Higher Likelihood Of Survival Research Articles

Defining the Ratio of Outcomes to Resources for Triage of Burn Patients in Mass Casualties

Management of a mass casualty involving burn patients that overwhelms local resources will likely require a triage process in which limited resources are devoted to the patients with the highest likelihood of survival. No objective criteria exist which define how patients could be categorized in such a situation. A table that classifies patients according to their anticipated survival from burn injury, and the resources required to achieve that survival, is presented here. The limitations and restrictions of applying such a guideline are discussed in detail.

Growth hormone replacement therapy in children with medulloblastoma: use and effect on tumor control.

Progress has been made in the treatment of medulloblastoma, the most common childhood malignant brain tumor: However, many long-term survivors will have posttherapy growth hormone insufficiency with resultant linear growth retardation. Growth hormone replacement therapy (GHRT) may significantly improve growth, but there is often reluctance to initiate GHRT because of concerns of an increased likelihood of tumor relapse. This study retrospectively reviewed the use of GHRT for survivors of medulloblastoma in 11 neuro-oncology centers in North America who received initial treatment for disease between 1980 and 1993 to determine its impact on disease control. A Landmark analysis was used to evaluate the relative risk of relapse in surviving patients. Five hundred forty-five consecutive patients less than 15 years of age at diagnosis were identified. Six-year progression-free survival (mean +/- SD) was 40% +/- 5% in children less than 3 years of age at diagnosis compared with 59% +/- 3% for older patients. Older patients with total or near-total resections (P = .003) and localized disease at diagnosis (P < .0001) had the highest likelihood of survival. One hundred seventy patients (33% +/- 3% of the cohort) received GHRT. GHRT use varied widely among institutions, ranging from 5% to 73%. GHRT was begun a mean of 3.9 years after diagnosis, later in children younger than 3 years at diagnosis (5.4 years). By Landmark analyses, for those surviving 2, 3, and 5 years after diagnosis, there was no evidence that GHRT increased the rate of disease relapse. This large retrospective review demonstrates that GHRT is underutilized in survivors of medulloblastoma and is used relatively late in the course of the illness. GHRT is not associated with an increased likelihood of disease relapse.

CVB4 In-Hospital Survival of Congestive Heart Failure Patients Treated with Dobutamine or Milrinone

Data indicate that oral positive inotropic agents have a negative effect on survival. However, evidence suggests that this conclusion may not apply to intravenous inotropic agents. Further, clinical differences in the action of these inotropes may lead to variations in their effect on survival. OBJECTIVE: This study assesses and compares the odds of in-hospital survival for patients who received either amrinone, dobutamine, or milrinone. METHODS: The data source was a hospital database of inpatient claims (1995–1996) from 40 U.S. hospitals, including information on diagnoses and procedures, costs and discharge, drug therapies, as well as patient and hospital characteristics. Study eligibility criteria require that the patient had a diagnosis of congestive heart failure or underwent a heart by-pass procedure, received at least one unit of an inotropic agent (dobutamine or milrinone), and received only one type. Baseline comorbidity measures were constructed and used as controls for confounding covariates such as patient and hospital characteristics, condition severity, complexity of drug therapy, insurance status, and treatment type. The likelihood of in-hospital survival was analyzed using logistic regression. Odds ratios are assessed and compared for each patient cohort. RESULTS: The logistic model correctly predicted 79% of the 308 observed deaths in 1,538 patients selected for analysis. The results correctly predicted the effect on survival due to increased age (negative), condition severity (negative), complexity of drug therapy (positive), aggressive drug therapy (positive), and a number of life-threat-ening comorbid conditions (negative); the two inotrope cohorts indicate a significant difference in in-hospital survival. Milrinone patients were more than twice as likely to survive the in-hospital stay than dobutamine patients. Further, dobutamine patients were twice as likely to survive than amrinone patients. CONCLUSION: In-hospital survival varied significantly by inotropic study cohort. Patients on milrinone had a higher likelihood of survival.

755-6 Neurosurgical Evacuation for Intracranial Hemorrhage Associated with Improved Outcome in GUSTO

In order to evaluate the impact of neurosurgical evacuation of intracranial hemorrhage (ICH) following thrombolytic therapy for acute myocardial infarction, we analyzed the 268 patients with ICH in the GUSTO Trial. In-hospital mortality was 60% with only 13% of patients discharged with minor or no disability. Of the 268 patients, 47 had neurosurgical intervention with the following results: For all patients with ICH, surgical evacuation was associated with a higher likelihood of survival without disability (odds ratio 2.1, 95% CI 0.95–4.7). The prognosis for patients with both SDH and parenchymal hemorrhage was very poor regardless of treatment strategy. Although the differences in outcome may be due in part to selection of patients for operation with lower mortality risk, physicians caring for patients with suspected intracranial hemorrhage following thrombolytic therapy should consider early neurosurgical consultation and intervention to potentially decrease patient disability and improve survival.

