Intensive Stuttering Therapy with Telepractice Follow-up: Longitudinal Outcomes

2021 ◽  
Author(s):  
Farzan Irani ◽  
Raúl Rojas
Keyword(s):  
Longitudinal Outcomes

Longitudinal outcomes of patients with pseudodementia: a systematic review

2018 ◽  
Vol 49 (5) ◽  
pp. 727-737 ◽  
Author(s):  
Michael H. Connors ◽  
Lena Quinto ◽  
Henry Brodaty
Keyword(s):  
Systematic Review ◽  
Significant Proportion ◽  
Conversion Disorder ◽  
Bibliographic Databases ◽  
Clinical Value ◽  
Trial Methodology ◽  
Longitudinal Outcomes ◽  
Increased Risk ◽  
Wide Range

AbstractDepression and a number of other psychiatric conditions can impair cognition and give the appearance of neurodegenerative disease. Collectively, this group of disorders is known as ‘pseudodementia’ and are important to identify given their potential reversibility with treatment. Despite considerable interest historically, the longitudinal outcomes of patients with pseudodementia remain unclear. We conducted a systematic review of longitudinal studies of pseudodementia. Bibliographic databases were searched using a wide range of search terms. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 18 studies with follow-up varying from several weeks to 18 years. Overall, 284 patients were studied, including 238 patients with depression, 18 with conversion disorder, 14 with psychosis, and 11 with bipolar disorder. Irrespective of diagnosis, 33% developed irreversible dementia at follow-up, 53% no longer met criteria for dementia, and 15% were lost to follow-up. Considerable variability was identified, with younger age at baseline, but not follow-up duration, associated with better outcomes. ECT and pharmacological interventions were also reported to be beneficial, though findings were limited by the poor quality of the studies. Overall, the findings suggest that pseudodementia may confer an increased risk of irreversible dementia in older patients. The findings also indicate, however, that a significant proportion improve, while many remain burdened with their psychiatric condition, independent of organic dementia. The findings support the clinical value of the construct and the need for its re-examination in light of developments in neuroimaging, genomics, other investigative tools, and trial methodology.

Group-based trajectory modeling a good model to explore sub-groups of recovery during acute bipolar mood episodes

2011 ◽  
Vol 26 (S2) ◽  
pp. 233-233
Author(s):  
K. M’bailara ◽  
O. Cosnefroy ◽  
A. Desage ◽  
S. Gard ◽  
L. Zanouy ◽  
...  
Keyword(s):  
Depressive Episode ◽  
Response To Treatment ◽  
Longitudinal Outcomes ◽  
Trajectory Modeling ◽  
Short Period ◽  
Trajectories Of Change ◽  
Dsm Iv ◽  
Bipolar Patients ◽  
Hypomanic Episode

Group-based trajectory modeling (GBTM) is a statistical method created to explore the heterogeneity of clinical groups based on their longitudinal outcomes by identifying distinct trajectories of change. This model can be applied to assess heterogeneity in responses to treatment. This pilot study explored the relevance of the GBTM associated with the dimensional evaluation of mood (MATHYS) to define trajectory of recovery in acute bipolar mood episodes on a short period of time during a naturalistic study.MethodThe sample consisted in 118 bipolar patients and all patients were recruited during an acute phase: 56% had a major depressive episode, 26% a manic or hypomanic episode, and 18% a mixed state using the DSM-IV criteria. Patients were assessed four times with MATHYS during a three weeks follow-up period. It is an observational study and treatment was prescribed as usual. We applied the GBTM method and MATHYS total score to define trajectories of recovery.ResultsThis method allows identifying 4 trajectories of recovery. At Baseline, two of them started with a score of inhibition but with quite different evolutive profiles (stable inhibition versus improvement). The two others trajectories started with a score of activation (mild versus moderate) and showed a linear improvement of symptoms but with a more rapid recovery for the patients with the higher activation at baseline.ConclusionWhen considering the diagnosis of patients belonging in each trajectory, there model seems particular relevant to explore the high heterogeneity in response to treatment in bipolar patients during an acute depressive episode.

scholarly journals Longitudinal Outcomes of Cardiogenic Shock Patients Undergoing Conventional Cardiac Surgery

2020 ◽  
Author(s):  
Nicholas Hess ◽  
Ibrahim Sultan ◽  
Yisi Wang ◽  
Floyd Thoma ◽  
Arman Kilic
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiogenic Shock ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Ventricular Assist ◽  
Longitudinal Outcomes ◽  
Device Implantation ◽  
Aortic Root Repair

