Demonstration project on epilepsy in Brazil - Outcome assessment

Purpose: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. Method. We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patient's and the physician's point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. Results: A total of 181 patients (93 women - 51%) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (> 10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients' and relatives' opinions were that in the majority (59%) the health status had improved a lot, some (19%) had improved a little, 20% experienced no change and in 2% the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. Discussion: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward in accordance with local health providers and managers

The Anchorage, Alaska Municipal Pretrial Diversion Program: Initial Outcome Assessment

This report provides an initial outcome assessment of the Anchorage Municipal Pretrial Diversion Program, a voluntary program aimed at diverting first-time offenders in certain criminal and traffic cases from traditional case processing, with successful complion of the terms of the program resulting in dismissal of charges. Pretrial diversion agreements under AMC 08.05.060 typically require the defendant to pay a fine or do community work service, usually within a month. The initial assessment examines offender completion under the program, adherence to conditions of probation, and time and cost savings for the Anchorage Municipal Prosecutor's Office.Office of the Anchorage Municipal Prosecutor, Municipality of Anchorage, AKAcknowledgments / Section I: Executive Summary / Counts and Charges of Defendants Offered Pretrial Diversion / Demographic Variations Among Defendants Offered Pretrial Diversion / Conditions of Pretrial Diversion / Length of Time for Pretrial Diversion Processes / Number of Court Hearings and Estimated Time Spent / Section II: Introduction / Section III: Literature Review / Descriptions of Pretrial Diversion / Pretrial Diversion in the United States / Description of Pretrial Diversion in Anchorage / Section IV: Methods / Data Collection / Section VI: Findings / Counts and Charges of Defendants Offered Pretrial Diversion / Demographic Variations Among Defendants Offered Pretrial Diversion / Conditions of Pretrial Diversion / Length of Time for Pretrial Diversion Processes / Number of Court Hearings and Estimated Time Spent / Section VII: Conclusion / References / Appendix: Anchorage Municipal Pretrial Diversion Data Collection For

Outcome assessment after hip fracture : is EQ-5D the answer?

Objectives: To study the measurement properties of a joint specific patient reported outcome measure, a measure of capability and a general health-related quality of life (HRQOL) tool in a large cohort of patients with a hip fracture. Methods: Responsiveness and associations between the Oxford Hip Score (a hip specific measure: OHS), ICEpop CAPability (a measure of capability in older people: ICECAP-O) and EuroQol EQ-5D (general health-related quality of life measure: EQ-5D) were assessed using data available from two large prospective studies. The three outcome measures were assessed concurrently at a number of fixed follow-up time-points in a consecutive sequence of patients, allowing direct assessment of change from baseline, inter-measure associations and validity using a range of statistical methods. Results: ICECAP-O was not responsive to change. EQ-5D was responsive to change from baseline, with an estimated standardised effect size for the two datasets of 0.676 and 0.644 at six weeks and four weeks respectively; this was almost as responsive to change as OHS (1.14 at four weeks). EQ-5D correlated strongly with OHS; Pearson correlation coefficients were 0.74, 0.77 and 0.70 at baseline, four weeks and four months. EQ-5D is a moderately good predictor of death at 12 months following hip fracture. Furthermore, EQ-5D reported by proxies (relatives and carers) behaves similarly to self-reported scores. Conclusions: Our findings suggest that a general HRQOL tool such as EQ-5D could be used to measure outcome for patients recovering from hip fracture, including those with cognitive impairment

A comparative study of breast surface reconstruction for aesthetic outcome assessment

Breast cancer is the most prevalent cancer type in women, and while its survival rate is generally high the aesthetic outcome is an increasingly important factor when evaluating different treatment alternatives. 3D scanning and reconstruction techniques offer a flexible tool for building detailed and accurate 3D breast models that can be used both pre-operatively for surgical planning and post-operatively for aesthetic evaluation. This paper aims at comparing the accuracy of low-cost 3D scanning technologies with the significantly more expensive state-of-the-art 3D commercial scanners in the context of breast 3D reconstruction. We present results from 28 synthetic and clinical RGBD sequences, including 12 unique patients and an anthropomorphic phantom demonstrating the applicability of low-cost RGBD sensors to real clinical cases. Body deformation and homogeneous skin texture pose challenges to the studied reconstruction systems. Although these should be addressed appropriately if higher model quality is warranted, we observe that low-cost sensors are able to obtain valuable reconstructions comparable to the state-of-the-art within an error margin of 3 mm.Comment: This paper has been accepted to MICCAI201

