Dissertations / Theses on the topic 'Chronic outcomes'
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1
Baker, Jannah F. "Bayesian spatiotemporal modelling of chronic disease outcomes." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/104455/1/Jannah_Baker_Thesis.pdf.
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This thesis contributes to Bayesian spatial and spatiotemporal methodology by investigating techniques for spatial imputation and joint disease modelling, and identifies high-risk individual profiles and geographic areas for type II diabetes mellitus (DMII) outcomes. DMII and related chronic conditions including hypertension, coronary arterial disease, congestive heart failure and chronic obstructive pulmonary disease are examples of ambulatory care sensitive conditions for which hospitalisation for complications is potentially avoidable with quality primary care. Bayesian spatial and spatiotemporal studies are useful for identifying small areas that would benefit from additional services to detect and manage these conditions early, thus avoiding costly sequelae.
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Fenton, Grania. "Benchmarking outcomes for psychological treatments of chronic pain." Thesis, University of Leeds, 2010. http://etheses.whiterose.ac.uk/1087/.
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In an attempt to bridge the widely acknowledged gap between research and clinical practice, this thesis examined the feasibility of benchmarking outcomes for published psychological treatments of chronic pain for application within routine clinical settings. Benchmarking outcomes is relatively common for psychological treatments in the mental health field, but in spite of the prevalence of chronic pain and its known impact on many areas of functioning, the chronic pain literature has previously only considered the generic application of benchmarks for developing services and considering standards for waiting times. Four studies of mixed methodological approaches were conducted. The first aimed to ascertain the extent of similarities between published psychological treatments of chronic pain and treatments delivered in routine clinical settings. This was to ensure that the application of benchmarks from the published literature to routine clinical settings would be meaningful. The second study examined whether the published literature was likely to facilitate the development of benchmarks, and the third sought clarification in terms of outcome domains within which useful benchmarks could be generated. The final study was a meta-analysis of data extracted from the published literature within specified outcome domains. The results suggested that it would be meaningful to apply benchmarks produced from the published literature to routine clinical settings, and that the literature would facilitate the development of benchmarks within several outcome domains. The meta-analysis led to the generation of four benchmarks. These were in the outcome domains of pain experience and physical functioning when compared with waiting list controls, and coping and cognitive appraisal and emotional functioning when compared with active controls. The impact of the design of each study and properties inherent within the literature on the benchmarks generated and their application within routine clinical settings was then considered, prior to suggestions for future research and clinical applications.
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Painter, Jacob T. "CHRONIC OPIOID USE IN FIBROMYALGIA SYNDROME: CHARACTERISTICS AND OUTCOMES." UKnowledge, 2012. http://uknowledge.uky.edu/pharmacy_etds/5.
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Fibromyalgia syndrome (FMS) is a chronic pain condition with significant societal and personal burdens of illness. Chronic opioid therapy in the treatment of chronic nonmalignant pain has increased drastically over the past decade. This is a worrisome trend in general, but specifically, given the pathophysiologic characteristics seen in fibromyalgia syndrome patients, the use of this class of medication deserves special scrutiny. Although the theoretical case against this therapy choice is strong, little empirical evidence exists. In order to supplement this literature, retrospective analysis methods are utilized to examine the association of state-, provider-, and patient level characteristics with the prevalence of chronic opioid use in this disease state. Data gathered through this analysis is then used to develop a propensity index for the identification of an appropriate control group for fibromyalgia patients, a task that has proven difficult in the literature to date. Using propensity stratification and matching techniques analysis of the impact of fibromyalgia, chronic opioid use, and the interaction of these two variables are undertaken.
Several key findings and updates to the understanding of chronic opioid use and fibromyalgia syndrome are reported. Wide geographic variation in chronic opioid utilization between states is seen. The role of diagnosing provider type in the rate of chronic opioid prescribing is significant and can be aggregated at various levels. Demographic characteristics, comorbid conditions, and concurrent medication use are all important associates of chronic opioid use in fibromyalgia syndrome. Additionally, chronic opioid use in fibromyalgia patients, independent of propensity to receive that therapy choice is a significant correlate with healthcare costs. A diagnosis of fibromyalgia is a statistically significant source of healthcare costs, though the clinical significance of its impact when compared to a closely matched control group is minimized. Despite the minimization of the role of this diagnosis the impact of the interaction of chronic opioid use with fibromyalgia, despite control for myriad regressors, is significant both statistically and clinically.
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Williams, Amanda Clare de Coetlogon. "Cognitive-behavioural management of chronic pain : models and outcomes." Thesis, King's College London (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.406221.
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Fertuck, Deborah. "Children with chronic physical disorder : maternal characteristics and child outcomes." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=56618.
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The purpose of this study was to examine child psychosocial adjustment (i.e., behavioural problems and self-esteem) as a function of maternal well-being, parenting competence, and maternal stress in a sample of children (8 to 16 years) with a chronic physical disorder (CPD) (n = 60) as compared to a sample of non-chronically disabled children (n = 60). While the groups did not differ on either maternal variables or child behavioural problems, CPD children had higher self-esteem than comparison group children. For both groups, mothers with high well-being, high competence, and low stress had children with fewer behavioural problems. Furthermore, mothers of older CPD children perceived themselves as more competent parents, which in turn was related to fewer behavioural problems and higher self-esteem in the child. Mothers who assessed their child's condition as less stressful also had a higher sense of well-being and/or perceived themselves as more competent mothers. While this sample consisted of children whose conditions were of mild to moderate severity, children with more severe conditions had higher self-esteem.
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Methven, Shona. "Predictors of renal and patient outcomes in chronic kidney disease." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3655/.
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Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease and end stage renal failure. Accurate identification of those with a reduced glomerular filtration rate and significant proteinuria facilitates early diagnosis and risk stratification. This thesis explores the optimal measure of proteinuria, to accurately quantify proteinuria and as a predictor of renal and patient outcomes. We examine the prevalence of CKD in a general population cohort and assess the impact of different estimated glomerular filtration rate (eGFR) formulae. We explore the prognostic role of reduced eGFR and proteinuria in patients with hypertension and present the baseline characteristics of a community cohort study of patients with predominantly early CKD. They will be followed for ten years to identify predictors of cardiovascular and renal outcome. Urine total protein:creatinine ratio (TPCR) and albumin:creatinine ratio (ACR) have largely replaced 24-hour urine collections for proteinuria quantification. The performance of these spot measures to identify significant proteinuria is compared in a cohort of 6842 patients attending a general nephrology clinic. Both tests perform well overall but TPCR is statistically significantly superior as a predictor of 24-hour total proteinuria than ACR (as measured by the area under the receiver operator characteristic (ROC) curve to predict 1g/day total proteinuria). On sub-group analysis the performance of the spot samples is poorer in women and the elderly, likely as a result of low muscle mass and low urine creatinine (the denominator in TPCR/ACR). The performance of TPCR and ACR were then compared as predictors of outcome in a similar cohort of 5586 CKD patients using a hierarchical Cox survival model. TPCR and ACR both performed well as independent predictors of death, commencement of renal replacement therapy (RRT) and doubling of serum creatinine. Notably TPCR performed well at low levels where albuminuria has been considered superior. These findings are novel. The spot samples performed as well as 24-hour collections in the sub-group with timed urine collections. The National Institute for Health and Clinical Excellence in England recommend ACR to monitor all patients with CKD; the Scottish Intercollegiate Guidelines Network recommend TPCR for non-diabetic renal disease. Therefore, we investigated the implications of these recommendations using survival modelling. The same cohort was divided into 5 groups: no proteinuria, low proteinuria (using TPCR and ACR), high proteinuria (TPCR and ACR) and two groups where TPCR and ACR were discordant (i.e. TPCR above the diagnostic threshold but ACR below it and vice versa) using the recommended thresholds (ACR 30mg/mmol/TPCR 50mg/mmol to predict 0.5g/day total proteinuria and ACR 70mg/mmol/TPCR 100mg/mmol to predict 1g/day total proteinuria). Using univariate survival analysis the discordant group had significantly poorer outcomes (using the same outcomes as previously) than those with significant proteinuria as measured by both tests. The discordant group was older with poorer renal function and some of the excess risk was abolished on multivariate analysis, however the risk did not return to the level of those without detectable proteinuria. TPCR, but not ACR, measures non-albumin proteins and these may have pathophysiological roles in progression. This requires further study. However this analysis confirmed that TPCR identifies patients at high risk of adverse outcomes. TPCR and ACR may vary as a result of muscle mass. We adjusted TPCR and ACR for estimated creatinine excretion (ECE) (calculated using the Cockcroft and Gault formula) and performed cross-sectional and longitudinal analyses. Adjusting TPCR and ACR for ECE improves prediction of significant proteinuria in sub-groups with poor baseline test performance (such as women and the elderly) using ROC curve analysis. However when adjusted and unadjusted values were compared as predictors of outcome (using a net reclassification index analysis) adjusted values were significantly inferior. Urine creatinine is an independent predictor of mortality and hence may be directly contributing to the predictive value of TPCR and ACR rather than simply correcting for urine flow rate. As such, adjusting for ECE may act to remove the effect of a second independent predictor, leading to inferior test performance. Therefore the decision to adjust TPCR and ACR for ECE depends on the test application: to predict significant proteinuria adjustment of TPCR and ACR is of benefit, but adjustment leads to inferior performance as a prognostic test. The prevalence of CKD stages 3-5 was assessed using a general population laboratory database. Overall population prevalence was 5.63% using the modification of diet in renal disease (MDRD) formula and fell to 4.94% when the CKD-Epidemiology group (CKD-EPI) formulae were applied. Those reclassified to an earlier stage of CKD were predominantly middle aged women. Prevalence over a five year period was found to be stable using the CKD-EPI formulae but rose slightly according to MDRD. Proteinuria and eGFR were assessed as predictors of outcome in a large specialist hypertension clinic cohort. On multivariate survival analysis both baseline dipstick proteinuria and an eGFR<60ml/min/1.73m2 remained strong independent predictors of cardiovascular and all-cause mortality, despite intensive specialist intervention to control blood pressure. These simple tests should be advocated for risk stratification in these patients. Lastly the baseline characteristics of a community CKD cohort are presented. We recruited 411 participants from seven general practices around Ayrshire and a detailed baseline clinical and biochemical assessment was performed. Patients were invited to participate if they were included in the primary care register of CKD stages 3-5. Over a quarter had an eGFR>60ml/min/1.73m2 on the meat-fasted study sample. Proteinuria was of notably low prevalence and the cohort had a large burden of cardiovascular disease. Complications of renal disease were uncommon. The characteristics of the cohort differ from those under hospital follow-up. Their long term outcomes should contribute to refining risk stratification in this population. Proteinuria and eGFR are key aspects of diagnosis and monitoring in CKD. Identification of the optimal measures of both is essential and findings presented here contribute to that. There is a need to refine risk stratification in CKD, to identify those who require intensive intervention, and to reassure the rest. The findings of this thesis also contribute to that. Further study is required to refine the core aspects of diagnosis and investigation of CKD.
