The clinical study evaluated peripheral nerve stimulation of the occipital nerves for chronic migraine. 157 patients were randomly assigned to an active or control group in a 2:1 ratio. The primary endpoint of a 10% difference in responders between groups was not met. However, secondary analyses found that the active group experienced significantly greater reductions in headache days, migraine disability, and improvements in quality of life and satisfaction compared to the control group.
Nonverbal Communication: Eye contact between physicians and older-patients i...rgbhat
This PP presentation delineates the nature of eye contact in anxiety-provoking interactions (e.g. cancer, acute medical visits) and compares it with eye contact in routine medical visits.
A very vital article that briefly and nicely describes how shpuld evidence be handled in order to evaluate it and make use of the information provided.
Evaluate and Compare the Effectiveness of Back Care with Traditional Method v...ijtsrd
A pressure ulcers is a localized area of tissue necrosis that tends to develop when soft tissue is compressed for a prolonged period of time between a bony prominence and an external surface. The frequency of pressure ulcers ranges from3 14 globally. The incidence of pressure ulcer in hospital has been reported to be 23 to 27.5 Prevention of pressure ulcers is a significant nursing concern. Nurses' ability to identify the patient at risk for the formation of the pressure ulcer would help to reduce the costs of treatment. Pressure ulcers not only cause suffering to the patients but also increases the economical burden. Mrs. Kanagavalli K | Dr. Harinderjeet Goel | Mrs. Madumitha Dey | Dr. Tankeshwar Boruah "Evaluate and Compare the Effectiveness of Back Care with Traditional Method versus Cavilon Spray in Term of Prevention of Decubitus Ulcer in Bedridden Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47501.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/47501/evaluate-and-compare-the-effectiveness-of-back-care-with-traditional-method-versus-cavilon-spray-in-term-of-prevention-of-decubitus-ulcer-in-bedridden-patients/mrs-kanagavalli-k
“Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking. Botella C. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Nonverbal Communication: Eye contact between physicians and older-patients i...rgbhat
This PP presentation delineates the nature of eye contact in anxiety-provoking interactions (e.g. cancer, acute medical visits) and compares it with eye contact in routine medical visits.
A very vital article that briefly and nicely describes how shpuld evidence be handled in order to evaluate it and make use of the information provided.
Evaluate and Compare the Effectiveness of Back Care with Traditional Method v...ijtsrd
A pressure ulcers is a localized area of tissue necrosis that tends to develop when soft tissue is compressed for a prolonged period of time between a bony prominence and an external surface. The frequency of pressure ulcers ranges from3 14 globally. The incidence of pressure ulcer in hospital has been reported to be 23 to 27.5 Prevention of pressure ulcers is a significant nursing concern. Nurses' ability to identify the patient at risk for the formation of the pressure ulcer would help to reduce the costs of treatment. Pressure ulcers not only cause suffering to the patients but also increases the economical burden. Mrs. Kanagavalli K | Dr. Harinderjeet Goel | Mrs. Madumitha Dey | Dr. Tankeshwar Boruah "Evaluate and Compare the Effectiveness of Back Care with Traditional Method versus Cavilon Spray in Term of Prevention of Decubitus Ulcer in Bedridden Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47501.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/47501/evaluate-and-compare-the-effectiveness-of-back-care-with-traditional-method-versus-cavilon-spray-in-term-of-prevention-of-decubitus-ulcer-in-bedridden-patients/mrs-kanagavalli-k
“Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking. Botella C. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Karen Sepucha, PhD, describes what a good decision is, how we measure decision quality and how the decision quality instrument might be used.
This presentation was part of a Shared Decision Making Month webinar -- What Makes a Good Medical Decision? Defining and Implementing Decision Quality Measures.
The New 2018 SCCM PADIS Guidelines: Quick Hits of Recommendations for Sedatio...Intensive Care Society
Dr. Needham is Professor of Pulmonary and Critical Care Medicine, and of Physical Medicine and Rehabilitation at the Johns Hopkins University in Baltimore, USA. He is Director of the “Outcomes After Critical Illness and Surgery” (OACIS) Research Group and core faculty with the Armstrong Institute for Patient Safety and Quality, both at Johns Hopkins. From a clinical perspective, he is an attending physician in the medical intensive care unit at Johns Hopkins Hospital and Medical Director of the Johns Hopkins Critical Care Physical Medicine and Rehabilitation program.
