Descriptive Study Of Outcome Research Articles

Pregnancy outcomes in women with imported malaria in mainland France: A retrospective study from 2004 to 2014

ObjectivesThere is little data on pregnant women with imported malaria in high-income countries, especially regarding offspring outcomes. We wanted to determine pregnancy outcomes of imported malaria in pregnant women in mainland France. Patients and methodsWe conducted a retrospective, descriptive study of outcomes in pregnant women hospitalized with malaria from 2004 to 2014 in two regions of mainland France. An adverse outcome was defined as a miscarriage, stillbirth, preterm birth (<35 weeks of gestation), low birth weight (LBW) defined as less than 2500 g, or congenital malaria. ResultsOf 60 pregnancies, 5 were excluded because of elective abortions; 55 were investigated, of which 11 were primigravidae and 44 multigravidae. Pregnancies were singleton (n = 51) or twin (n = 4). Mean age was 30.4 years (range:19–45 y). Among the 55 cases, 9 ended in a miscarriage (8 singletons and 1 twin pregnancy) and 1 had a stillbirth at 21 weeks of gestation, all immediately after the malarial episode. 45 gave birth (29 vaginal deliveries and 16 caesarean sections) to 48 (42 singletons and 6 twins) newborns. Amongst these, 30 were healthy full-term newborns, 10 had LBW, and 8 were preterm. Overall, 26 of 55 (47.3%) pregnancies, and 29 of 59 (49.2%) offsprings had adverse outcomes. Compared to singleton pregnancies, twin pregnancies were associated with adverse outcomes (p = 0.0438). ConclusionsImported malaria has a severe impact on pregnancy outcomes. Prevention and management of imported malaria in pregnancy should be optimized.

A preliminary evaluation of the effectiveness of dialectical behaviour therapy in a forensic psychiatric setting.

Dialectical behaviour therapy (DBT) is a therapy model incorporating elements of Eastern philosophies and cognitive behavioural principles. Originally designed for people struggling with chronic suicidality and borderline personality disorder (BPD), it has been adapted to treat complex, multi-diagnostic presentations, such as those in forensic mental health settings. To date, there has been little evaluation when the primary diagnosis is of psychosis. To explore the effectiveness of DBT, with patients, with multiple comorbidities, including psychosis, in a forensic psychiatric inpatient setting. A descriptive outcome study with a cohort of offender-patients in one specialist forensic mental health unit. Before and after treatment change scores were compared on anger, aggression, hopefulness, coping abilities, emotional intelligence, insight and subjective symptom severity scales, as well as staff-rated risk, and length of stay. Nine men and five women residents in one Canadian secure hospital completed a standard DBT programme, and self-ratings, over about 1 year. Scale scores indicated significantly increased insight and acknowledgment of problems. Apparently increased anger and vengeance scores were clinically associated. Independent staff ratings indicated reductions in risk and most patients achieved early release. This study provides support for extension of the use of DBT to offender-patients with psychosis among the complex mix in their presentation. It suggests that a randomised controlled trial with cost-benefit analysis is warranted, as well as further work, to promote understanding of mechanisms of effectiveness.

Descriptive study of outcome of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of weight bearing long bones

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Infected non-union of tibia and femur is a debilitating disorder for patient as well as challenging task for treating surgeon. Conventionally treatment of infected non-union is a two staged procedure. But antibiotic cement-impregnated intramedullary nailing (ACIINs) is a single staged and cost-effective procedure. Hence we intended to study the outcome of ACIIN use in infected non-union of tibia and femur.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a hospital based prospective case series type of descriptive study conducted in Department of Orthopedics, SMS Medical College and Hospital, Jaipur. We studied 35 cases of infected non-union of femur and tibia fracture with interlock nail in situ. All patients were treated with interlock nail removal, debridement and freshening of sclerosed bony ends and fixation with ACIIN. All were followed for at least 6 months for infection control and bony union and final results were evaluated by Paley’s bony criteria and functional criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Infection was controlled in 94.28% cases. Bony union was achieved in 88.57% cases (19 femur and 12 tibia). Average duration for bony union was 7.3 months for femur and 8 months for tibia. According to Paley’s criteria for bony outcome and functional outcome 65.71% and 51.43% had shown excellent outcome respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ACIIN is a good modality for treatment of infected non union of tibia and femur in terms of infection control and bony union and has a good functional outcome when bone gap is less.&lt;/p&gt;

Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis.

