Newborns with Severe Disability or Impairment

2021 ◽  
pp. 275-289
Author(s):  
M. Devereaux ◽  
K. L. Marc-Aurele
Keyword(s):  
Severe Disability

scholarly journals Impact of monthly headache days on anxiety, depression and disability in migraine patients: results from the Spanish Atlas

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
P. Irimia ◽  
M. Garrido-Cumbrera ◽  
S. Santos-Lasaosa ◽  
M. Aguirre-Vazquez ◽  
J. Correa-Fernández ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Psychiatric Comorbidity ◽  
Severe Disability ◽  
Anxiety And Depression ◽  
Headache Frequency ◽  
Positive Linear Correlation ◽  
Disabled Patients ◽  
Anxiety Depression

AbstractIdentifying highly disabled patients or at high risk of psychiatric comorbidity is crucial for migraine management. The burden of migraine increases with headache frequency, but the number of headache days (HDs) per month after which disability becomes severe or the risk of anxiety and depression is higher has not been established. Here, we estimate the number of HDs per month after which migraine is associated with higher risk of anxiety and depression, severe disability and lower quality of life. We analysed 468 migraine patients (mean age 36.8 ± 10.7; 90.2% female), of whom 38.5% had ≥ 15 HDs per month. Our results show a positive linear correlation between the number of HDs per month and the risk of anxiety (r = 0.273; p < 0.001), depression (r = 0.337; p < 0.001) and severe disability (r = 0.519; p < 0.001). The risk of anxiety is higher in patients having ≥ 3HDs per month, and those with ≥ 19HDs per month are at risk of depression. Moreover, patients suffering ≥ 10HDs per month have very severe disability. Our results suggest that migraine patients with ≥ 10HDs per month are very disabled and also that those with ≥ 3HDs per month should be screened for anxiety.

Abstract P47: Predicting Death and Stroke After Carotid Endarterectomy in Asymptomatic Patients: A Clinical Prediction Model

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Linda Calvillo-King ◽  
Song Zhang ◽  
Lei Xuan ◽  
Ethan A Halm
Keyword(s):  
Carotid Endarterectomy ◽  
Risk Score ◽  
Prediction Rule ◽  
Severe Disability ◽  
Clinical Prediction ◽  
Imaging Data ◽  
Final Model ◽  
Complication Risk ◽  
Asymptomatic Patients ◽  
History Of

Background and Purpose: National AHA guidelines on carotid endarterectomy (CEA) for asymptomatic patients (Pts) stipulate that the long term benefit of surgery is dependent on having a ≤ 3% risk of perioperative death or stroke (D/S) due to the procedure. We developed and validated a multivariate model of risk of D/S within 30 days of CEA for asymptomatic disease and a clinical prediction rule based on the final model. Methods: We analyzed data from 6553 asymptomatic cases in the New York Carotid Artery Surgery (NYCAS) study, a population-based cohort of all Medicare beneficiaries having CEA in NY State from 1/98 to 6/99. Medical records were abstracted for: sociodemographics, neurological history, carotid imaging data, comorbidities, and D/S within 30 days. All events were adjudicated. Multivariate logistic regression with GEE was used to identify independent predictors of combined D/S. The final model was cross-validated with100 random splits. A CEA-8 Clinical Risk Score assigned 1 point to each risk factor except for disability which got 2 points. Results: The 6553 CEAs were performed by 435 surgeons in 157 hospitals. Mean age was 74 years, 3655 were male, 4152 had coronary artery disease (CAD), 873 valvular disease, 611 congestive heart failure (CHF), 1453 history of distant stroke or TIA, and 93 severe disability. Nearly all (6413) had 70-90% ipsilateral stenosis, and 2469 had ≥ 50% contralateral stenosis. The combined 30 day D/S rate was 3.0% (198 of 6553). Multivariable predictors of perioperative D/S were: female (OR, 1.5; 95% CI, 1.1-1.9), non-white (OR, 1.8; 1.1-2.9), severe disability (OR, 3.7; 1.8-7.7), CHF (OR, 1.6; 1.1-2.4), CAD (OR, 1.6; 1.2- 2.2), valvular heart disease (OR, 1.5; 1.1-2.3), distant history of stroke/TIA (OR, 1.5; 1.1- 2.0), and non-operated stenosis ≥50% (OR, 1.8; 1.3-2.3). The CEA-8 Risk Score stratified Pts from a D/S rate of 0.6% (3 of 509) to 10% (16 of 159). Conclusions: Several sociodemographic, neuroseverity, and comorbidity factors predicted risk of D/S in asymptomatic patients having CEA. A CEA-8 Risk Score of ≥ 4 identifies high risk Pts (predicted D/S rate of >7.5%) with 2.5 times the AHA guideline acceptable complication risk in asymptomatic Pts (≤ 3%).

