Improvement In Several Aspects Research Articles

Conversion from valproic acid onto topiramate in adolescents and adults with epilepsy

To explore efficacy and tolerability outcomes of topiramate (TPM) in patients with epilepsy transitioning from valproic acid (VPA) because of insufficient efficacy and/or tolerability onto TPM. Multicenter, open label, single arm, non-interventional study examining patients (> or =12 years) with epilepsy, transitioning onto TPM from baseline mono-or combination therapy with VPA. TPM was added onto the existing antiepileptic drug (AED) treatment and started at a dose of 25 mg once daily. The dose was titrated up with 25 mg/day increments, once every 1-2 weeks, until a final dose between 50-200 mg/day was reached. Based on clinical judgment, the treating physician decided whether or not and when the existing AED treatment especially with VPA could be withdrawn. Documented were type and frequency of seizures, TPM dose, quality of life (QOLIE-10 questionnaire), subjective perception of improvement, and adverse events (AE). One hundred and forty-seven patients (59% women, mean age 41 years) switched from baseline VPA treatment onto TPM because of insufficient efficacy (61%) and/or poor tolerability (81%). Average duration of follow-up was 20.3 weeks with an overall discontinuation rate of 16.3% of patients, mainly because of AE (in 8.2% of 147 patients). At study endpoint, the intended shift to TPM monotherapy was achieved in 70% of patients at a median dose of 150 mg/day. A seizure reduction of > or =50% was achieved in 75% of patients in the last scheduled period (week 8-20), and 51% of patients entering that period remained seizure-free. Quality of life improved significantly as compared with baseline for all domains of QOLIE-10 (P < 0.001). Most frequent AEs were weight decrease (4.8%), paraesthesia and fatigue (4.1% each), speech disorder and headaches (2.7% each). In patients with epilepsy not satisfactorily treated with VPA, conversion to TPM was associated with improved seizure control as well as improvement in several aspects of quality of life.

Complicated query aggregation algorithms for multi-dimensional data

Complex inquiry to the spatial multi-dimensional data is the key point and the difficulty of the multi-dimensional data research.This article has made improvement in several aspects as the following: carry out the data piecemeal according to the grouping attribute value;carry out effective sorting to the integrated data;carry out the optimization in the accumulation function's application.It indicated that the improved algorithm can enhance the inquiry's efficiency greatly via analog data's experiment.

Epilepsy outcomes in elderly treated with topiramate

To explore effectiveness, tolerability and quality of life in elderly patients with epilepsy treated with topiramate. One year, open-label, flexible-dosing clinical trial. One hundred and seven patients (mean age 69 years, 53% men) were studied during 273 +/- 141 days. The average final dose in monotherapy was 98 mg/day vs 153 mg/day in adjunctive treatment. Mean monthly cumulative seizure frequency decreased from 3.7 +/- 15 to 1.6 +/- 7.7 (n = 101, P < 0.0001), 78% of patients with seizures at baseline (n = 102) achieved at least 50% reduction in seizure frequency, 44% were seizure-free throughout the trial. Total scores on the quality of life in epilepsy inventory (QOLIE-31) improved from 57 +/- 17 to 68 +/- 18 (n = 64, P < 0.0001). The most frequently reported adverse events included convulsions, dizziness and tiredness. Elderly patients treated with topiramate showed marked reductions in seizures, good tolerability and significant improvements in several aspects of quality of life.

Manufacturing Process and Application of Pseudo-thermoplastic Polyvinyl Alcohol

Polyvinyl alcohol (PVA) has too close melting and degradation temperatures which causes the failure of temperature control during processing. This study uses glycerin as plasticizing agent to improve high thermo-melting property of PVA so that PVA can be processed at a thermo-melt temperature of 190°C and be equipped with the pseudo-thermoplastic characteristic. The PVA processed with this method is called pseudo-thermoplastic PVA (PT-PVA). Moreover, using this process the PT-PVA's original PVA high water soluble characteristic can also be preserved which enables PT-PVA to have melting blend with other polymers. As a result, it can be used to produce various kinds of products; such as fibers and films, by melting processing method. With hot water treatment, the PT-PVA contained in the products can be dissolved to generate microporous characteristic. In conclusion, the application of PVA may result in significant improvement in several aspects including reduction of production cost, waste water treatment, and environmental protection.