Background:Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown.Objectives:We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario.Methods:We conducted a descriptive study of outcomes and home palliative care use by Ontario residents maintained on chronic dialysis using multiple provincial healthcare datasets. The period of study was the final year of life, for those died between January 2010 and December 2014.Results:We identified 9611 patients meeting inclusion criteria. At death, patients were (median [Q1, Q3] or %): 75 (66, 82) years old, on dialysis for 3.0 (1.0-6.0) years, 41% were women, 65% had diabetes, 29.6% had dementia, and 13.9% had high-impact neoplasms, and 19.9% had discontinued dialysis within 30 days of death. During the last year of life, 13.1% received ⩾1 home palliative services. Compared with patients who had no palliative services, those who received home palliative care visits had fewer emergency department and intensive care unit visits in the last 30 days of life, more deaths at home (17.1 vs 1.4%), and a lower frequency of deaths with an associated intensive care unit stay (8.1 vs 37.8%).Conclusions:Only a small proportion of patients receiving dialysis in Ontario received support through the home palliative care system. There appears to be an opportunity to improve palliative care support in parallel with dialysis care, which may improve patient, family, and health-system outcomes.

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy.

A comprehensive child death review (CDR) program was introduced in England and Wales in 2008, but as yet data have only been analyzed at a local level, limiting the learning from deaths. The aim of this study is to describe the profile of causes and risk factors for sudden unexpected death in infancy (SUDI) as determined by the new CDR program. This was a descriptive outcome study using data from child death overview panel Form C for SUDI cases dying during 2010-2012 in the West Midlands region of England. The main outcome measures were: cause of death, risk factors and potential preventability of death, and determination of deaths probably due to unintentional asphyxia. Data were obtained for 65/70 (93%) SUDI cases. 20/65 (31%) deaths were initially categorized as due to medical causes; 21/65 (32%) as SIDS; and 24/65 (37%) as undetermined. Reanalysis suggested that 2/21 SIDS and 7/24 undetermined deaths were probably due to unintentional asphyxia, with 6 of these involving co-sleeping and excessive parental alcohol consumption. Deaths classified as "undetermined" had significantly higher total family and environmental risk factor scores (mean 2.6, 95% CI 2.0-3.3) compared to those classified as SIDS (mean 1.6, 95% CI 1.2-1.9), or medical causes for death (mean 1.1, 95% CI 0.8-1.3). 9/20 (47%) of medical deaths, 19/21 (90%) SIDS, and 23/24 (96%) undetermined deaths were considered to be potentially preventable. There were inadequacies in medical provision identified in 5/20 (25%) of medically explained deaths. The CDR program results in detailed information about risk factors for SUDI cases but failed to recognize deaths probably due to unintentional asphyxia. The misclassification of probable unintentional asphyxial deaths and SIDS as "undetermined deaths" is likely to limit learning from these deaths and inhibit prevention strategies. Many SUDI occurred in families with mental illness, substance misuse and chaotic lifestyles and most in unsafe sleep environments. This knowledge could be used to better target safe sleep advice for vulnerable families and prevent SUDI in the future.

