Family Interaction and Child Outcome in a High-Risk Sample

1990 ◽  
Vol 66 (2) ◽  
pp. 675-688 ◽  
Author(s):  
Deborah F. Greenwald
Keyword(s):  
High Risk ◽  
Psychiatric Illness ◽  
Family Interaction ◽  
Predictors Of Outcome ◽  
Child Outcome ◽  
Social Emotional ◽  
Normal Range ◽  
Family Measures

This study hypothesized that the quality of family interaction would predict longitudinally children's follow-up functioning. The subjects were 97 boys, functioning on the average within the normal range but considered to be at risk for psychopathology because one parent had previously been hospitalized for psychiatric illness. Family measures of deviant and healthy communication and of activity, balance, and warmth related significantly to children's competent social/emotional/cognitive functioning at a 3-yr. follow-up. The findings suggest the importance of considering multiple predictors of outcome for children and of employing clinical interventions that attend to more than one aspect of family functioning.

Family Interaction and Outcome IQ in High-Risk Boys

1989 ◽  
Vol 65 (1) ◽  
pp. 95-103 ◽  
Author(s):  
Deborah F. Greenwald
Keyword(s):  
High Risk ◽  
Psychiatric Illness ◽  
Adaptive Functioning ◽  
Family Interaction ◽  
Social Emotional ◽  
Family Activities ◽  
Social Emotional Functioning ◽  
Communication Deviance ◽  
The Relationship

This study examined the relationship between measures of family interaction and outcome for 97 boys at risk for psychopathology from having one parent previously hospitalized for psychiatric illness. Measures of communication deviance and of activity, balance and warmth, derived from two family activities, correlated significantly with 3-yr. follow-up adaptive functioning, measured by IQ. Poor family interaction, in previous studies associated with schizophrenic symptomatology, was here correlated with poor cognitive/social/emotional functioning, suggesting that family interaction may be a broad predictor of adequacy of functioning.

scholarly journals A novel application of the lotus petal flap in high-risk perineal urethrostomy: principles and outcomes

2018 ◽  
Vol 1 (1) ◽  
pp. 135-139
Author(s):  
Daniel J Reilly ◽  
Eric K Sham ◽  
Justin BL Chee ◽  
Ajay Chauhan
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Ileal Conduit ◽  
Soft Tissue Coverage ◽  
Skin Flaps ◽  
Flexible Cystoscopy ◽  
Urethral Strictures ◽  
Lotus Petal Flap

Introduction: Perineal urethrostomy is a valuable technique in the management of complex anterior urethral strictures, as well as following penectomy or urethrectomy. Traditional techniques that employ perineal or scrotal skin flaps have documented failure rates of up to 30%. Current techniques for salvage have only modest success, leaving patients few options other than permanent suprapubic catheter or cystectomy and ileal conduit formation.Results: We present a new method of perineal urethrostomy using perforator-based lotus petal flaps in cases which were high risk or unsuitable for traditional perineal urethrostomy techniques, or where traditional strategies had failed. All patients demonstrated continent voiding at a minimum of 22 months follow-up, with patency confirmed by flexible cystoscopy. No complications were encountered.Conclusion: Utilisation of lotus petal flaps in high-risk cases of perineal urethrostomy will lead to significant improvements in patient outcomes. The availability of larger amounts of soft tissue coverage will obviate the need for compromise on either resection of involved urethra, or calibre and inset of urethrostomy. This will subsequently minimise the rates of failure, reduce the requirement for urinary diversion procedures and lead to improved quality of life.

scholarly journals Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features

2018 ◽  
Vol 36 (34) ◽  
pp. 3361-3369 ◽  
Author(s):  
Anna L. Godfrey ◽  
Peter J. Campbell ◽  
Cathy MacLean ◽  
Georgina Buck ◽  
Julia Cook ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Platelet Count ◽  
High Risk ◽  
Vascular Events ◽  
End Point ◽  
High Risk Factors ◽  
Patient Reported

