Process-Outcome Relationships and Solution-Based Goal-Setting Interventions With Grandparent Caregivers

The present study examines the impact of change processes on outcomes in a solution-based thinking and goal-setting intervention for grandparents raising their grandchildren. We found that across the 6 program sessions there was stability and/or increases in the salience of hypothesized change processes, i.e., hopefulness about the future, solution-based thinking, positive thoughts about one's grandchild, multiple indicators of decisional personal goal-setting regarding one's own well-being and grandchild relationship quality. Indicators of change processes were for the most part, related to both post-program outcomes as well as to pre-post program outcome difference scores. Regression analyses suggested that change processes in many cases partially mediated pre-post primary program outcome scores. These data suggest that how grandmother caregivers think about themselves and their grandchildren and their approach to setting personal goals are key change processes explaining the impact of a solution-based, goal-setting intervention on them.

The unstable hip in children with cerebral palsy: does an acetabuloplasty add midterm stability?

Purpose This study addresses whether an additional pelvic procedure is superior to a varus derotation osteotomy femur (VDRO) alone in unstable hips in children with cerebral palsy (CP). Methods All patients had unstable hips utilising the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). We compared one group that underwent VDRO alone with one that had a combination of VDRO and Dega osteotomy (VDRO+). Measurements were taken before surgery, postoperatively, two years after surgery and at latest follow-up. Generalised estimating equations were used to account for known and unknown correlations between hips from bilateral cases. Results In total, 74 hips in 57 children fulfilled the inclusion criteria. There was no outcome difference between Gross Motor Function Classification System levels III, IV and V. Age at time of operation ranged from three to 16 years (mean 9.8 years). Mean follow-up was 49.1 months. In the VDRO group (28 hips) migration percentage (MP) changed from 61% preoperative to a final value of 35.7%. In the VDRO+ group (46 hips) the MP changed from 64.4% to 19.3%. At final follow-up 15 hips (54%) were stable in the VDRO group, 37 hips (83%) in the VDRO+ group. The odds ratio (OR) of hip stability at final follow-up was 3.5-times higher in the VDRO+ group versus the VDRO group (OR = 3.9; 95% confidence interval = 1.5 to 9.7; p = 0.004). Conclusion Reconstruction of unstable hips via VDRO + Dega in children with CP provides a higher likelihood of long-term stability than an isolated VDRO. Level of Evidence Level III, retrospective comparative study

Complete hemispheric exposure vs. superior sagittal sinus sparing craniectomy: incidence of shear-bleeding and shunt-dependency

Purpose Decompressive hemicraniectomy (DC) has been established as a standard therapeutical procedure for raised intracranial pressure. However, the size of the DC remains unspecified. The aim of this study was to analyze size related complications following DC. Methods Between 2013 and 2019, 306 patients underwent DC for elevated intracranial pressure at author´s institution. Anteroposterior and craniocaudal DC size was measured according to the postoperative CT scans. Patients were divided into two groups with (1) exposed superior sagittal sinus (SE) and (2) without superior sagittal sinus exposure (SC). DC related complications e.g. shear-bleeding at the margins of craniectomy and secondary hydrocephalus were evaluated and compared. Results Craniectomy size according to anteroposterior diameter and surface was larger in the SE group; 14.1 ± 1 cm vs. 13.7 ± 1.2 cm, p = 0.003, resp. 222.5 ± 40 cm2 vs. 182.7 ± 36.9 cm2, p < 0.0001. The SE group had significantly lower rates of shear-bleeding: 20/176 patients; (11%), compared to patients of the SC group; 36/130 patients (27%), p = 0.0003, OR 2.9, 95% CI 1.6–5.5. There was no significant difference in the incidence of shunt-dependent hydrocephalus; 19/130 patients (14.6%) vs. 24/176 patients (13.6%), p = 0.9. Conclusions Complete hemispheric exposure in terms of DC with SE was associated with significantly lower levels of iatrogenic shear-bleedings compared to a SC-surgical regime. Although we did not find significant outcome difference, our findings suggest aggressive craniectomy regimes including SE to constitute the surgical treatment strategy of choice for malignant intracranial pressure.

Sex and Gender Differences in Kidney Cancer: Clinical and Experimental Evidence

Sex and gender disparities have been reported for different types of non-reproductive cancers. Males are two times more likely to develop kidney cancer than females and have a higher death rate. These differences can be explained by looking at genetics and genomics, as well as other risk factors such as hypertension and obesity, lifestyle, and female sex hormones. Examination of the hormonal signaling pathways bring further insights into sex-related differences. Sex and gender-based disparities can be observed at the diagnostic, histological and treatment levels, leading to significant outcome difference. This review summarizes the current knowledge about sex and gender-related differences in the clinical presentation of patients with kidney cancer and the possible biological mechanisms that could explain these observations. Underlying sex-based differences may contribute to the development of sex-specific prognostic and diagnostic tools and the improvement of personalized therapies.