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Darvall, Katy Abigail Leigh. "Outcomes from ultrasound-guided foam sclerotherapy for chronic venous disease." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3795/.
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The objective of this research is to investigate the role of ultrasound-guided foam sclerotherapy (UGFS) in the treatment of chronic venous disease (CVD). UGFS was found to be a safe and effective treatment for both primary and recurrent great saphenous vein (GSV) and small saphenous vein (SSV) incompetence, assessed by occlusion of treated veins on duplex ultrasound (DUS), and by disappearance of visible varicose veins (VV) on clinical examination. There was some evidence that healing of chronic venous ulcers (CVU) may be improved by UGFS when combined with compression bandaging. When compared with patients undergoing superficial venous surgery (SVS), UGFS was associated with significantly less pain, bruising and analgesia requirement, and a quicker return to work and driving. Significant improvements in both generic physical and disease-specific health-related quality of life (HRQL)were observed following UGFS, and were sustained for 12 months after treatment. UGFS significantly improved lower limb physical symptoms (pain, itching, restlessness, swelling, heaviness, cramp and tingling), cosmetic appearance, and provided life-style benefits in the majority of patients. Furthermore, the great majority of patients who expected such benefits had their expectations met or exceeded.
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Ramzam, Naveen, Hemang Panchal, Edward Leinaar, Christian Nwabueze, Shimin Zheng, and Timir Paul. "Investigating the Association between Chronic Kidney Diseasse and Clinical Outcomes." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6300.
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Background: Chronic Kidney Disease (CKD) can be described as the loss of the kidney function over time. Symptoms usually develop slowly and it may not appear in early stages. Lab tests can confirm a CKD diagnosis. The approximate number of incidents per year is more than 200,000 cases and approximately 30 million people are living with CKD today in the United States. This long-standing disease ultimately leads to renal failure at the end. At this present time, there are no known cures for CKD and the only treatment available is dialysis.
Objectives: The purpose of this study is to determine the association between CKD and further with Hemodialysis (HD) and medical condition such as cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications, and death.
Methods: The study employed secondary data in a cross-sectional design. A sample of 106,969 was drawn from the population. The outcome variables were a diagnosis of CKD and/or CKD with HD. The predictor variables were cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death. Logistic regression was conducted to analyze the relationship between outcome variable and each independent variable. Variables with a p-value <0.05 were considered significant. Odds Ratio (OR) and 95% Confidence Intervals (CI) were reported and discussed. The statistical analysis was performed using SAS version 9.4.
Results: Analysis shows that subjects with cardiac complications were 17% less likely to have CKD as compared to those who did not have cardiac complications (OR: 0.83, 95% CI: 0.78-0.88). CKD patients who had cardiac complications were 18% more likely to have HD than the subjects who did not have cardiac complications (OR: 1.18, 95% CI: 1.01-1.39). Patients with cardiogenic shock were 86% more likely to have CKD than the subjects who did not have cardiogenic shock (OR: 1.86, 95% CI: 1.82-1.91). CKD patients who had cardiogenic shock were also 18% more likely to have HD than the subjects who did not have cardiogenic shock (OR: 1.18, 95% CI: 1.11-1.25). Similar results have been reported if a patient had other conditions.
Conclusion: Chronic kidney disease with hemodialysis is significantly associated by the other medical conditions such as cardiac complications cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death in the United States. Further studies are needed to confirm the results and to understand the prognosis.
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Ramzan, Naveen, Shimin Zheng, Hemang Panchal, Edward Leinaar, Christian Nwabueze, and Timir K. Paul. "Investigating The Association Between Chronic Kidney Disease and Clinical Outcomes." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/21.
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Background
Chronic Kidney Disease (CKD) can be described as the loss of the kidney function over time. Symptoms usually develop slowly, and it may not appear in early stages. Lab tests can confirm a CKD diagnosis. The approximate number of incidents per year is more than 200,000 cases, and approximately 30 million people are living with CKD today in the United States. This long-standing disease ultimately leads to renal failure at the end. At this present time, there are no known cures for CKD, and the only treatment available is dialysis. Objectives
The purpose of this study is to determine the association between CKD and further with hemodialysis (HD) and medical condition such as cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications, and death. Study design
The study employed secondary data in a cross-sectional design. Methods
A sample of 106,969 was drawn from the population. The outcome variables were a diagnosis of CKD and/or CKD with HD. The predictor variables were cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death. Logistic regression was conducted to analyze the relationship between outcome variable and each independent variable. Variables with a p-value Results
Analysis shows that subjects with cardiac complications were 17% less likely to have CKD as compared to those who did not have cardiac complications (OR: 0.83, 95% CI: 0.78-0.88). CKD patients who had cardiac complications were 18% more likely to have HD than the subjects who did not have cardiac complications (OR: 1.18, 95% CI: 1.01-1.39). Patients with cardiogenic shock were 86% more likely to have CKD than the subjects who did not have cardiogenic shock (OR: 1.86, 95% CI: 1.82-1.91). CKD patients who had cardiogenic shock were also 18% more likely to have HD than the subjects who did not have cardiogenic shock (OR: 1.18, 95% CI: 1.11-1.25). We have similar results if a patient had other conditions. Conclusion
Chronic kidney disease with hemodialysis is significantly associated by the other medical conditions such as cardiac complications cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death in the United States. Further studies are needed to confirm the results and to understand the prognosis.
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Shiu, Shiona. "Achieving equity in educational outcomes for students with chronic illness." View thesis, 2008. http://handle.uws.edu.au:8081/1959.7/19222.
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Thesis (Ed.D.)--University of Western Sydney, 2008.A thesis submitted to the University of Western Sydney, College of Arts, School of Education, in fulfilment of the requirements for the degree of Doctor of Education. Includes bibliography.
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Sharry, Renee Maree. "Patient-focused outcomes of a multidiscilpinary pain centre : inpatient chronic pain management program /." St. Lucia, Qld, 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17955.pdf.
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Kalirai, Kirandeep Kaur. "The effects of Chronic Obstructive Pulmonary Disease on work related outcomes." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6846/.
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Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. Some studies suggest that COPD may affect work, however this relationship remains poorly understood. Various methods are used in this thesis to investigate the impact of COPD on employment and work productivity. Findings from the systematic review showed that patients with COPD had lower employment and higher sickness absence rates compared to those without COPD. From the cross-sectional analyses, breathlessness and occupational exposures to vapours, gases, dusts and fumes (VGDF) were identified as the main modifiable factors associated with unemployment and poor work productivity in COPD patients. Finally, few patients agreed to take part in the occupational intervention. Although most participating patients received a range of recommendations, these were not taken up by all. Potential benefits and suggestions for future occupational interventions were identified. This work confirms that having COPD adversely affects patients' rates of employment and work productivity. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve work ability and work productivity among patients with COPD. The development of novel interventions should draw upon lessons learned from the feasibility study reported in this thesis.
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Fraser, Simon D. S. "Inequalities, outcomes, and health literacy in people with chronic kidney disease." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/375497/.
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Marks, Angharad. "Outcomes and epidemiology of chronic kidney disease : the first Grampian laboratory outcomes morbidity and mortality study (GLOMMS-I)." Thesis, University of Aberdeen, 2013. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=202777.
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To identify those with kidney disease early and thus facilitate earlier instigation of disease-progression slowing treatments, new definitions of chronic kidney disease (CKD) were introduced in 2002 (KDOQI). After this, the worldwide introduction of estimated glomerular filtration rate (eGFR) reporting (2006 onwards), also facilitated more widespread identification of those with CKD. Prognosis in those with CKD identified in this way was not known and the numbers with CKD appeared higher than originally expected. This thesis aimed to improve understanding of outcomes in those who met the definition of chronic kidney disease and facilitate better directed care. Data-linkage of several healthcare datasets including to laboratory, morbidity and mortality healthcare data for individuals in the Grampian region with measures of renal function in 2003 allowed those aims to be addressed. Patterns in the testing of kidney function over time were also described. Mortality and RRT initiation during the GLOMMS-I cohort's 6.5 years of follow-up were described, as were variables that were associated with these outcomes. Other measures of decline of kidney function over time (progression), were explored and compared to the ultimate measure of progression - the initiation of RRT. Various models to predict outcomes (RRT initiation, mortality and survival) were explored. Measures of model performance including discrimination, calibration, goodness of model fit and predictive performance were described. Overall the aim of this thesis was met - to improve the understanding of the prognosis of those currently labelled with chronic kidney disease. The work in this thesis has also provided the necessary information to plan and start a much wider population based study of outcome in those both with and without CKD (GLOMMS-II).