Qualidade de vida em mulheres após tratamento da incontinência urinária de esforço com fisioterapia

PURPOSE: to compare women's quality of life (QoL) before and after physical therapy treatment for stress urinary incontinence (SUI). METHODS: an uncontrolled clinical trial of 26 women, who had mainly complaints of SUI. Post-menopausal women with overactive bladder, cystocele >grade II and previous surgical/conservative treatments were excluded from the study. The physiotherapy treatment relied on 12 individual pelvic floor exercises assisted by electromyographyc-biofeedback sessions. A total of 200 contractions were carried out, divided in phasic (quick) and tonic (slow). The tool used to evaluate QoL was the King's Health Questionnaire (KHQ), before and after the treatment. RESULTS: there was a decrease in the urinary symptoms, particularly in urinary frequency, nocturia, urgency and urinary incontinence. Regarding the QoL, there was a significant improvement in the following domain scores: general health perception (49.0±24.0 versus 26.9±15.7; p=0.0015), incontinence impact (78.2±28.2 versus 32.1±30.5; p=0.001), activity limitation (75.0±28.2 versus 13.5±22.6; p<0.001), physical limitation (72.4±29.4 versus 15.4±24.5; p<0.001), social limitations (38.3±28.6 versus 6.4±14.5; p<0.001), emotions (59.0±33.8 versus 14.1±24.7; p=0.0001, sleep/energy (34.0±23.8 versus 6.4±16.4; p=0.001) and severity measures (66.9±19.6 versus 22.3±24.2; p<0.001), except for personal relationships (60.5±33.9 versus 41.7±16.7; p=0.0679). CONCLUSIONS: there was an improvement in several aspects of women's QoL treated by physiotherapy, when evaluated with a specific tool, the KHQ.

Hospital Nursing Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 162 Institutions

Monitoring customer satisfaction is an important and useful quality improvement tool and is required of most clinical laboratories in the United States. To survey the level of nursing satisfaction with hospital clinical laboratory services. Participating laboratories provided information regarding laboratory demographics and practices. These laboratories then surveyed hospital nursing personnel regarding their level of satisfaction with defined aspects of laboratory service. College of American Pathologists Q-Probes laboratory quality improvement study in 162 hospital laboratories. Nursing overall satisfaction score (ranging from 1, not satisfied, to 5, very satisfied) and satisfaction scores for 13 specific aspects of clinical laboratory services. One hundred sixty-two institutions submitted data from a total of 7033 nursing surveys. The overall satisfaction score for all institutions ranged from 2.5 to 4.6. The median overall score for all participants was 3.9 (10th percentile, 3.2; 90th percentile, 4.2). Nursing personnel were most satisfied with the accuracy of test results, phlebotomy courtesy toward patients and nursing staff, and notification of abnormal results. They were least satisfied with stat test turnaround time, laboratory management responsiveness and accessibility, phlebotomy responsiveness to service requests, and routine test turnaround time. The most important aspect of laboratory service reported by nursing personnel was stat test turnaround time. Most nursing personnel are satisfied with the clinical laboratory services that are provided to the patients in their care. Although test result accuracy is very highly regarded, there is room for improvement in several aspects of service, particularly in test turnaround time and laboratory management accessibility and responsiveness.

Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin

This observational cohort study examined the effect of laparoscopic full excision of endometriosis combined with postoperative triptorelin treatment on deep dyspareunia (DD) and quality of sex life. One year after completing the postoperative treatment, 45.9% of the patients had no DD and 34.7% reported a decrease in DD intensity; an increase in the frequency of sexual intercourse was reported by 62.2% of the women; objective improvements in several aspects of sex life were observed.

