The impact of 2006 guidance on nutrition support, in clinical outcome
                        measures

Background: To assess disease progression in multiple sclerosis (MS) several outcome measures are available. The interrelation of changes on different scales has not been studied extensively and the concept of combining scales has only recently been introduced in MS. Objective: To explore combining different clinical outcome measures in the evaluation of disease progression in MS. Methods: In 553 patients we studied the presence of relevant changes according to standard definitions on the Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW) and the Multiple Sclerosis Impact Scale (MSIS-29). We examined ‘exclusive worsening’ (worsening on one measure while not worsening on any other measure) and ‘opposing changes’ (worsening on one measure while improving on another measure). Finally, we investigated the impact of combining assessments. Results: Based on the EDSS alone, 140 patients progressed. However, almost twice as many (275) showed worsening on any of the clinical outcome measures. Exclusive worsening was observed in 37 patients on the EDSS, 13 on the 9HPT, 39 on the T25FW and 44 on the MSIS physical. Of all worsened patients 76 (28%) showed opposing changes, a phenomenon predominantly observed when combining physician-based and patient-derived outcome measures. Conclusion: When assessing disease progression in MS, sensitivity to change can be increased by combining different outcome measures. The added value is especially present when combining measures from different perspectives. However, further research is needed to evaluate the optimal way to combine outcome measures before implementing this strategy in clinical studies.

Download Full-text

Development of health-system inpatient pharmacy clinical metrics

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz225 ◽

2019 ◽

Vol 76 (23) ◽

pp. 1958-1964

Author(s):

Stacy Cassat ◽

Lindsay Massey ◽

Stephanie Buckingham ◽

Tamara Kemplay ◽

Jeff Little

Keyword(s):

Clinical Outcome ◽

Health System ◽

Outcome Measures ◽

Patient Outcomes ◽

Assessment Tool ◽

Time Frame ◽

Pharmacy Services ◽

Systematic Process ◽

Institutional Review Board Review ◽

The Impact

Abstract Purpose To describe a process to identify metrics that represent the impact of inpatient pharmacy services on patient outcomes across a health system. Summary The authors describe a systematic process of identifying inpatient clinical outcome measures that could represent pharmacists’ impact on patient outcomes and eventually be displayed in a dashboard within the electronic medical record (EMR). A list was generated through literature review, assessment of practices at other sites, evaluation of current pharmacy services, and collaboration with the quality department and System Pharmacy Clinical User Group. The project team narrowed the list through assessment against standardized criteria. An assessment tool was designed and distributed to stakeholders to prioritize clinical outcome measures for inclusion on the dashboard. The clinical outcome measures were transformed into metrics by determining measurement criteria, inclusion and exclusion parameters, and review time frame. After validation, the metrics are planned to be displayed on an inpatient pharmacy EMR dashboard. Exemption from institutional review board review was granted for this project. Conclusion A systematic process was developed and used to identify inpatient clinical outcome metrics.

Download Full-text

Nutrition support and clinical outcome in advanced cancer patients

Proceedings of The Nutrition Society ◽

10.1017/s0029665118000459 ◽

2018 ◽

Vol 77 (4) ◽

pp. 388-393 ◽

Cited By ~ 12

Author(s):

Alessandro Laviano ◽

Luca Di Lazzaro ◽

Angela Koverech

Keyword(s):

Clinical Outcome ◽

Cancer Patients ◽

Metastatic Cancer ◽

Tumour Response ◽

Nutrition Therapy ◽

Response To Therapy ◽

New Drugs ◽

Nutrition Support ◽

Artificial Nutrition ◽

The Impact

Newly diagnosed cancer patients are frequently found suffering from a metastatic disease, which poses additional challenges to the delivery of effective therapies. Chemotherapy and radiotherapy are associated with side effects which reduce tolerance to treatment and likelihood of tumour response. Identifying preventable factors of reduced response to therapy would translate into better care of cancer patients. Among other factors, malnutrition, as diagnosed by non-volitional weight loss, and cachexia, as revealed by sarcopenia, are universally recognised negative prognostic factors. Less certainty exists on the role of nutrition therapy in improving cancer patients’ body composition and clinical outcome. The reasons for the lack of convincing evidence are manifold, mostly related to the poor design of nutritional trials. Metastatic cancer patients should receive a quantitatively and qualitatively adequate diet, and in case of reduced tolerance of food, artificial nutrition is indicated. Most importantly, nutritional care should target the underlying mechanisms of reduced food intake/impaired anabolic response, and aim at minimising the impact of catabolic crisis, to maximise the recovery phase. The combined and early use of supplemental energies and proteins, as well as modulators of inflammatory response has been shown to improve nutritional status and may also benefit clinical outcome. When part of early palliative care, nutrition therapy improves cancer patients’ quality of life and may prolong survival at a fraction of the costs of developing new drugs.