Background: Cardiogenic shock is a known risk factor for early mortality following conventional cardiac surgery, however its impact on longitudinal outcomes is less established. This study evaluated longer-term outcomes of conventional cardiac surgery in patients with cardiogenic shock. Methods: This was a retrospective review of conventional cardiac operations performed in patients presenting with cardiogenic shock between 2010 and 2020. The primary outcome was survival, and secondary outcomes included postoperative complications, and rates of heart failure readmission. Multivariable Cox proportional hazards modeling was conducted to identify risk-adjusted predictors of mortality. Results: 604 patients were included, representing 4% of all cardiac cases. Median follow up was 4.3 (IQR 0.3-6.8) years. Aortic root repair/replacement (31.6%) was most commonly performed. 11.1% of patients required preoperative cardiopulmonary resuscitation. Bridging modalities included intravenous inotropes (35.4%), intra-aortic balloon pump (33.4%), Impella (0.5%), or venoarterial extracorporeal membrane oxygenation (3.3%). Operative mortality was 21.5%. Complications included reoperation (24.3%), stroke (15.9%) renal failure (19.2%), and prolonged ventilation (47.9%). Unadjusted 1- and 5-year survival were 71.7% and 62.1%. Risk-adjusted preoperative predictors for mortality included peripheral vascular disease (HR 1.75, 95% CI 1.23-2.49), dialysis dependency (HR 6.30, 95% CI 3.77–10.51) and increasing age (HR 1.02, 95% CI 1.02–1.04). Three patients eventually underwent ventricular assist device implantation and no patients underwent heart transplantation. Conclusions: Despite high initial rates of morbidity and mortality following conventional cardiac surgery in patients presenting with cardiogenic shock, 62% survive to 5 years and most do not require heart failure readmission or advanced heart failure surgical therapy.

Meeting the Assumptions of Inverse-Intensity Weighting for Longitudinal Data Subject to Irregular Follow-Up: Suggestions for the Design and Analysis of Clinic-Based Cohort Studies

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Eleanor M. Pullenayegum
Keyword(s):  
Cohort Studies ◽  
Conditional Independence ◽  
Visit Time ◽  
Independence Assumption ◽  
Longitudinal Outcomes ◽  
Disease Flare ◽  
Additional Information ◽  
Conditional Independence Assumption ◽  
Data Subject

AbstractClinic-based cohort studies enroll patients on first being admitted to the clinic, and follow them as part of usual care, with interest being in the marginal mean of the outcome process. As the required frequency of follow-up varies among patients, these studies often feature irregular visit times, with no two patients sharing a visit time. Inverse-intensity weighting has been developed to handle this, however it requires that the visit process be conditionally independent of the outcome given the observed history. When patients schedule visits in response to changes in their health (for example a disease flare), the conditional independence assumption is no longer plausible, leading to biased results. We suggest additional information that can be collected to ensure that conditional independence holds, and examine how this might be used in the analysis. This allows clinic-based cohort studies to be used to determine longitudinal outcomes without incurring bias due to irregular follow-up.

scholarly journals High-Throughput Digitization of Analog Human Echocardiography Data

2020 ◽  
Author(s):  
Alan Chin Kwan ◽  
Gerran Salto ◽  
Emmanuella Demosthenes ◽  
Birgitta T Lehman ◽  
Ewa Osypiuk ◽  
...  
Keyword(s):  
Analytical Techniques ◽  
Original Image ◽  
Imaging Data ◽  
Community Based ◽  
Longitudinal Outcomes ◽  
Moving Images ◽  
Adult Participants ◽  
Epidemiological Cohort ◽  
Prospective Analyses

Echocardiographic imaging data has been acquired for adult participants of a longitudinal community-based epidemiological cohort study at serial examinations between 1987 and 1998. The original image acquisition approach was analog with storage of moving images on Video Home System (VHS) tapes. Accordingly, we designed and implemented a standardized methodology for digitizing, anonymizing, and organizing these analog data to enable contemporary image-based analyses. Herein, we describe the overall methodology and the operational workflow, quality control, Health Insurance Portability and Accountability Act compliance, and data formatting issues that we addressed. We present this method as an accessible pipeline for enabling digitization of historical imaging data, originally acquired from large cohort studies, in order to preserve and repurpose them for application of advanced and continually evolving image analytical techniques. Such pipelines are critical not only for data conservation but are also invaluable for prospective analyses of imaging phenotypes in relation to already-accrued longitudinal outcomes in community-based cohorts that have been under careful surveillance over up to several decades of follow up.