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Kosik, Kyle B. "CHRONIC ANKLE INSTABILITY AND AGING." UKnowledge, 2017. http://uknowledge.uky.edu/rehabsci_etds/39.
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Lateral ankle sprains are the most common musculoskeletal injury among the general population and U.S. military personnel. Despite the common perception of being a minor injury, at least 1 out of 3 individuals with a previous ankle sprain will develop chronic ankle instability (CAI). This clinical phenomenon creates a significant barrier for patients to return to their prior level of physical function. Specifically, CAI is associated with reductions in physical activity level, leading to decreases in lower health-related quality of life and increase risk of developing of post-traumatic ankle osteoarthritis. Current evidence has largely focused on characterizing the mechanical and sensorimotor insufficiencies associated with CAI in adolescent and young-adult populations, with little attention on middle- and older-aged adults. This restricts our understanding of how these insufficiencies associated with CAI that develop in early adulthood progress over time and contribute to other chronic diseases such as post-traumatic osteoarthritis. Therefore, the overall objective of this study was to compare self-reported and physical function between three age groups: 1) young, 2) middle-aged, and 3) older-aged adults with and without CAI. We hypothesized participants with CAI would have age-related changes in self-reported and physical function compared to non-injured individuals across the lifespan.
The objective of this dissertation was to compare regional and global health- related quality of life (HRQoL), static and dynamic balance, spinal reflex excitability of the soleus muscle, open- and closed-kinetic chain dorsiflexion range of motion and spatiotemporal gait parameters between those with and without CAI across the lifespan. Her callIt was hypothesized that all self-reported and physical characteristics would be decrease with age, but significantly more in those with CAI compare to non-injured individuals.
Results from the first study demonstrated participants with CAI had worse regional HRQoL compared to healthy-controls as evidenced by the lower Foot and Ankle Disability Index scores. Likewise, participants with CAI reported having worse overall physical function and pain interference during activity compared to healthy-controls. There was no significant interaction for Injury (CAI and healthy-control) and Age group (young, middle, and old) for any dependent variable. In the second, it was determined that static and dynamic balance, spinal reflex excitability, ankle (dorsiflexion and plantarflexion) and hip extension torque were all lower in the older-aged participants compared to the younger-aged adults. In addition, it was determined that participants with CAI had decreased dorsiflexion range of motion, ankle (dorsiflexion and plantar flexion) and hip extension peak isometric torque compared to the healthy-control group. However, no significant interaction was found for Injury (CAI & healthy-control) and Age (young, middle, old) for any dependent variable. In the third study, there were no differences in spatiotemporal gait parameters between groups (CAI vs. healthy-controls) or age categories.
It can be concluded from this dissertation that regardless of the age, individuals with CAI have worse region-specific HRQoL, lower overall physical function, greater pain interference, limited dorsiflexion range of motion, and decreased ankle and hip peak isometric torque compared to healthy-controls. Several age-related observations were found including decreased static and dynamic balance, ankle and hip strength, and spinal reflex excitability. Though no relationship was found between CAI and age, several interactions were found to be trending towards significance. Therefore, future work is needed to better understand the consequences of CAI on middle- and older-aged adults.
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McGarrigle, Leona. "Living with paediatric chronic pain : a study of treatment outcomes and processes." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/25683.
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This thesis investigated treatment outcomes and processes in young people with chronic pain. The first chapter describes a systematic review, which examined the effectiveness of acceptance and mindfulness-based interventions in improving pain-related outcomes in young people. Secondary aims were to review changes in proposed treatment processes following the interventions, and to compare the effectiveness of these interventions to control conditions. Although there was evidence to suggest that these treatments may improve outcomes, particularly levels of daily functioning, further research is needed to adequately assess the utility of acceptance and mindfulness-based approaches with paediatric chronic pain populations. The second chapter details a cross-sectional study of contextual and cognitive processes in adolescents with chronic pain. Specifically, the study tested the mediating effects of acceptance, catastrophising and kinesiophobia in the relationship between pain intensity and indicators of adjustment. Both acceptance and kinesiophobia mediated the effects of pain intensity on disability and quality of life, while catastrophising mediated the effect of pain intensity on levels of anxiety and depression. The results demonstrated that both contextual and cognitive factors are important determinants of young people’s well-being. Future research would benefit from gaining a greater understanding of how these processes interact with each other to affect pain-related outcomes.
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Collins, Diana Lee. "Improving Outcomes for Congestive Heart Failure Patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5688.
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Managing patients diagnosed with congestive heart failure (CHF) requires coordination with subspecialties and frequent outpatient monitoring. The lack of communication among health care providers and patients can result in a gap in practice when managing patients with CHF in the outpatient setting. Guided by the chronic care model, this quality improvement project was an initiative to develop and implement a 6-week self-care management program provided by nurse practitioners in an outpatient primary care practice. The goal of the project was to improve the day-to-day self-care management of patients with CHF and addressed the practice-focused question of whether a 6-week CHF program offered in the outpatient setting would result in better symptom management due to patients' enhanced adherence to treatment plans. A total of 10 patients participated in the 6-week program, and all participants demonstrated improvement in their CHF symptoms, which allowed them to be reclassified into a lower class on the New York Heart Association's CHF staging system. Of the 10 participants, 7 were completely compliant with attending weekly visits, performing daily journaling, and adhering to dietary recommendations and medication management; 3 participants demonstrated less compliance with the self-care recommendations during the program, but also showed sufficient improvement in symptoms to be reclassified. The project demonstrated the potential for reducing the symptom burden of CHF through proactive outpatient management, contributing to positive social change by improving the quality of life for these patients. Nurse practitioners may find the program description helpful for developing similar initiatives in their clinical settings.
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Tynkevich, Elena. "Muscle Wasting in Non-end Stage Chronic Kidney Disease : Determinants and Outcomes." Thesis, Paris 11, 2014. http://www.theses.fr/2014PA11T086.
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Faible masse musculaire a été peu étudiée chez les patients avant le stade terminal de la maladie rénale chronique (MRC). Nous avons évalué la masse musculaire à partir de la créatininurie des 24h pour étudier ses déterminants, son évolution avec le déclin de la fonction rénale ainsi que ses liens avec les risques de progression vers l’insuffisance rénale terminale traitée (IRTT) et de décès avant IRTT. Dans la cohorte NephroTest incluant 1429 patients avec une MRC stades 1 à 4, le débit de filtration glomérulaire a été mesuré par la clairance du 51Cr-EDTA (DFGm) et estimé par l’équation CKD EPI (DFGe). La créatininurie moyenne à l’inclusion diminuait de 15.3±3.1 à 12.1±3.3 mmol/24 chez les hommes et de 9.6±1.9 à 7.6±2.5 chez les femmes, pour une baisse du DFGm de ≥ 60 à < 15 mL/min/1.73 m2. Être plus âgé, avoir un diabète, un faible IMC ou un niveau faible de protéinurie et d’apports protidiques était associé à un niveau faible de créatininurie. Un déclin annuel du DFGm de 5 mL/min/1.73 m2 était lié à une baisse de créatininurie, indépendamment de ces déterminants. Au cours d’un suivi médian de 3.6 ans, 229 patients ont développé une IRTT, et 113 sont décédés avant IRTT. Après ajustement sur les facteurs de confusion, le hasard ratio (HR) était de 1.6 (0.88-2.9) pour le risque de décès et de 0.60 (0.39-0.91) pour le risque d’IRTT, dans le 1er vs 4ème quartile de créatininurie. La baisse de la créatininurie apparait précocement dans la MRC et est liée au décès avant dialyse. La diminution du risque d’IRTT pourrait s’expliquer par un démarrage plus tardif de la dialyse en raison d’une surestimation du DFGm par le DFGe chez les patients avec une faible créatininurieMainly described in patients on dialysis, muscle wasting has received little attention in early stage chronic kidney disease (CKD). We used 24-hour creatininuria to assess determinants of low muscle mass and its putative associations with CKD outcomes, using data from the NephroTest cohort, including 1429 non-dialysis patients with CKD stages 1 to 5. Kidney function was assessed with both measured (mGFR, by 51Cr-EDTA renal clearance) and estimated glomerular filtration rate (eGFR, by CKD-EPI equation). End-stage renal disease (ESRD) and pre-ESRD death were the main studied outcomes. The mean baseline creatininuria decreased from 15.3±3.1 to 12.1±3.3 mmol/24 h in men and from 9.6±1.9 to 7.6±2.5 in women, when mGFR fell from ≥ 60 to < 15 mL/min/1.73 m2. Other determinants of low creatininuria were an older age, diabetes, a lower body mass index, a lower level of proteinuria or protein intake. A fast annual decline in mGFR of 5 mL/min/1.73 m2 was linked with a 2-fold decrease in creatininuria, independent of changes in protein intake and other determinants of muscle mass. Over a median follow-up of 3.6 years, 229 patients developed ESRD and 113 patients died before ESRD. After adjustment for confounders, patients with low muscle mass showed a significantly higher risk for pre-ESRD death (HR 1.6, 95% CI 0.88-2.9), but a lower risk for ESRD (HR 0.60, 95% CI 0.39-0.91). The latter was reversed (HR 1.5, 95% CI 1.01-2.4) when mGFR was replaced by eGFR. Decrease in 24-hour creatininuria may appear early in CKD patients, is related to pre-ESRD death. The lower risk for ESRD may reflect later dialysis start due to overestimation of true GFR by eGFR in patients with low muscle mass
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Skowno, Philippa. "Psychological factors and physical outcomes in patients with chronic diseases of lifestyle." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20324.