Training in the Use of Psychotherapy Outcome Assessment Measures at Psychology Internship Sites

American Psychological Association accredited psychology internship training programs (N = 407) were surveyed concerning their attitudes, beliefs, and practices with regard to outcome assessment measures. Results indicated that 47% of surveyed sites use outcome measures for assessment, and 66% used these measures for diagnostic purposes. In addition, 79% of respondents supported using outcome assessment measures to evaluate client progress, 61% supported training interns in the use of outcome assessment measures, and 87% felt outcome assessment measures would increase in importance in the future. The discrepancy between support for outcome assessment measures and actual use is discussed and recommendations provided

Radiomics for Response and Outcome Assessment for Non-Small Cell Lung Cancer.

Routine follow-up visits and radiographic imaging are required for outcome evaluation and tumor recurrence monitoring. Yet more personalized surveillance is required in order to sufficiently address the nature of heterogeneity in nonsmall cell lung cancer and possible recurrences upon completion of treatment. Radiomics, an emerging noninvasive technology using medical imaging analysis and data mining methodology, has been adopted to the area of cancer diagnostics in recent years. Its potential application in response assessment for cancer treatment has also drawn considerable attention. Radiomics seeks to extract a large amount of valuable information from patients' medical images (both pretreatment and follow-up images) and quantitatively correlate image features with diagnostic and therapeutic outcomes. Radiomics relies on computers to identify and analyze vast amounts of quantitative image features that were previously overlooked, unmanageable, or failed to be identified (and recorded) by human eyes. The research area has been focusing on the predictive accuracy of pretreatment features for outcome and response and the early discovery of signs of tumor response, recurrence, distant metastasis, radiation-induced lung injury, death, and other outcomes, respectively. This review summarized the application of radiomics in response assessments in radiotherapy and chemotherapy for non-small cell lung cancer, including image acquisition/reconstruction, region of interest definition/segmentation, feature extraction, and feature selection and classification. The literature search for references of this article includes PubMed peer-reviewed publications over the last 10 years on the topics of radiomics, textural features, radiotherapy, chemotherapy, lung cancer, and response assessment. Summary tables of radiomics in response assessment and treatment outcome prediction in radiation oncology have been developed based on the comprehensive review of the literature

Work-related outcome assessment instruments

Prevention of work disability is a primary goal within treatment of spinal disorders. Work-related outcome measures therefore are essential indices within evidence-based medicine. So far many measures suffer, however, from standardized measurement, standardized terminology, and a lack of theoretical background. This review addresses traditional indicators like work status and sickness absence, and discusses more theory-bound concepts, i.e. work ability, occupational risk factors for recurrence of symptoms and re-injury, work-related attitudes that may become obstacles to recovery, and individual reactions to occupational stressors that increase the risk of maintenance and recurrence of symptoms. The review includes methodological and theoretical considerations and recommendations for the use of work-related outcome measures in future outcome researc

Back related outcome assessment instruments

A literature review of the most widely used condition specific, self administered assessment questionnaires for low back pain had been undertaken. General and historic aspects, reliability, responsiveness and minimum clinically important difference, external validity, floor and ceiling effects, and available languages were analysed. These criteria, however, are only part of the consideration. Of similar importance are the content, wording of questions and answers in each of the six questionnaires and an analysis of the different score results. The issue of score bias is discussed and suggestions are given in order to increase the construct validity in the practical use of the individual questionnaire

