Predictors Of Positive Outcomes Research Articles

Primary caregiver involvement in management of type 2 diabetes mellitus: A community-based observational study from urban Puducherry

Background: Adherence to medication and lifestyle modification is an important predictor of positive outcome of diabetes management among adults in which primary caregiver (PCG) plays an important role. Objectives: The objectives of this study were to describe the involvement of PCG in adherence to the drugs, diets, and lifestyle changes among patients with type 2 diabetes mellitus in an urban area of Puducherry. Methodology: A total of 311 type 2 diabetes patients irrespective of their source of diabetes care were included from the service area of an urban health and training center in an urban area of Puducherry. The PCG for each patient was identified, and the PCG and the patient were interviewed separately to obtain the information on adherence and involvement in various aspects of diabetes management, respectively, using an interview schedule. The information on diabetes control status of the patient was obtained from the records available. Results: About 10% of the patients did not have caregiver. Nearly 90% of the PCGs were involved in either of the lifestyle modification, drug adherence, checking type and frequency of medication, accompanying for consultation, or all. About 80% of the PCGs remind the patient to take medicines when out of station mainly by phone call/short message service. Encouragement toward physical activity was proportionately less compared to diet and drugs, and that was reflected in the patient's level of adherence in those domains. Overall involvement of spouse was more than the nonspouse. PCG involvement was found to be significantly associated with adherence to diet (P = 0.027) but not with drug and physical activity (P > 0.05). Conclusion: The PCG should also be considered while designing health education intervention on various aspects of diabetes management, focusing and highlighting the areas of poor involvement and their importance in disease management. The health system should place special focus on patients without PCG.

Effectiveness, Safety, and Predictors of Response to Botulinum Toxin Type A in Refractory Masticatory Myalgia: A Retrospective Study

Masticatory muscle pain disorders respond well to conservative therapy; however, in some patients the pain becomes refractory. Botulinum toxin type A (BoT-A) therapy has been shown to be an effective modality in the management of refractory headache disorders. Conversely, there are conflicting reports in the literature regarding the efficacy, safety, and predictors of therapeutic response to BoT-A therapy for management of refractory masticatory muscle pain. We performed a retrospective chart review of patients who underwent at least 2 injection cycles of 100 U of BoT-A for refractory masticatory myalgia in the Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, between May 2012 and June 2016. Information regarding demographic, diagnostic, and therapeutic characteristics was extracted and analyzed. The χ2 test was used for analysis between independent and dependent variables. Forward step-wise-type logistic regression analysis was conducted to determine the predictors of outcome. Among 116 participants, 30.6% reported significant relief in pain for a mean period of 10.1weeks. A total of 16.4% of participants reported at least 1 adverse effect. The effectiveness of theBoT-A therapy was found to be statistically associated with the presence of muscle hypertrophy (P= .004), range of motion (P= .02), concurrent use of opioid analgesics (P= .003), and local anesthetic trigger-point injections (P= .003). Logistic regression analyses suggested that the presence of muscle hypertrophy and occurrence of adverse effects were predictors of positive outcome. On the contrary, concurrent use of opioid analgesics was found to be a predictor for no or minimal relief. BoT-A therapy provides significant relief for approximately one third of patients with refractory masticatory muscle pain. Therapy is associated with a mild risk of adverse effects. The presence of muscle hypertrophy, occurrence of an adverse effect, and concurrent use of opioid analgesics were found to be predictors of outcome response.

Moderators of Symptomatic Outcome in Metacognitive Training for Psychosis (MCT). Who Benefits and Who Does Not?

