Validation of prognosis-based in vitro fertilization grant selection criteria.

Objective: To validate a prognosis-based scoring system for in vitro fertilization (IVF) grant allocation. Design: Retrospective cohort study. Setting: A 501(c)(3) nonprofit foundation that awards donated IVF cycles and grants to those with demonstrated financial need. In contrast to lottery-based or subjective allocation systems, applications are scored according to medical prognostic criteria in addition to personal characteristics. Patients: Grant recipients from 2015 to 2019. Interventions: None. Main outcome measures: Live birth rate (LBR) and cumulative LBR (CLBR) among grant recipients were compared with 2019 Society for Assisted Reproductive Technology (SART) national averages. Results: A total of 435 applications were reviewed, with 59 grants awarded for 51 autologous IVF cycles, 6 donor oocyte cycles, and 2 gestational carrier cycles, resulting in 39 live births after initial embryo transfer (LBR 61.9%) and 43 CLBRs (CLBR 72.9%). Among autologous cycles, the mean (±SD=3.9 years) age was 31.8 years, and LBR and CLBR were 62.8% and 68.6% vs. 28.2% and 37.1% among all autologous SART cycles, respectively. A subanalysis of grant recipients aged <35 years (n=39) revealed LBR and CLBR of 66.7% and 74.4% vs. 40.7% and 47.8% among autologous SART cycles aged <35 years, respectively. Conclusions: A scoring system incorporating medical criteria identified IVF grant applicants with a high likelihood of achieving a LB. Although most IVF grant programs select recipients through a lottery or personal characteristics, a prognosis-based scoring system should be considered to maximize LBR in a limited resource setting.

My Vocational Situation (MVS): Case Example and Psychometric Review.

This case report provides an overview of the psychometric properties and clinical utility of the My Vocational Situation (MVS) instrument. The accompanying hypothetical case description illustrates how clinicians could use the MVS to evaluate vocational preferences and outcomes and how the MVS can be used to inform treatment planning and rehabilitation decision making. The information contained in this report is intended to familiarize clinicians with the administration and scoring of the MVS, the psychometric information necessary to interpret results obtained from the MVS, and how the results could be used to provide comprehensive, patient-centered care. It is important to note that the information provided represents only a sample of the available research literature on the MVS.

Use of the Pressure Ulcer Scale for Healing (PUSH) in Inpatient Rehabilitation: A Case Example.

PURPOSE: Nurses who specialize in rehabilitation frequently assess and treat patients with pressure ulcers. The purpose of this case study is to describe the use of the Pressure Ulcer Scale for Healing (PUSH), which has demonstrated excellent psychometric properties, to assess, monitor progress, and guide clinical decision-making during inpatient rehabilitation. METHODS: The psychometric properties, clinical utility, and data that can be used to interpret the results of the PUSH instrument are presented. Application of the instrument in clinical practice is also described. FINDINGS AND CONCLUSIONS: Systematic measurement of a pressure ulcer using the PUSH has potential to demonstrate change in pressure ulcer status that results from clinical treatment. This case provides an example of how results of a clinical assessment can effectively guide clinical decisions.

Measurement characteristics and clinical utility of the Brief Pain Inventory-Short Form for individuals with multiple sclerosis.

This Rehabilitation Measures Database summary provides a review of the psychometric properties of the BPI in individuals with MS. A full review of the BPI as well as reviews of over 330 other instruments can be found at www.rehabmeasures.org.

Measurement characteristics and clinical utility of the Patient Health Questionnaire-9 among individuals with spinal cord injury.

This Rehabilitation Measures Database summary provides a review of the psychometric properties of the PHQ-9 individuals with SCI. A full review of the PHQ-9 as well as reviews of over 300 other instruments can be found at www.rehabmeasures.org.

Risk of morbidity and mortality following hepato-pancreato-biliary surgery.

INTRODUCTION: Hepatic, pancreatic, and complex biliary (HPB) surgery can be associated with major morbidity and significant mortality. For the past 5 years, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has gathered robust data on patients undergoing HPB surgery. We sought to use the ACS-NSQIP data to determine which preoperative variables were predictive of adverse outcomes in patients undergoing HPB surgery. METHODS: Data collected from ACS-NSQIP on patients undergoing hepatic, pancreatic, or complex biliary surgery between 2005 and 2009 were analyzed (n = 13,558). Diagnoses and surgical procedures were categorized into 10 and eight groups, respectively. Seventeen preoperative clinical variables were assessed for prediction of 30-day postoperative morbidity and mortality. Multivariate logistic regression was utilized to develop a risk model. RESULTS: Of the 13,558 patients who underwent an HPB procedure, 7,321 (54%) had pancreatic, 4,881 (36%) hepatic, and 1,356 (10%) biliary surgery. Overall, 70.3% of patients had a cancer diagnosis. Post-operative complications occurred in 3,850 patients for an overall morbidity of 28.4%. Serious complications occurred in 2,522 (18.6%) patients; 366 patients died for an overall peri-operative mortality of 2.7%. Peri-operative outcome was associated with diagnosis and type of procedure. Hepatic trisectionectomy (5.8%) and total pancreatectomy (5.4%) had the highest 30-day mortality. Of the preoperative variables examined, age >74, dyspnea with moderate exertion, steroid use, prior cardiac procedure, ascites, and pre-operative sepsis were associated with morbidity and mortality (all P < 0.05). CONCLUSIONS: While overall morbidity and mortality for HPB surgery are low, peri-operative outcomes are heterogeneous and depend on diagnosis, procedure type, and key clinical factors. By combining these factors, an ACS-NSQIP "HPB Risk Calculator" may be developed in the future to help better risk-stratify patients being considered for complex HPB surgery.