The use of the "Once-Upon-A-Time…" Test in treatment outcome assessment

In an era in which the advent of managed health care is questioning the value of traditional psychological assessment, we discuss the role of the "Once-upon-a-time…" Test in treatment outcome assessment. The "Once upon a time..." Test (Fagulha, 1992, 1997) is a storytelling projective technique whose purpose is to describe the way children deal with the emotions of anxiety and pleasure. In psychodynamic theories, these emotions have an important adaptive function for psychological development (Freud, 1926/1978; Klein, 1932/1969). The “Once upon a time..." Test task is to complete seven stories which are presented as pictures in a cartoon format. Each story depicts common situations in the life of any child that evoke emotions of anxiety and of pleasure. Five cards refer to anxiety provoking situations and two refer to pleasurable experiences. For each card there are nine scenes that represent different possible ways of dealing with the emotional experience evoked by the card. These scenes are grouped into three categories of three scenes each – the Anxiety category (A), the Fantasy category (F) and the Reality category (R). The child is asked to complete the story drawn on the card by selecting and then placing three of these nine scenes in sequence. The categories of the scenes chosen by the child and the sequences organized with these scenes reflect the way children deal with their emotions, anxiety and pleasure, in a transitional space (Winnicott, 1971/1975) between fantasy and reality. After selecting and placing the scenes in sequence, the child tells the story that he/she has just invented. Although the majority of the studies done on the "Once upon a time..." Test have been centered on the analysis of the chosen scenes, according to their category (Anxiety, Fantasy and Reality) and their placement in sequence (in the first, second or third position), a complementary coding system was developed afterwards. This system involves the study of the arranged sequences based on the nine scenes available for each card, and not only the three categories (Pires & Fagulha, 2001). According to this system, the arranged sequences based on the nine scenes available for each card correspond to four different possible ways of facing anxiety and confronting with it. There is a strategy that represents the non-recognition of the painful emotion – Denial –, and three strategies that involve the recognition of this disturbing affect, corresponding to two distinct ways of coping with it – Operational Adaptive Strategy and Emotional Equilibration Strategy – and to one other that proves to be inefficient in dealing with it – Impossibility. The studies done with both coding systems have come to the same conclusion: the patterns of answers reflect differences in ages. As children mature they are able to master anxiety in a more active and efficient manner. In the coding system category of the scenes chosen and their position in the sequence, this developmental achievement is seen through a tendency to respond to anxious situations by choosing scenes that show either anxiety or reality in the first position of the sequence. There is also a progressive decrease in choice of anxiety scenes for story endings corresponding to an increase in the choice of reality or fantasy scenes. As children mature, fantasy scenes in first position of the sequence are less chosen because they reflect the denial of the distress reflected in the card (Fagulha, 1992, 1997, 2000) Regarding the complementary coding system sequences of scenes, the higher degree of emotional stability allows children to deal with anxious situations through adaptive strategies, such us Operational Adaptive Strategy and Emotional Equilibration Strategy. Denial of the anxiety and Impossibility to deal with it are strategies less used by mature children (Pires & Fagulha, 2001) In view of these empirical data is our aim to analyze and discuss a child pattern of answers to the "Once upon a time..." Test at two different moments of her psychotherapeutic process, at treatment initiation and then again to make a decision about treatment termination. We expect to give an account of the "Once upon a time..." Test potentialities to the objective evaluation of the results of child psychotherapy

The Public Health Dimension of Disasters—Health Outcome Assessment of Disasters

A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters. During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health outcome assessment, such as: (1) what is meant by disaster health outcome assessment?; (2) why should one conduct a disaster health outcome assessment, and what are the objectives?, and (3) who benefits from the information obtained by a disaster health outcome assessment? A disaster health outcome assessment can be defined as a systematic assessment of the current and potential health problems in a population affected by a disaster. Different methods can be used to examine these health problems such as: (1) rapid assessment of health needs; (2) (longitudinal) epidemiological studies using questionnaires; (3) continuous surveillance of health problems using existing registration systems; (4) assessment of the use and distribution of health services; and (5) research into the etiology of the health effects of disasters. The public health impact of a disaster may not be immediately evident. Disaster health outcome assessment provides insight into the health related consequences of disasters. The information that is obtained by performing a disaster health outcome assessment can be used to initiate and adapt the provision of health care. Besides information for policy-makers, disaster health outcome assessments can contribute to the knowledge and evidence base of disaster health outcomes (scientific objective). Finally, disaster health outcome assessment might serve as a signal of recognition of the problems of the survivors. Several stakeholders may benefit from the information obtained from a disaster health outcome assessment. Disaster decision-makers and the public health community benefit from performing a disaster health outcome assessment, since it provides information that is useful for the different aspects of disaster management. Also, by providing information about the nature, prevalence, and course of health problems, (mental) health care workers can anticipate the health needs and requirements in the affected population. It is important to realize that the disaster is not over when the acute care has been provided. Instead, disasters will cause many other health problems and concerns such as infectious diseases and mental health problems. Disaster health outcome assessments provide insight into the public health impact of disaster