Dr. Needham received his MD degree from McMaster University in Hamilton, Canada, and completed both his residency in internal medicine and his fellowship in critical care medicine at the University of Toronto. He obtained his PhD in Clinical Investigation from the Bloomberg School of Public Health at Johns Hopkins University. Notably, prior to his medical training, he completed Bachelor and Master degrees in Accounting and practiced in a large international accounting firm, with a focus in the health care field.
Dr. Needham is Principal Investigator on a number of NIH research grants and has authored more than 250 publications. His research interests include evaluating and improving ICU patients’ long-term physical, cognitive and mental health outcomes, including research in the areas of sedation, delirium, early physical rehabilitation, and knowledge translation and quality improvement.
Course Project Phase Two
Pavel Garbuz
April 12th, 2017
Rasmussen College
1. Confidence interval
1) Confidence interval is a range which is used to provide an estimate of population mean. It is believed that the population mean would be from that range.
2) Point estimate is the value which we derive from a sample to give an estimate about the population.
3) The best point estimate is an estimate about the population mean. We derive this by finding the mean of the sample as a sample represents a population and there for its mean gives the best point estimator of population mean.
4) Normally samples represent a population. In theory it should be the same as a population but in reality the sample may have higher values and may not contain lower values and vice versa thus we don’t get the best point estimators of the population. To cater to this problem we use confidence interval by which we calculate a range in which the population mean is assumed to be present.
2. Best Point estimate of population Mean
BPE = sum of all ages / number or patients
BPE = 3709 / 60
BPE = 62 (61.82 round up)
3. Confidence interval
Confidence interval = 61.82 (+-) Z0.05/2 (S/ ((n)^(1/2))
= 61.82 (+-) 1.96 ( 8.92/ (601/2 )
= 61.82 - 2.257 , 61.82 + 2.257
= 59.56 > X > 64.077
4. Interpretation of confidence interval
In the research we were looking at the significance that old people tend to have particular infectious disease. We constructed a confidence interval to have an idea were the population mean lies. By constructing a confidence interval we have a point estimate of population mean. 95% of the samples would have a mean within the above range which is between 59.56 > age > 64.077.
5. Calculating confidence interval at 99%
61.82 (+-) 2.5758 (8.92/ (601/2)
= 58.85 > age > 64.79
A) Yes I did notice change in the interval as the range has increased as we can see in the calculation above.
B) Now the range for the point estimate has increase and as it at 99% confidence level we can say that its more accurate as 99 sample means would be within this sample. Whereas in 95% confidence we had 95 sample mean in that interval.
G310 Advanced Statistics and Analytics – Option 2
An Application of Statistical Methods
Pavel Garbuz
April 6th, 2017
Rasmussen College
1. Introduction
As a health care professional, this study works to improve and maintain families, and communities in various settings. To understand current problem and its solution this study uses statistical tools to analyze results. The objective of this project is the application of basic statistical tools to a fictional scenario in order to impact the health and wellbeing of the clients being served.
2. Scenario/Problem
You are currently working at NCLEX Memorial Hospital in the Infectious Diseases Unit. Over the past few days, you have noticed an increase in patients admitted with a particular infectious disease. It is believed t.
Preventive home monitoring of COPD patients across sectors–an advantage for the patients and healthcare professionals. Birthe Dinesen, Associate professor,
Department of Health Science and Technology, Aalborg University, Denmark
Via Christi Women's Connection presentation on advance in depression treatment by Matthew Macaluso, DO, medical director of Via Christi Psychiatric Clinic.
Running head: NECK PAIN 1
NECK PAIN 2
NECK PAIN
Bamgbola Abitogun
Grand Canyon University
NRS 433V
April 2nd, 2017
Dosage impacts of spinal manipulative treatment for endless neck torment Comment by Denise Foti: APA: The first line of your paper needs to be your paper title not bold-faced
Neck pain is second most common spinal pain to low back torment among musculoskeletal grievances revealed in the all inclusive community and among those exhibiting to manual treatment suppliers. Ceaseless neck torment (i.e. neck torment enduring longer than 90 days) is a typical purpose behind introducing to a chiropractor's office, and such patients frequently get spinal control or activation. Comment by Denise Foti: Indent
Research question: In adults with chronic neck pain, what is the base measurements of control important to create a clinically vital change in neck pain contrasted with directed practice in 2 months Comment by Denise Foti: You need to revise this. Look at the example I provided the first day of class.
(P)-Population: Adults 18 to 60 years old, with a clinical conclusion of endless mechanical neck pain who have not gotten cervical spinal manipulative therapy in the previous year. Patients with non-mechanical neck agony or contraindications to cervical control will be rejected.