G459(P) Improving the investigation of unexpected infant deaths

Aims Since 2008, in England, all unexpected infant deaths must be investigated jointly by police, health and social services. This study aims to learn of bereaved parents’ and professionals’ experiences of this joint agency approach (JAA) as well as assess the effectiveness of the JAA in determining causes and risk factors for deaths and use this knowledge to improve professional practice. Methods A mixed methods study of JAA investigation of SUDI cases in one English region; involving case note analysis, questionnaires and in–depth interviews with bereaved parents and the relevant professionals. A descriptive study of outcomes of JAA SUDI investigation using Child Death Overview Panel (CDOP) data. Results 23/111 families were recruited giving theoretical saturation. The median time between infants’ deaths and parental study participation was 33 weeks; data collection took place between 2011–3. 25 professionals were interviewed. CDOP Form Cs were obtained for 65/70 (93%) SUDI cases dying during 2010–2. Non–specialist police often arrived at the parents’ home along with the ambulance; increasing parental distress. Parents felt that the JAA provided information about why their baby died but offered minimal emotional support. The joint home visit by police and paediatrician is a key investigative process and most parents found this helpful. Final case discussions were used to discuss relevant risk factors but not to determine the cause of death; in nearly all cases the final cause of death relied on post–mortem examination alone ignoring findings of death scene examinations. Many deaths fitted the diagnostic criteria for SIDS but despite this were labelled as unascertained. Social care were only involved in 13/23 JAA investigations, in two cases without involvement there were safeguarding concerns. Some Coroners were reluctant to share post–mortem examination reports with paediatricians preventing effective JAA investigations. Conclusion Ideally, SUDI investigations should be carried out only by specialist clinicians who do this work frequently and the JAA fully integrated with social care and Coroners’ investigations. There needs to be a clearer system for classifying unexplained SUDI. Police should reconsider their immediate response to SUDI; parents would like more follow–up and bereavement support from professionals.

Outcomes of traditional Chinese medicine (traditional acupuncture) treatment for people with long-term conditions

A set of outcome questionnaires has been developed to measure the range of treatment effects of traditional acupuncture. In this descriptive outcome study we validated these questionnaires in a busy National Health Service funded acupuncture clinic serving communities of diverse socio-economic circumstances. Some of the questionnaires performed better than others in this setting but EQ-5D and MYMOP-qual both showed statistically and clinically significant improvement in physical and psychological health after six weeks and six months, in all categories of disease and degrees of chronicity. Both the written qualitative data and the Patient Enablement Instrument (PEI) demonstrated considerable patient enablement and, for some patients, the acquisition of new coping and self-care strategies.The questionnaires were feasible to administer, acceptable to patients and clinic staff, and provided robust and detailed quantitative and qualitative outcome data of use for service provision, future planning, and as a basis for further cost-effectiveness studies.

Identifying patients unlikely to benefit from further chemotherapy: A descriptive study of outcome at each relapse in ovarian cancer

Objective Not all patients with relapsed ovarian cancer (EOC) benefit from further treatment and thus treatment should be selectively applied. Methods/patients A retrospective review of survival and response outcomes in 120 women with relapsed EOC, all treated at original diagnosis with surgery and platin plus paclitaxel, who had all their initial and subsequent relapse therapy carried out at the BCCA. Results In those patients selected for re-treatment upon relapse, lack of progression rates were 63%, 50%, 45%, 44%, 29%, and 20% respectively for first through sixth relapse. The corresponding median survivals from that relapse were 14, 10, 6, 7, 8, and 5 months. A predictive model based upon the length of the interval between the two preceding relapses (or diagnosis to 2nd relapse) predicted which patients would survive less than 6 months (patient defined “lack of benefit” to chemotherapy criterion): diagnosis to second relapse <12 months; first to third relapse <6 months; second to fourth <6 months; third to fourth <6 months, and fifth to sixth <6 months. Conclusion In selected patients, multiple episodes of re-treatment are of value. A time-based statistic identifies those who will not benefit, defined as survival less than 6 months.

Border screening for SARS in Australia: what has been learnt?