Metacognitive training (MCT) for psychosis is a group intervention targeted at reducing positive symptoms in schizophrenia through an improvement of cognitive biases in these patients. Despite evidence for its feasibility and efficacy, the recommendations for including or excluding patients from MCT have so far been largely based on anecdotal clinical wisdom rather than empirical evidence. Predictors and moderators of outcome are presently unknown. We reanalyzed data from a large randomized controlled trial, for which 150 patients were randomly assigned to either MCT or CogPack® (neurocognitive training) and followed up for up to 3 years. We explored which demographic variables, baseline symptoms, and cognitive biases would predict overall outcome and specific treatment benefits in MCT. Low self-esteem and social anxiety at baseline as well as positive appraisal of the intervention were consistently associated with improved outcome in MCT relative to CogPack®. Among other variables, improvement of cognitive biases and selective attention during the intervention period as well as number of sessions attended were general predictors of positive outcome, irrespective of the type of intervention. Patients with cognitive biases and psychological strain (e.g., low self-esteem and quality of life) paired with social problems may represent an ideal target group for MCT. The present findings await replication in independent samples and may not generalise to other forms of metacognitive training (e.g., MCT for depression) or individualized metacognitive intervention for psychosis (MCT+).

Therapeutic effect of capsaicin nasal treatment in patients with mixed rhinitis unresponsive to intranasal steroids.

Literature is convincing regarding the efficacy of capsaicin nasal treatment in idiopathic rhinitis (IR). However, up to 50% of IR patients do not meet the strict inclusion criteria of the trials conducted so far. As a consequence, the efficacy of capsaicin is unknown in a significant number of IR patients that do not meet the strict inclusion/exclusion criteria (J Allergy Clin Immunol. 2014;133:1332, J Allergy Clin Immunol. 2017; [Epub ahead of print]). "Mixed rhinitis" (MR) patients have more than one major etiologic factor involved in the mucosal pathology. We have no idea about the efficacy of capsaicin nasal spray in these patients nor about the time interval to seek a second application. We report here that capsaicin nasal spray is effective in a broader group of IR than the purely selected ones described before, that subjective nasal hyper-reactivity is a good predictor of positive outcome, and that the time interval for seeking a second treatment is likely to be shorter in MR patients than in the strictly selected IR patients.

Predictors of positive esophagogastroduodenoscopy outcomes in children and adolescents: a single center experience

BackgroundEsophagogastroduodenoscopy (EGD) has become a key element in the diagnosis and therapy of many gastrointestinal diseases affecting children. The aim of this study was to evaluate predictors of positive outcomes in children undergoing their first diagnostic EGD with biopsies at a single center.ResultsThis retrospective study was based on findings from existing EGD and histopathological reports. All procedures were performed between July 2006 and July 2013. Details of each patient’s clinical presentation and EGD were abstracted from medical records to determine the predictors of positive EGD outcomes. A total of 1133 records of patients between the ages of 0 and 18 years old were evaluated. Of these patients, 51.5% (n = 573) were female and 24.5% (n = 278) were younger than 4 years old. The mean age at the time of EGD was 9.6 ± 5.7 years (mean ± standard deviation). The most common indications for the procedure were abdominal pain (54.9%) and emesis (31.9%). The overall prevalence of any endoscopic abnormality was 54.5% and the overall prevalence of any histological abnormality was 59.1%. A multivariate logistic regression found that patients 12 years or older (odds ratio, OR = 1.46; 95% confidence interval, CI 1.31–1.63), African–American race (OR = 2.20; 95% CI 1.45–3.34), dysphagia (OR = 1.96; 95% CI 1.28–3.00) and positive celiac antibodies (OR = 2.25; 95% CI 1.52–3.34) were all significant independent predictors of a positive EGD outcome.ConclusionsSeveral clinical variables were found to be independent predictors of positive EGD outcomes in children and adolescents. Prospective studies using standardized definitions of clinical variables and endoscopy outcomes are needed to further understand predictors of positive EGDs.