Improvement in Social Competence With Short-Term Atypical Antipsychotic Treatment: A Randomized, Double-Blind Comparison of Quetiapine Versus Risperidone for Social Competence, Social Cognition, and Neuropsychological Functioning

Objective: While neuropsychological test performance is correlated with social outcomes in patients with schizophrenia, there is little evidence to date that changes in neuropsychological performance are associated with changes in these outcomes. As part of an efficacy and tolerability study of atypical antipsychotics, the authors used a performance-based measure of social competence as a short-term outcome measure and examined the correlations between changes in social competence and improvements on neuropsychological tests. Method: Patients with schizophrenia were randomly assigned in a 1:1 ratio to receive treatment with either quetiapine (dose range: 200–800 mg/day) or risperidone (dose range: 2–8 mg/day) for an 8-week period. Results: Of 673 patients initially randomized, 289 had baseline and endpoint neuropsychological and functional competence data. Scores on the performance-based measure of social competence significantly improved with both treatments, as did a number of aspects of neuropsychological performance. Improvements in several aspects of neuropsychological performance were correlated with the extent of improvement in social competence. There were no overall differences between the treatments in their impact on social competence and neuropsychological performance. Conclusions: Short-term treatment with both quetiapine and risperidone resulted in improvements in social competence, with these improvements associated with improvements on some of the neuropsychological measures. In addition to their clinical importance, these results support the use of performance-based competence assessments as outcome measures in clinical trials.

Improvement in Social Competence With Short-Term Atypical Antipsychotic Treatment: A Randomized, Double-Blind Comparison of Quetiapine Versus Risperidone for Social Competence, Social Cognition, and Neuropsychological Functioning

While neuropsychological test performance is correlated with social outcomes in patients with schizophrenia, there is little evidence to date that changes in neuropsychological performance are associated with changes in these outcomes. As part of an efficacy and tolerability study of atypical antipsychotics, the authors used a performance-based measure of social competence as a short-term outcome measure and examined the correlations between changes in social competence and improvements on neuropsychological tests. Patients with schizophrenia were randomly assigned in a 1:1 ratio to receive treatment with either quetiapine (dose range: 200-800 mg/day) or risperidone (dose range: 2-8 mg/day) for an 8-week period. Of 673 patients initially randomized, 289 had baseline and endpoint neuropsychological and functional competence data. Scores on the performance-based measure of social competence significantly improved with both treatments, as did a number of aspects of neuropsychological performance. Improvements in several aspects of neuropsychological performance were correlated with the extent of improvement in social competence. There were no overall differences between the treatments in their impact on social competence and neuropsychological performance. Short-term treatment with both quetiapine and risperidone resulted in improvements in social competence, with these improvements associated with improvements on some of the neuropsychological measures. In addition to their clinical importance, these results support the use of performance-based competence assessments as outcome measures in clinical trials.

Evaluation of a Learning Collaborative to Improve the Delivery of Preventive Services by Pediatric Practices

Effective delivery of preventive services is an essential component of high-quality pediatric health care. However, both variation in and deviation from accepted guidelines have been reported. Learning collaboratives (LCs) have been shown to result in improvement in several aspects of pediatric care. The objective of this study was to determine whether pediatric practices that participated in a preventive services LC would improve their delivery of preventive services. After conducting an initial audit of the medical records of twenty 2-year-olds and twenty 4-year-olds for documentation of preventive services on the basis of national standards, practice teams attended a quality improvement workshop. They were presented with evidence to support the value of preventive services and the results of their audits and taught quality improvement methods, eg, rapid cycles of change. Each team developed plans to improve 1 or more services. Brief audits with feedback and monthly conference calls were used to support practices to conduct rapid cycles of change, to discuss barriers and solutions, and to monitor progress. The results of final chart audits of twenty 2-year-olds and 4-year-olds were compared with the initial chart audits. A Preventive Service Score (PSS) was assigned to each practice on the basis of the number of services provided, and initial to final comparisons were made. Fourteen practices participated. PSSs improved for all practices after the LC. Mean PSS for 2-year-olds increased from 4.0 +/- 1.1 to 4.9 +/- 1.2 and for 4-year-olds increased from 3.8 +/- 1.8 to 5.6 +/- 1.9. The proportions of children who received 9 of the 10 individual preventive services also improved significantly. LCs are a potentially effective method of improving the quality of care that is delivered by pediatric practices.