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INTRODUCTION: Chronic diseases of lifestyle (CDL) are a major cause of global morbidity and mortality. Although CDL are largely preventable and treatable through adopting and maintaining healthy lifestyle behaviours, CDL rehabilitation programmes remain an underutilised resource. Behaviour modification is thus complex, and requires a collaborative approach between psychologists and medical clinicians involved in the management of CDL. This thesis examined the role of psychological factors in the management of patients with CDL who participated in a comprehensive lifestyle intervention (CLI) programme. METHODS: An explanatory mixed methods design was used to describe the CLI experience. These included an initial clinical audit of 308 patients commencing and completing a twelve week CLI programme to test associations of psychological, demographic, medical and diagnostic factors with physical outcomes. Two qualitative studies were subsequently conducted to further understand patient experiences of CDL and CLI programmes. The first involved interviews of 14 patients at programme commencement and completion. The second consisted of a case study of a patient participating in the programme using human centred design principles as well as ethnography.
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Eddington, Helen. "Improving the outcomes of patients with chronic kidney disease-mineral bone disorder." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/improving-the-outcomes-of-patients-with-chronic-kidney-disease--mineral-bone-disorder(0c72d2af-4523-43c4-a1f9-95ecb304e5ac).html.
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Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) is a systemic disorder which includes abnormal bone chemistry, vascular or soft tissue calcification, and abnormal bone formation. Many of the parameters of CKD-MBD have been associated with an increased mortality risk in renal patients. There were three main facets to this research project. The first aim of this research was to perform two different studies using the Chronic Renal Insufficiency Standards Implementation Study (CRISIS) data. This prospective epidemiological study is designed to identify factors associated with renal progression and survival in the pre-dialysis CKD population. We have shown that for each 0.323mmol/L (1mg/dL) increase in serum phosphate there was a significant stepwise increased risk of death. (HR1.3 (1.1, 1.5) P=0.01). The association of baseline phenotypic data against vascular stiffness measurements was also investigated. Augmentation index measured at the radial artery was associated with a raised systolic blood pressure but no association with biochemical abnormalities was found.We hypothesised that the phosphate effect on survival was related to the effects within the CKD-MBD spectrum and therefore control of secondary hyperparathyroidism would improve bone and cardiovascular parameters. Therefore for the second part of this research we performed a randomised controlled trial to examine the effects of cinacalcet with standard therapy compared to standard therapy alone on bone and cardiovascular parameters in haemodialysis patients with uncontrolled hyperparathyroidism. The change of biochemical parameters and cardiovascular markers were also further explored in secondary analyses alongside survival data. The primary end point of change in vascular calcification at 52 weeks showed no significant difference between arms. As equivalent control of phosphate and iPTH was achieved in both arms secondary analyses were performed. This showed a significant regression of left ventricular hypertrophy and carotid intima-media thickness associated with phosphate but not iPTH reduction. Patients whose phosphate reduced during the study had a survival advantage when followed for 5 years (HR=10.2 (1.1, 104.5) P=0.049). The third part of this research was to investigate iPTH assay variability. We explored the variation in iPTH assays across the North West and paired this with regional audit data. This study showed that despite there being significant variation among iPTH assays across the region the variation in clinical management was still accounting for some variation in achieving PTH targets.In conclusion, serum phosphate, within the normal laboratory range, is associated with an increased mortality in CKD patients. Haemodialysis patients may have improvement of cardiovascular outcomes with tight control of secondary hyperparathyroidism, by whichever therapeutic means. Intact PTH assays variation may alter our clinical management but variation in practice still affects guideline achievement.
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Band, Rebecca Jane. "Significant others, patient outcomes and maintenance of symptoms in chronic fatigue syndrome." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/significant-others-patient-outcomes-and-maintenance-of-symptoms-in-chronic-fatigue-syndrome(c60fc232-698b-4669-9c53-fb8b4f31994c).html.
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This thesis explored significant other responses to CFS/ME in association with patient illness outcomes and symptom maintenance utilising a multi-method approach; a systematic review, cross-sectional, longitudinal and momentary methods were included. The review identified empirical evidence for two potential interpersonal mechanisms. The evidence suggested that significant other beliefs and responses, dyadic relationship quality, and patient outcomes associated with each mechanism were different. Dyadic belief incongruence was also highlighted as important with respect to relationship quality. Thus, potential research questions and current methodological limitations were identified; the subsequent empirical papers presented attempted to address these. The first empirical study (Chapter 3) utilised the Expressed Emotion (EE) framework to investigate the impact of critical comments and EOI; no cross-sectional associations between EE and patient outcomes were observed. A longitudinal design was also employed to examine the predictive validity of EE. Longitudinally, high critical comments predicted higher fatigue severity; further analyses indicated that depression mediated this relationship. High EOI was also predictive of higher fatigue severity at follow-up. This was the first study to examine EE within a CFS/ME sample; the longitudinal impact of high-EE upon patient outcomes suggests that it is a potentially beneficial target for future interventions. Paper 2 (Chapter 4) sought to examine the factors that might contribute to significant other EE by examining significant other illness beliefs and dyadic belief incongruence. The results indicated that significant others rated as high-EE had stronger illness models, more negative beliefs about the consequences associated with the condition, and negative emotional representations. These findings identify those beliefs that may be particularly important for high-EE within the current patient group. Overall dyadic belief incongruence was not important for EE-rating; high-EE dyads reported similar illness beliefs, whilst low-EE significant others reported more optimistic beliefs about the condition. These findings suggest that optimistic beliefs about the condition may be better for both significant other and patient outcomes. The final empirical study (Chapter 5) examined the associations between significant other negative and solicitous responses and fluctuations in patient illness outcomes on a momentary basis. The impact of significant other responses was largely transitory; changes in patient outcomes did not extend past the current momentary assessment. Negative significant other responses were associated with momentary increases in symptom severity; patient distress partially mediated this relationship. Patient-perceived solicitous responses were associated with increased activity limitation, but reduced disability reported at the same momentary assessment. These results suggest that momentary reports capture more dynamic processes than observed in traditional cross-sectional analyses. Taken together, the findings presented within this thesis provide further evidence for the impact of significant other factors on patient outcomes. The evidence for the hypothesised mechanism associated with critical EE was consistent throughout studies. However, the evidence for the role of EOI currently requires further exploration. Finally, the results suggest that the development of significant other-focussed interventions may be beneficial for both patient and significant other outcomes.
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Alderson, Helen. "Investigation of chronic kidney disease related biomarkers in association with clinical characteristics and outcomes in a large prospective CKD cohort." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/investigation-of-chronic-kidney-disease-related-biomarkers-in-association-with-clinical-characteristics-and-outcomes-in-a-large-prospective-ckd-cohort(de946dd2-b3b6-4466-a8f4-9d5f212d81e2).html.
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Chronic Kidney Disease (CKD) is common and is associated with increased risk of progression to end stage renal disease, cardiovascular disease and death. CKD is a heterogeneous condition and accurately predicting an individual’s risk for adverse outcomes remains a challenge. Over the past decade there has been a focus on the identification of novel biomarkers that may help improve risk stratification and the prediction of clinical endpoints in this population. The overall aim of this research project was to investigate a series of novel biomarkers in patients from the Chronic Renal Insufficiency Standards Implementation Study (CRISIS), a prospective observational study of outcome in all cause non-dialysis dependent CKD 3-5. The biomarkers selected for this project were Anti-Apolipoprotein A-1 (Anti-apoA-1 IgG), fetuin-A, fibroblast growth factor-23 (FGF23), high sensitivity cardiac troponin T (HS-cTnT), kidney injury molecule-1 (KIM-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), neutrophil gelatinase associated lipocalin (NGAL) and osteoprotegerin (OPG). These biomarkers were chosen to address the three clinical endpoints of progression, cardiovascular disease and death with biomarkers considered both individually and as groups of related markers. The first aim of this project was to examine associations between the novel biomarkers and the clinical characteristics of the CRISIS population. The second aim was to investigate the associations between novel biomarkers and the study endpoints. In the case of FGF23 longitudinal measurements were analysed and in all other cases associations between baseline levels of the markers and clinical outcomes were considered. The third aim was to consider whether the biomarkers investigated in this project actually improve parameters of risk stratification and model discrimination, thereby demonstrating a potential to improve the prediction of outcome events in the CKD population. Many of the biomarkers were independently associated with one or all of the clinical outcomes considered. Despite these associations, it was more difficult to demonstrate clear improvement in risk classification or the prediction of clinical endpoints. Baseline models of standard biochemical and clinical parameters performed very well so even biomarkers that were strongly associated with clinical outcomes resulted in only small incremental improvements in the prediction of outcome events. It is now important to focus on defining how biomarkers may fit into clinical decision pathways.
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Melro, Hélder Filipe Fernandes. "Contributions for unravelling chronic obstructive pulmonary disease trajectory: associations between genetics and clinical measures." Master's thesis, Universidade de Aveiro, 2017. http://hdl.handle.net/10773/21403.
