scholarly journals Modeling recovery curves with application to prostatectomy

Biostatistics ◽  
2018 ◽  
Vol 20 (4) ◽  
pp. 549-564 ◽  
Author(s):  
Fulton Wang ◽  
Cynthia Rudin ◽  
Tyler H Mccormick ◽  
John L Gore

Summary In many clinical settings, a patient outcome takes the form of a scalar time series with a recovery curve shape, which is characterized by a sharp drop due to a disruptive event (e.g., surgery) and subsequent monotonic smooth rise towards an asymptotic level not exceeding the pre-event value. We propose a Bayesian model that predicts recovery curves based on information available before the disruptive event. A recovery curve of interest is the quantified sexual function of prostate cancer patients after prostatectomy surgery. We illustrate the utility of our model as a pre-treatment medical decision aid, producing personalized predictions that are both interpretable and accurate. We uncover covariate relationships that agree with and supplement that in existing medical literature.

1991 ◽  
Vol 75 (Supplement) ◽  
pp. S50-S58 ◽  
Author(s):  
Ronald M. Ruff ◽  
David Young ◽  
Theresa Gautille ◽  
Lawrence F. Marshall ◽  
Jeff Barth ◽  
...  

✓ A total of 40 severely head-injured patients were selected from the Traumatic Coma Data Bank, supported by the National Institute of Neurological Disorders and Stroke, to analyze the recovery of verbal learning across baseline and 6- and 12-month evaluations postinjury. During the initial 6 months, the group demonstrated marked recovery, followed by an absence of improvement over the latter part of the year. Analysis of this recovery curve on a case by case basis revealed three recovery subtypes: namely, a flat curve, a peak-drop curve, or an improvement curve. These three subtypes proved to have concurrent validity when compared with another memory test. Adding 19 new patients to the sample cross-validated the subtypes. However, the memory performance of the 59 patients was dissociated from other neuropsychological tests which showed recovery at more equivalent rates across the subtypes. Analysis of the demographic and neurological characteristics disclosed that the group with a peak-drop recovery curve was less well educated and the group with a flat curve demonstrated a trend toward higher levels of hypoxia. Moreover, the three subgroups were rated by their relatives to have equivalent levels of depression at baseline and at 6 months, but only the improved subgroup demonstrated reduced depression at 1 year. The clinical relevancy of these differential recovery curves is discussed.


2021 ◽  
pp. postgradmedj-2021-140420
Author(s):  
Yandy Marx Castillo Aleman

BackgroundHealthcare workers often use terms such as Apgar, Babinski or Glasgow in their routine duties. These terms are used worldwide; they are universal and recognised in various languages. Medical eponyms are immutable by the nature; they save valuable time by streamlining communication among health professionals. However, some of these terms lack accuracy and lead to confusion.Objective and methodsThis perspective article aims to analyse the current status of the divergent trends about redeeming (or not) the long-standing tradition of using medical eponyms. Multiple positions regarding the use of these terms have been expressed in the medical literature, and these are summarised in the manuscript. Although, this compilation is based primarily on the author’s medical background and experience.ResultsThere is an interesting debate in the scientific community about the suitability of certain eponyms. Defenders and detractors argue a broad spectrum of points, but there is still no international consensus. The use of classical, ethical and well-recognised medical eponyms will remain a cornerstone in daily clinical settings, textbooks and medical journals. However, their use can be inconsistent or confused in specific conditions, and they can be influenced by local geography and culture.ConclusionsThere is a need to refrain from using unethical and controversial eponyms throughout the whole of science. Further academic and scientific efforts should be addressed to provide a structural systematisation, semantic classification and etymological categorisation on the use of medical eponyms.


Author(s):  
Eric A. J. Hoste ◽  
John A. Kellum ◽  
Norbert Lameire

The lack of a precise biochemical definition of acute kidney injury (AKI) resulted in at least 35 definitions in the medical literature, which gave rise to a wide variation in reported incidence and clinical significance of AKI, impeded a meaningful comparison of studies.The first part of this chapter describes and discusses different definitions and classification systems of AKI. Patient outcome and the need for renal replacement therapy are directly related to the severity of AKI, an observation that supports the use of a categorical staging system rather than a simple binary descriptor. The severity of AKI is commonly characterized using the relative changes in serum creatinine and urine output. Recently introduced staging systems including the RIFLE classification and the Acute Kidney Injury Network (AKIN) use these relatively simple and readily available parameters allowing the assignment of individual patients to different AKI stages. More recently, a Kidney Disease: Improving Global Outcomes (KDIGO) workgroup developed a consensus-based AKI staging system drawing elements of both RIFLE and AKIN. The potential pitfalls and limitations of the proposed definitions and classifications are briefly described.The second part of the chapter describes the epidemiology of AKI in different clinical settings; the intensive care unit (ICU), the hospitalized population, and the community. The different spectrum of AKI in the emerging countries is discussed and the most important causes and aetiologies of the major clinical types of AKI, prerenal, renal, and post-renal are summarized in table form. Finally the patient survival and renal functional outcome of AKI are briefly discussed