To assess the effectiveness of the Australian border entry screening program to detect arriving travellers with symptoms of severe acute respiratory syndrome (SARS). Descriptive study of outcomes of screening at Australian airports and seaports between 5 April 2003 and 16 June 2003. To determine the number of international travellers who were symptomatic on arrival in Australia but missed by screening, data were obtained on the number of arrivals screened and the number with symptoms (from the Australian Quarantine and Inspection Service [AQIS]), as well as the number of people investigated for SARS (from the Australian SARS Case Register). There were 1.84 million arrivals into Australia during the study period, and 794 were referred for screening to AQIS staff. Of these, the findings in four travellers were consistent with the World Health Organization case definition for SARS, and they were referred by the Chief Quarantine Officers to designated hospitals for further investigation. None of these people was confirmed to have SARS. One person reported as a probable SARS case acknowledged being symptomatic on arrival, but had been missed by border screening. The low identification rate was attributed to the low prevalence of SARS, the use of exit screening by affected countries, and the subjective measures used in the screening process. With current knowledge about SARS, border screening should focus on educating incoming travellers, especially groups at high risk of transmitting the disease (the elderly and those with underlying chronic illnesses). Objective screening measures should be used during SARS outbreaks to prevent importation of the disease.

Neurodevelopmental outcome of young pediatric intensive care survivors of serious brain injury.

To determine the number of children with severe brain injury due to closed head injury or hypoxic-ischemic encephalopathy as a proportion of all admissions of children <3 yrs of age in the regional pediatric intensive care unit; to determine the outcome of these children at >6 mos postinjury; and to explore the relationship of outcome measures to predictors of outcome obtained within the first 24 hrs after brain injury. Prospective, descriptive outcome study of an inception cohort. Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital, Edmonton, Canada. Of a cohort of 53 children of <3 yrs of age (4% of pediatric intensive care unit admissions, 1995-1998) admitted for severe acquired brain injury (Glasgow Coma Score, <or=8), 12 (23%) died, three (6%) were lost to follow-up, and 38 (71%) survived and received multidisciplinary outcome assessments. Of 50 children with known outcome, 23 (46%) had a good recovery on the Glasgow Outcome Scale; however, only eight (16%) of these had average or above scores on both the mental and motor developmental indices of the Bayley Scales of Infant Development-II at 18-36 mos of age. Acute injury predictors of adverse outcome were apnea at scene, bolus epinephrine given for resuscitation, pupils nonreactive, arterial pH <or=7.2, and Glasgow Coma Score of 3. For 38 survivors, sensitivity and specificity from predictors for the Glasgow Outcome Scale were 73% and 83% respectively; for mental scores, 86% and 93%; for motor scores, 75% and 89%. Of children of <3 yrs of age identified by a Glasgow Coma Score of <or=8 after acute brain injury, >80% have adverse outcome of death, disability, or mental or motor developmental scores below average. A Glasgow Outcome Scale of 5 overestimates good recovery. Universal registry and follow-up of these children are needed.

Scintimammography: an adjunctive test for the detection of breast cancer.

To describe the diagnostic utility of scintimammography in patients with a breast mass, including patients who have undergone previous breast surgery or radiotherapy. Descriptive outcome study. A university teaching hospital and a private hospital breast clinic in New South Wales. 115 consecutively referred women investigated by x-ray mammography and scintimammography before surgical excision biopsy of a breast mass. Sensitivity and specificity of x-ray mammography and scintimammography in the detection of breast cancer overall, and in women who had or had not undergone previous breast surgery. 44 (38%) patients had undergone previous breast surgery or external beam radiotherapy, including nine with bilateral silicone breast implants. The overall (n = 115) sensitivity for the detection of breast cancer with scintimammography was 84%, compared with 66% for x-ray mammography (P = 0.004), and the respective specificities were 84% and 67% (P = 0.194). For patients who had a history of previous breast surgery, the respective sensitivities of the two tests were 83% and 50% (P = 0.006), compared with 85% and 73% (P = 0.087) for patients who had had no previous surgery. Scintimammography offers additional diagnostic advantage in the detection of breast cancer in patients who have had previous breast surgery or local radiotherapy.

Residential treatment for youngsters with difficult-to-manage insulin dependent diabetes mellitus.