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Mestrado em Biomedicina MolecularChronic Obstructive Pulmonary Disease (COPD) is a multifactorial and heterogeneous disease which impacts differently on patients with similar grades. This suggests that factor others than lung function may affect patients experience of the disease. Patient-reported outcomes (PROs) are a set of measures that allow to assess patients’ self-perception and experience of the disease. Recent studies have reported associations between specific single nucleotide polymorphisms (SNPs) and PROs, however not much is known about these associations and their meanings. Thus, this study had as main objective to explore possible associations between specific genetic variants and clinical measures, including PROs. It also sought to contribute for a characterization of the genotypes from patients with COPD in Portugal. A cross-sectional study was conducted in a total number of 60 patients with COPD. The PROs assessed were: 1) self-reported frequency of exacerbations, 2) dyspnoea with modified Medical Research Council and Borg scales , 3) fatigue with Borg scale, 4) anxiety and depression with Hospital Anxiety and Depression scale; 5) impact of the disease with COPD Assessment Test and 6) health-related quality of life (HRQOL) with St. George Respiratory questionnaire; Additionally, several surrogate outcomes were also assessed i. e., lung function, peripheral muscle strength with digital dynamometer, respiratory muscle strength with the respiratory pressure assessment and functional capacity through the 1 minute and 5 time sit-to-stand. Both oropharyngeal swabs and saliva samples were collected from the patients for genotyping. Significant associations were found between genetic variants and dyspnoea (rs1143634, rs1042717, rs1138272 and rs12504628), fatigue (rs1042714, rs1138272), anxiety (rs1051303, rs1800450 and rs1131620), impact of the disease (rs10461985 and rs11172113) and HRQOL (rs11172113, rs1042713, rs1138272 and rs12504628). Significant associations were also found between genetic variants and lung function (rs1042713, rs1042717, rs5030737), respiratory muscle strength (rs1130866), peripheral muscle strength (rs1042713, rs1042717, rs11172113, rs11556218) and functional capacity (rs12899618, rs11046966 and rs1138272). This was an exploratory study and more investigations are necessary to confirm the results obtained and to explore deeply the associations and interpretations between genetics and COPD trajectory.
A Doença Pulmonar Obstrutiva Crónica (DPOC) é uma doença multifatorial e heterogénea que apresenta impactos diferentes em pacientes com estadios da doença semelhantes. Isto sugere que outros fatores para além da função pulmonar podem afetar a forma como o paciente experiencia a sua doença. As medidas reportadas pelo paciente (PROs) são um conjunto de variáveis que permitem avaliar a autoperceção e experiência dos doentes em relação à sua doença. Estudos recentes reportaram a existência de associações entre polimorfismos de nucleótidos simples (SNPs) e PROs, mas pouco ainda se sabe sobre estas associações e seu significado. Assim, este estudo teve como objetivo principal explorar possíveis associações entre variantes genéticas específicas e medidas clínicas, entre as quais PROs. Pretendeu também contribuir para a caracterização dos genótipos dos doentes com DPOC em Portugal. Realizou-se um estudo transversal com 60 doentes com DPOC. As PROs avaliadas foram 1) frequência de exacerbações autoreportadas pelos doentes, 2) dispneia com a modified medical Research Council Scale e Borg, 3) fadiga com a Borg, 4) ansiedade e depressão através da escala de ansiedade e depressão hospitalar, 5) impacto da doença com o teste de avaliação da DPOC e 6) qualidade de vida relacionada com a saúde (QVRS) com questionário do hospital de St. George na doença respiratória. Adicionalmente, outras medidas clínicas também foram avaliadas, i. é., função pulmonar, força muscular periférica com dinamometria digital, força dos músculos respiratórios com a medição das pressões respiratórias e capacidade funcional através do teste de levantar e sentar cinco vezes e 1 minuto. Zaragatoas orofaríngeas e amostras de saliva foram recolhidas de todos os pacientes para genotipagem. Foram encontradas associações significativas entre variantes genéticas e dispneia (rs1143634, rs1042717, rs1138272 e rs12504628), fadiga (rs1042714 e rs1138272), ansiedade (rs1051303, rs1800450 e rs1131620), impacto da doença (rs10461985 e rs1172113) e QVRS (rs11172113, rs1042713, rs1138272 e rs12504628). Também foram encontradas variantes significativamente associadas à função pulmonar (rs1042713, rs1042717 e rs5030737), força dos músculos respiratórios (rs1130866), força muscular periférica (rs1042713, rs1042717, rs11172113 e rs11556218) e capacidade funcional (rs12899618, rs11046966 e rs1138272). Este foi um estudo exploratório e mais investigações são necessárias para confirmar os resultados obtidos e para explorar mais profundamente a associação e interpretação entre a genética e a trajetória da DPOC.
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Hoch, Matthew C. "THE EFFECT OF JOINT MOBILIZATION ON FUNCTIONAL OUTCOMES ASSOCIATED WITH CHRONIC ANKLE INSTABILITY." UKnowledge, 2011. http://uknowledge.uky.edu/gradschool_diss/166.
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Ankle sprains are among the most common injuries sustained by physically active individuals. Although ankle sprains are often considered innocuous in nature, a large percentage of individuals experience repetitive sprains, residual symptoms, and recurrent ankle instability following a single acute sprain; otherwise known as chronic ankle instability (CAI). In addition to repetitive ankle trauma, those with CAI experience reductions in functional capacity over the life span. This indicates that current intervention strategies for CAI are inadequate and require further investigation.
The objective of this dissertation was to explore differences in walking and running gait parameters between individuals with and without CAI; as well as, examine the effects of a 2-week Maitland Grade III anterior-to-posterior talocrural joint mobilization intervention on self-reported function, ankle mechanics, postural control, and walking and running gait parameters in a cohort of individuals with CAI. It was hypothesized that individuals with CAI would exhibit different gait kinematics and joint coupling variability patterns compared to healthy individuals and the joint mobilization intervention would improve patient-oriented, clinician-oriented, and laboratory-oriented measures of function in those with CAI.
Several observations were made from the results. In the first study, alterations in single joint kinematics and joint coupling variability were found between those with CAI and healthy individuals. In the second study, it was determined that the joint mobilization intervention improved patient-oriented and clinician-oriented measures of function as indicated by improved Foot and Ankle Ability Measure scores, increased weight-bearing dorsiflexion range of motion, and increased reach distances on the Star Excursion Balance Test. However, there were no changes in measures of instrumented ankle arthrometry or laboratory measures of postural control. In the third study, there were no changes in single joint kinematics or joint coupling variability during walking and running associated with the joint mobilization intervention. It can be concluded that joint mobilizations had a significant positive impact on patient-, and clinician-oriented measures of function. Though the laboratory measures did not detect any improvements, joint mobilizations did not produce deleterious effects on function. Therefore, future investigation on the effects of joint mobilization in conjunction with other, more active, rehabilitation strategies is warranted.
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Scott, Whitney. "The role of perceived injustice in chronic pain: outcomes, mechanisms, and clinical implications." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123026.