Abstract P426: Platelet Glycoprotein IIb/IIIa Inhibitors as an Adjunct to Stent Placement of Carotid Stenosis in Symptomatic Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sachin M Bhagavan ◽  
Ammad Ishfaq ◽  
Muhammad F Ishfaq ◽  
Mukaish Kumar ◽  
Shruthi Pulimamidi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Stent Placement ◽  
Severe Disability ◽  
Platelet Glycoprotein ◽  
Carotid Stent ◽  
Significant Difference ◽  
Ischemic Attack

Background: Intra-arterial or intravenous platelet glycoprotein (GP) IIb/IIIa inhibitors have been used as adjunct to stent placement of carotid stenosis in patients with ischemic stroke or transient ischemic attack. Objective: To determine the proportion of patients with ischemic stroke or transient ischemic attack who received platelet GP IIb/IIIa inhibitors as adjunct to carotid stent placement and associated outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1, 2000 to July 1, 2018. We identified patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis and received Abciximab, Eptifibatide, or Tirofiban. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 8.4 % of 4567 patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis received platelet GP IIb/IIIa inhibitors. Patients who received platelet GP IIb/IIIa inhibitors were more likely to experience cerebral ischemia (14.8% versus 7.5%) and undergo intubation/mechanical ventilation (4.4% versus 2%). There was a significant difference between patients who did or did not receive platelet GP IIb/IIIa inhibitors in terms of in hospital mortality rates (2.7% versus 1.2%, p=0.0152), none to mild disability (67.3% vs 75.7%, p=0.0003), and moderate to severe disability (30.1% vs 23.1%,p=0.0024). Conclusions: Adjunct use of platelet GP IIb/IIIa inhibitors in patients undergoing carotid stent placement for symptomatic carotid stenosis was associated with increased rates of in hospital mortality and moderate to severe disability.

Estimation of annual probabilities of changing disability levels in Australians with relapsing-remitting multiple sclerosis

2018 ◽  
Vol 25 (13) ◽  
pp. 1800-1808 ◽  
Author(s):  
Hasnat Ahmad ◽  
Ingrid van der Mei ◽  
Bruce V Taylor ◽  
Robyn M Lucas ◽  
Anne-Louise Ponsonby ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Transition Probabilities ◽  
Age At Onset ◽  
Small Sample ◽  
Severe Disability ◽  
Economic Evaluations ◽  
Combining Data ◽  
Relapsing Remitting ◽  
Mild Disability ◽  
Small Sample Sizes

Background: Transition probabilities are the engine within many health economics decision models. However, the probabilities of progression of disability due to multiple sclerosis (MS) have not previously been estimated in Australia. Objectives: To estimate annual probabilities of changing disability levels in Australians with relapsing-remitting MS (RRMS). Methods: Combining data from Ausimmune/Ausimmune Longitudinal (2003–2011) and Tasmanian MS Longitudinal (2002–2005) studies ( n = 330), annual transition probabilities were obtained between no/mild (Expanded Disability Status Scale (EDSS) levels 0–3.5), moderate (EDSS 4–6.0) and severe (EDSS 6.5–9.5) disability. Results: From no/mild disability, 6.4% (95% confidence interval (CI): 4.7–8.4) and 0.1% (0.0–0.2) progressed to moderate and severe disability annually, respectively. From moderate disability, 6.9% (1.0–11.4) improved (to no/mild state) and 2.6% (1.1–4.5) worsened. From severe disability, 0.0% improved to moderate and no/mild disability. Male sex, age at onset, longer disease duration, not using immunotherapies greater than 3 months and a history of relapse were related to higher probabilities of worsening. Conclusion: We have estimated probabilities of changing disability levels in Australians with RRMS. Probabilities differed between various subgroups, but due to small sample sizes, results should be interpreted with caution. Our findings will be helpful in predicting long-term disease outcomes and in health economic evaluations of MS.