Pregnancy outcome study between Pradhan mantri surakshit matriva abhiyan service utilization group and pradhan mantri surakshit matriva abhiyan service non-utilization group: a comparative study

Background: Safe pregnancy has become a social movement in our country. Almost 15 % of all pregnant women can develop potentially life-threatening complications. As a result, identification of high-risk pregnancies at earliest stage will be useful in directing appropriate intervention. Hence this study was done to evaluate the betterment of pregnancy outcome of the women who had taken the adequate service of Pradhan Mantri Surakshit Matriva Abhijyan service (PMSMA) than who had not.Method: A longitudinal study was conducted at Malda medical college during January 2019 to June 2019. 385 women selected who had taken at least three antenatal checkups (from record analysis) at PMSMA designated clinic and another 385 women selected who had not taken PMSMA services. Women of both groups were followed up their delivery events and puerperal days till discharge from hospital. Pregnancy outcomes were compared and statistical analysis of both groups were done by SSPS software. Results: A significant outcome difference of PMSMA service utilized and non-utilized groups in respect to fetal and maternal parameters including moderate to severe anemia, (12.98% vs 26.49%), intra uterine growth retardation (IUGR, 20.0% vs 29.87%), hypertensive disorders in pregnancy (HDP, 8.31% vs 13.50%), low-birth-weight (21.30% vs 31.16%) and stillborn (1.29% vs 2.89%) were observed.Conclusions: This study showed positive pregnancy outcome of PMSMA utilized group than non-utilized group. Improving the availability and accessibility of quality antenatal and delivery care through PMSMA services in all our institutions, will improve pregnancy outcome.

Factors Associated with Decisions for Initial Dosing, Up-Titration of Propiverine and Treatment Outcomes in Overactive Bladder Syndrome Patients in a Non-Interventional Setting

Two doses of propiverine ER (30 and 45 mg/d) are available for the treatment of overactive bladder (OAB) syndrome. We have explored factors associated with the initial dosing choice (allocation bias), the decision to adapt dosing (escalation bias) and how dosing relative to other factors affects treatment outcomes. Data from two non-interventional studies of 1335 and 745 OAB patients, respectively, receiving treatment with propiverine, were analyzed post-hoc. Multivariate analysis was applied to identify factors associated with dosing decisions and treatment outcomes. Several parameters were associated with dose choice, escalation to higher dose or treatment outcomes, but only few exhibited a consistent association across both studies. These were younger age for initial dose choice and basal number of urgency and change in incontinence episodes for up-titration. Treatment outcome (difference between values at 12 weeks vs. baseline) for each OAB system was strongly driven by the respective baseline value, whereas no other parameter exhibited a consistent association. Patients starting on the 30 mg dose and escalating to 45 mg after 4 weeks had outcomes comparable with those staying on a starting dose of 30 or 45 mg. We conclude that dose escalation after 4 weeks brings OAB patients with an initially limited improvement to a level seen in initially good responders. Analysis of underlying factors yielded surprisingly little consistent insight.

Contemporary Analysis of Minimal Clinically Important Difference in the Neurosurgical Literature

BACKGROUND Minimal clinically important difference (MCID) is determined when a patient or physician defines the minimal change that outweighs the costs and untoward effects of a treatment. These measurements are “anchored” to validated quality-of-life instruments or physician-rated, disease-activity indices. To capture the subjective clinical experience in a measurable way, there is an increasing use of MCID. OBJECTIVE To review the overall concept, method of calculation, strengths, and weaknesses of MCID and its application in the neurosurgical literature. METHODS Recent articles were reviewed based on PubMed query. To illustrate the strengths and limitations of MCID, studies regarding the measurement of pain are emphasized and their impact on subsequent publications queried. RESULTS MCID varies by population baseline characteristics and calculation method. In the context of pain, MCID varied based on the quality of pain, chronicity, and treatment options. CONCLUSION MCID evaluates outcomes relative to whether they provide a meaningful change to patients, incorporating the risks and benefits of a treatment. Using MCID in the process of evaluating outcomes helps to avoid the error of interpreting a small but statistically significant outcome difference as being clinically important.

