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Ultimate Outcome (ultimate + outcome)
Selected AbstractsHyponatremia and Heart Failure,Treatment ConsiderationsCONGESTIVE HEART FAILURE, Issue 1 2006Domenic A. Sica MD Hyponatremia as it occurs in the heart failure patient is a multifactorial process. The presence of hyponatremia in the heart failure patient correlates with both the severity of the disease and its ultimate outcome. The therapeutic approach to the treatment of hyponatremia in heart failure has traditionally relied on attempts to improve cardiac function while at the same time limiting fluid intake. In more select circumstances, hypertonic saline, loop diuretics, and/or lithium or demeclocycline have been used. The latter two compounds act by retarding the antidiuretic effect of vasopressin but carry with their use the risk of serious renal and/or cardiovascular side effects. Alternatively, agents that selectively block the type 2 vasopressin receptor increase free water excretion without any of the adverse consequences of other therapies. Conivaptan, lixivaptan, and tolvaptan are three such aquaretic drugs. Vasopressin receptor antagonists will redefine the treatment of heart failure-related hyponatremia and may possibly evolve as adjunct therapies to loop diuretics in diuretic-resistant patients. [source] Alternative approaches can greatly reduce the number of fish used for acute toxicity testingENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 5 2006Conny C. Hoekzema Abstract Acute toxicity tests with algae, daphnids, and fish are required for the classification and environmental risk assessment of chemicals. The degree of risk is determined by the lowest of these acute toxicity values. Many ecotoxicological programs are seeking to reduce the numbers of fish used in acute toxicity testing. The acute threshold test is a recently proposed strategy that uses, on average, only 10 (instead of 54) fish per chemical. We examined the consequences of reducing the number of fish used in toxicity testing on the ultimate outcome of risk assessments. We evaluated toxicity data sets for 507 compounds, including agrochemicals, industrial chemicals, and pharmaceuticals from our internal database. Theoretical applications of the acute threshold test gave similar results to those obtained with the standard fish median lethal concentration (LC50) test but required only 12% as many fish (3,195 instead of 27,324 fish used for all compounds in the database). In 188 (90%) of the 208 cases for which a complete data set was available, the median effect concentration for algae or daphnids was lower than the LC50 for fish. These results show that replacement of the standard fish LC50 test by the acute threshold test would greatly reduce the number of fish needed for acute ecotoxicity testing without any loss of reliability. [source] Salvage treatment for recurrent oropharyngeal squamous cell carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2010Christof Röösli MD Abstract Background. This study evaluates the oncological outcome of patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after primary radiation therapy ± chemotherapy, primary surgical therapy, and surgical therapy followed by radiation therapy ± chemotherapy. Methods. A total of 156 patients (36%) of a cohort of 427 treated for OPSCC between 1990 and 2006 developed recurrent disease. Fifty-one patients (12%) qualified for salvage treatment. Study endpoints were 5-year overall survival (OS) and disease-specific survival (DSS). Results. The 5-year OS and DSS rates after salvage treatment were 29% and 40%; after initial primary radiation therapy, 25% and 40%; after initial surgery followed by radiation therapy, 40% and 40%; and after initial surgery alone, 20% and 40%. Conclusions. Patients with an advanced OPSCC have a considerable risk for recurrence. Despite poor ultimate outcome, salvage treatment should be attempted in patients with resectable disease, good performance status, and absence of distant metastases. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source] Capacity building: A concept analysis of the term applied to researchINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2007Sarah L Condell RGN RM RNT BNS MA Recent policy developments in Ireland have led to a focus on research capacity building as a means of consolidating nurse and midwifery education in the Irish academic setting. This follows similar initiatives in the United Kingdom and Australia. However, sparse literature and a lack of clarity of the term ,research capacity building' leads to some confusion. A concept analysis using Rodgers' framework was conducted. The literature examined included ,grey' literature, policy documents and indexed papers across a range of disciplines, derived from CINAHL/PubMed searches. The concept of research capacity building was deemed to imply a funded, dynamic intervention operationalized through a range of foci and levels to augment ability to achieve objectives in the research field over the long-term, with aspects of social change as an ultimate outcome. This is presented as an interim statement because of the evolutionary nature of the concept and the limitations of the exercise. [source] The lure of choiceJOURNAL OF BEHAVIORAL DECISION MAKING, Issue 4 2003Nicola J. Bown Abstract We report three studies demonstrating the ,lure of choice' people prefer options that allow them to take further choices over those that do not, even when the extra choices cannot improve the ultimate outcome. In Studies 1 and 2, participants chose between two options: one solitary item, and a pair of items between which they would then make a further choice. Consistent with the lure of choice, a given item was more likely to be the ultimate choice when it was initially part of a choice pair than when it was offered on its own. We also demonstrate the lure of choice in a four-door version of the Monty Hall problem, in which participants could either stick with their original choice or switch to one of two unopened doors. Participants were more likely to switch if they could first ,choose to choose' between the two unopened doors (without immediately specifying which) than if they had to choose one door straightaway. We conclude by suggesting that the lure of choice is due to a choice heuristic that is very reliable in the natural world, but much less so in a world created by marketers. Copyright © 2003 John Wiley & Sons, Ltd. [source] A Prospective Ten-Year Clinical Trial of Porcelain VeneersJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 2 2006Article first published online: 25 APR 200 abstract Objective:, The purpose of this prospective clinical study was to evaluate the performance of porcelain veneers after 5 and 10 years of clinical service. Materials and Methods:, A single experienced clinician placed 87 porcelain veneers in 25 patients in 1990 and 1991. The teeth included maxillary central incisors to first premolars. As described in the 5-year report of this study, preparations included a chamfer margin, 0.3 to 0.7 mm labial enamel reduction, and incisal edge coverage. A single laboratory technician fabricated the veneers using feldspathic porcelain on refractory dies. Internal surfaces were etched with 5% hydrofluoric acid and silanated. Teeth were isolated with a rubber dam prior to veneer placement. All veneers were bonded with a light-activated resin cement. Patients were recalled at 5 to 6 years and at 10 years after initial veneer placement. Two evaluators examined each veneer for retention, fractures, color match, surface roughness, marginal adaptation, leakage, recurrent caries, pulp vitality, and patient satisfaction. Marginal adaptation was assessed further using scanning electron microscopy to examine epoxy replicas. Results:, Five years after placement, all 87 veneers remained in place and had "perfect" color match and surface smoothness. Four veneers had fractures, but only one of those required repair. Ninety-nine percent of the veneers had clinically acceptable marginal adaptation, although just 14% of the veneers had "perfect" marginal adaptation at all margins. One had clinically unacceptable staining from leakage. Recurrent caries was present at the proximal margin of two veneers. At the 10-year evaluation, which had a 93% recall rate, color match and surface roughness remained optimal. Thirteen of 22 patients were very satisfied with the esthetic result, whereas 7 complained of minor esthetic problems. The fracture rate increased substantially, to 34% at the 10-year recall. However, only 11% of the fractures were clinically unacceptable. None of the veneers had debonded, but the percentage of veneers with "perfect" marginal adaptation had declined to only 4%. Leakage was now evident around two-thirds of the veneers, and eight restorations had recurrent caries. Conclusion:, Porcelain veneers are a reliable and effective means for conservative esthetic treatment of anterior teeth in the long term. After 10 years of clinical service, esthetic results remained good, patient satisfaction was high, and the retention rate was excellent. The number of irreparable fractures was low. Appropriate