“Broken Windows”: Frumkin Responds

I thank Melendez for his careful reading of my editorial and for raising the very reasonable question of whether “broken windows”—an indicator of neighborhood squalor—are causally related to poor health. Clearly the relationship between features of the built environment—including signs of degradation and outcomes such as behavior and health—is very complex. Many of the causal arrows are probably bidirectional. True clinical trials, which might help disentangle and clarify specific causal pathways, are difficult to carry out, as Melendez points out. However, at least two interesting studies approximate a trial and are informative. First, in the mid-1990s, former New York City police commissioner William Bratton implemented a “fixing broken windows” approach—enforcing nuisance laws, cleaning up graffiti, and so on. This approach was credited with a substantial subsequent decrease in street crime (Bratton 1995; Bratton and Knowlner 1998; Kelling and Coles 1996). Second, the Moving to Opportunity trial in the mid-1990s enrolled over 3,000 families in high-poverty neighborhoods of Baltimore, Maryland; Boston, Massachusetts; Chicago, Illinois; Los Angeles, California; and New York, New York. They were randomly assigned to receive housing vouchers usable in low-poverty neighborhoods or to remain where they were. Although the results were variable, families moving to low-poverty neighborhoods did experience improvements in several aspects of physical and mental health (Orr et al. 2003). So while these effects are not simple, there is some evidence that less-chaotic, disordered environments may predict better health. Perhaps the fundamental issue is that in poor communities, environmental factors and social factors are inextricably intertwined. Our efforts to understand their effects on health, and to improve people’s lives, need to focus on the root causes of both poverty and environmental hazards.

Cognitive Effects of Once Weekly (QW) Epoetin Alfa in Anemic Patients (pts) with Hematologic Malignancies Receiving Chemotherapy (CT): Interim Results of the EPOLYM Trial.

CT-associated cognitive dysfunction, which frequently manifests as subtle changes in memory, concentration, and ability to remain focused or organized, can adversely affect cancer pts' QOL. EPOLYM, a prospective, international, multicenter, open-label, phase IIIb trial has been conducted to investigate the efficacy, safety, and clinical outcomes, including effect on cognitive function, of epoetin alfa 40,000 IU sc QW in anemic (Hb <12 g/dL) pts with hematologic malignancies. Pts enrolled had either non-Hodgkin's lymphoma, multiple myeloma, Hodgkin's disease, or chronic lymphocytic leukemia, for which they were receiving or were expected to receive CT (planned N = 1,000). Dosage increases or decreases were to be made based on clinical response (target Hb, 11.5–13.0 g/dL). Cognitive function was evaluated from baseline to Week 24 (or last evaluation) using the Cognitive Drug Research Computerised Cognitive Assessment System, patient-completed, computer-scored tasks of attention (Simple Reaction Time, Choice Reaction Time, Digit Vigilance), working memory (Numeric Working Memory), and secondary memory (Immediate and Delayed Word Recognition, Picture Recognition). To further characterize the data, task scores were variously summed to provide 4 factor scores (and aspects of cognitive function measured): Power of Attention (concentration intensity), Continuity of Attention (ability to sustain concentration), Quality of Memory (amount of information that can be stored and successfully retrieved in working and long-term memory), and Speed of Memory (speed in ability to recognize information previously presented or held in working memory). Changes from baseline in Hb levels and transfusion requirements were determined and QOL was assessed using the Functional Assessment of Cancer Therapy-Anemia Subscale and the Linear Analog Scale Assessment. Because of the apparent relationship between affect and cognition, anxiety and depression were evaluated at the time of cognitive assessment using the Hospital Anxiety and Depression Scale (HADS). Transfusion, QOL, and HADS results are not considered here. The cognitive data for 568 pts who had completed up to 24 weeks of therapy were examined in an interim analysis. Results showed that Power of Attention was slightly impaired and Continuity of Attention was slightly improved over the course of the study; however, these effects were small and unlikely to have everyday behavioral significance. Greater changes were observed in regard to memory. Mean Speed of Memory was decreased 358.9 msec by Week 24, representing an 8% improvement from baseline. Also, improvement was noted in Quality of Memory, with the score for this factor increased by 0.0899 at Week 24 from a baseline value of 2.895. The improvement in cognitive function was associated with an increase in Hb from 10.5 g/dL at baseline to about 12 g/dL beginning at Weeks 8 to 12 and sustained for up to 24 weeks. Results of this interim analysis suggest improvement in several aspects of cognitive function associated with increased Hb levels in anemic CT pts with hematologic malignancies. These results will have to be confirmed by findings based on the full study cohort.