(I)-Intervention: Subjects randomized to have control would get standard rotational or sidelong break enhanced method once, twice, or three times each week over a time of 2, 4, or a month and a half. These subjects would likewise get a similar practice regimen given to the control gathering to take out practice as a moment variable influencing results.
(C)-Comparison-An institutionalized administered practice regimen would be utilized as a dynamic control bunch. All subjects, paying little heed to gathering task, would play out an institutionalized practice administration at every session over a time of a month and a half. Utilizing this methodology, we will have the capacity to limit the non-particular impacts because of going to a facility.
(O)-Outcome- Changes in neck pain, measured utilizing the 100mm VAS for agony.
(T)-Time-The result would be measured week by week for two months
Reference
Vernon, H., & Mior, S. (January 01, 1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14, 7, 409-15.
Injuries to the cervical spine, particularly those including the delicate tissues, speak to a huge wellspring of unending handicap. Techniques for appraisal for such inability, particularly those focused at exercises of day by day living which are most influenced by neck agony, are very few. An alteration of the Oswestry Low Back Pain Index was led ...
Placée en soins intensifs le soir même, elle sera alors prise en charge par le docteur Norbert Manzo et son équipe. Résultats des examens à l'appui, on lui annonce un méningiome, c'est-à-dire, une tumeur au cerveau. L'opération est programmée pour le 22 août. « J'ai pris la nouvelle avec beaucoup de philosophie. J'ai appelé mon fils, j'ai envoyé un texto à certains de mes amis leur disant que je venais de prendre un billet aller-retour et que mon retour se fera avec la bénédiction du seigneur. Je leur disais aussi que je n'avais que de l'amour à transmettre » . L'opération qui a débuté à 9 h s'est terminée à 19 h » . L'équipe soignante fut très étonnée de sa grande capacité de récupération suite à une si longue et délicate intervention.
Et si elle tient tant à témoigner aujourd'hui, c'est parce que Jocelyne considère qu'elle sort de loin et qu'elle a eu la chance de tomber sur un médecin et une équipe exceptionnelle de l'hôpital de la Meynard
2. Clinical Study Design
Patient
Enrolled
Group A: Active
PNS
Implanted
2:1 Ratio
Randomize and
Device Activation Group B: Control (Blind)
80- to 90-day roll in 4-week visit 12-week visit 24-week visit 52-week visit
The integrity of the Control (or blind) group was maintained as:
1/ Both patients in the Control group, and the study investigator were blinded, so nobody knew
who was active or control
2/ All Control patients were given programmers that appeared to be functioning, but did not
communicate with the IPG (for the first 12 weeks).
3/ Patients in the control group were told that a range of different settings were being
tested which was not indicative of whether they were in the control or active group.
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division.
3. Clinical Study Design
Study Inclusion Criteria Study Exclusion Criteria
Diagnosed with chronic migraine Patients identified as having Medication
Overuse Headache (MOH) - per
headache days/month assessment by study investigator
Has tried at least 2 migraine-specific Patients who within 8 weeks prior to initial
acute medications and at least 2 baseline have started new medications or
different classes of prophylactic therapy to treat headache pain
medications and found to be refractory
Patients who had tried Botox who had tried
VAS score of 6 cm (or greater) 6 months prior to
on a 10-cm line initial baseline
Headache pain is posterior head pain or Patients who have undergone a destructive
pain originating in the cervical region procedure affecting
C2/C3/occipital distribution
Cervical abnormality that does
not allow for placement of the percutaneous
lead
The above inclusion/ exclusion criteria were used in the clinical research to
define the study population for chronic migraine.
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division.
4. Baseline Patient Demographics
Control Group Active Group
(N=52) (N=105)
Mean (+std) 44,6 (+ 10,3) 45,0 (+ 11,3)
Age
Range 23 65 18 72
Male 9 (17,3%) 24 (22,9%)
Gender
Female 43 (82,7%) 81 (77,1%)
Mean (+std) 24,6 + 13,3 21,9 + 14,9
Duration of Headache (yrs)
Range 2,4 54 1,3 66
Baseline Number of Headache
Days
Mean (+std) 72,3 (+ 23,5) 80,7 (+ 18,2)
(out of 90 From MIDAS
Questionnaire)
Study participants in the active and control groups were similar at baseline
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division.
5. Results: Primary Endpoint
50% Reduction in Pain on VAS
Continuous Proportion Responder Analysis Based on Mean Daily Average Pain Intensity
VAS Measurements With No Increase in Average Headache Frequency or Duration
Primary Endpoint:
The primary endpoint in the study was a statistical reference point imposed by
the FDA:
10% differential between responders in active group vs. control group
(95% IC) and,
Responders were defined with 50% reduction (or greater) in mean VAS vs.
baseline
Statistically significant and Clinically relevant for Responders defined at 30%.