preparation design, occlusion, and use of adhesive materials contribute to the ultimate outcome. [source] Outcome following removal of canine spindle cell tumours in first opinion practice: 104 casesJOURNAL OF SMALL ANIMAL PRACTICE, Issue 11 2009D. Chase Objectives:To define the outcome of a cohort of canine patients with a histological diagnosis of spindle cell tumour of soft tissue managed solely by surgery in first opinion practice. Methods:Clinical details of 104 spindle cell sarcomas submitted to Finn Pathologists during the year 2000 were reviewed. Questionnaires were sent to the submitting veterinarians, requesting details about the tumour, surgery performed and ultimate outcome of the patient. Results:The method of surgical resection was described as marginal in 45 dogs (44·2 per cent). Excision margins of 3 cm or more were described in less than 10 per cent of cases. Tumours recurred locally in 29 dogs (27·9 per cent). Eighteen dogs (21·7 per cent) died of tumour-related causes. Most deaths were unrelated to sarcoma (50 dogs, 60·2 per cent) or unknown (15 dogs, 18 per cent). The median survival time was 1013 days. Tumour size, location or degree of surgical resection were not significantly related to survival or tumour recurrence. A palpable assessment of tumour invasion into underlying tissues was significantly associated with decreased disease-free interval (P<0·0001) and survival time (P = 0·0070). Clinical Significance:The results of this retrospective study indicate that many spindle cell tumours managed in first opinion practice exhibit a low-grade biological behaviour and may respond well to more conservative surgery than current recommendations advise. [source] Combinations of cytogenetics and international scoring system can predict poor prognosis in multiple myeloma after high-dose chemotherapy and autologous stem cell transplantation,AMERICAN JOURNAL OF HEMATOLOGY, Issue 5 2009Yoshihiro Inamoto High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard therapy for newly diagnosed multiple myeloma. Combinations of recently proposed prognostic factors such as cytogenetics and international scoring system (ISS) may be useful to predict prognosis after ASCT. This study evaluated 60 consecutive patients who underwent ASCT in four institutes. The median age of patients was 57 years old. Cytogenetic analyses of bone marrow at diagnosis detected metaphase abnormalities in 9 of 51 patients and interphase abnormalities in six of 35 patients (17p13 deletion, t(4;14) and t(14;16)). Seventeen patients had ISS stage 3 at diagnosis. Twenty-five patients who had any of these risk factors were defined as high risk. All patients were conditioned with high-dose melphalan. With a median follow-up of 3.4 years, overall survival and event-free survival at 3 years were significantly worse in high-risk patients (48% vs. 97%; P = 0.0005 and 16% vs. 37%; P = 0.038, respectively) despite the higher CR plus VGPR rate among high-risk patients. In addition, survival at 1 year after progression was significantly worse in high-risk patients despite salvage chemotherapy containing thalidomide (32% vs. 100%, P = 0.0001). Combinations of cytogenetics and ISS could readily predict prognosis. Quality of response is a poor surrogate marker for ultimate outcome. High-risk patients may need more effective treatment. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] Chemopreventive Effect of Celecoxib in Oral Precancers and Cancers,THE LARYNGOSCOPE, Issue 10 2006Lining Feng PhD Abstract Objectives: Oral cancer has become an important health care problem in many countries. Because this disease develops slowly, early detection and intervention can greatly affect ultimate outcome. Celecoxib is a cyclooxygenase-2 inhibitor with significantly less toxicity. This study investigated the possibility of using it for chemoprevention of oral cancer at the early stages. Study Design: Randomized animal study. Methods: Dysplastic lesions were induced in the buccal pouches of 47 hamsters by a 5 week painting of 9,10-dimethl-1,2-benzanthrancene (DMBA). Basal diets or diets containing 500 or 1,500 ppm of Celecoxib were orally given for 7 weeks. The T50 (50% incidence; i.e., the time to appearance of tumors in 50% of the hamsters) was observed, and volume of tumors was measured on day 1, 9, 19, 28, 35, and 48 with the Celecoxib treatment. Results: The T50 was 9, 19, and 28 days with the treatment in the control group, in the 500 ppm group, and in the 1,500 ppm group, respectively. It indicated that the Celecoxib treatment could delay progression of early lesion. The