Standardized Protocol Improves Asthma Management in Emergency Department

This study assessed, 30 months after its initiation, the impact of a standardized asthma management program designed to facilitate the implementation of asthma management guidelines in a tertiary teaching hospital adult emergency department. The program was initiated in a stepwise manner: first, a retrospective baseline audit; followed by generation of local guidelines; validation of these guidelines by all staff involved; distribution of the guidelines; a second practice audit; use of these results to further improve the program; feedback to the staff; twice‐yearly information meetings; and a new audit 2 years later. The main results were a significant improvement in history taking (p < 0.001), increased use of serial airflow measurements (p < 0.001), increased steroid use (p < 0.001), and better documentation of follow‐up arrangements (p < 0.01). Several tests of questionable value were no longer prescribed routinely. The improvements persisted after 2.5 years. In contrast, there was no improvement in the proportion of medical files that contained records of discharge prescriptions for outpatients. Implementation of locally agreed guidelines resulted in a marked improvement in several aspects of asthma management in an emergency department; the program must be pursued to maintain and further improve quality of care.

EFFECTS OF AN AQUATIC EXERCISE PROGRAM ON PHYSICAL PERFORMANCE OF OLDER FEMALES WITH ARTHRITIS

The purpose of this study was to examine the effects of a 12-week water exercise program on several physical performance variables of older females with arthritis, compared with non-exercising controls. The arthritis group consisted of nineteen older females (age = 64.8 yr.) recruited for a pool arthritis exercise program, while the control group consisted of nine (age = 60.8) non-exercising females with arthritis. Pretest data for each of these subjects was collected prior to participation in the arthritis exercise program and consisted of: age, height, weight, sit and reach, side bend flexibility, shoulder rotation flexibility, arm curls, grip strength, one foot balance, sit to stand and walk, and six minute walk. A one-way ANOVA was used to compare mean pretest and posttest measurements between the two groups, and a significance level of p < .05 was used. A repeated measures ANOVA was used to determine the significance of the differences between pretest and posttest scores for each group. In comparing the pretest scores, there was no difference in age or height, while weight and BMI were substantially greater in the exercise group. The exercise group had significantly poorer sit to stand and walk scores, and somewhat lower scores on the one foot balance. There were no differences in the remainder of the initial performance scores between the two groups. Comparison of the pretest and posttest scores indicated that grip strength, number of arm curls, and one foot balance improved significantly in the exercise group, while there were no corresponding improvements in the performance of the control group. In conclusion, there were improvements in several aspects of the physical performance of arthritic subjects following a 12-week exercise program, suggesting that strength and balance were specifically improved. Other performance variables related to cardiovascular fitness and flexibility were not found to improve following 12 weeks of this program.

Analysis of Arrival Information and Status of the Patients in Emergency Department

Background: For effective and systematic management of patients in the emergency department(ED), the data on patient arrival and status in ED of Yeungnam University Hospital were evaluated. Materials and Methods: During the seven days from Apr. 1 to Apr. 7, 1998, the general patient information such as onset time and place, factors associated with transportation, causes of admission, cared department and patient disposition were recorded. Results: Total of 464 patients visited the ED during the seven days, and the mean number of patients per day was 66.3. Male to female ratio was 1:0.71. Daily staying patients were 17.3, and 83.6 patients were cared totally each day. The methods of transportation and distribution of patients according to region and event were as follows: visit by walk(57.3%). transportation by car(58.0%), place of event in residence(85.3%), regional distribution in Taegu(81.5%), and direct visit(97.4%). Cause of admission due to diseases was 74.6%. The percentages of departments which cared the patients were internal medicine 26.6%, pediatrics 16.8%, orthopedics 8.6%, neurology 8.2%, neurosurgery 7.8% and other department including emergency medicine 8.2%, respectively. Patient dispositions were admission 38.4%, discharge 61.0% and death on arrival(DOA) 0.6%, but referred patient-to-another-hospital was zero. Conclusion: Improvements in several aspects of ED's caring system such as fast tracking system and reinforcement of disease and trauma caring system, would be helpful for effective management of emergency patients.