Pain drawings predict outcome of surgical treatment for degenerative disc disease in the cervical spine

Introduction: Pain drawings have been frequently used in the preoperative evaluation of spine patients. For lumbar conditions comprehensive research has established both the reliability and predictive value, but for the cervical spine most of this knowledge is lacking. The aims of this study were to validate pain drawings for the cervical spine, and to investigate the predictive value for treatment outcome of four different evaluation methods.Methods: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. A pain drawing together with Neck Disability Index (NDI) was completed preoperatively, after 2 and 5 years. The inter- and intraobserver reliability of four evaluation methods was tested using κ statistics, and its predictive value investigated by correlation to change in NDI.Results: Included were 151 patients, mean age of 47 years, female/male: 78/73. The interobserver reliability was fair for the modified Ransford and Udén methods, good for the Gatchel method, and very good for the modified Ohnmeiss method. Markings in the shoulder and upper arm region on the pain drawing were positive predictors of outcome after 2 years of follow-up, and markings in the upper arm region remained a positive predictor of outcome even after 5 years of follow-up.Conclusions: Pain drawings were a reliable tool to interpret patients’ pain prior to cervical spine surgery and were also to some extent predictive for treatment outcome.

Use Developmental Stages to Guide Treatment in ASD

Use Developmental Stages to Guide Treatment in ASD

SVCT-2 determines the sensitivity to ascorbate-induced cell death in cholangiocarcinoma cell lines and patient derived xenografts

Cholangiocarcinoma (CC) is a devastating malignancy with late diagnosis and poor response to conventional chemotherapy. Recent studies have revealed anti-cancer effect of vitamin C (l-ascorbic acid, ascorbate) in several types of cancer. However, the effect of l-ascorbic acid (AA) in CC remains elusive. Herein, we demonstrated that AA induced cytotoxicity in CC cells by generating intracellular reactive oxygen species (ROS), and subsequently DNA damage, ATP depletion, mTOR pathway inhibition. Moreover, AA worked synergistically with chemotherapeutic agent cisplatin to impair CC cells growth both in vitro and in vivo. Intriguingly, sodium-dependent vitamin C transporter 2 (SVCT-2) expression was inversely correlated with IC50 values of AA. Knockdown of SVCT-2 dramatically alleviated DNA damage, ATP depletion, and inhibition of mTOR pathway induced by AA. Furthermore, SVCT-2 knockdown endowed CC cells with the resistance to AA treatment. Finally, the inhibitory effects of AA were further confirmed in patient-derived CC xenograft models. Thus, our results unravel therapeutic potential of AA alone or in combination with cisplatin for CC. SVCT2 expression level may serve as a positive outcome predictor for AA treatment in CC.

Relevance of MicroRNA200 Family and MicroRNA205 for Epithelial to Mesenchymal Transition and Clinical Outcome in Biliary Tract Cancer Patients.

Extensive stromal interaction is one reason for the dismal outcome of biliary tract cancer (BTC) patients. Epithelial to mesenchymal transition (EMT) is involved in tumor invasion and metastasis and is partly regulated by microRNAs (miRs). This study explores the expression of anti-EMT miR200 family (miR141, −200a/b/c, −429) and miR205 as well as the EMT-related proteins E-cadherin and vimentin in a panel of BTC cell lines and clinical specimens by quantitative real-time polymerase chain reaction, Western blot and immunohistochemistry, respectively. MicroRNA expression was correlated to (i) the expression patterns of E-cadherin and vimentin; (ii) clinicopathological characteristics; and (iii) survival data. MicroRNA-200 family and miR205 were expressed in all BTC cells and clinical specimens. E-cadherin and vimentin showed a mutually exclusive expression pattern in both, in vitro and in vivo. Expression of miR200 family members positively correlated with E-cadherin and negatively with vimentin expression in BTC cells and specimens. High expression of miR200 family members (but not miR205) and E-cadherin was associated with longer survival, while low miR200 family and high vimentin expression was a predictor of unfavorable survival. Overall, the current study demonstrates the relevance of the miR200 family in EMT of BTC tumors and suggests these miRs as predictors for positive outcome.