Download Full-text

Erratum to “The impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: a prospective cohort study with propensity score matching,” Nutrition (2017) 37C, 53–59

Nutrition ◽

10.1016/j.nut.2017.04.001 ◽

2017 ◽

Vol 42 ◽

pp. 121

Keyword(s):

Cohort Study ◽

Cost Effectiveness ◽

Propensity Score ◽

Clinical Outcome ◽

Propensity Score Matching ◽

Prospective Cohort ◽

Nutrition Support ◽

Nutritional Risk ◽

Effectiveness Analysis ◽

The Impact

Download Full-text

Clinical outcome measures in SPMS trials: An analysis of the IMPACT and ASCEND original trial data sets

Multiple Sclerosis Journal ◽

10.1177/1352458519876701 ◽

2019 ◽

Vol 26 (12) ◽

pp. 1540-1549 ◽

Cited By ~ 1

Author(s):

Marcus W Koch ◽

Jop Mostert ◽

Bernard Uitdehaag ◽

Gary Cutter

Keyword(s):

Clinical Outcome ◽

Outcome Measures ◽

Progressive Multiple Sclerosis ◽

Trial Data ◽

Data Sets ◽

Disability Progression ◽

Data Set ◽

Original Trial ◽

Baseline Characteristics ◽

The Impact

Background: Still too little is known about the natural history of clinical outcome measures beyond the Expanded Disability Status Scale (EDSS), such as the timed 25-foot walk (T25FW) and nine-hole peg test (9HPT) in secondary progressive multiple sclerosis (SPMS). Objective: To describe progression on the EDSS, T25FW, 9HPT, and their combinations. To investigate the association of the baseline characteristics age, sex, EDSS, T25FW, gadolinium-enhancing lesions, and relapse activity with EDSS and T25FW progression. Methods: Using original trial data from the placebo arms of the IMPACT and ASCEND randomized controlled trials, we describe disability progression (with and without 3- or 6-month confirmation). We investigated the association of selected baseline characteristics with EDSS and T25FW progression over 2 years using binary logistic regression. Results: T25FW was the single outcome measure with the largest proportion of patients progressing, followed by EDSS and 9HPT. EDSS and T25FW at baseline were associated with EDSS and T25FW progression in both data sets. Age and relapse activity were only mild and inconsistent predictors, while sex and gadolinium enhancement at baseline did not predict disability progression in either data set. Conclusion: Our analyses inform the selection of primary outcome measures as well as inclusion criteria for clinical trials in SPMS.

Download Full-text

The impact of the AIS 2005 revision on injury severity scores and clinical outcome measures

Injury ◽

10.1016/j.injury.2009.05.013 ◽

2009 ◽

Vol 40 (9) ◽

pp. 999-1003 ◽

Cited By ~ 37

Author(s):

Kristin Salottolo ◽

April Settell ◽

Phyllis Uribe ◽

Shelley Akin ◽

Denetta Sue Slone ◽

...

Keyword(s):

Clinical Outcome ◽

Outcome Measures ◽

Injury Severity ◽

Severity Scores ◽

The Impact

Download Full-text

Although the computer-aided implant placement technique has statistically significant better outcomes than partially guided and free-handed implant placement, the observed clinical outcome measures are similar and insignificant

Journal of Evidence Based Dental Practice ◽

10.1016/j.jebdp.2021.101538 ◽

2021 ◽

pp. 101538

Author(s):

Paul S. Farsai

Keyword(s):

Clinical Outcome ◽

Outcome Measures ◽

Implant Placement ◽

Computer Aided ◽

Placement Technique

Download Full-text

LINC-25. BRAF ABERRATIONS IN PEDIATRIC PILOCYTIC ASTROCYTOMAS (PCAs): PREVALENCE AND IMPACT ON CLINICAL OUTCOME

Neuro-Oncology ◽

10.1093/neuonc/noaa222.459 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii383-iii383

Author(s):

Subramaniam Ramanathan ◽

Maya Prasad ◽

Tushar Vora ◽

Mamta Gurav ◽

Ayushi Sahay ◽

...