A descriptive outcome study of 52 children with insulin-dependent diabetes mellitus (IDDM) admitted to a residential treatment program over 6 years. Criteria for admission included repeated hospitalizations for diabetes-related problems, excessive school absences, and/or familial disruption. Residential treatment included individual, group, and family psychotherapy, diabetes education, and close medical supervision. The design included collection of data before, during and after treatment. Children admitted to the residential unit were compared to a population of pediatric IDDM outpatients from the same geographical area. Treatment was associated with a reduction in diabetes-related hospitalizations, improved school attendance, decreased glycosylated hemoglobin levels, weight gain, individualized insulin changes, improved knowledge about diabetes, and a normalization of attitudes towards this disease.

Race in the Treatment of Homeless Mentally Ill Veterans

A multi-site descriptive outcome study examined differences between black and white veterans in admission characteristics, program participation, and outcomes following an episode of treatment in a Veterans Affairs residential program for homeless veterans with psychiatric and substance abuse problems. Admission, discharge, and 6-month and 12-month postdischarge follow-up data were collected on 119 black and 144 white veterans admitted to the Domiciliary Care for Homeless Veterans Program at three sites. Chi-square tests and t-tests were used to identify differences between racial groups at admission. Factorial repeated-measures analysis of covariance was then used to identify differences between black and white veterans in improvement, controlling for differences that were significant at the time of admission. On admission, blacks were younger and had more problems with drugs and violent behavior, but were less likely than whites to have clinical diagnoses of alcohol abuse or a serious psychiatric disorder, and had fewer suicide attempts. They also had more social contacts and had more frequently experienced a recent disruption in an important relationship. Few differences were found between the two racial groups in measures of program participation. One year after discharge, both black and white veterans had improved in virtually all domains. Black veterans showed greater improvement in medical symptomatology, social contacts, and violence, while white veterans showed a greater increase in outpatient health service use. While both black and white veterans benefitted from participation in residential treatment, the data suggest that blacks were more likely to re-establish previously disrupted social ties while whites increased their involvement in the VA health care system.

Community-Based Home-Care Program for the Management of Pre-Eclampsia

OBJECTIVE: To evaluate the safety, acceptability and cost of a community-based home-care program for the management of mild pre-eclampsia. DESIGN: A descriptive study of outcomes between Apr. 1, 1985, and Dec. 31, 1989. SETTING: St. Boniface General Hospital, Winnipeg. PATIENTS: Urban Winnipeg residents between 27 and 40 weeks' gestation with mild pre-eclampsia who demonstrated acceptance and compliance with home-care management; 321 patients of 1330 were enrolled in the program. INTERVENTIONS: Bed rest at home with daily biochemical and biophysical follow-up protocol and weekly clinic visits; patient education; hospital admission for labour, induction, worsening pre-eclampsia or noncompliance with rest at home. OUTCOME MEASURES: Patterns of referral to the program; clinical, biochemical and biophysical profiles; incidence of severe complications; reduction in total hospital stay and cost analysis. RESULTS: As many women were referred from physicians' offices as were referred from the hospital's antepartum unit, the average gestational age at referral being 36 weeks. Most (205 [64%]) of the women were nulliparous. The average length of stay in the program was 11.5 days. The program's availability resulted in a reduction of 2 days (from 5.7 days to 3.7 days) on average in the length of hospital stay when analysed for all 1330 women with pre-eclampsia. Of the 321 patients in the program 137 (43%) were admitted to hospital for worsening pre-eclampsia; severe pre-eclampsia developed 4 days after admission in 9. No patient suffered eclampsia, disseminated intravascular coagulopathy, abruption or fetal loss related to pre-eclampsia while in the program. The estimated cost saving in the management of pre-eclampsia was over $700,000 over the study period. CONCLUSION: The community-based home-care program is a safe, feasible and less costly alternative to hospital admission in the management of mild pre-eclampsia.

Long-term hospital treatment of borderline patients: a descriptive outcome study.

The authors report a prospective 2-year outcome study of 40 inpatients with severe personality disorders who were treated on a specialized long-term unit for patients with "borderline conditions." Treatment goals included improving interpersonal relationships and facilitating a lasting discharge from the hospital. Data were collected at admission, discharge, and 1 and 2 years after discharge. The data reflect change from admission to follow-up in impulsivity, psychotherapy, and social adjustment. Mediating effects of length of stay on outcome are discussed.