicity with external radiotherapy for prostate cancer,

CANCER, Issue S13 2009
Clinical issues
Abstract The objective of the current study was to analyze the state of the art and present limitations of available predictive clinical models (when available) estimating the risk of genitourinary tract and small bowel complications, erectile dysfunction, and acute and late symptoms of the rectal syndrome caused by prostate cancer external irradiation. An analysis of the literature indicated that very limited attention has been devoted to the development of "integrated," patient-tailored, user-friendly, and clinically usable tools for the prediction of external beam radiotoxicity. In this article, the authors reported on the multivariate correlation between late genitourinary and gastrointestinal toxicities and clinical/dosimetric risk factors, as well as on the first set of nomograms developed to predict acute and late rectal side effects. At the present state of knowledge, the use of nomograms as predictive instruments of radiotoxicity appears to be particularly attractive for several main reasons. They are "user friendly" and easily developed using the results of multivariate analyses, as they weigh the combined effects of multiple independent factors found to be correlated with the selected clinical endpoint. The integrated evaluation of clinical and dosimetric parameters in the single patient can help to provide a tailored probability of the specific outcome considered. Predicting a high probability of toxicity could avoid unnecessary daily costs for the individual patient in terms of quality of life modification during and after treatment, helping patients in the decision-making process of choosing the best individual, quality of life,related treatment, and clinicians in better tailoring the treatment to patient's characteristics. Cancer 2009;115(13 suppl):3141,9. © 2009 American Cancer Society. [source]

Beyond breaking bad news

CANCER, Issue 2 2008
The roles of hope, hopefulness
Abstract BACKGROUND. Hope is important to patients, yet physicians are sometimes unsure how to promote hope in the face of life-threatening illness. ANALYSIS. Hope in medicine is of two kinds: specific (hope for specific outcomes) and generalized (a nonspecific sense of hopefulness). At the time of diagnosis of a life-ending condition, the specific goal of a long life is dashed, and there may be no medically plausible specific outcome that the patient feels is worth wishing for. Yet the physician may nonetheless maintain an open-ended hopefulness that is compatible with the physician's obligation to be truthful; this hopefulness can help sustain patient and family through the turbulent period of adaptation to the unwelcome reality of major illness. As this adaptation evolves, the physician can help patients and families adapt to suffering and loss of control by selecting and achieving specific goals such as improvement of the patient's environment in hospital or hospice, pain control, and relief of sleeplessness. Thus hope for specific (but far more modest) future events can again become a positive part of the patient s emotional landscape. The authors do not propose that physicians remain upbeat no matter the circumstance, for they must respect the constraints of reality and the patients' mortality. However, physicians can provide both cognitive and affective support as patients learn how to adapt. Hope and hopefulness are both important in this process. SUMMARY. Hope is always important to patients. Physicians can and should promote hopefulness without endorsing unrealistic hope. Cancer 2008. © 2008 American Cancer Society. [source]

Patient-Reported Outcomes with Botulinum Toxin Type A Treatment of Glabellar Rhytids: A Double-Blind, Randomized, Placebo-Controlled Study

DERMATOLOGIC SURGERY, Issue 2007
FACS, STEVEN FAGIEN MD
BACKGROUND Global patient-reported outcomes do not evaluate specific aspects of treatment that are important to patients. OBJECTIVE The objective was to evaluate self-perception of age and specific outcomes that are important to patients receiving botulinum toxin type A or placebo for moderate to severe glabellar lines (using the Facial Line Outcomes Questionnaire to assess how much facial lines bother them, make them look older, detract from their facial appearance, prevent a smooth facial appearance, and make them look tired, stressed, or angry). METHODS AND MATERIALS In the double-blind phase of this 12-week study, 70 patients were randomly assigned to treatment with 20 U botulinum toxin type A (BOTOX Cosmetic) or placebo. At Week 4, those still with moderate or severe glabellar lines were offered open-label 20 U botulinum toxin type A. RESULTS Median glabellar line severity was significantly lower after botulinum toxin treatment than after placebo. Compared with placebo, botulinum toxin also resulted in significantly superior patient assessments and a greater proportion of patients considering they looked younger than their current age. CONCLUSIONS Botulinum toxin type A can achieve specific goals of treatment that are important to patients and help them feel that they look younger than their current age. [source]

Effectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart disease

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2005
Tamara Page RN BN HyperbaricNursCert GradDipNSc(HighDep) MNSc
Executive summary Background, Coronary heart disease is the major cause of illness and death in Western countries and this is likely to increase as the average age of the population rises. Consumers with established coronary heart disease are at the highest risk of experiencing further coronary events. Lifestyle measures can contribute significantly to a reduction in cardiovascular mortality in established coronary heart disease. Improved management of cardiac risk factors by providing education and referrals as required has been suggested as one way of maintaining quality care in patients with established coronary heart disease. There is a need to ascertain whether or not nurse-led clinics would be an effective adjunct for patients with coronary heart disease to supplement general practitioner advice and care. Objectives, The objective of this review was to present the best available evidence related to nurse-led cardiac clinics. Inclusion criteria, This review considered any randomised controlled trials that evaluated cardiac nurse-led clinics. In the absence of randomised controlled trials, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Participants were adults (18 years and older) with new or existing coronary heart disease. The interventions of interest to the review included education, assessment, consultation, referral and administrative structures. Outcomes measured included adverse event rates, readmissions, admissions, clinical and cost effectiveness, consumer satisfaction and compliance with therapy. Results, Based on the search terms used, 80 papers were initially identified and reviewed for inclusion; full reports of 24 of these papers were retrieved. There were no papers included that addressed cost effectiveness or adverse events; and none addressed the outcome of referrals. A critical appraisal of the 24 remaining papers identified a total of six randomised controlled trials that met the inclusion criteria. Two studies addressed nurse-led clinics for patients diagnosed with angina, one looked at medication administration and the other looked at educational plans. A further four studies compared secondary preventative care with a nurse-led clinic and general practitioner clinic. One specifically compared usual care versus shared care introduced by nurses for patients awaiting coronary artery bypass grafting. Of the remaining three studies, two have been combined in the results section, as they are an interim report and a final report of the same study. Because of inconsistencies in reporting styles and outcome measurements, meta-analysis could not be performed on all outcomes. However, a narrative summary of each study and comparisons of specific outcomes assessed from within each study has been developed. Although not all outcomes obtained statistical significance, nurse-led clinics were at least as effective as general practitioner clinics for most outcomes. Recommendations, The following recommendations are made: ,The use of nurse-led clinics is recommended for patients with coronary heart disease (Level II). ,Utilise nurse-led clinics to increase clinic attendance and follow-up rates (Level II). ,Nurse-led clinics are recommended for patients who require lifestyle changes to decrease their risk of adverse outcomes associated with coronary heart disease (Level II). [source]

Using effectiveness studies for prescribing research, part 2

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2002
N. Freemantle PhD
Summary Trials that consider the effects of interventions on prescribing behaviour amongst clinicians often have complex design implications resulting in data that has inherent hierarchical structure. It follows that both experimental design and analysis plans must account for this structure and thus results should be considered in terms of clinician behaviour rather than individual patient response. We describe this change in perspective and the necessity for using statistical techniques that allow incorporation of potential confounding effects. We also discuss the appropriateness of some specific outcomes in relation to these trials. [source]

Relationships between Australian real estate and stock market prices,a case of market inefficiency

JOURNAL OF FORECASTING, Issue 3 2002
John Okunev
Abstract This paper explores the relationship between the Australian real estate and equity market between 1980 and 1999. The results from this study show three specific outcomes that extend the current literature on real estate finance. First, it is shown that structural shifts in stock and property markets can lead to the emergence of an unstable linear relationship between these markets. That is, full-sample results support bi-directional Granger causality between equity and real estate returns, whereas when sub-samples are chosen that account for structural shifts the results generally show that changes within stock market prices influence real estate market returns, but not vice versa. Second, the results also indicate that non-linear causality tests show a strong unidirectional relationship running from the stock market to the real estate market. Finally, from this empirical evidence a trading strategy is developed which offers superior performance when compared to adopting a passive strategy for investing in Australian securitized property. These results appear to have important implications for managing property assets in the funds management industry and also for the pricing efficiency within the Australian property market. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Health economics of asthma: assessing the value of asthma interventions

ALLERGY, Issue 12 2008
J. D. Campbell
The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0,100). Six studies (15%) had quality category 2, 26 studies (65%) achieved quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. [source]

