Outcome and Effectiveness

Nava et al. showed a successful weaning rate of 55% in 42 patients with COPD in whom rehabilitation was continued after the ICU (12), and Scheinhom reported improvements in survival, after discharge, with time probably due to the improved expertise of the personnel (30). In survivors of PMV, physical function is often limited after discharge (8,16,37). Quality of life has been defined not only as good, quite good, reasonable, or normal, but also as severely reduced, in a minority of studies (8,37) often it had improved by 6 to 12 months after discharge (38,39). 

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Eklund C, Melin L, Hiltunen A Borg S (1994). Detoxification from methadone maintenance treatment in Sweden long-term outcome and effects on quality of life and life situation. The International Journal of the Addictions, 29, 627-45... 

Use of a standardized methodology for data collection is critical for collecting information for all study subjects, regardless of exposure or disease status. Information must be collected on exposure, outcome, and effect modifiers or confounders. There are several methods available for ascertaining information on exposures and outcomes, such as self-reported data obtained in personal or telephone interviews, self-administered questionnaires, diaries, observation, existing records, actual physical measurements, and collection of biological specimens (Armstrong et al. 1995). 

Knechtle, S.J., DnAlessandro, A.M., Armbrust, M.J., Musat, A., Kalay-oglu, M. Surgical portosystemic shunts for treatment of portal hypertensive bleeding outcome and effect on liver function. Surgery 1999 ... 

Aronin SI, Peduzzi P, QuaghareUo VJ. Community-acquired bacterial meningitis risk stratification for adverse chnical outcome and effect of antibiotic timing. Ann Intern Med 1998 129(ll) 862-9. 

V. Westphal, S. Kjaergaard, J.A. Davis, S.M. Peterson, F. Skovby and H.H. Freeze, Genetic and metabolic analysis of the first adult with congenital disorder of glycosylation type Ib long-term outcome and effects of mannose supplementation. Mol. Genet. Metab., 73, 77-85 (2001). 

Moustapha A, Assali AR, Sdringola S, et al. Percutaneous and surgical interventions for in-stent restenosis Long-term outcomes and effect of diabetes mellitus. J Am Coll Cardiol 2001 37 1877-1882. 

Dionisi-Vici C, et al. Classical organic acidurias, propionic aciduria, methylmalonic aciduria and isovaleric aciduria long-term outcome and effects of expanded newborn screening using tandem mass spectrometry. J Inherit Metab Dis. 2006 29(2-3) 383-9. 

Failure Mode and Ejfect Analysis (FMEA) This is a systematic study of the causes of failures and their effects. All causes or modes of failure are considered for each element of a system, and then all possible outcomes or effects are recorded. This method is usually used in combination with fault tree analysis, a quantitative technique. FMEA is a comphcated procedure, usually carried out by experienced risk analysts. 

Successful installation, or roll-out, of your PSM systems requires sound planning and effective execution. No matter how diligent you have been, or how receptive and well-managed your company may be, no system as complex as PSM can work perfectly the first time. As every project manager knows, it s impossible to anticipate every outcome or contingency—especially when human behavior is involved. Pilot testing a new system provides the opportunity to identify weaknesses under controlled conditions this in turn enables you to fix problems before the system becomes fully operational. Once these problems are corrected, the pilot test produces a template for installation that can be replicated elsewhere. 

Fishbone Diagrams are cause-and-effect diagrams used in quality management to help describe all the activities that can influence the management process and its outcome. These diagrams show the relationship between different activities and how they are grouped around specific types of activity. 

Failure Modes and Effects Analysis (FMEA) A hazard identification technique in which all known failure modes of components or features of a system are considered in turn and undesired outcomes are noted. 

Between the emission of greenhouse gases and change in the climate are a range of climate and biological cycles that can influence the end result. Such outcome-modifier effects are called feedbacks or indirect effects in the climate change literature. 

Mentor and mentees meet bi-monthly on average, away from either person s office. Mentor Up co-ordinators occasionally distribute discussion guides to facilitate productive meetings and outcomes. These guides have proven very valuable in ensuring that an open and effective exchange of ideas and issues takes place in the mentoring context. 

Several studies with alcohol-dependent patients showed that BCT improves outcomes in relationship adjustment and reduces drinking (McCrady et al. 1991 O Farrell et al. 1992). In one study, BCT was found to be more cost-effective than individual or group counseling (O Farrell et al. 1996). However, little is known about the components of BCT that are associated with improved outcomes, and most studies have applied this therapy in groups of patients with little psychiatric comorbidity and with cooperative significant others. 

