Índice de cambio fiable

  • 文章类型: Journal Article
    目的:本研究旨在分析癫痫和手术变量与术后记忆表现之间的关系,术后因海马硬化(HS)引起的难治性内侧颞叶癫痫(MTLE)。
    方法:回顾了201例MTLE/HS手术患者的即时和晚期随访的逻辑记忆(LM)和视觉记忆(VM)评分。用年龄和教育程度相匹配的54名健康个体的对照组对分数进行标准化。计算可靠变化指数(RCI)以验证晚期LM和VM分数的个体记忆变化。使用LM和VM评分以及临床变量对RCI进行多元线性回归分析。
    结果:总共112例(56%)患者有正确的HS。右HS组的RCI显示6例(7%)患者在晚期LM中表现出改善,而5例(6%)患者表现出降低的评分;对于晚期VM,7例(8%)患者出现改善,2例(3%)患者的评分较差。左HS组的RCI显示3(3%)个人得分提高,而5例(4%)患者的晚期LM评分恶化;对于晚期VM,3例(3%)患者得分较高,6例(5%)得分较低。左HS和首次癫痫发作时的高龄是晚期LM丢失的预测因素(p<0.05)。
    结论:左MTLE/HS和高龄时癫痫发作是晚期LM恶化的预测因素。我们观察到左侧HS组的基线LM功能较差,而一些切除右侧MTL的患者的LM改善。正确的HS组患者的VM和LM评分的术后可靠改善百分比更高。
    OBJECTIVE: This study was performed with the purpose of analysing the relationship between epileptological and surgical variables and post-operative memory performance, following surgery for refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS).
    METHODS: Logical memory (LM) and visual memory (VM) scores for immediate and late follow-up of 201 patients operated for MTLE/HS were reviewed. Scores were standardized with a control group of 54 healthy individuals matched for age and education. The Reliable Change Index (RCI) was calculated to verify individual memory changes for late LM and VM scores. A multiple linear regression analysis was carried out with the RCI, using LM and VM scores as well as the clinical variables.
    RESULTS: A total of 112 (56%) patients had right HS. The RCI of the right HS group demonstrated that 6 (7%) patients showed improvement while 5 (6%) patients showed decreased scores in late LM; for late VM, 7 (8%) patients presented improvement, and 2 (3%) patients showed poorer scores. RCI of the left HS group showed that 3 (3%) individuals showed improved scores, while scores of 5 (4%) patients worsened for late LM; for late VM, 3 (3%) patients presented higher scores and 6 (5%) showed lower scores. Left HS and advanced age at onset of the first epileptic seizure were predictors of late LM loss (p<.05).
    CONCLUSIONS: Left MTLE/HS and seizure onset at advanced ages were predictive factors for the worsening of late LM. We observed poorer baseline LM function in the left HS group and improvement of LM in some patients who had resection of the right MTL. Patients in the right HS group showed a higher percentage of reliable post-operative improvement for both VM and LM scores.
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  • 文章类型: Journal Article
    目的:比较两种评估结果的方法,以评估哮喘控制专业教育计划的治疗干预措施的有效性。
    方法:自然主义,干预研究,其中哮喘患者由参加特殊教育计划的临床医生(IG组)和接受仍在等待培训的临床医生的医疗援助的对照组(CG)参加。
    方法:同一地区的五个城市初级保健保健中心。
    方法:从100名患者的初始样本中,76形成了用于分析的最终样品。这项研究包括37名男性和39名女性,年龄在18至65岁之间(M=41.2岁)。除性别变量外,两个研究组均同质。
    方法:临床治疗依从性培训计划。
    方法:峰值流量作为肺活量指数,结构化面试。
    方法:最初使用基于稳健方差分析模型的经典技术分析结果,然后通过计算可靠变化指数(RCI)。
    结果:方差分析模型,每个性别分别进行,没有显着差异,由于样本量。RCI方法显示两组患者改善的百分比存在显着差异,以及单独观察到的临床相关变化。
    结论:就有助于临床决策的经典分析方法而言,RCI方法被认为是一种有吸引力的替代方法。
    OBJECTIVE: To compare two methods for the evaluation of outcomes to assess effectiveness of a therapeutic intervention of a professional education program on asthma control.
    METHODS: A naturalistic, intervention study in which asthmatic patients were attended by clinicians (IG group) who Had taken part in a special education program and a control group (CG) that received medical assistance from clinicians still waiting to be trained.
    METHODS: Five urban Primary Care Health Centres of the same region.
    METHODS: From an initial sample of 100 patients, 76 formed the final sample for analysis. The study included 37 males and 39 females, aged between 18 and 65 years (M=41.2 years). The two study groups were found to be homogeneous except for the sex variable.
    METHODS: Training program for clinical treatment adherence.
    METHODS: Peak flow as spirometric index, and structured interview.
    METHODS: The results were initially analysed using classical techniques based on robust ANOVA models, and then by calculating the Reliable Change Index (RCI).
    RESULTS: ANOVA models, conducted separately for each sex, showed no significant differences, due to sample size. RCI methodology showed significant differences in the percentage of patients improved in both groups, as well as clinically relevant changes being observed individually.
    CONCLUSIONS: The RCI method is presented as an attractive alternative as regards the classical methods of analysis that can help in the clinical decision.
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  • 文章类型: Case Reports
    Evaluation of therapeutic results and of the efficacy and effectiveness of treatments is an area of interest both for clinicians and researchers. In general, randomized controlled trial designs have been used as the methodology of choice in which intergroup comparisons are made having a minimum of participants in each arm of treatment. However, these procedures are seldom used in daily clinical practice. Despite this fact, the evaluation of treatment results for a specific patient is important for the clinician in order to address if therapeutic goals have been accomplished both in terms of statistical significance and clinical meaningfulness. The methodology based on the reliable change index (Jacobson y Truax)1 provides an estimate of these two criteria. The goal of this article is to propose a procedure to apply the methodology with a single case study of a woman diagnosed with major depression and treated with electroconvulsive therapy.
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