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Biopsychosocial conceptualizations highlight the role of cognitive factors in the experience of chronic pain. Emerging research suggests that injustice-related appraisals contribute to more adverse chronic pain outcomes. At present, however, little is known about the mechanisms underlying the relationship between perceived injustice and pain outcomes or how perceived injustice might be managed in the clinical setting. Therefore, this thesis aims to extend previous research by elucidating the processes by which perceived injustice influences pain outcomes and to provide an empirical basis to guide the clinical management of perceived injustice. Study 1 examines anger intensity and regulation style as mechanisms underlying the relationship between perceived injustice and chronic pain outcomes. This cross-sectional study reports on a sample of 173 patients with chronic musculoskeletal pain who completed self-report measures of perceived injustice, anger intensity and regulation style, pain intensity, disability, and depressive symptoms. The results of mediation analyses indicated that anger variables differentially explained the relationships between perceived injustice and pain outcomes. The implications of these findings for clinical intervention are addressed. Study 2 investigates the synergistic influence of perceived injustice and pain intensity on depressive symptoms. This cross-sectional study reports on a sample of 107 patients with chronic musculoskeletal pain who completed self-report measures of pain intensity, perceived injustice, and depressive symptoms. As predicted, pain intensity predicted depressive symptoms only for patients with elevated levels of perceived injustice. Therefore, interventions for depressive symptoms may be optimized by the identification of patients with elevated levels of both pain and perceived injustice and subsequent matching of these patients with injustice-targeting interventions. The final study identifies a clinical cut off score on the Injustice Experiences Questionnaire (IEQ) to facilitate the identification of patients with elevated levels of perceived injustice in the clinical setting. This prospective study reports on a sample of 103 patients with persistent pain following whiplash injury. Patients completed the IEQ prior to and immediately following a 7-week multidisciplinary rehabilitation program. Patients reported on their employment status, pain intensity, and narcotic use one year following completion of treatment. Receiver Operating Characteristic curve analyses were used to identify optimal cut off scores on the IEQ in relation to patients' work status, pain intensity, and narcotic use at the one-year follow-up. The results serve to inform the identification of patients with problematic injustice perceptions who might require targeted intervention. Considered together, the results of studies 1 through 3 extend previous research by examining the processes underlying the detrimental impact of perceived injustice, specifying the nature of the interacting influence of perceived injustice and pain on adjustment, and providing an empirical basis upon which clinicians might identify at-risk patients. The General Discussion presents a developing theoretical model of perceived injustice in chronic pain. The Discussion concludes with an examination of the implications of this model for clinical practice.Des nouvelles recherches suggèrent que des perceptions d'injustice contribuent aux conséquences indésirables de la douleur chronique. Cependant plus de recherches sont requises pour découvrir les mécanismes qui expliquent la relation entre les perceptions de l'injustice et la douleur. En outre, des recherches sont nécessaires pour déterminer, plus précisément, comment des perceptions d'injustices peuvent être adressées dans un milieu clinique. Par conséquent, la présente thèse vise à développer les recherches précédentes pour éclaircir les processus par lesquels les perceptions d'injustice influencent l'expérience de la douleur chronique. De plus, l'objectif de cette thèse est de fournir une base empirique qui pourrait informer le traitement de la douleur dans les milieux cliniques. La première étude a pour but d'examiner si l'intensité de colère et la manière de régulation peuvent mieux expliquer (en tant que mécanismes) la relation entre la perception d'injustice et les conséquences de la douleur chronique. Cette étude emploi un échantillon de 173 patients atteints avec de la douleur musculo-squelettique. Ces patients ont complété des questionnaires portant sur leurs perceptions d'injustice, l'intensité et la régulation de leur colère, l'intensité de leur douleur, leur niveau d'incapacité et finalement leurs symptômes dépressifs. Les résultats indiquent que les variables liés à la colère expliquent la relation entre les perceptions d'injustice et les conséquences de la douleur. Les implications suggérées par ces résultats envers des interventions cliniques, seront également discutées. La deuxième étude examine l'influence combinée des perceptions d'injustice et l'intensité de douleur sur les symptômes dépressifs. Cette étude emploi un échantillon de 107 patients atteints avec de la douleur musculo-squelettique. Ces patients ont complété des questionnaires portant sur l'intensité de leur douleur, leurs perceptions d'injustice, et leurs symptômes dépressifs. Comme prévu, l'intensité de douleur prédit le nombre de symptômes dépressifs, seulement pour les patients avec un haut niveau de perceptions d'injustice. Par conséquent, les traitements visant a diminuer des symptômes dépressifs pourraient être améliorer en identifiant ces patients atteints de douleur et qui ont, en même temps, des perceptions d'injustice élevés. Des interventions conçues spécifiquement pour adresser des perceptions d'injustice pourront donc, être plus efficaces pour ces types de patients. La dernière étude vise à identifier le score, généré par le questionnaire 'Injustice Experiences Questionnaire', qui représente un niveau de perception d'injustice qui est cliniquement significatif. Cette étude prospective emploi un échantillon de 103 patients souffrant de douleur persistante suite a un coup de fouet cervical. Ces patients on complété l'IEQ avant et immédiatement après un programme de réadaptation. Un an après la fin du traitement, les patients ont décrit leur statut d'emploi, l'intensité de leur douleur, et si des narcotiques ont été utilisé. Des analyses de courbe ROC ont été utilisées pour déterminer les scores optimaux par rapport au statut d'emploi, l'intensité de douleur et l'usage de narcotiques, au suivi un an après. Ces résultats pourront être utilisés pour améliorer la détection de patients avec des perceptions d'injustice qui sont problématiques et qui pourraient avoir besoin d'un traitement plus spécifique. Les résultats de ces études, ensembles, ont développé plus profondément les recherches précédentes en examinant la manière dont des perceptions d'injustice influencent négativement l'expérience de la douleur. En se basant sur les résultats présentés, la discussion générale propose un model théorique qui intègre les perceptions d'injustice dans l'expérience de douleur chronique. La discussion se conclut avec une explication des implications que ce type de model théorique aurait dans un milieu clinique.
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Freeman-Hildreth, Yolonda. "THE PATIENT PERSPECTIVE: EXPLORING THE INFLUENCE OF SOCIAL INTERACTIONS ON CHRONIC DISEASE OUTCOMES." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1554315427596961.
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Marais, Christoff de Villiers. "Functional outcomes and patient satisfaction after fasciotomy performed for chronic exertional compartment syndrome." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25068.
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Study Rationale: Chronic exertional compartment syndrome often forces patients to change their sporting activities or reduce their level of participation. Many undergo surgery with the aim to return to their activities symptom free. The aim of the study was to determine if fasciotomies for chronic exertional compartment syndrome are a reliable treatment option with a predictable outcome to allow patients to return to the same level of activities. Objective: The evaluation of the functional outcomes and patient satisfaction in an active population who had surgery, namely fasciotomies, for chronic exertional compartment syndrome (CECS) of the lower leg. Design: A retrospective descriptive cohort study with a telephonic follow-up interview. Patients: A consecutive series of 41 patients that were surgically treated for CECS by a single orthopaedic surgeon from July 2005 to October 2013. Main Outcome Measures: Patient records were reviewed to determine their presenting symptoms, diagnostic investigations and surgical procedures performed. A questionnaire was completed by each participant to assess pain and level of activity before and after surgery, level of improvement after surgery and patient satisfaction with surgical outcomes. Results: Twenty-one of the 41 patients that were included in the study were categorized as active sportsmen, participating at a competitive or a non-competitive level. The remaining 20 were experiencing symptoms during leisure activities. The majority of all the patients (63%) had to stop their activity due to their symptoms. After surgery 95% were able to return to participate in the same level of activities as before surgery. Ninety percent of the active sportsmen were able to return to participation at a competitive or non-competitive level, with 45% reporting an increase in the level of intensity that they could maintain. Overall satisfaction was reported by 80% of participants although only 46% were completely pain free. Conclusions: Fasciotomies are a viable surgical treatment option for chronic exertional compartment syndrome in active patients, including athletes. There is an 87% return rate to previous activities within 6 months and an 80% satisfaction rate reported by patients post-surgery. We do acknowledge that some of the data collected regarding symptomology is subject to recall bias due to the interval between surgery and completion of the questionnaire.
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Scheidler, LeighAnn E. "Treatment Outcomes of an Interdisciplinary Chronic Pain Rehabilitation Program in Smokers and Nonsmokers." Cleveland State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=csu1383587125.
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Worsham, Scott L. "The Effects of Perceived Locus of Control and Dispositional Optimism on Chronic Pain Treatment Outcomes." Thesis, University of North Texas, 2004. https://digital.library.unt.edu/ark:/67531/metadc4676/.
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The financial cost for health care and lost productivity due to chronic pain has been estimated at over $70 billion per year. Researchers have attempted to discover the psychosocial and personality factors that discriminate between people who learn to cope well with chronic pain and those who have difficulty adjusting. The purpose of the present study was to examine the effects of perceived locus of control and dispositional optimism on chronic pain treatment outcomes. Subjects reported significantly lower post-treatment pain levels as compared with pre-treatment levels (M = 0.66, SD = 1.58), t(45) = 2.85, p = .007 (two-tailed), but decreased pain was not associated with scores on the internality dimension of the Pain Locus of Control Scale (PLOC) or on the Life Orientation Test-Revised (LOT-R) (a measure of dispositional optimism). Overall, participants' increased coping ability was associated with scores on the LOT-R, but not with scores on the internality dimension of the PLOC. Subjects with the lowest pre-treatment scores on the LOT-R demonstrated significantly greater increases in post-treatment coping ability than those with the highest scores (F(2,40) = 3.93, p < .03). Participants with the highest pre-treatment scores on both the PLOC internality dimension and the LOT-R demonstrated greater post-treatment coping ability (F(2,32) = 4.65, p < .02), but not less post-treatment pain than other subjects. Participants' post-treatment LOT-R scores were significantly higher than their pre-treatment scores (M = 2.09, SD = 3.96), t(46) = 3.61, p = .001 (two-tailed), but post-treatment PLOC internality scores were not significantly higher than pre-treatment scores. Implications of these results are discussed.
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Guo, Jing. "Assessment of Health Outcomes for Chronic Obstructive Pulmonary Disease (COPD) Patients Using Long-acting Beta2- Agonists." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1367938331.
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Ray, Lynne. "Promoting the health of families raising a child with a chronic condition : directions for outcomes research /." Thesis, Connect to this title online; UW restricted, 1997. http://hdl.handle.net/1773/7256.
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Patel, Neil. "Evaluation of saliva biomarkers in chronic obstructive pulmonary disease : correlation to patient reported outcomes." Thesis, Keele University, 2016. http://eprints.keele.ac.uk/2467/.
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COPD is a debilitating chronic respiratory disease with a systemic footprint. COPD is a highly heterogeneous disease but invariably its management involves a one-size fits all approach. This fails to address individual variations in disease progression, symptom burden and functional decline. There remains a need for sensitive monitoring tools that could provide personalised care based on patients’ particular phenotypes and informative self-management. This thesis has standardised collection protocols and processing for saliva, a complex bodyfluid which is readily accessible and user-friendly for near-patient testing. I have modified immunoassays to work in saliva with demonstrable reproducible results for quantification of C-reactive protein, Procalcitonin and Neutrophil Elastase. Symptom assessment is crucial in longitudinal self-monitoring of COPD. I designed a novel patient wellbeing scale incorporated into an electronic self-assessment diary, which was embraced by patients as improving symptom change recognition, education and self-management. Using sophisticated analytical tools, I have attempted to cluster/phenotype disease trajectory paths driven by a compilation of symptom scores, spirometric volumes and saliva biomarker levels and produced novel patientspecific multidimensional composite scores with significant correlation to COPD disease severity. Prodromal changes in FEV1, salivary biomarkers and self-assessment scores were reproducibly demonstrated, with potential to predict exacerbation onset. These results could be exploited for the development of a much-needed personalised COPD monitoring eco-system, which isolates early deteriorations and prompts timely interventions, leading to beneficial disease outcomes. Patient-researcher iterative co-design has been key throughout this thesis. One outcome of this relationship is the design and production of a bespoke integral saliva collector prototype which could substitute laboratory-based processing of saliva samples in readiness for analyte testing. In conclusion, this thesis has created the necessary tools to improve the classification and monitoring of COPD, opening new avenues for proactive patient self-management and providing the basis for future personalised and stratified care.