Purpose Cytoreductive therapy is beneficial in patients with essential thrombocythemia (ET) at high risk of thrombosis. However, its value in those lacking high-risk features remains unknown. This open-label, randomized trial compared hydroxycarbamide plus aspirin with aspirin alone in patients with ET age 40 to 59 years and without high-risk factors or extreme thrombocytosis. Patients and Methods Patients were age 40 to 59 years and lacked a history of ischemia, thrombosis, embolism, hemorrhage, extreme thrombocytosis (platelet count ≥ 1,500 × 109/L), hypertension, or diabetes requiring therapy. In all, 382 patients were randomly assigned 1:1 to hydroxycarbamide plus aspirin or aspirin alone. The composite primary end point was time to arterial or venous thrombosis, serious hemorrhage, or death from vascular causes. Secondary end points were time to first arterial or venous thrombosis, first serious hemorrhage, death, incidence of transformation, and patient-reported quality of life. Results After a median follow-up of 73 months and a total follow-up of 2,373 patient-years, there was no significant difference between the arms in the likelihood of patients reaching the primary end point (hazard ratio, 0.98; 95% CI, 0.42 to 2.25; P = 1.0). The incidence of significant vascular events was low, at 0.93 per 100 patient-years (95% CI, 0.61 to 1.41). There were also no differences in overall survival; in the composite end point of transformation to myelofibrosis, acute myeloid leukemia, or myelodysplasia; in adverse events; or in patient-reported quality of life. Conclusion In patients with ET age 40 to 59 years and lacking high-risk factors for thrombosis or extreme thrombocytosis, preemptive addition of hydroxycarbamide to aspirin did not reduce vascular events, myelofibrotic transformation, or leukemic transformation. Patients age 40 to 59 years without other clinical indications for treatment (such as previous thrombosis or hemorrhage) who have a platelet count < 1,500 × 109/L should not receive cytoreductive therapy.

scholarly journals TRIM study protocol - a prospective randomized multicenter Trial to assess the Role of Imaging during follow-up after radical surgery of stage IIB-C and III cutaneous malignant Melanoma

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ylva Naeser ◽  
Hildur Helgadottir ◽  
Yvonne Brandberg ◽  
Johan Hansson ◽  
Roger Olofsson Bagge ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Malignant Melanoma ◽  
Potential Benefit ◽  
Radical Surgery ◽  
Multicenter Trial ◽  
Cutaneous Malignant Melanoma ◽  
Link Type

Abstract Background The incidence of cutaneous malignant melanoma (CMM) is increasing worldwide. In Sweden, over 4600 cases were diagnosed in 2018. The prognosis after radical surgery varies considerably with tumor stage. In recent years, new treatment options have become available for metastatic CMM. Early onset of treatment seems to improve outcome, which suggests that early detection of recurrent disease should be beneficial. Consequently, in several countries imaging is a part of the routine follow-up program after surgery of high risk CMM. However, imaging has drawbacks, including resources required (costs, personnel, equipment) and the radiation exposure. Furthermore, many patients experience anxiety in waiting for the imaging results and investigations of irrelevant findings is another factor that also could cause worry and lead to decreased quality of life. Hence, the impact of imaging in this setting is important to address and no randomized study has previously been conducted. The Swedish national guidelines stipulate follow-up for 3 years by clinical examinations only. Methods The TRIM study is a prospective randomized multicenter trial evaluating the potential benefit of imaging and blood tests during follow-up after radical surgery for high-risk CMM, compared to clinical examinations only. Primary endpoint is overall survival (OS) at 5 years. Secondary endpoints are survival from diagnosis of relapse and health-related quality of life (HRQoL). Eligible for inclusion are patients radically operated for CMM stage IIB-C or III with sufficient renal function for iv contrast-enhanced CT and who are expected to be fit for treatment in case of recurrence. The planned number of patients is > 1300. Patients are randomized to clinical examinations for 3 years +/− whole-body imaging with CT or FDG-PET/CT and laboratory tests including S100B protein and LDH. This academic study is supported by the Swedish Melanoma Study Group. Discussion This is the first randomized prospective trial on the potential benefit of imaging as a part of the follow-up scheme after radical surgery for high-risk CMM. Results The first patient was recruited in June 2017 and as of April 2020, almost 500 patients had been included at 19 centers in Sweden. Trial registration ClinicalTrials.gov, NCT 03116412. Registered 17 April 2017, https://clinicaltrials.gov/ct2/show/study/NCT03116412

Quality of life in intermediate or high risk prostate cancer patients treated by 3-D external beam radiotherapy and brachytherapy with or without androgen deprivation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14587-14587
Author(s):  
B. Guix ◽  
T. M. Lacorte ◽  
F. Guedea
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
High Risk ◽  
Sexual Function ◽  
External Beam Radiotherapy ◽  
External Beam ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