Based on feedback from our study investigators this outcome is highly significant in
this patient population particularly when you consider the improvement in disability
and quality of life.
Furthermore it is important to note that a 30% reduction in pain is the mark used by
pharmaceutical companies when they assess whether a specific pain treatment is
efficacious or not.
The study primary end point was not met.
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division. in pain. p-value=0,02
Significance was demonstrated at 30% reduction
6. Results: Primary Endpoint
50% Reduction in Pain on Visual Analog Scale
Continuous Proportion Responder Analysis Based on Mean Daily Average Pain Intensity
VAS Measurements With No Increase in Average Headache Frequency or Duration
met
% Control Active
Patients Achieving Various Levels of protocol
reduction Group % Group % p-
Pain Relief from responder responder value1
objective
100% (>10%
baseline s (n=52) s (n=105)
dif.)2
Percentage of Patients
80% 10,0% 30,8% 56,2% 0,003 Yes
20,0% 19,2% 40,0% 0,009 Yes
60%
30,0% 17,3% 35,2% 0,020 Yes
40%
40,0% 15,4% 25,7% 0,143 No
50,0% 13,5% 17,1% 0,553 No
20%
60,0% 9,6% 11,4% 0,731 No
70,0% 1,9% 4,8% 0,664 No
0%
0% 20% 40% 60% 80% 100%
80,0% 1,9% 3,8% 1 No
Percentage of Pain Reduction 90,0% 0,0% 1,0% 1 No
100,0% 0 0 0 No
Control (n=52) Active (n=105)
The study primary end point was not met.
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division. in pain. p-value=0,02
Significance was demonstrated at 30% reduction
7. Results: Secondary Endpoints
Reduction in Headache Days at the 12-Week
Control Phase (using patient diary)
Patient diaries recorded whether or not patients had a headache each day, the daily average
headache intensity, and the daily headache duration, in hours.
Data was used to identify Headache Days, defined as a day with a headache lasting four or
more hours with at least moderate intensity.
Visit Control Group (n=52) Active Group (n=105) P-Value
Baseline
Mean ( std) 17,1 ( 8.2) 20,5 ( 7,6) 0,011
Week 12
Mean Change1 -4,3 (25,1%) -7,3 (35,6%) 0,02
Significant reduction -3.0 days in Headache Days (per month) between
Active and Control groups (p=0.02)
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division.
8. Results: Secondary Endpoints
Reduction in MIDAS Disability Score at 12-Week
Control Phase
The Migraine Disability Assessment (MIDAS) is a questionnaire which measures
headache-related disability during the previous 90 days.
Visit Control Group (n=52) Active Group (n=105) P-Value
Baseline
Mean ( std) 152,7 ( 77,1) 158,4 ( 76,8) 0,664
Week 12
Mean Change1 -20,4 -64,6 <0,001
The MIDAS questionnaire was completed at baseline and 12 weeks after the system
was implanted.
The reduction in disability of 44.1 days between the groups is statistically significant
(p<0.001).
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division.
9. Results: Pain Relief & Patient Satisfaction
12-Week Control Phase
Active group participants reported (on average) 42,1% pain relief and 51,4% of them
were satisfied with their level of pain relief.
Percentage of Pain Relief Since Percentage of Patients Satisfied
Surgery With Headache Relief
100%
100%
80%
80%
60%
60% 51,4%
42,1%
40% 40%
17,2% 19,2%
20% 20%
0% 0%
Control Group (n=52) Active Group (n=105)
Control Group (n=52) Active Group (n=105)
The differences reported between the Active and Control Groups for both
measures were statistically significant (p<0,001).
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division.
10. Results: Quality of Life & Patient Assessment -
Open Label Phase
Overall Quality of Life Were you satisfied with the results of your
100% procedure? (N=138)
4%
80% n=6
68,4%
64,3%
60%
Very Satisfied
15% 23%
n=21 n=32 Satisfied
40%
30,0%
14% Unsatisfied
26,3% n=19
Very Unsatisfied
20% 44%
n=60 Unable to Determine
5,7% 5,3%
0%
Improved Stayed the Same Deteriorated
Week 24 (N=140) Week 52 (N=133)
At the conclusion of the study 68.4% pts reported improved QOL, and 67% were
either satisfied or very satisfied w/ the results of the therapy.
Confidential. For Internal Use Only. St. Jude Medical Neuromodulation Division.