Cephalalgia ◽  
2007 ◽  
Vol 27 (7) ◽  
pp. 803-808 ◽  
Author(s):  
G Coppola ◽  
L Di Clemente ◽  
A Fumal ◽  
D Magis ◽  
V De Pasqua ◽  
...  

In order to explore possible interictal brainstem dysfunctions in migraine, we have studied the R2 component of the nociceptive specific blink reflex (nBR) after conditioning by supraorbital or index finger stimuli in 14 untreated migraine without aura patients (MO) between attacks and in 15 healthy volunteers. We determined the R2 recovery curve at increasing inter-stimulus intervals between 50 and 600 ms. The nBR was conditioned by a paired supraorbital stimulus and, in another session, by an ipsilateral electrical shock delivered to the index finger. The R2 nBR recovery curves were normal in MO patients for both the supraorbital and peripheral conditioning. These results do not favour persistent interictal sensitization in the spinal trigeminal sensory system. They also suggest that the control exerted by descending brainstem pathways on medullary R2 interneurones is normal in migraine between attacks.


2019 ◽  
pp. 18-20
Author(s):  
Abasova Inara Afrail

In the article the development of a mathematical model describing the PRC is studied on the base of pressure recovery curve method.Detailed processing of the pressure recovery curve made it possible to determine the deterioration of reservoir permeability in many wells. Here two methods are considered - stationary (steady conditions of selection) and non- stationary.The article proves that the use of these methods allows to develop a mathematical model to increase the determination of this task.On the base of numerical simulation, the following facts had impact on the results of the pressure recovery curve: well shutdown time, taking into account the initial transition section, taking into account curve change section before well shutdown.The study of variable factors impact on the results is carried out by interval estimation.The mathematical model describing the pressure recovery curve is local and changes its structures. This model can be used in industry conditions.


1992 ◽  
Vol 1 (2) ◽  
pp. 25-29 ◽  
Author(s):  
James McLean

My summary reaction to the controversy at hand is that the success of the Biklen and Crossley procedures cannot be discounted on the basis of present knowledge about autism. I know that Calculator also agrees that there is every possibility that literacy skills have been ignored, and even suppressed, by past treatment practices and past segregation policies. Professional tolerance (let alone encouragement) for the use of any communication mode except speech is a relatively new stage for professionals in speech and language. We need only look at our past practices of denigrating manual sign language among people who are deaf to realize how egocentric people without disabilities have been. Overall, however, I think Calculator is right to point out the need for empirical efforts to objectify the procedures and provide a better understanding of the process and the theoretical basis for facilitated communication. I have long championed the notion that treating human problems at only the procedural level, with no understanding as to the theoretical or empirical bases of the treatment, is less than professional and, indeed, is dangerous behavior. Biklen also reflects this awareness, however. He posits his praxis rationale with some support from the literature (Grandin & Scariano, 1986; Oppenheim, 1974). It seems premature to dismiss it as readily as Calculator seems to do. Clearly, however, the proponents of facilitated communication need to do a more complete and rigorous job of objectifying their procedures and more fully describing the people for whom this procedure is "successful." Surely there are extant communication and cognitive abilities among the successful users of these procedures that could be identified and differentiated from the abilities present among those for whom the procedures are less successful. For example, one might look at the recent literature that describes the intentional communication repertoires of nonspeaking people with autism as a guide to some possibly productive taxonomies for describing the pre-treatment behavior of people who showed literacy after experience with facilitated communication procedures (see, for example, Wetherby & Prutting, 1984; Wetherby, Yonclas, & Bryan, 1989). Any extant speech repertoire needs to be carefully described and analyzed. Objective measures of children’s receptive language and reading abilities are also needed. Clearly, being able to predict differential success in the use of facilitated communication procedures would go a long way in helping to establish both empirical and theoretical bases for them. Although it really isn’t necessary, I say to Calculator, have faith. If it turns out that some time is spent in the process of clinically testing these procedures, it is the price we pay to ensure that we do not dismiss ideas and procedures that are unconventional in terms of past practices and past knowledge. If your concerns about these procedures are valid, empiricism will win out over superstition and emotionalism. Neither clinicians, nor consumers of clinical services, can be sustained for long without documented success... success that is measured not only in the research laboratories, but in clinical settings as well. Denying a procedure its opportunities for validation in the clinical arena is not a desirable step. Not all empiricism is found in the laboratory, and not all truth is found in formal research.


Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shailesh Male ◽  
Georgios Tsivgoulis ◽  
Nitin Goyal ◽  
Efstathios Boviatsis ◽  
Abhi Pandhi ◽  
...  

Background&Purpose: Despite recent landmark RCTs showing significant survival and functional outcome benefits with HCT compared with medical therapy (MT) in patients with malignant MCA infarction (MMCAI), HCT rates have not substantially increased in the US. It is difficult for patients’ families to reconcile the wishes of the patient with the possibility of poor functional outcome. We sought to evaluate early outcomes in patients with MMCAI who were treated with HCT (cases) in comparison to patients treated with MT due to the perception of procedural futility by families (controls). Subjects&Methods: We evaluated in a retrospective cohort study design consecutive patients with acute MMCAI treated in two tertiary care centers during a seven-year period. Pre-treatment NIHSS, NIHSS at discharge and modified Rankin Scale (mRS) at three months were documented. Functional independence (FI) and survival without severe disability (SWSD) were defined as mRS of 0-2 and 0-4 respectively. Results: A total of 66 patients (37 cases and 29 controls) fulfilled the study inclusion criteria [mean age 59±15 years, 52% men, median admission NIHSS-score: 19 points (IQR: 16-22]. Cases were younger (51±11 vs 68±13 years; p<0.001) and tended to have lower median admission NIHSS than controls [18 (IQR:16-20) vs 20 (IQR: 18-23); p=0.072], but the two groups did not differ significantly (p>0.05) in terms of other baseline characteristics. The rates of FI and SWSD at three months were higher in cases than controls [16% vs 0% (p=0.031) & 62% vs 0% (p<0.001)], while three-month mortality was lower (24% vs 77%; p<0.001). Multivariate Cox regression analysis identified HCT as the most important predictor of lower risk of death at three months (HR: 0.02, 95%CI: 0.01-0.10; p<0.001). Conclusions: HCT is a critical and effective therapy for patients with MMCAI but cannot provide a gurantee of functional recovery. Refusal of HCT by medical decision makers is common and reflects the complexity of issues under consideration in terms of patient outlook beyond the reduction of mortality following acute MMCAI.


2013 ◽  
Vol 7 (1) ◽  
pp. 51-63 ◽  
Author(s):  
Carolina Leyva ◽  
Mike Zender ◽  
Katherine Staun ◽  
Anna Heeman ◽  
William Brinkman ◽  
...  

Author(s):  
Makenzie Pryor ◽  
Doug Ebert ◽  
Vicky Byrne ◽  
Khalaeb Richardson ◽  
Qua Jones ◽  
...  

The present study examined a diagnostic medical decision aid developed to help inexperienced operators to diagnose and treat a simulated patient. Diagnosis and treatment accuracy using the tool were assessed and compared across both physicians and non-physicians. Initial analysis revealed more accurate diagnostic and treatment choices for non-physicians, but upon further investigation, physicians were found to have recognized signs for another diagnosis and correctly diagnosed and treated based on the limited information in the patient simulation. This fit with other noted behaviors, such as non-physicians opening the diagnostic support tool within the aid more often than physicians, and frequently returning to the tool during the task. In general, non-physicians were supported in choosing the correct diagnosis and treatment by the aid, while physicians disregarded the aid’s recommendations to make decisions based on their own expertise. These results have implications for the development of future decision support aids for non-physicians performing medical procedures.


2001 ◽  
Vol 7 (6) ◽  
pp. 433-442 ◽  
Author(s):  
David Meagher

Acute mental disturbance associated with physical illness is well described in early medical literature, but it was not until 1 AD that Celsus coined the term ‘delirium’ (Lindesay, 1999). Although delirium has many synonyms that are applied in particular clinical settings (Box 1), all acute disturbances of global cognitive functioning are now recognised as ‘delirium’, a consensus supported by both ICD–10 (World Health Organization, 1992) and DSM–IV (American Psychiatric Association, 1994) classification systems. Delirium is a complex neuropsychiatric syndrome that typically involves a plethora of cognitive and non-cognitive symptoms, resulting in a broad differential diagnosis dominated by mental disorders. Psychiatrists' skills in assessing cognitive function and psychopathology, coupled with their knowledge of psychotropic agents, make them well suited to improving detection, coordinating management and facilitating research into this understudied disorder.


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