TFL is essentially a transition lubrication regime between EHL and boundary lubrication. A new postulation based on the ordered model and ensemble average (rather than bulk average) was put forward to describe viscosity in the nanoscale gap. In TFL, EHL theories cannot be applied because of the large discrepancies between theoretical outcomes and experimental data. The effective viscosity model can be applied efficiently to such a condition. In thin him lubrication, the relation between Him thickness and velocity or viscosity accords no longer with an exponential one. The studies presented in this chapter show that it is feasible to use a modi-Hed continuous scheme for describing lubrication characteristics in TFL. 

One challenge in applying this approach, which relies on prior estimates of method prediction reliability, is how to deal with differences between future compounds to be tested and the universe of all compounds on which the collected experience of R D process effectiveness has been based. If new active compounds fall within the space previously sampled, then knowledge of chemical properties is just another kind of conditioning within a Bayesian network if they fall outside this space, then the initial model of both outcomes and predictions has an unpredictable error. The use of sampling theory and models of diversity [16] are therefore promising extensions of the above approach. 

The Bayesian network technology embedded in the ARBITER tool is also well suited for learning both probability relationships (e.g., method reliability estimates) and the essential structure of cause and effect, from data sets where predictions and outcomes can be compared. Colleagues have already applied this capability on a large scale for risk management (selection of potentially suspect claims for further inspection and examination) in the insurance industry. 

Only two randomized, controlled trials have been completed, and neither provides anything like compelling data (Table 2.6). Chouinard and Albright (1997) conducted a unique evaluation of a subset of patients from a previously conducted clinical trial. Subjects were categorized and profiled at baseline and end point according to clinical severity, and a group of psychiatric nurses were asked to rate various aspects of likely outcome and quality of life to each profile (mild, moderate or severe symptoms). Health state utilities were then calculated risperidone was found to provide more than double the number of quality-adjusted life years compared with haloperidol. Csernansky and Okamoto (1999) conducted a rather more conventional trial, but included no economic analyses. However, they did find that the use of risperidone substantially reduced relapse rates compared with haloperidol—an outcome likely to have a positive impact on cost-effectiveness. 

Randomized, controlled clinical trials reduce bias and variability by a process of selection, randomization and standardization of treatment, and often take place under artificial conditions isolated from those of routine clinical practice (Freemande et al, 1993 Simon et al, 1995b). Yet it is the uncontrolled interactions of a dmg technology with patients, health-care workers and the system of health care that ultimately lead to much of the variability in outcomes and expenditures in clinical practice. Thus the value of RCTs in evaluating cost-effectiveness in clinical practice maybe limited (Reeder, 1995 Simon et al, 1995b Hotopf et al, 1996). 

However, several important studies have shown that intravenous thrombolysis may be beneficial more than 3 hours after stroke onset, provided that only patients with a significant diffusion-perfusion mismatch are treated. In one such smdy, Ribo et al. found that patients with a significant diffusion-perfusion mismatch could be treated safely and effectively in the 3-6-hour time period. In phase II of the desmo-teplase in acute stroke (DIAS) trial, patients with diffusion-perfusion mismatch were treated with desmoteplase up to 9 hours after stroke onset, and showed better outcomes than patients given placebo, with only a minimal incidence of symptomatic hemorrhage. Similar success was achieved in the same time window by the dose escalation study of desmoteplase in acute ischemic stroke (DEDAS). ... 

Yoon SS, Dambrosia J, Chalela J, Ezzeddine M, Warach S, Haymore J, Davis L, Baird AE. Rising statin use and effect on ischemic stroke outcome. BMC Med 2004 2 4. 

Parra A, Kreiter KT, Williams S, Sciacca R, Mack WJ, Naidech AM, Commichau CS, Fitzsimmons BF, Janjua N, Mayer SA, Connolly Jr. ES, Effect of prior statin use on functional outcome and delayed vasospasm after acute aneurysmal subarachnoid hemorrhage a matched controlled cohort study. Neurosurgery 2005 56 476 84 [discussion 476 84]. 

Wijdicks EE, Diringer MN. Middle cerebral artery territory infarction and early brain swelling progression and effect of age on outcome. Mayo Clin Proc 1998 73 829-836. 

Suarez JI. Outcome in neurocritical care advances in monitoring and treatment and effect of a specialized neurocritical care team. Crit Care Med 2006 34 s232-s238. 

Empirical data are rarely suitable for assessing the effectiveness of a system s outcomes and impacts on public health. Nonetheless, certain measures can serve as proxies for evaluating the efficacy of drug regulation. 

This example shows not only that it is difficult to develop outcome measures, but that measuring outcomes may be rendered more difficult and complicated by other factors. On the one hand, spurious effects may be found, caused by factors other than regulatory functions. On the other hand, even when regulation does work, detection of the desired outcomes and their impact may be difficult. 

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