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Gait Problems in Cerebral Palsy focuses on the surgical care and postoperative rehabilitation of children with cerebral palsy as they grow through early and late childhood, and adolescence. The book describes the neurologic and musculoskeletal issues that are frequently treated in children in each age group. It describes how to evaluate the children, create problem lists, make treatment choices, carry out interventions, and provide rehabilitation therapies. It: Emphasizes the critical importance of dialogue with children and parents, and age-related data derived from the GOAL questionnaire is provided to focus insight on the priorities of patients and families. Presents descriptions of patient and family priorities, decision-making and surgical techniques, and rehabilitation therapies for each age group. Offers consistent chapter structures that emphasize clarity and brevity, supplemented by figures and tables. Highlights the importance of building collaborative multidisciplinary clinical teams. Includes access to numerous videos which demonstrate clinical teams at work with patients, surgical techniques, and rehabilitation activities.   Essential reading for orthopaedic surgeons, physiatrists, physical therapists, kinesiologists, gait analysis experts, and other members of the interdisciplinary team involved.  

This book defends medical nihilism, which is the view that we should have little confidence in the effectiveness of medical interventions. If we consider the frequency of failed medical interventions, the extent of misleading evidence in medical research, the thin theoretical basis of many interventions, and the malleability of empirical methods in medicine, and if we employ our best inductive framework, then our confidence in the effectiveness of medical interventions ought to be low. Part I articulates theoretical and conceptual groundwork, which offers a defense of a hybrid theory of disease, which forms the basis of a novel account of effectiveness, and this is applied to pharmacological science and to issues such as medicalization. Part II critically examines details of medical research. Even the very best methods in medical research, such as randomized trials and meta-analyses, are malleable and suffer from various biases. Methods of measuring the effectiveness of medical interventions systematically overestimate benefits and underestimate harms. Part III summarizes the arguments for medical nihilism and what this position entails for medical research and practice. To evaluate medical nihilism with care, the argument is stated in formal terms. Medical nihilism suggests that medical research must be modified, that clinical practice should be less aggressive in its therapeutic approaches, and that regulatory standards should be enhanced.

Artificial Intelligence for Improved Patient Outcomes provides new, relevant, and practical information on what AI can do in healthcare and how to assess whether AI is improving health outcomes.  With clear insights and a balanced approach, this innovative book offers a one-stop guide on how to design and lead pragmatic real-world AI studies that yield rigorous scientific evidence-all in a manner that is safe and ethical. Daniel Byrne, Director of Artificial Intelligence Research at AVAIL (the Advanced Vanderbilt Artificial Intelligence Laboratory) and author of landmark pragmatic studies published in leading medical journals, shares four decades of experience as a biostatistician and AI researcher. Building on his first book, Publishing Your Medical Research, the author gives the reader the competitive advantage in creating reproducible AI research that will be accepted in prestigious high-impact medical journals.

Awarded first place in the 2013 AJN Book of the Year Awards in the Advanced Practice Nursing category Named a Doody's Core Title \"This is an excellent and timely tool for advanced practice nurses.\" Score: 100, 5 stars -Doody's Medical Reviews Measuring the results of APN care has become increasingly important as a way to demonstrate.

Purpose To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. Methods The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1–2 who received invasive mechanical ventilation. Results 2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO 2 /FiO 2 ratio, and higher non-pulmonary SOFA score were associated with poorer outcome. Of the 578 (24.3 %) patients with a limitation of life-sustaining therapies or measures decision, 498 (86.0 %) died in hospital. Factors associated with increased likelihood of limitation of life-sustaining therapies or measures decision included older age, immunosuppression, neoplasia, lower pH and increased non-pulmonary SOFA scores. Conclusions Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS. Trial Registration: ClinicalTrials.gov NCT02010073.

Background Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families. Methods An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set. Results The Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined. Conclusions We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.