Social capital on mobile SNS addiction

Purpose – Social capital has been identified as a valuable resource that can lead to various positive outcomes of social activities in both online and offline communities. The purpose of this paper is to argue that social capital can also be an important ingredient in the development of adverse outcomes, such as technology addiction. Design/methodology/approach – Based on social capital theory and prior research related to perceived integration, a research model that reflects the effects of online and offline social capitals as well as perceived integration on mobile social networking service (SNS) addiction was developed and empirically examined based on data collected from 458 mobile SNS users in China. Findings – The structural equation modeling analysis shows that online social interaction ties and online social supports positively affect mobile SNS addiction, whereas offline social supports and online social identification negatively affect mobile SNS addiction. In addition, perceived integration between online and offline channels by using mobile SNS positively influences online social interaction ties, offline social interaction ties, and mobile SNS addiction. Practical implications – From the practical perspective, the results of the study offer interesting implications for managing mobile SNS addiction. The study found that online social interaction ties and online social support positively influence mobile SNS addiction, whereas offline social support negatively influence mobile SNS addiction. Social implications – The mobile SNS users should invest more time to participate in offline social activities and maintain good social relationships with their family, colleagues, and friends in the real world. Originality/value – The present study has both theoretical and practical implications. From a theoretical perspective, unlike many previous studies tend to regard social capital as the predictor of positive outcomes of users’ social activities, the study contributes to the extant information systems literature by exploring the potential negative consequences of social capital on users’ social lives. The results of the study indicate that social capital is a significant predictor of mobile SNS addiction.

The use of intrarenal Doppler ultrasonography as predictor for positive outcome after renal artery revascularization.

Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACCmax ≤ 1.3 m/s2) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.

Investigating discrepancies in program quality related to youth volleyball athletes’ needs support

Program quality has been outlined as an important predictor of positive outcomes in youth development programs; however, little evidence exists to support this, particularly within sport. Objective: The purpose of this study was to examine the associations between researcher- and coach-assessed program quality scores as they relate to youth volleyball athletes’ basic needs support. Design: Observational data and self-report data were gathered from coaches and youth. Researchers completed 84 observations using a measure of program quality across 14 teams. Coaches completed the same measure at the end of the season and 138 athletes (Mage = 14.50) from the 14 teams completed a self-report questionnaire pertaining to needs support. Data were analyzed using polynomial regressions with response surface methodology. Results: Athletes’ needs support was significantly (p < 0.001) associated with all domains of researcher- and coach-assessed program quality (i.e., safe environment, supportive environment, interaction, engagement), and between 20 and 35% of the variance in athletes’ needs support was explained by these variables. The degree of discrepancy between researcher- and coach-assessed program quality increased when progressing through three domains of program quality (safe environment, supportive environment, engagement). Response surface methods indicated that as the degree of agreement increased between researchers’ and coaches’ ratings of the safety of the environment, supportiveness of the environment, and opportunities for engagement, so did athletes’ basic needs support scores in a linear fashion. Conclusions: Practical implications surrounding coach education and the importance of knowledge translation between academics and practitioners are noted, and future research directions are discussed.

Could renal impairment be a positive predictor of outcome in autografts for myeloma?

Could renal impairment be a positive predictor of outcome in autografts for myeloma?

A test of the Social Identity Model of Cessation Maintenance: The content and role of social control

Engagement with self-help groups is a predictor of positive outcomes for those attempting to control their addictive behaviours. In common with other groups, self-help groups have to manage non-normative (‘deviant’) behaviour to ensure the social values of the group remain preserved, and the group can fulfil its aims. These processes may protect group members from relapse. Drawing on the Social Identity Model of Cessation Maintenance, the current study asked a number (n=44) of attendees of fellowship (AA/NA/CA) and of SMART groups to list behaviours they saw as normative and deviant, and rate a variety of responses to deviant behaviours. Costs of relapse to both the self and the group were also measured alongside self-efficacy regarding cessation and identity as both an active addict and as a member of a self-help group. Results suggest that social control responses to deviance grouped into education, punishment and avoidant type responses. More social control was perceived by highly identifying self-help group members. Educational responses were seen as used by groups more extensively than other responses. Punishment responses were mediated by the perceived costs an individual's relapse incurred on the rest of the group. These findings inform our understanding of what standards of normative and deviant behaviour self-help groups hold, and how they react to violations of such norms. They also have a number of implications for practitioners and facilitators in regard to using social identities as part of the treatment process.