scholarly journals The association of neurologists with headache health care utilization and costs

Neurology ◽  
2018 ◽  
Vol 90 (6) ◽  
pp. e525-e533 ◽  
Author(s):  
Brian C. Callaghan ◽  
James F. Burke ◽  
Kevin A. Kerber ◽  
Lesli E. Skolarus ◽  
John P. Ney ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
First Year ◽  
Longitudinal Outcomes ◽  
Headache Diagnosis ◽  
Ed Visits ◽  
Health Care Claims ◽  
Headache Patients

ObjectiveTo determine the association of a neurologist visit with headache health care utilization and costs.MethodsUtilizing a large privately insured health care claims database, we identified patients with an incident headache diagnosis (ICD-9 codes 339.xx, 784.0x, 306.81) with at least 5 years follow-up. Patients with a subsequent neurologist visit were matched to controls without a neurologist visit using propensity score matching, accounting for 54 potential confounders and regional variation in neurologist density. Co–primary outcomes were emergency department (ED) visits and hospitalizations for headache. Secondary outcomes were quality measures (abortive, prophylactic, and opioid prescriptions) and costs (total, headache-related, and non-headache-related). Generalized estimating equations assessed differences in longitudinal outcomes between cases and controls.ResultsWe identified 28,585 cases and 57,170 controls. ED visits did not differ between cases and controls (p = 0.05). Hospitalizations were more common in cases in year 0–1 (0.2%, 95% confidence interval [CI] 0.2%–0.3% vs 0.01%, 95% CI 0.01%–0.02%; p < 0.01), with minimal differences in subsequent years. Costs (including non-headache-related costs) and high-quality and low-quality medication utilization were higher in cases in the first year and decreased toward control costs in subsequent years with small differences persisting over 5 years. Opioid prescriptions increased over time in both cases and controls.ConclusionCompared with those without a neurologist, headache patients who visit neurologists had a transient increase in hospitalizations, but the same ED utilization. Confounding by severity is the most likely explanation given the non-headache-related cost trajectory. Claims-based risk adjustment will likely underestimate disease severity of headache patients seen by neurologists.

Routine revascularization is unnecessary in the majority of patients requiring zone II coverage during thoracic endovascular aortic repair: A longitudinal outcomes study using United States Medicare population data

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 239-245 ◽  
Author(s):  
Jonathan E Wilson ◽  
Edgar L Galiñanes ◽  
Parker Hu ◽  
Viktor Y Dombrovskiy ◽  
Todd R Vogel
Keyword(s):  
Population Data ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Longitudinal Outcomes ◽  
Aortic Repair ◽  
Initial Procedure ◽  
Zone Ii ◽  
Outcomes Study ◽  
One Year

Objective We aimed to evaluate outcomes of thoracic endovascular aortic repair (TEVAR) with left subclavian artery (LSA) coverage without bypass (TEVAR + SUB) to TEVAR with coverage of the LSA with a bypass at the time of the initial procedure or later at a separate procedure (TEVAR + SUB + BYPASS). Methods The Centers for Medicare & Medicaid Services inpatient claims for 2006–2007 were queried using Current Procedural Terminology codes for TEVAR, TEVAR + SUB, TEVAR + SUB + BYPASS or later as a separate procedure. Results A total of 2676 patients underwent TEVAR; 869 (32.5%) underwent TEVAR + SUB and 49 (5.6%) TEVAR + SUB + BYPASS. At the time of the initial procedure, TEVAR + SUB + BYPASS was associated with a higher incidence of stroke compared to TEVAR + SUB (12.8% vs. 3.8 %; p = 0.0033). Among TEVAR + SUB, only 1.93% (50 patients) had a subsequent bypass performed during a one-year follow-up. Overall rates of morbidity ( p = 0.004) and mortality ( p = 0.011) trended towards significance in favor of TEVAR + SUB. Conclusions TEVAR + SUB were associated with lower rates of mortality and complications. Only a small percentage of TEVAR + SUB required a bypass at one year after procedure. Our data suggest that routine LSA bypass during TEVAR is unnecessary and associated with increase morbidity and mortality.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

Sign in / Sign up

Export Citation Format

Share Document