Improvement in Subjective Visual Function and Quality of Life Outcome Measures After Blepharoptosis Surgery

To examine patients' subjective perception of visual function and health-related quality of life as affected by blepharoptosis and the change in these perceptions after blepharoptosis surgery. A 27-item questionnaire pertaining to vision-related activities and symptoms was used preoperatively to assess 50 consecutive patients (18 years old or older) with unilateral or bilateral acquired involutional blepharoptosis, and postoperatively six to eight weeks after blepharoptosis repair. Of the 24 items statistically analyzed, 16 items (67%) demonstrated significant improvement postoperatively (P < .05) among the unilateral cases and 18 items (75%) showed significant improvement postoperatively (P < .05) among the bilateral cases. The four activities that improved the most after surgery for both the unilateral and bilateral groups were the ability to perform fine manual work, hanging or reaching objects above eye level, watching television, and reading. Surgical repair of acquired involutional blepharoptosis resulted in significant improvement in several aspects of patients' subjective visual function and health-related quality of life. These issues are important in determining both the indications for and outcome of blepharoptosis surgery.

Improved guidelines for the sizing of vents in dust explosions

Current vent sizing guidelines, developed both in Europe (VDI 3673) and in the United States (NFPA 68) for the protection of equipment and buildings from dust explosions, rely on statistical regressions of test data. This leads to limitations in the range of applicability of the design methods, and, in some cases, to questionable scaling of the results. Analysis of available experimental information with knowledge derived from models of vented explosions offers a suitable alternative which can overcome these problems. An effort based on this approach has produced significant improvements in several aspects of explosion vent sizing, including: vent duct and panel inertia effects, partial volume deflagrations, venting of equipment inside buildings, and explosions at initial elevated pressure. The output of this work has been incorporated in revised vent sizing guidelines which are used by Factory Mutual Engineering Association (FMEA) loss prevention consultants in the development of loss prevention recommendations for industrial and commercial properties. This paper discusses the development of the guidelines, with emphasis on the aspects in which they significantly differ from the guidance provided by other published methods.

Outbreaks of paralytic poliomyelitis and polio surveillance in Shandong province of China.

Widespread outbreaks of paralytic poliomyelitis occurred in Shandong province, China, starting from 1988. In 1989, 484 cases were recorded, which was the peak during the past 4 years. Although emergency immunization with trivalent oral poliovirus vaccine (OPV) was carried out in selected counties in 1989 and 1990, control of the outbreak was not satisfactory. OPV mass immunization campaigns were introduced to cover the whole province in early 1991, and the number of patients with paralytic poliomyelitis decreased to 95. In addition to this new immunization strategy, we began to construct new polio surveillance systems. These were a network for case-negative reporting and an immediate reporting system of acute flaccid paralysis (AFP). As for the case-negative reporting, presently more than 90% of counties have been reporting presence or absence of new AFP cases. Monitoring of AFP immediate reporting has also shown a gradual improvement in several aspects. These polio surveillance activities are crucial to polio eradication programme management.

Do education groups help diabetics and their parents?

The importance of education in the management of diabetes is recognised but has rarely been assessed in children. In a longitudinal controlled study we have examined the effect of a programme of education on the knowledge, diet, and concentration of glycated haemoglobin A1c in a group of diabetics. The programme took the form of two packages of education each consisting of four weekly meetings, in which small groups of parents and older children were led in a discussion of different aspects of diabetes. Only one of the 119 families who began the study failed to complete it. Family knowledge about diabetes improved as a result of the programme, although this was poorly retained in the fathers. A trend to improvement in several aspects of diet was noted but did not reach significance. A significant fall in glycated haemoglobin A1c was apparent seven months after the education in children aged 11 years and over. Those whose initial control was poor improved most. We conclude that such meetings should be considered as a useful adjunct to regular diabetic clinics.

Unprompted Between Subject Generalization of Home Safety Skills

In this study, an eight-year-old boy received home safety skills training from his mother and demonstrated clear improvements in several aspects of home safety. His five-year-old brother never received formal training from an adult, but was allowed to observe training and received unprompted teaching from his older brother. He, too, showed large improvements in several aspects of home safety skills training. The importance and utility of peer training is described and methods of enhancing this procedure are discussed.