Comparison of In-Situ and Retrospective Self-Reports on Assessing Hearing Aid Outcomes

Background Ecological momentary assessment (EMA) is a methodology involving repeated surveys to collect in-situ self-reports that describe respondents' current or recent experiences. Audiology literature comparing in-situ and retrospective self-reports is scarce. Purpose To compare the sensitivity of in-situ and retrospective self-reports in detecting the outcome difference between hearing aid technologies, and to determine the association between in-situ and retrospective self-reports. Research Design An observational study. Study Sample Thirty-nine older adults with hearing loss. Data Collection and Analysis The study was part of a larger clinical trial that compared the outcomes of a prototype hearing aid (denoted as HA1) and a commercially available device (HA2). In each trial condition, participants wore hearing aids for 4 weeks. Outcomes were measured using EMA and retrospective questionnaires. To ensure that the outcome data could be directly compared, the Glasgow Hearing Aid Benefit Profile was administered as an in-situ self-report (denoted as EMA-GHABP) and as a retrospective questionnaire (retro-GHABP). Linear mixed models were used to determine if the EMA- and retro-GHABP could detect the outcome difference between HA1 and HA2. Correlation analyses were used to examine the association between EMA- and retro-GHABP. Results For the EMA-GHABP, HA2 had significantly higher (better) scores than HA1 in the GHABP subscales of benefit, residual disability, and satisfaction (p = 0.029–0.0015). In contrast, the difference in the retro-GHABP score between HA1 and HA2 was significant only in the satisfaction subscale (p = 0.0004). The correlations between the EMA- and retro-GHABP were significant in all subscales (p = 0.0004 to <0.0001). The strength of the association ranged from weak to moderate (r = 0.28–0.58). Finally, the exit interview indicated that 29 participants (74.4%) preferred HA2 over HA1. Conclusion The study suggests that in-situ self-reports collected using EMA could have a higher sensitivity than retrospective questionnaires. Therefore, EMA is worth considering in clinical trials that aim to compare the outcomes of different hearing aid technologies. The weak to moderate association between in-situ and retrospective self-reports suggests that these two types of measures assess different aspects of hearing aid outcomes.

PENGARUH SELF DAN PEER AFFECTIVE ASSESSMEN PADA HASIL BELAJAR KIMIA DASAR MAHASISWA DIII ANALIS KESEHATAN

– This study investigate Basic Chemistry learning outcome difference in Health Analyst Level 3 Diploma sudents who did self-affective assessment and peer-affective assessment. Participant of this study were two student groups in which 30 students in class A who did self-affective assessment and 28 students in class B who did peer-affective assessment, while Basic Chemistry learning experience in both classes were identical. The result of this study showed that class A Basic Chemistry learning outcome (78.21) is higher and significantly different (asymp sig. 0.001, α = 0.05) than class B learning outcome (70.90). Based on questionnare, it was found that class A students found themselves more motivated, discipline, responsible, and have self abitity consciousness. While class B students found themselves growing reflective, motivation, dan sympathy behaviors. Class A students focused on learning and their own selves, while class B students focused on learning, their selves, and peer’s behavior. Affective assessment wether it’s self or peer assessment can be used to help student continually watch their behavior development in learning and develop their long life learner behavior. Abstrak – Penelitian ini mengkaji perbedaan hasil belajar mahasiswa DIII Analis Kesehatan pada mata kuliah Kimia Dasar yang melaksanakan self-affective assessment dan peer-affective assessment. Responden terdiri dari dua kelompok mahasiswa terdiri dari 30 orang kelas A melaksanakan self-affective assessment dan 28 orang kelas B melaksanakan peer-affective assessment, dengan keseluruhan pengalaman belajar mata kuliah Kimia Dasar yang persis sama. Hasil penelitian menunjukkan hasil belajar mata kuliah Kimia Dasar mahasiswa DIII Analis Kesehatan yang melaksanakan self-affective assessment (78,21) lebih tinggi dan berbeda secara signifikan (asymp sig. 0,001, α = 0,05) dengan mahasiswa yang melaksanakan peer-affective assessment (70,90). Berdasarkan hasil angket, ditemukan bahwa mahasiswa kelas A mendapati diri mereka lebih termotivasi, disiplin, tanggung jawab, dan mengenal kemampuan diri. Sementara itu mahasiswa kelas B mendapati diri mereka menumbuhkan sikap reflektif, motivasi, dan simpati. Mahasiswa kelas A lebih fokus pada materi pembelajaran dan perkembangan dirinya sendiri, sementara mahasiswa kelas B berfokus pada materi pembelajaran, perkembangan diri sendiri, dan mengamati perkembangan teman sejawat. Penialaian afektif baik berupa self-affective assessment maupun peer-affective assessment dapat digunakan untuk membantu mahasiswa memantau perkembangan sikapnya dalam belajar dan menumbuhkan sikap pembelajar sepanjang hayat.