Predictors of Positive Outcomes in Pulmonary Rehabilitation

Predictors of Positive Outcomes in Pulmonary Rehabilitation

THE ROLE OF PARENTAL ATTITUDES IN CHILDREN'S MOTIVATION TOWARD HOMEWORK ASSIGNMENTS

Completing homework assignments is part of students' daily routine. Because this task is embedded within the home environment, parents play an important role in homework‐related attitudes and behaviors. Recent findings have demonstrated that effort and cognitive engagement while doing homework are better proximal predictors of positive outcomes than merely the time spent on it. The purpose of the current study was to examine whether parental goal emphasis explains children's motivational orientation toward homework and the perceived dissonance between home and school. Participants included parent–child dyads (N = 220), who completed surveys adapted from the Patterns of Adaptive Learning Scales. Path analysis using structural equation modeling indicated that parents’ emphasis on mastery goals was associated with children's mastery goals, which was in turn linked with higher achievement in school. Parents’ emphasis on performance goals was associated with children's performance goals and a higher sense of dissonance between home and school.

A5147 - Can postoperative anthropometric changes predict diabetic response after bariatric surgery?

Background: Type 2 diabetes mellitus (T2DM) is a life-threatening obesity linked condition often treated with bariatric surgery. Predictors of diabetic improvement often include duration and severity of diabetes, type of operation employed and various patient factors. Central obesity, as measured by waist circumference (WC) and waist/ hip ratio, has been associated with an increased cardiometabolic risk. In this study, anthropometric changes after surgery were analyzed and correlated with T2DM response. Method: Morbidly obese patients undergoing surgery at Loyola Health University Chicago were enrolled in this IRB approved cohort study. Analyzed were 35 patients having T2DM. Demographic data, diabetic type (non-insulin or insulin dependent) and type of surgery were analyzed. Anthropometric factors were measured pre and postoperatively. Predictors of diabetic remission (complete remission, improvement and non-response) were analyzed. Definition of complete remission was considered when there was a return to “normal” glucose metabolism (HbA1C o 6%, fasting glucose o 100 mg/Dl). Diabetic improvement (DI) was defined as lower drug dosage with sub-diabetic hyperglycemia. Results: 35 patients (22 women; mean age 1⁄4 44.86 9.81) were analyzed. The follow up time is 20.22 4.85 (range, 6-32) months. Surgical intervention included 19/35 (54.28%) gastric bypass (LRYGB), 10/35 (28.57%) sleeve gastrectomy (LSG) and 6/35 (17.15%) gastric banding (LAGB). There were no demographic or anthropometric measurement differences between type of surgery and gender (p1⁄4 0.370), race (p1⁄40.503) or diabetic type (p1⁄4 0.267). Mean preoperative BMI (kg/m) was 45.03 6.31 (LRYGB), 53.25 10.49 (LSG), and 50.41 13.70 (LAGB). Twenty (57.14%), ten (28.57%) and five (14.28%) of the 35 patients had complete remission, improvement and non-response of their diabetes respectively. In univariate analysis, preoperative independent predictors of success (complete response and diabetic improvement) included; white race (p1⁄40.013), LRYGB (p1⁄40.011), non-insulin dependent (p1⁄40.023), pre-BMI r 60 kg/ m (p1⁄40.016) and pre-WC r 160 cm (p1⁄40.018). Postoperative parameters of success included; decrease in waist/hip ratio at 1, 3 and 12 months (0.012, 0.00 and 0.00 respectively). In multivariate logistical regression analysis, type of surgery (p1⁄40.012; CI: 0.1321.194), greater Δ waist circumference and greater Δ neck circumference at 12 months remained independent predictors of success. Conclusion: Bariatric surgery remains the most effective treatment of diabetes (overall 85.71% of success) in the morbidly obese patient. Predictors of positive outcome may not only include the type of surgery and duration/ severity of T2DM, but changes in fat distribution. Gastric bypass, in this intermediate-term study, led to a greater degree of change in central obesity. Long-term follow-up may show that gastric bypass is superior in resolving central adiposity and therefore decreasing cardiometabolic risk and improving diabetes.