tumor measurement showed that this treatment was also effective in delaying tumor growth in both treatment groups. There was a difference in the treatment efficacy between the 500 ppm and 1,500 ppm of Celecoxib, indicating a dose-dependent efficacy. Conclusions: Celecoxib is effective in delaying onset of early lesions induced by DMBA and in slowing growth of the tumors in hamster cheek pouches during the postinitiation stage. Its treatment efficacy appears to be dose dependent. [source] The immunopathogenesis of periodontal diseaseAUSTRALIAN DENTAL JOURNAL, Issue 2009EJ Ohlrich Abstract Treatment planning in periodontics, as with any disease, must be based on an understanding of the aetiology and pathogenesis of the disease. In this context, it has slowly become recognized over the past three decades that while plaque is the cause of the disease, it is the innate susceptibility of the host that determines the ultimate outcome of the disease process. Innate susceptibility, in turn, is determined by the nature of the immune response to the specific periodontopathic complexes comprising the plaque biofilm. The aim of this review was to examine current understanding of the immunopathogenesis of chronic periodontitis with respect to its possible clinical implications in terms of treatment planning and risk assessment. Numerous studies have demonstrated that the periodontitis lesion itself involves predominantly B cells and plasma cells, while the gingivitis lesion is primarily a T cell mediated response. This led to the concept over 30 years ago that the development of periodontitis involves a switch from a T cell lesion to one involving large numbers of B cells and plasma cells. It is also well recognized that control of this shift is mediated by a balance between the so-called Th1 and Th2 subsets of T cells, with chronic periodontitis being mediated by Th2 cells. More recently, T regulatory (Treg) and Th17 cells have been demonstrated in periodontal tissues, raising the possibility that these cells are also important in the immunoregulation of periodontal disease. The clinical implications of these observations can be seen in the fact that identification of Th1/Th2 and Treg/Th17 cytokine gene expression in the peripheral blood and salivary transcriptomes is now being trialled as a possible marker of disease susceptibility. If this proves to be the case, a chairside salivary diagnostic could be developed within the next five to 10 years. [source] Individual Ministerial Responsibility During the Howard Years: 1996,2007AUSTRALIAN JOURNAL OF POLITICS AND HISTORY, Issue 2 2008Luke Raffin Upon winning the 1996 election, John Howard became the first Australian prime minister to codify his understanding of individual ministerial responsibility by publishing A Guide on Key Elements of Ministerial Responsibility. This article examines how this ministerial code of conduct was applied to significant allegations of ministerial impropriety that occurred during the 1996,2007 Howard era, and highlights the relationship between the media, the Prime Minister's response and the ultimate outcome. It finds that Howard's early rigorous application of the Guide to allegations of conflicts of interest involved political pain and instigated its decline. Howard retreated, redefined ministerial responsibility as requiring deliberate wrongdoing and raised the threshold required for a minister's dismissal. His inability to firmly apply the Guide to instances of ministerial misconduct betrays the traditional view that ministers are responsible for their own actions. The contemporary practice is that ministers do not resign for departmental failures for which they are not personally responsible, irrespective of the gravity of that wrongdoing. [source] Joint Modelling of Repeated Transitions in Follow-up Data , A Case Study on Breast Cancer DataBIOMETRICAL JOURNAL, Issue 3 2005B. Genser Abstract In longitudinal studies where time to a final event is the ultimate outcome often information is available about intermediate events the individuals may experience during the observation period. Even though many extensions of the Cox proportional hazards model have been proposed to model such multivariate time-to-event data these approaches are still very rarely applied to real datasets. The aim of this paper is to illustrate the application of extended Cox models for multiple time-to-event data and to show their implementation in popular statistical software packages. We demonstrate a systematic way of jointly modelling similar or repeated transitions in follow-up data by analysing