scholarly journals Assessing the distributional impact of reforms to disability benefits for older people in the UK: implications of alternative measures of income and disability costs

2012 ◽  
Vol 34 (2) ◽  
pp. 232-257 ◽  
Author(s):  
RUTH HANCOCK ◽  
STEPHEN PUDNEY
Keyword(s):  
Older People ◽  
Low Income ◽  
Severe Disability ◽  
Disability Benefits ◽  
Disabled People ◽  
Alternative Measures ◽  
The Uk ◽  
Distributional Impact ◽  
Distributional Impacts

ABSTRACTThe UK Attendance Allowance (AA) and Disability Living Allowance (DLA) are non-means-tested benefits paid to many disabled people aged 65 + . They may also increase entitlements to means-tested benefits through the Severe Disability Premium (SDP). We investigate proposed reforms involving withdrawal of AA/DLA. Despite their present non-means-tested nature, we show that withdrawal would affect mainly low-income people, whose losses could be mitigated if SDP were retained at its current or a higher level. We also show the importance of the method of describing distributional impacts and that use of inappropriate income definitions in official reports has overstated recipients' capacity to absorb the loss of these benefits.

scholarly journals Long-Term Systematic Outcome Assessment of Patients Following Spine Surgery in Rwanda: The Use of Patient Reported Outcome Tools

2020 ◽  
pp. 1-11
Author(s):  
Steven Nshuti ◽  
Steven Nshuti ◽  
Beryl Guterman ◽  
David Hakizimana ◽  
Eric Buramba ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spine Surgery ◽  
Patient Reported Outcome ◽  
Severe Disability ◽  
Assessment Tools ◽  
Trauma Patients ◽  
Patient Reported ◽  
Injured Patients ◽  
Spinal Cord Injured ◽  
Trauma Group

Background: We conducted a systematic evaluation of neurological, functional, quality of life and pain outcomes of patients who underwent spine surgery in our neurosurgery unit using patient reported outcome (PRO) assessment tools. Methods: The study was performed by assessing outcome of all the patients who underwent spine surgery at our department in a cross-sectional fashion using a 5-year operative database. This was an all-inclusive spine outcome study with 2 main groups; a trauma group composed of spinal cord injured patients and a non-trauma group composed of patients with spinal degenerative diseases, spinal tumors, deformity, infection, and vascular malformations. Results: Our analysis included 197 patients who met inclusion criteria for the study. The overall study population was mainly dominated by spinal cord injured patients and spinal degenerative disease patients; 34 % and 60.9 % respectively. The average age was 42 years (range: 15-78 years) with patients in the trauma group being substantially younger than the rest of the cohort. Eighty five percent of trauma patients presented with spinal cord injury causing neurological deficit, of which 58% had no preservation of motor function below the level of injury; ASIA IS A and B (35.8% and 22% respectively). Additionally, 68% of patients in the non-trauma group underwent surgery with severe disability. Overall, 60% of all trauma patients showed improvement of their neurological status as per ASIA IS. Of note, 40% of patients with preoperative ASIA IS B and 8% of patients with preoperative ASIA IS A gained full neurological recovery postoperatively (ASIA IS E). Using the Core outcome measurement Index (COMI) from patient’s perspective, 78.6% of patients reported to have no pain significant enough to make them stop their normal daily activities. Rate of overall return to work (RTW) in the non-trauma group was 77% with 52% of patients being fully functional without condition-related work interruptions. Conclusion: Careful selection of patients for surgery is key for good outcome of patients undergoing spine surgery. In contradiction to most other patients’ groups, patients with severe disability with spinal degenerative conditions might benefit most from surgery. Postoperative outcome of spinal cord injured patients with severe neurological deficits might be better than commonly believed. Controlled prospective data is likely to draw stronger conclusions.

scholarly journals Intensive Task-oriented Training for Mobility and Balance in a Patient with Multiple Strokes: a Case Report

2017 ◽  
Vol 51 (4) ◽  
Author(s):  
Maribeth Anne P. Gelisanga ◽  
Edward James R. Gorgon
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Adverse Events ◽  
Outcome Assessment ◽  
Severe Disability ◽  
Positive Outcomes ◽  
Meaningful Change ◽  
Poor Outcomes ◽  
Task Oriented