Keyword(s):

Clinical Outcome ◽

Statistical Significance ◽

Tumor Resection ◽

Brafv600e Mutation ◽

Therapeutic Implications ◽

Pilocytic Astrocytomas ◽

Ffpe Tissues ◽

Braf Fusion ◽

Poor Outcomes ◽

The Impact

Abstract BACKGROUND Increasing knowledge on pilocytic astrocytoma (PCA) biology now points towards an aberration in BRAF/MAPK/ERK pathway which has both diagnostic and therapeutic implications. This study was done to note the impact of BRAF aberrations on clinical outcome in childhood PCA. METHODS FFPE tissues of all childhood PCA diagnosed during 2011–2017 were evaluated for BRAFV600E mutation by Sanger sequencing and KIAA1549 fusion transcripts (16–9;15–9;16-11) by reverse transcriptase polymerase chain reaction. Children undergoing gross tumor resection received no adjuvant treatment. Unresectable tumors (only biopsy) and NF-1 associated PCAs, were treated if clinically indicated. Only patients with documented therapy details/followup were included for analysis. STUDY RESULTS Ninety-eight patients (median age-7.7yrs; boy:girl ratio-1.4) were included. Major sites were: Cerebellum-37(38%), 3rd Ventricle-26(27%), Cerebrum-15(15%). While BRAFV600E mutation was noted in 7/89(8%) specimens, BRAF-fusions were found in 34/85(40%). Following surgery/biopsy, 23(24%) and 21(22%) received adjuvant chemotherapy and radiotherapy respectively. The 1-year/3-year/5-year-EFS of the overall cohort was 90.7%/81.3%/67.4% respectively. Cerebellar tumors did better vis-à-vis other sites(5yr-EFS:74.3% v/s 66.4%;p=0.403). The 5yr-EFS of BRAF-fusion positive tumors (34), tumors without any BRAF aberration (40) and BRAFV600E mutant tumors (7) was 84.8%/ 69.6%/ 42.9% (p=0.215). CONCLUSIONS BRAF-fusion and BRAFV600E mutation were associated with good and poor outcomes respectively. Lack of statistical significance could be attributed to use of radiation as planned therapy in patients from earlier years. Data on BRAF aberrations in PCAs aids decision making regarding adjuvant therapy and choosing appropriate salvage-therapy especially in relapsed/refractory PCAs.

Download Full-text

663 Improved Sleep After a Brief Intervention for Insomnia Mediates Improvements in Depression Symptoms During the COVID-19 Pandemic

SLEEP ◽

10.1093/sleep/zsab072.661 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A259-A259

Author(s):

Kathleen O’Hora ◽

Mateo Lopez ◽

Allison Morehouse ◽

Andrea Cordero ◽

Raquel Osorno ◽

...

Keyword(s):

Depressive Symptoms ◽

Outcome Measures ◽

Symptom Severity ◽

Post Treatment ◽

Symptom Improvement ◽

Depression Symptoms ◽

Insomnia Symptom ◽

The Impact ◽

Insomnia Symptoms ◽

Rate Of Improvement

Abstract Introduction The COVID-19 Pandemic and mitigation efforts have led to drastic increases in acute insomnia symptoms, which left untreated may contribute to increased risk for other negative mental health outcomes, including depression. However, the impact of treating acute insomnia symptoms on future depression outcomes remains unknown. Moreover, whether sleep improvements as a result of an insomnia treatment mediate subsequent reduction of depression symptoms similarly remains unknown. Methods At this writing, 44 individuals experiencing insomnia symptoms (Insomnia Severity Index; ISI ≥ 10) that began during the COVID-19 pandemic have been randomized to receive a brief, telehealth Cognitive Behavioral Therapy for Insomnia (CBTI) waitlist control. Treatment was delivered in 4 sessions over a 5-week period. CBTI is the gold-standard behavioral intervention for chronic insomnia and has been applied successfully via telemedicine. Outcome measures were depressive symptoms as measured by the Patient Health Questionnare-9 (PHQ-9) minus the sleep item and insomnia symptom severity as measured by the ISI. Both outcome measures were collected at baseline (week 0), throughout treatment phase (weeks 2–6), and at the post-treatment (week 7). Linear mixed models determined the impact of treatment on depression and insomnia symptom severity. Mediation was tested using the MacArthur framework. Results There was a significant Group x Time interaction, with CBTI leading to a greater rate of improvement in ISI (b = -1.14, p < 0.001) and PHQ-9 (b = -0.61, p = 0.002) than the control. Critically, the rate of improvement in insomnia symptoms to the last session of treatment, was associated with the subsequent improvement in depressive symptoms post-treatment (b = 2.06, p = 0.017). In contrast, depressive symptom improvement was not associated with insomnia symptom improvement (b = 4.28, p = 0.102). Conclusion This preliminary data suggests that brief CBTI can reduce pandemic onset insomnia and other depressive symptoms. The preliminary mediation results further suggest that sleep may be an important treatment target for reducing situational depressive symptoms and supports the need to examine the physiological mechanisms of sleep using high-density EEG in a larger sample. Support (if any):

Download Full-text