Paths to Positive Development: a Model of Outcomes in the New Zealand Youth Transitions Study

This study examined predictors of positive developmental outcomes, including: life satisfaction; optimism; educational achievement; civic engagement; and positive peer influence; in a sample of young people comprised of a study group (n = 593) facing significant challenges and a comparison group (n = 778) who were progressing more normatively. The study modelled the demographic, risk, and resource predictors of positive outcomes across both groups, and compared the fit of the model across groups using integrative data analysis techniques. Results suggested that positive outcomes were predicted by: resilience; ethnicity; peer problems; depression age; gender; relationship status; and parental monitoring. Although the study group faced significantly (p < .0001) greater levels of adversity than the comparison group, the fitted model was shown to be equivalent across groups, suggesting that general models of positive developmental outcomes can be applied to vulnerable youth. The model also suggests that the pathways to positive developmental outcomes are complex being influenced by a diverse range of factors and that of these factors, resilience appears to be the most important.

Emotional arousal predicts observed social support in German and American couples talking about breast cancer.

Social support in couples often occurs during conversations and is an important predictor of positive outcomes in patients with breast cancer. Even though talking about cancer may be upsetting, vocally expressed emotional arousal and its association with social support have not been examined. The goal of this study was to examine the role of vocally encoded emotional arousal and social support behaviors in 129 German and American couples, assessed at baseline of clinical trials for women with breast cancer and their male partners. Range of fundamental frequency was used as a measure of expressed emotional arousal during videotaped interactions in which the women shared cancer-related concerns. Social support behaviors were assessed as specific social support behaviors at the talk-turn level (positive, neutral, and negative) and broader communication behaviors also relevant to social support at the global level (depth and articulation, caring, quality of communication) using the Social Support Interaction Coding System (Bradbury & Pasch, 1994). Data were analyzed using actor-partner interdependence models. Women displayed more positive, fewer neutral support-receiving behaviors, and greater depth and articulation if their own emotional arousal was higher. Women also displayed more neutral and (at the trend level) fewer positive support-receiving behaviors if their partners' emotional arousal was higher. Men's behaviors were not associated with their own or women's emotional arousal. Results indicate that it may be adaptive for women with cancer to openly experience their distress during social support conversations with their partners; high emotional arousal of the partners may interfere with this process.

"It's Not Like You Need to Live 10 or 20 Years": Challenges to Patient-Centered Care in Gynecologic Oncologist-Patient Interactions.

The literature suggests that the patient-perspective approach (i.e., eliciting and responding to patients' perspectives, including beliefs, preferences, values, and attitudes) to patient-centered care (PCC) is not a reliable predictor of positive outcomes; however, little is known about why the patient-perspective approach does not necessarily lead to positive outcomes. By using discourse analysis to examine 44 segments of oncologist-patient interactions, we found that providers' use of patient-perspective contextualization can affect the quality of care through (a) constructing the meanings of patient conditions, (b) controlling interpreting frames for patient conditions, and (c) manipulating patient preferences through strategic information sharing. We concluded that providers' use of patient-perspective contextualization is an insufficient indicator of PCC because these discursive strategies can be used to control and manipulate patient preferences and perspectives. At times, providers' patient-perspective contextualization can silence patients' voice and appear discriminatory.