14587 Background: To elucidate long-term changes in health-related quality-of-life (HRQOL) outcomes by prospectively re-evaluating a cohort of intermediate- or high-risk prostate cancer patients treated by a combination of 3-D External Beam Radiotherapy (EBRT) and Brachytherapy (BT) with or without androgen deprivation (AD). Methods: A cross-sectional survey was administered to 200 consecutive patients with intermediate (Gleason 7 or PSA 10–20 or T2A-B) or high (Gleason >7 and/or PSA >20 and/or >T2B) - Risk Prostate cancer who were treated by EBRT to the prostate followed by BT to the prostate given either by permanent 125-I seeds (LDR) or high dose rate (HDR) implants before treatment and at 6 months interval during 4 years follow-up. The EORTC CLQ-C30 with the PR-25 module was employed. HRQOL was compared among therapy groups. Comparisons between therapy groups was performed using regression models to control covariates. HRQOL of treatment parameters were evaluated. Distribution of responses for bowel-, urinary- and sexual-related functions were analyzed. Results: 200 patients completed the questionnaires. Significant changes in HRQOL were found depending of the time after treatment. After a temporal decline in HRQOL, an improvement owas found during the first 18 months after end of treatment. Significant improvement in the urinary irritative-obstructive performance (p < 0.006) was found after 6 months post-treatment. Bowel domains worsened after therapies (p < 0,05) but improved after 18 months follow-up (p < 0.02). Overall sexual HRQOL deteriorated depending greatly on treatment (p < 0.008). Patients who were given AD presented a significant lower Sexual Function values, that were difficult to recover after AD cessation (p < 0.007). No differences in HRQOL were found between LDR or HDR BT implants. Satisfaction with either treatment was high. Conclusions: After a decline in HRQOL after treatment, it recovered fully during follow-up. In patients treated by AD, sexual function was the most adversely affected quality-of-life domain. Sexual impairment induced by AD was difficult to recover. These results may be of assistance to men and to clinicians when making treatment decisions, mainly relating AD. No significant financial relationships to disclose.

Prospective randomized trial of genomic classifier impact on treatment decisions in patients at high risk of recurrence following radical prostatectomy (G-MINOR).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. TPS154-TPS154 ◽  
Author(s):  
Todd Matthew Morgan ◽  
David Christopher Miller ◽  
Rodney Dunn ◽  
Linsell Susan ◽  
Linda Okoth ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Treatment Decisions ◽  
Risk Of Recurrence ◽  
Clinical Center ◽  
Patient Reported ◽  
Impact On Treatment ◽  
The Impact

TPS154 Background: Approximately 30% of patients will have ≥pT3 disease and/or positive surgical margins at radical prostatectomy (RP), indicating a high risk of local recurrence. While current guidelines recommend consideration of adjuvant radiotherapy (aRT) in this setting, < 10% undergo aRT. The Decipher assay is a novel, tissue-based genomic classifier (GC) developed and validated in the post-RP setting as a predictor of metastasis. Current retrospective evidence suggests that patients with a high GC score may benefit from aRT, while observation may be safe for those with a lower GC score. However, there are no randomized prospective data evaluating the clinical utility of biomarkers in men with adverse features after RP. Here we see to determine the impact of GC test results on adjuvant treatment decisions for high-risk post-RP patients vs. clinical factors alone. Methods: Genomics in Michigan ImpactiNg Observation or Radiation (G-MINOR) is a 4-year (12-month enrollment, 3-year follow-up) prospective, cluster-crossover, unblinded, study of 350 subjects from twelve Urology practices in the Michigan Urological Surgery Improvement Collaborative (MUSIC). MUSIC is a physician-led quality improvement consortium nearly all academic and community urology practices within the state of Michigan. Each clinical center participating in this trial will be randomly assigned to either a Genomic Classifier (GC)-based strategy or control arm for a period of 3 months. Patients in both arms will receive a predicted risk of recurrence based on a validated clinical nomogram, the CAPRA-S score, enabling a head-to-head comparison of the Decipher assay with a freely-available validated prognostic tool. Random assignments will be generated centrally by a study statistician and provided to centers immediately before commencing enrollment in each 3-month period. Each center will have two GC and two UC enrollment periods, maintaining study-wide balance and blinding of assignments in subsequent periods. Patients will be followed for receipt of adjuvant therapy as well as oncologic (recurrence, metastasis, and death) and patient-reported quality of life. Clinical trial information: NCT02783950.

scholarly journals Endoscopy of Nasopharyngeal Cancer

1994 ◽  
Vol 1 (2) ◽  
pp. 63-68 ◽  
Author(s):  
Brian B. Burkey ◽  
Robert H. Ossoff
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
High Resolution ◽  
Local Anesthesia ◽  
Nasopharyngeal Cancer ◽  
Cost Effective ◽  
Cost Effective Approach ◽  
The World

Nasopharyngeal cancer (NPC) is a unique disease with increasing interest for many physicians due to its unusual etiology, histology, and epidemiology. The recent era of fiberoptic endoscopy now provides the clinician with better tools for the screening, diagnosis, staging, and follow-up of NPC. The use of high resolution flexible and rigid nasopharyngoscopy gives the physician an opportunity for a more sensitive examination in a higher proportion of patients. Ultimately, this will allow for earlier diagnosis of NPC, and improved prognosis and better quality of life for the patients with this disease. Also, by allowing the clinician to perform directed biopsies of the nasopharynx under local anesthesia, fiberoptic nasopharyngoscopy allows a less morbid and more cost-effective approach towards this disease, including screening protocols in certain high risk regions of the world.