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Wong, Ting, and 黃婷. "Follow-up study on the psychological aspects of chronic pain : quantitative and qualitative correlates of outcomes at one year." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/207180.
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Objective: Chronic back pain is highly prevalent in orthopaedic clinics. The aim of the study was to investigate the relationship of psychological factors affecting disability and distress outcomes in chronic low back pain patients. Clinicians shared the impression that chronic pain patients resulted from Injury on Duty (IOD) were particularly difficult to manage. Profiles of IOD patients and non-IOD patients were compared.
Methods: The present study is a prospective follow-up study. Fifty-four patients from a public orthopaedic out-patient clinic were assessed with low back pain as their primary complaint. Self-report inventories together with semi-structured interview were used to assess patients’ pain intensity, pain disability, psychological distress, positive and negative affect, as well as relevant pain-related parameters including pain catastrophizing thought, pain-related fear, pain self-efficacy and chronic pain acceptance. Patients were interviewed during their first visit to the orthopaedic out-patient clinic (i.e. Time 1), after 6 months (i.e. Time 2) and after 1 year (i.e. Time 3) of the first consultation. Both qualitative and quantitative analyses were conducted.
Results: Chronic pain acceptance predicted mid-term and long-term pain disability and psychological distress at a period of one year after their initial assessment. However, the pain-related parameters of pain catastrophizing, pain-related fear and pain self-efficacy did not show a significant predictive effect on outcomes. Pain rating is an inadequate estimate to assess patients’ level of disability and psychological status. The meaning of pain is important for patients to make sense of their pain experience and employ appropriate coping strategies. Attaching a positive value to pain helps patients to accept their pain. In addition, half of the chronic pain patients showed a need for psychiatric services at one year follow-up, pointing to a high co-morbidity between chronic pain and psychiatric problems.
Among the 54 patients, 17 (31.5%) were injured on duty (IOD). More IOD patients than non-IOD patients took sick leaves or were not working during the year. However, there is no significant difference between IOD group and non-IOD group on psychological distress, pain disability and other pain-related measures across 3 time points.
Discussion and Conclusion: Pain problems in the context of chronic pain are different from those in the context of acute pain. Intervention focusing on pain relief is inadequate to treat patients’ chronic pain. A multi-factorial perspective is needed to understand and develop suitable models to account for chronic pain experience instead of just relying on the prevalent fear-avoidance model. A more comprehensive assessment that is tailored to patients’ needs is necessary for more effective rehabilitation. Chronic pain patients’ need for psychiatric intervention is also highlighted, with a focus on work-related issues for IOD patients.published_or_final_version
Psychiatry
Doctoral
Doctor of Philosophy
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Haas, Ashley Anne. "Gender Differences in Treatment Outcomes Among Fibromyalgia Patients." Cleveland State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=csu1407345255.
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Tsui, Jin-ching Wilson. "Control, appraisals, and coping as predictors of health outcomes in chinese patients with chronic illness." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1994. http://hub.hku.hk/bib/B29695624.
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Essery, Rosie. "A process evaluation of engagement and outcomes in Internet support physical rehabilitation for chronic dizziness." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/412631/.
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Ellis, Monica U. "Chronic Outcomes in Interhemispheric Transfer Time Among Children with Moderate to Severe Traumatic Brain Injury." Thesis, Fuller Theological Seminary, School of Psychology, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10274421.
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Background: Each year, nearly ½ million youth under 15 years old sustains a traumatic brain injury (TBI). Although racial disparities have not been found in pediatric TBI (Howard, Joseph, & Natale, 2005), the consequences of TBI still remain a serious public health concern. Moderate and severe TBI (msTBI) frequently result in diffuse axonal injury and other white matter damage. The corpus callosum (CC) is particularly vulnerable to injury, though the impact of this damage may not be apparent until several months-to-years following injury. Damage to the CC has been associated with impaired neurocognitive functioning in youth with TBI.
Method: The investigator for this dissertation study utilized event-related potentials, an electrophysiological measure of neural processing, to measure interhemispheric transfer time (IHTT) as an indicator of CC integrity in 31 youth with msTBI at the chronic phase of recovery (i.e., 13-18 months post injury), compared with 20 healthy control youth. Neurocognitive performance was also examined among these groups.
Results: At the chronic phase of recovery, TBI group youth overall demonstrated slower IHTTs and worse neurocognitive functioning than youth in the control group. Only a subset of msTBI group children had IHTTs that were outside the range of the healthy controls; however, this impairment in interhemispheric communication was not significantly associated with neurocognitive performance. A pattern of differential impairments emerged between TBI group participants. Chronic-phase outcomes in IHTT were correlated with the presence of neurosurgery at the acute phase of injury.
Conclusion: Overall, this study demonstrated that msTBI results in longstanding differences in interhemispheric and neurocognitive functioning, but injured children are differentially impacted. Functional reorganization resulting from neuroplasticity may help explain these results among children with slow IHTT but intact neurocognitive functioning. However, interpretations regarding the course of recovery could not be made due to the cross-sectional methodology used in this study. Investigators conducting future studies might explore additional outcomes associated with interhemispheric and neurocognitive functioning following msTBI at the chronic phase of recovery, including corresponding structural and metabolic changes using advanced imaging techniques.
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Bucknor, Delaney Andreka. "Exploring and changing cognitive representations, coping and quality of life outcomes in chronic spontaneous urticaria." Thesis, London Metropolitan University, 2016. http://repository.londonmet.ac.uk/1143/.
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Chronic Spontaneous Urticaria (CU) is a pruritic skin disorder that affects 0.8% of the population. As its aetiology is not fully understood the aim is to control symptoms through medicines to improve quality of life (QoL). Demographic and clinical factors have been inconsistent and poorly predict QoL but one modifiable factor that has gained credence is ones illness representations. The Common-Sense Model (Leventhal, Meyer and Nerenz, 1980) postulates that these guide coping procedures that impact outcomes. The aim of the thesis was to examine whether CU representations (mediated by coping) predicted QoL and whether both representations and QoL in CU were amenable to change via intervention. Preliminary studies undertaken validated CSM measures in CU and confirmed key reference values for CU-related QoL and its measurement. CU was seen as uncontrollable, emotionally arousing, chronic, cyclical, caused by stress and immunity with serious consequences and has a moderate impact on QoL (n=78). The necessity to take CU medicines equalled concerns about side effects. Cognitive representations were the strongest predictors of QoL explaining 35.0-60.6% of the variance independent of coping. Qualitative analyses presented CU as unsightly, uncontrollable and difficult to comprehend and self-regulate. Fifteen participants undertook psych-education and action plans to change CU representations. Multivariate analyses found a strong within-group main effect on QoL outcomes (p < .001) and for aspects of outcome over time (all p < .001). Correlation based change analysis further inferred that targeting CU cognitions resulted in changing QoL outcomes over time. In summary the thesis supported that: poor QoL is prevalent in individuals experiencing CU. Not only do CU representations predict QoL outcomes, they are amenable to change via intervention as are QoL outcomes. Such findings have implications for CU-related QoL research and how health psychology-dermatology collaborations maybe instrumental to improving outcome through psycho-education interventions in routine care to facilitate better CU self-management.
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Jury, Jo. "Psychological variables involved in chronic pain outcomes : the role of pain catastrophizing and self-compassion." Thesis, Lancaster University, 2015. http://eprints.lancs.ac.uk/74360/.
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Psychological variables have been shown to be important in the experience of chronic pain. One such variable, pain catastrophizing, has repeatedly been demonstrated as a significant predictor of pain intensity. With the aim to explore the relationship between pain catastrophizing and pain intensity, a systematic review of published empirical research was undertaken. The results suggested that there is a significant relationship between pain intensity and pain catastrophizing on a cross-sectional basis. However this relationship becomes more complex when additional psychological factors are controlled for or considered as mediating or moderating variables. The limitations of the review and implications of findings are discussed. The second section of this thesis is an empirical study that considered the relationship between chronic pain-related outcomes and a more recently emerging psychological variable in the field of chronic pain, self-compassion. This took a cross-sectional self-report questionnaire design. Recruitment took place in NHS chronic pain clinics, community support groups, social media websites and online forums (N = 210). This research suggested that, while some aspects of self-compassion were significantly correlated with pain intensity and pain-related disability, together they could not explain a unique amount of variance in either outcome variable once other psychological variables were controlled for in hierarchical regression models. Limitations of the study and clinical implications are discussed. The third section of this thesis takes the form of a critical appraisal which further discusses the process of conducting the research element of this thesis.
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Arrowood, Tamara Marie. "Long-term follow-up of exercise rehabilitation outcomes in patients with chronic obstructive pulmonary disease." Electronic thesis, 2002. http://dspace.zsr.wfu.edu/jspui/handle/10339/223.
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Lundström, Karl-Johan. "Outcomes and complications in surgical and urological procedures." Doctoral thesis, Umeå universitet, Institutionen för kirurgisk och perioperativ vetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-135046.
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Background: Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective. Aim: To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events. Results: When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days. Conclusions: The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated.
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Murphy, Christel A. "The Development of an Educational and Vocational Needs Survey for Adults with Childhood-Onset Chronic Health Conditions." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1540565225128269.
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Ogale, Sarika S. "Mortality and cardiovascular outcomes associated with medications used in the treatment of chronic obstructive pulmonary disease /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/7959.
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Chan, Ting-bun, and 陳霆斌. "Comparison of surgical outcomes between post-hepatectomy HCC patients with chronic kidney disease and normal kidney." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48333475.