Measuring outcomes in a longitudinal birth cohort

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2009
Jean Golding
Longitudinal studies are often focussed on specific outcomes to address predetermined hypotheses. Nevertheless, many discoveries have been made with data collected that were not part of the original design. Measurement of a broad range of outcomes is therefore important. Here we describe examples of the types of outcome that a birth cohort should collect, with emphasis on accuracy. We emphasise the use of continuous traits as well as of dichotomous outcomes, using a variety of examples. [source]

Anonymous non-response analysis in the ABCD cohort study enabled by probabilistic record linkage

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2009
M. Tromp
Summary Selective non-response is an important threat to study validity as it can lead to selection bias. The Amsterdam Born Children and their Development study (ABCD-study) is a large cohort study addressing the relationship between life style, psychological conditions, nutrition and sociodemographic background of pregnant women and their children's health. Possible selective non-response and selection bias in the ABCD-study were analysed using national perinatal registry data. ABCD-study data were linked with national perinatal registry data by probabilistic medical record linkage techniques. Differences in the prevalence of relevant risk factors (sociodemographic and care-related factors) and birth outcomes between respondents and non-respondents were tested using Pearson chi-squared tests. Selection bias (i.e. bias in the association between risk factors and specific outcomes) was analysed by regression analysis with and without adjustment for participation status. The ABCD non-respondents were significantly younger, more often non-western, and more often multiparae. Non-respondents entered antenatal care later, were more often under supervision of an obstetrician and had a spontaneous delivery more often. Non-response however, was not significantly associated with preterm birth (odds ratio 1.10; 95% CI 0.93, 1.29) or low birthweight (odds ratio 1.16; 95% CI 0.98, 1.37) after adjustment for sociodemographic risk factors. The associations found between risk factors and adverse pregnancy outcomes were similar for respondents and non-respondents. Anonymised record linkage of cohort study data with national registry data indicated that selective non-response was present in the ABCD-study, but selection bias was acceptably low and did not influence the main study questions. [source]

Self-Regulation and Its Relations to Adaptive Functioning in Low Income Youths

AMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 1 2009
John C. Buckner PhD
Most studies of self-regulation involving children have linked it to specific outcomes within a single domain of adaptive functioning. The authors examined the association of self-regulation with a range of indices of adaptive functioning among 155 youth ages 8,18 years from families with very low income. Controlling for other explanatory variables, self-regulation was strongly associated with various outcome measures in the areas of mental health, behavior, academic achievement, and social competence. The authors also contrasted youths relatively high and low in self-regulation (the top and bottom quartiles). Youths with good self-regulation had much better indices of adaptive functioning across measures of social competence, academic achievement, grades, problem behaviors, and depression and anxiety than their counterparts with more diminished self-regulatory capacities. In addition, youths with better self-regulation skills stated more adaptive responses both in terms of how they coped with past stressful live events and how they would deal with hypothetical stressors. This study indicates that self-regulation is robustly associated with a range of important indices of adaptive functioning across many domains. Findings are discussed in light of their implications for theory and intervention for children of diverse economic backgrounds. [source]

Assessment of treatment response in mania: commentary and new findings

BIPOLAR DISORDERS, Issue 2 2003
Ross J Baldessarini
Background:, Assessment of therapeutic interventions in bipolar disorder is complicated by rapid, complex clinical changes, high placebo-response rates, and varying times to specific levels of clinical recovery that may not be adequately reflected in averaged rating-scale scores particularly in acute mania, calling for improved methods to evaluate treatment responses. Chengappa et al. (1) propose operational criteria for specific outcomes based on rating-scale data from two placebo-controlled trials of olanzapine in mania. Methods:, These trials and other recent research were considered in commenting on the design, conduct, analysis and interpretation of experimental therapeutic trials in mania and to optimize olanzapine versus placebo contrasts by systematically varying end-point criteria for mania (YMRS) and depression (HDRS) ratings. Results:, Olanzapine versus placebo responses were optimally separated at scores of 10 for final paired mania and depression ratings, or 5 for each rating scale considered separately. Conclusions:, Use of empirically determined end-points derived from standard rating scales used in experimental therapeutics research in mood disorders can improve both outcome-assessment and separation of active treatment from placebo responses in acute mania. [source]