Predicting survival from out-of-hospital cardiac arrest: A graphic model

To develop a graphic model that describes survival from sudden out-of-hospital cardiac arrest as a function of time intervals to critical prehospital interventions. From a cardiac arrest surveillance system in place since 1976 in King County, Washington, we selected 1,667 cardiac arrest patients with a high likelihood of survival: they had underlying heart disease, were in ventricular fibrillation, and had arrested before arrival of emergency medical services (EMS) personnel. For each patient, we obtained the time intervals from collapse to CPR, to first defibrillatory shock, and to initiation of advanced cardiac life support (ACLS). A multiple linear regression model fitting the data gave the following equation: survival rate = 67%-2.3% per minute to CPR-1.1% per minute to defibrillation-2.1% per minute to ACLS, which was significant at P < .001. The first term, 67%, represents the survival rate if all three interventions were to occur immediately on collapse. Without treatment (CPR, defibrillatory shock, or definitive care), the decline in survival rate is the sum of the three coefficients, or 5.5% per minute. Survival rates predicted by the model for given EMS response times approximated published observed rates for EMS systems in which paramedics respond with or without emergency medical technicians. The model is useful in planning community EMS programs, comparing EMS systems, and showing how different arrival times within a system affect survival rate.

Analysis of Prehospital Scene Time and Survival from Out-of-Hospital, Non-Traumatic, Cardiac Arrest

AbstractThe purpose of this study was to determine whether shorter prehospital scene time (ST) is associated with an increased survival rate in non-traumatic, out-of-hospital, cardiac arrest (CA) in a medium-sized, metropolitan EMS system. Information was retrieved for all adult victims (age ≥18 years) of CA treated and transported by a metropolitan fire department over a 16month period (6/87–9/88). Data were retrieved from the fire department's database, hospital records, and death certificates. Statistical analysis of continuous variables was performed using the two-tailed, Student's t-test and non-parametric evaluations were performed by square analysis with p&lt;0.05 considered significant. Two hundred ninety-eight cases were recorded of which 293 patients (98.3%) had documented ST (study group). Seventy-nine patients (27.0%) had ST &lt;12 minutes, while 214 (73.0%) had ST≥12 minutes. Patients with ST &lt;12 minutes were more likely to have return of spontaneous circulation in the field (26.6% vs. 15.9%, p&lt;0.05) and also were more likely to survive than were patients with ST ≥12 minutes (13.9% vs. 6.5%, p&lt;0.05). Mean ST for survivors was significantly less than for non-survivors (12.8 vs. 15.3 min., p&lt;0.05).We conclude that, in our system, adult victims of CA with ST &lt;12 minutes are more likely to survive than are patients with longer ST. In addition, the mean ST for survivors is shorter than for non-survivors. It remains unclear whether shorter ST actually has an impact on survival or is merely a reflection of a sub-group with rapid resuscitation and consequently a higher likelihood of survival. Future investigations are needed to determine whether shorter ST actually impacts the likelihood of survival from CA.

Environments and Strategies of Organization Start-Up: Effects on Early Survival

Examines both the separate and combined impact of environmental conditions (e.g., resource availability and competitive concentration) and organizational strategies (e.g., market breadth and market aggressiveness) on the probability of startup survival in the computer industry. It is hypothesized that young firms have a higher likelihood of survival when demand is increasing, competitive concentration is declining, they are specialist rather than generalist organizations, and they are aggressive rather than efficient organizations. It is also hypothesized that when demand is increasing and concentration is declining, startups that are generalist organizations will have a higher likelihood of survival than specialist organizations and that when demand is declining and concentration is increasing, young firms that are efficient organizations will have a higher likelihood of survival than aggressive organizations. Data were gathered from the 10-Ks and annual reports of 108 minicomputer producers in the United States founded between 1957 and 1981. Based on the criteria used to classify these 108 firms, only 44 survived through 1981 and 64 were coded as failures. Results indicate that market demand, both by itself and when interacting with strategy variables, is the primary environmental influence on the probability that startups will survive. It was also determined that when unit sales increase, specialist organizations are more likely to survive as startups than generalist organizations. In addition, aggressive startup firms are shown to have a greater survival chance than efficient startup firms. In addition, when sales are increasing, generalist strategies rather than specialist strategies do improve the likelihood of new firm survival. Finally, when sales are declining, more efficient organizations survive while more aggressive firms do not. (SFL)

Predator Determination and Efficiency on Heliothis virescens1 Eggs in Cotton Using 32 P 2

Radioactive Heliothis virescens (F.) eggs were placed in an east Texas cotton field during 1977, and the following arthropods showed evidence of predation on the eggs: Solenopsis invicta Buren; Orius insidiosus (Say); Geocoris punctipes (Say); Geocoris uliginosus (Say); Pseudatomoscelis seriatus (Reuter); Hippodamia convergens Guerin-Meneville; Cycloneda sanguinea (L.); Coleomegilla maculata (De Geer); Scymnus loewii Mulsant; Heliothis spp. larvae; Phidippus spp.; Peucetia viridans (Hentz); Oxyopes salticus Hentz; and Misumenops spp. These and other unidentified predators and parasites were a dominant factor in the destruction of Heliothis spp. eggs throughout the growing season. The mean predation for eggs per 24-h exposure period ranged from 48–90% with a seasonal mean of 73%. Seasonal mean predation for exposures of 48 and 72 h were 87 and 93% respectively, with a single case of 100% predation following a 72 h exposure. Older (>24 h) Heliothis virescens eggs were found to have a higher likelihood of survival than younger eggs (< 24 h) found in the field at the same time. In addition, predation rates were reduced for as long as 48 h after the occurrence of rain.