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Based on figure from American Association for Cancer Research (2010) & Global Cancer Statistics (2011), Liver cancer (HCC) is the sixth most frequently diagnosed cancer globally and third leading cause of cancer death (Jemal, A. et al., 2011; Jemal, A., Center, M. M., DeSantis, C. et al., 2010). In Hong Kong, Liver Cancer caused 1488 deaths in 2009 in total; it is 2nd and 4th leading killer of cancer death among Hong Kong male and female respectively (Hong Kong Cancer Registry, 2010). However, surgical resection for HCC remains as mainstream treatment modality and extensive studies on post-operative surgical outcomes for different HCC treatment modalities have been published. Nevertheless, the influence of kidney function on surgical outcomes on HCC patient stays novel and it emerges a need to explore on the relation. This study aims to compare the surgical outcomes of post hepatectomy HCC patients between reduced kidney function and normal kidney function in terms of (1) Length of hospital stay, (2) Survival rate, (3) Hospital Mortality and (4) Overall post operative complications. The kidney function can be reflected by the glomerular filtration rate (Thomas, R., Stanley, B. & Datta, S., 2007; Daugirdas, J. T., 2011). The direct measurement of GFR is a complicated and expensive procedure, which is not clinical possible to screen every patient. Thus this study adopted modified Cockcroft- Gault (CG) Formula, one type of creatinine based glomerular filtration rate estimation formulas with normalization to body surface area. Modified CG formula calculate the estimated glomerular filtration rate (eGFR) based on age, body weight, body height, gender and serum creatinine level (Himmelfarb, J. & Sayegh, M. H., 2010; Daugirdas, J. T., 2011; Joanna, Q. H. & Heather A. N., 2011).
The eGFR of 452 HCC patients with major hepatectomy was evaluated and categorized into different kidney function groups according to the chronic kidney disease staging system suggested by K/DOQI, National Kidney Foundation. Hence, the surgical outcomes from different kidney function groups are analyzed and compared. Length of hospital stay was analyzed by Kruskal-Wallis Test. Hospital mortality and incidences of post-op complication are analyzed by Chi-square test. Lastly, the survival rate is analyzed by Kaplan-Meier Log rank test; the result is presented in form of survival curve, then 5-year survival rate of different group of samples are obtained and compared.
Result of the study shows no evidence that patients with chronic kidney disease will have a longer hospital stay and more prone to surgical complications post operatively. However, it is indicated that the hospital mortality is associated with the severity of kidney function reduction and suggested that patients with chronic kidney disease are at higher risk of post-operative death than those with normal kidney. Patient with severe reduction of kidney function should be aware of high foreseeable chance of death after the surgery and special caution need to be taken. Surprisingly, the result revealed that the overall survival improves with the severity of kidney function reduction and the patients with worse kidney function are more likely to have a better survival. Nevertheless, the result on survival rate suspected to be biased by possible confounders and underlying co-morbidities of samples.
In conclusion, eGFR formula is recommended in clinical estimation of kidney function for the patients. Also, it is suggested that HCC patients with reduced kidney function are more susceptible to hospital death after hepatectomy than normal individuals. Thus, cautious consideration and risk analysis before operation is particularly crucial for HCC patient with chronic kidney disease.published_or_final_version
Medicine
Master
Master of Medical Sciences
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Duarte, Rui. "Intrathecal drug delivery for chronic non-malignant pain : pharmacological complications, cost effectiveness and long-term outcomes." Thesis, Birmingham City University, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.549730.
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Background and aims Intrathecal drug delivery (IDD) is a last resort treatment for the management of severe chronic pain due to its invasive nature, high initial cost, concerns about long-term opioid use and possible complications related to the procedure. Although it has been available since 1981 some of the possible complications of this treatment have only recently been observed and are not fully understood. Additionally the current available literature exploring the longterm effectiveness and cost effectiveness of IDD is limited. The aims of this study were to explore some of the least investigated complications, long-term effectiveness and cost effectiveness of IDD. Methods The methodology used included both retrospective and prospective data collection to investigate intrathecal morphine dose escalation, granuloma formation, hormonal effects, bone mineral density (BMD), long-term effectiveness and cost effectiveness of IDD. Results A model was developed that allows the prediction of the intrathecal opioid dose at year six of therapy based on year two dose and the duration of pain prior to initiation of intrathecal therapy. An association between opioid concentration and formation of intrathecal granulomas was confirmed for the first time in humans and a tool to assist recognition of asymptomatic granulomas was identified. It was observed that hypogonadism is prevalent in this population and free testosterone is a more reliable method to diagnose this condition. An association between low BMD and hypogonadism as a result of IDD was reported for the first time. Effectiveness of IDD was verified following a mean of 13.5 years of therapy. A new concept with implications for cost analyses was identified. Conclusion This study presents a thorough analysis of IDD therapy. Despite potential side effects, this therapy can be effective over periods longer than 10 years in appropriately selected patients. The cost effectiveness of IDD systems was confirmed based on real patients’ data. Most side effects can be prevented with attentive follow-ups.
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Lemons, Courtney Ann. "The Role of Social Support and Emotional Representations in Health Outcomes for Individuals with Chronic Illness." UNF Digital Commons, 2013. http://digitalcommons.unf.edu/etd/431.
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Health related outcomes for individuals with chronic symptoms of illness can be influenced by complex, socio-emotional processes. The primary interest of this study was to determine whether perceived social support lessens the negative emotional appraisals of illness experience (e.g. anger, fear, hostile interpretations of illness), and the role of these emotional appraisals in health outcomes for those diagnosed either with a conventional chronic illness (e.g. diabetes, arthritis, chronic obstructive pulmonary disease) or a functional somatic syndrome (e.g. fibromyalgia, chronic fatigue syndrome, irritable bowel). Data for this study were collected from a series of four surveys administered online, which included measures of perceived social support (MSPSS), emotional representations of illness (IPQ-R), and health outcomes (SF-36). The sample included 151 participants (129 Female, 22 Male), all of whom experienced chronic somatic symptoms for at least 3 months, with 57 classified as having a conventional diagnosis (CD) and 94 with a functional somatic syndrome (FSS). The results suggest a potential mechanism for the buffering effect of social support, such that those with higher levels of social support reported lower degrees of emotional representations. After controlling for demographic and illness-related variables, social support was a significant predictor of emotional representations of illness. Emotional appraisals of physical symptoms predicted a majority of the health dimensions of the SF-36; including social functioning, role limitations due to physical problems and emotional problems, emotional well-being, vitality, and overall perception of general health. The pattern of findings underscores the need to consider the influence of psychosocial processes on both psychological and physical well-being in populations adjusting to chronic illness.
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Hammonds, Tracy Lynn. "The Influence of the Caregiver on Healthcare Outcomes in Patients with Chronic Obstructive Pulmonary Disease (COPD)." Kent State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=kent1426543939.
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Bliss, Ethan Loper. "The Roles of Attachment, Depression, and the Working Alliance in Predicting Treatment Outcomes in Chronic Pain Patients Seeking Physical Therapy Services." Scholarly Repository, 2009. http://scholarlyrepository.miami.edu/oa_dissertations/301.
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Psychosocial variables such as attachment style, depression and the working alliance were examined as predictors of treatment outcomes in the context of chronic pain patients receiving physical therapy. Four treatment outcomes were examined: change in pain severity, change in pain interference, patient satisfaction with physical therapy services and patient compliance with treatment recommendations. A model of the interplay between depression and chronic illness presented by Katon (2003) was used as a framework for the current model. Two main hypotheses were suggested. (1) The working alliance is positively related to treatment outcomes. (2) Depression is negatively associated with treatment outcomes. Data were gathered at three outpatient rehabilitation clinics and the physical therapy unit of a multidisciplinary pain clinic in two Midwestern cities. A total of 59 subjects participated and regression analyses found evidence supporting both main hypotheses. The working alliance was found to be positively correlated to the change in pain severity, the change in pain interference, patient satisfaction and patient compliance. Depression was found to be negatively correlated to the change in pain interference, patient satisfaction and patient compliance. Implications for physical therapists working with chronic pain patients include clinical recommendations for developing a good working alliance and screening for depression.
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Ali, Ayad. "Natural killer cells dictate outcomes of infection by orchestrating innate and adaptive immunity." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1624914672655234.
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Keedy, Nicole Hochhausen. "Health locus of control, self-efficacy, and multidisciplinary intervention for chronic back pain." Diss., University of Iowa, 2009. https://ir.uiowa.edu/etd/386.
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Chronic back pain is costly and potentially disabling, with low response to medical procedures. Poor physical and mental health demonstrate correlation with chronic back pain. The current study investigated the value of using health-related locus of control and pain-related self-efficacy to predict physical and mental health outcomes following multidisciplinary intervention for chronic back pain. Form C of the Multidimensional Health Locus of Control scales and the Chronic Pain Self Efficacy scale were administered to 28 males and 33 females ages 28 to 72 completing chronic back pain rehabilitation. Locus of control, self-efficacy, and physical and mental health demonstrated treatment-related changes, with notable improvements in physical and mental health. Regression analyses examined the value of pre-treatment health locus of control and pain-related self-efficacy as predictors of physical and mental health one month following treatment. Higher internal and lower doctor health locus of control, and higher self-efficacy at baseline predicted higher lift scores one month after treatment. Higher baseline self-efficacy also predicted better physical functioning and lower disability at one month. Pain-related self-efficacy and health locus of control may be valuable predictors of treatment benefit for chronic back pain patients. Limitations included low sample size.