The role of measurement and the benefits of outcome measures are defined as important tools used to document change in one or more constructs over time, help to describe a client's condition, formulate a prognosis, as well as to evaluate the effects of occupational therapy intervention. Occupational Therapy Assessments for Older Adults: 100 Instruments for Measuring Occupational Performance presents over 100 outcome measures in the form of vignettes that encompass a brief description of each instrument, a review of its psychometric properties, its advantages and disadvantages, administration procedures, permissions to use, author contact information, as well as where and how to procure the instrument. Occupational Therapy Assessments for Older Adults by Dr. Kevin Bortnick narrows down the list of possible choices for the occupational therapy student or clinician to only those with an amount of peer review, bibliographic citations, as well as acceptance within the profession. The text also includes research-based information with text citations and has over 100 tables, diagrams, and figures. Included in the review of each outcome measure: Description: A brief record of the measure. Psychometrics: A review of the level of research evidence that either supports or does not support the instrument, including such items as inter-rater, intra-rater, and test-retest reliabilities, as well as internal consistencies and construct validities among others. Advantages: Synopsis of the benefits of using the measure over others including its unique attributes. Disadvantages: A summary of its faults. For example, the amount of research evidence may be limited or the measure may be expensive. Administration: Information regarding how to administer, score, and interpret results. Permissions: How and where to procure the instrument, such as websites where it may be purchased or journal articles or publications that may contain the scale. Summary: A brief summation of important information. Occupational Therapy Assessments for Older Adults: 100 Instruments for Measuring Occupational Performance encourages occupational therapy and occupational therapy assistants to expand their thinking about the use of appropriate outcome measures with older adult populations. Using the appropriate outcome measure based on evidence can aid in the promotion of health, well-being, and participation of clients.

Purpose An essential aspect of patient-centered outcomes research (PCOR) and comparative effectiveness research (CER) is the integration of patient perspectives and experiences with clinical data to evaluate interventions. Thus, PCOR and CER require capturing patient-reported outcome (PRO) data appropriately to inform research, healthcare delivery, and policy. This initiative’s goal was to identify minimum standards for the design and selection of a PRO measure for use in PCOR and CER. Methods We performed a literature review to find existing guidelines for the selection of PRO measures. We also conducted an online survey of the International Society for Quality of Life Research (ISOQOL) membership to solicit input on PRO standards. A standard was designated as “recommended” when >50 % respondents endorsed it as “required as a minimum standard.” Results The literature review identified 387 articles. Survey response rate was 120 of 506 ISOQOL members. The respondents had an average of 15 years experience in PRO research, and 89 % felt competent or very competent providing feedback. Final recommendations for PRO measure standards included: documentation of the conceptual and measurement model; evidence for reliability, validity (content validity, construct validity, responsiveness); interpretability of scores; quality translation, and acceptable patient and investigator burden. Conclusion The development of these minimum measurement standards is intended to promote the appropriate use of PRO measures to inform PCOR and CER, which in turn can improve the effectiveness and efficiency of healthcare delivery. A next step is to expand these minimum standards to identify best practices for selecting decision-relevant PRO measures.

The present study examined language trajectories and placement outcomes for children with autism spectrum disorder (ASD) receiving early intensive behavioral intervention (EIBI). Language measures were collected at baseline and 6, 12, 18, 24, and 36 months or until exit from EIBI in 131 children with ASD. Growth models estimated overall and subgroup language trajectories. Overall, children receiving EIBI showed substantial increases in language relative to normative expectations. Earlier age at EIBI start, higher baseline cognitive function, and lower baseline ASD severity predicted better language trajectories. Although there was significant variability in language trajectories and educational outcomes, most children showed significant increases in language scores, relative to normative expectations. Additional research, in more representative samples, is needed to understand this variability.

Background The challenges of implementing evidence-based innovations (EBIs) are widely recognized among practitioners and researchers. Context, broadly defined as everything outside the EBI, includes the dynamic and diverse array of forces working for or against implementation efforts. The Consolidated Framework for Implementation Research (CFIR) is one of the most widely used frameworks to guide assessment of contextual determinants of implementation. The original 2009 article invited critique in recognition for the need for the framework to evolve. As implementation science has matured, gaps in the CFIR have been identified and updates are needed. Our team is developing the CFIR 2.0 based on a literature review and follow-up survey with authors. We propose an Outcomes Addendum to the CFIR to address recommendations from these sources to include outcomes in the framework. Main text We conducted a literature review and surveyed corresponding authors of included articles to identify recommendations for the CFIR. There were recommendations to add both implementation and innovation outcomes from these sources. Based on these recommendations, we make conceptual distinctions between (1) anticipated implementation outcomes and actual implementation outcomes, (2) implementation outcomes and innovation outcomes, and (3) CFIR-based implementation determinants and innovation determinants. Conclusion An Outcomes Addendum to the CFIR is proposed. Our goal is to offer clear conceptual distinctions between types of outcomes for use with the CFIR, and perhaps other determinant implementation frameworks as well. These distinctions can help bring clarity as researchers consider which outcomes are most appropriate to evaluate in their research. We hope that sharing this in advance will generate feedback and debate about the merits of our proposed addendum.