an event-history dataset consisting of 270 breast cancer patients, that were followed-up for different clinical events during treatment in metastatic disease. First, we show how this methodology can also be applied to non Markovian stochastic processes by representing these processes as "conditional" Markov processes. Secondly, we compare the application of different Cox-related approaches to the breast cancer data by varying their key model components (i.e. analysis time scale, risk set and baseline hazard function). Our study showed that extended Cox models are a powerful tool for analysing complex event history datasets since the approach can address many dynamic data features such as multiple time scales, dynamic risk sets, time-varying covariates, transition by covariate interactions, autoregressive dependence or intra-subject correlation. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Erythrocyte variants and the nature of their malaria protective effectCELLULAR MICROBIOLOGY, Issue 6 2005Gundula Min-Oo Summary The malaria threat to global health is exacerbated by widespread drug resistance in the Plasmodium parasite and its insect vector, and the lack of an efficacious vaccine. Infection with Plasmodium parasites can cause a wide spectrum of pathologies, from a transient mild form of anaemia to a severe and rapidly fatal cerebral disease. Epidemiological studies in humans and experiments in animal models have shown that genetic factors play a key role in the onset, progression, type of disease developed and ultimate outcome of malaria. The protective effect of polymorphic variants in erythrocyte-specific structural proteins or metabolic enzymes against the blood-stage of the disease is one of the clearest illustrations of this genetic modulation, and has suggested co-evolution of the Plasmodium parasite with its human host in areas of endemic disease. Here, we present a brief overview of erythrocyte polymorphisms with biological relevance to malaria pathogenesis, and current work on the mechanism(s) by which these mediate their protective effect. The recent addition of erythrocyte pyruvate kinase to this group of protective genes will also be discussed. [source] Free Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic PregnancyACADEMIC EMERGENCY MEDICINE, Issue 8 2007Chris Moore MD BackgroundEctopic pregnancies are frequently present in women who present to the emergency department with pregnancy and abdominal pain or bleeding, a subset of whom may require operative intervention. ObjectivesTo prospectively determine if emergency physician (EP)-performed transabdominal pelvic ultrasonography (US) with determination of free abdominal fluid in the hepatorenal space predicted the need for operative intervention. MethodsPatients who were suspected to have an ectopic pregnancy were prospectively enrolled over a ten-month period. An EP-performed bedside transabdominal pelvic US that included a view of the hepatorenal space (Morison's pouch) for free fluid. The EP US was classified as intrauterine pregnancy (IUP) or no definitive IUP, with Morison's pouch classified as positive or negative. The majority of patients had a subsequent transvaginal pelvic US performed by the Department of Radiology. Patients were followed up for radiology results, need for operative intervention, and ultimate outcome of the pregnancy. ResultsThere were 242 patients enrolled, with an average time to complete the EP US of 4 minutes and 27 seconds. There were 28 ectopic pregnancies diagnosed (11.6%), of which 18 patients underwent operative intervention. Free fluid in Morison's pouch was identified in ten patients, nine of whom underwent operative intervention, yielding a positive likelihood ratio of 112 (95% confidence interval = 15 to 831) for patients with suspected ectopic pregnancy who required operative intervention. ConclusionsFree intraperitoneal fluid found in Morison's pouch in patients with suspected ectopic pregnancy may be rapidly identified at the bedside by EP-performed US and predicts the need for operative intervention. [source] Rehospitalization of very preterm infantsACTA PAEDIATRICA, Issue 10 2004LAA Kollée Rehospitalization rates of very preterm infants because of reasons that are related to neonatal morbidity states can be decreased with further improvement of neonatal intensive care provided. Conclusion: Analysis of rehospitalization data should be included in follow-up programmes as a contribution to the development of strategies to improve neonatal care and the ultimate outcome for very-low-birthweight infants. [source] | |||||||||||||