Patients with multiple strokes are often excluded from studies due to poor outcomes. This case report described change in mobility and balance in a 54-year-old male with four strokes following intensive physical therapy (PT) based on the Taskoriented Approach. Outcome assessment demonstrated clinically meaningful change in balance and mobility, and no adverse events. Intensive task-oriented PT is safe and feasible, and may contribute toward positive outcomes in severe disability related to multiple strokes.

scholarly journals Beyond Accuracy: Investigating the Potential Clinical Utility of Predicting Functional Dependency and Severe Disability or Death in Successfully Reperfused Patients using Machine Learning

2020 ◽  
Author(s):  
Raphael Meier ◽  
Meret Burri ◽  
Samuel Fischer ◽  
Richard McKinley ◽  
Simon Jung ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Support ◽  
Clinical Utility ◽  
Prediction Models ◽  
A Priori ◽  
Secondary Analysis ◽  
Severe Disability ◽  
Ensemble Method ◽  
Net Benefit ◽  
Primary Analysis

AbstractObjectivesMachine learning (ML) has been demonstrated to improve the prediction of functional outcome in patients with acute ischemic stroke. However, its value in a specific clinical use case has not been investigated. Aim of this study was to assess the clinical utility of ML models with respect to predicting functional impairment and severe disability or death considering its potential value as a decision-support tool in an acute stroke workflow.Materials and MethodsPatients (n=1317) from a retrospective, non-randomized observational registry treated with Mechanical Thrombectomy (MT) were included. The final dataset of patients who underwent successful recanalization (TICI ≥ 2b) (n=932) was split in order to develop ML-based prediction models using data of (n=745, 80%) patients. Subsequently, the models were tested on the remaining patient data (n=187, 20%). For comparison, baseline algorithms using majority class prediction, SPAN-100 score, PRE score, and Stroke-TPI score were implemented. The ML methods included eight different algorithms (e.g. Support Vector Machines and Random forests), stacked ensemble method and tabular neural networks. Prediction of modified Rankin Scale (mRS) 3–6 (primary analysis) and mRS 5–6 (secondary analysis) at 3 months was performed using 25 baseline variables available at patient admission. ML models were assessed with respect to their ability for discrimination, calibration and clinical utility (decision curve analysis).ResultsAnalyzed patients (n=932) showed a median age of 74.7 (IQR 62.7–82.4) years with (n=461, 49.5%) being female. ML methods performed better than clinical scores with stacked ensemble method providing the best overall performance including an F1-score of 0.75 ± 0.01, an ROC-AUC of 0.81 ± 0.00, AP score of 0.81 ± 0.01, MCC of 0.48 ± 0.02, and ECE of 0.06 ± 0.01 for prediction of mRS 3–6, and an F1-score of 0.57 ± 0.02, an ROC-AUC of 0.79 ± 0.01, AP score of 0.54 ± 0.02, MCC of 0.39 ± 0.03, and ECE of 0.19 ± 0.01 for prediction of mRS 5–6. Decision curve analyses suggested highest mean net benefit of 0.09 ± 0.02 at a-priori defined threshold (0.8) for the stacked ensemble method in primary analysis (mRS 3–6). Across all methods, higher mean net benefits were achieved for optimized probability thresholds but with considerably reduced certainty (threshold probabilities 0.24–0.47). For the secondary analysis (mRS 5–6), none of the ML models achieved a positive net benefit for the a-priori threshold probability 0.8.ConclusionsThe clinical utility of ML prediction models in a decision-support scenario aimed at yielding a high certainty for prediction of functional dependency (mRS 3–6) is marginal and not evident for the prediction of severe disability or death (mRS 5–6). Hence, using those models for patient exclusion cannot be recommended and future research should evaluate utility gains after incorporating more advanced imaging parameters.

scholarly journals Development of Independent Mobility Aids for Persons with Severe Disability

Biomechanisms ◽  
2012 ◽  
Vol 21 (0) ◽  
pp. 65-77
Author(s):  
Takenobu INOUE ◽  
Atsushi TSUKADA ◽  
Misono SAKAI ◽  
Katsuhiko SAKAUE ◽  
Motoi SUWA
Keyword(s):  
Severe Disability ◽  
Independent Mobility ◽  
Mobility Aids
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