scholarly journals The Effect of Referral Process and Complications to Maternal Mortality

2015 ◽  
Vol 3 (3) ◽  
pp. 400
Author(s):  
Indah Handriani ◽  
Soenarnatalina Melaniani
Keyword(s):  
High Risk ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Medical Records ◽  
Multivariable Analysis ◽  
Secondary Data ◽  
Case Control ◽  
Referral Process

ABSTRACTMaternal Mortality Rate (MMR) in East Java was still high. in 2013, MMR in sidoarjo district has readed 96.27 per 100,000 live birth. This aim of this study was to the effect of the referral process to maternal mortality in RSUD Sidoarjo. This research was analytic observational with case control design. The Samples of this study were 25 pregnant women who were referred to RSUD Sidoarjo and death. The case controls were 50 pregnant women who were referred to RSUD Sidoarjo who did not experience death. Techniques of data collection using secondary data from the register book maternal and neonatal Emergency (MNE) and medical records and interviews with the mother/family/husband of respondents. The data was analyzed by using univariable, bivariable and multivariable analysis with logistic regression. The results of this study confirmed that the referral process was poor (OR=9,783,95% CI: 2,275 to 42,072, p=0,002) and the complications (OR=0,005,95%CI: 0,001-0,057, p=0,000).thus, the incidence maternal mortality increased. The conclusion of this study is the referral process and the complications to maternal mortality affect the occurrence of maternal mortality. Midwives need to conduct health education should be given to women in their productive age, increase the participation of families, communities and cadres in the process of early detection of complications during pregnancy, childbirth and postpartum, the quality of antenatal care (ANC) and the quality of referrals should be improved by creating a close referral system in a region associated with a high risk pregnant women were detected inventoried and scheduled control/termination and monitored (follow-up) so that high risk always monitored.Keywords: maternal mortality, referral process, complications

Pelvic SABR with HDR boost in intermediate- and high-risk prostate cancer (SPARE): Favorable early toxicity and quality-of-life outcomes.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 60-60 ◽  
Author(s):  
Hima Bindu Musunuru ◽  
Andrea Deabreu ◽  
Melanie Davidson ◽  
Ananth Ravi ◽  
Joelle Antoine Helou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
High Risk ◽  
Hdr Brachytherapy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Brachytherapy Boost ◽  
Early Toxicity

60 Background: ASCENDE-RT has provided level 1 evidence supporting the use of androgen deprivation therapy (ADT), external beam radiotherapy and brachytherapy boost in intermediate- and high-risk prostate cancer. The objectives of this study are to report early toxicity and quality of life (QOL) outcomes in patients treated on a hybrid protocol using five-fraction pelvic stereotactic ablative radiotherapy (SABR) with a MRI dose painted HDR brachytherapy boost (HDR-BT). Methods: A phase I/II study was performed where intermediate (IR) and high-risk (HR) prostate cancer patients received HDR-BT 15Gy in single fraction to the prostate and up to 22.5Gy to the MRI nodule. Gantry-based 25Gy SABR was delivered to pelvis, seminal vesicles and prostate in 5 weekly fractions. ADT was used for 6-18 months. Common Terminology Criteria for Adverse Events version 3.0 was used to assess toxicities. QOL was captured using EPIC at every follow-up. A minimally clinically important change (MCIC) definition was triggered if the EPIC QOL score at each time point decreases > 0.5 SD, where SD is the standard deviation of baseline scores. Results: Thirty-three patients (NCCN 6.0% low IR, 45.5% high IR and 48.5% HR) completed this treatment with a median follow-up of 13.8 months (IQR 12.1, 18.8). The incidence of worst toxicities is shown in Table 1.The 3 grade 3 GU patients were due to temporary urinary catheterization in the acute period following HDR-BT. Mean (95% SD) EPIC urinary QOL scores were 82.5 (16.5), 83.2 (12.9) and 83.7 (16.3) at baseline, 3 months and 12 months and the bowel scores were 95.9 (3.8), 92.6 (8.2) and 90.5 (8.3), respectively. Proportion of patients experiencing MCIC at 3 months and 12 months were 20.8% and 14.3% for urinary domain, 47.8% and 53.9% for bowel domain; respectively (see Table). Conclusions: This novel treatment protocol incorporating MRI dose painted HDR brachytherapy boost and SABR pelvic radiation for intermediate- and high-risk prostate cancer in combination with ADT is feasible and well tolerated in the acute setting. Clinical trial information: REB 269-2014. [Table: see text]

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