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McAllister, Lindy. "The experience of being a clinical educator." Phd thesis, School of Physiotherapy, 2001. http://hdl.handle.net/2123/4017.
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Thesis (Ph. D.)--University of Sydney, 2001.Title from title screen (viewed Jan. 22, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Physiotherapy, Faculty of Health Sciences. Includes bibliography. Also available in print form.
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Doherty, M. "Pyrophosphate arthropathy : a clinical study." Thesis, University of Cambridge, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.598580.
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Bok, Arnold Pierre Louis. "Subdural empyema : a clinical study." Master's thesis, University of Cape Town, 1987. http://hdl.handle.net/11427/25699.
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Subdural empyema is a relatively rare condition that carries a high mortality if not treated adequately. The experience at Groote Schuur Hospital over 8 years from 1979 to 1986 was reviewed. 47 cases of subdural empyema following on contiguous or distant infection, or where the source was not known, were included in this study. Subdural empyema following cranial operation, head trauma~, or meningitis was excluded. Computer Tomographic scanning facilitated early diagnosis and pinpointed subdural collections, and was used postoperatively, to locate residual subdural pus, which was then drained. The results indicate that an aggressive approach using modern radiological techniques to guide surgical procedures, vastly improves the outcome from subdural empyema. The mortality rate was only 8,5%, while 72,3% of our patients were cured and returned to pre-disease activity. The availability of Computer Tomographic scanning in the management of subdural empyema improves the outcome of patients treated with burrhole drainage and diminishes the need for craniotomy. Rare cases may even be managed with antibiotics only. It remains important to deal with the source of subdural empyema - paranasal in 31, otogenic in 10, osteitis in 2 and not known in 4 of the patients. Anaerobic organisms (28%), which are difficult to culture, and contribute to the high incidence of sterile cultures (32%), play an important role in subdural empyema. Chloramphenicol remains the most useful antibiotic. In the long term only 18,6% of patients had seizures and only 16,3% had focal neurological signs. Complications, especially brain abscess developed in 5 cases where pus was not drained adequately initially, and this contributed to a poorer outcome. Steroid administration did not seem to affect the management of subdural empyema. Repeated surgical drainage and administration of broad spectrum antibiotics remain the mainstays of the treatment of subdural empyema.
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Buchel, Elwin Herbert. "Autoimmune hepatitis a clinical study /." Pretoria : [s.n.], 2008. http://upetd.up.ac.za/thesis/available/etd-01132009-102127.
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Hoffman, Karen. "Students' perceptions of clinical teacher behaviors." Virtual Press, 1995. http://liblink.bsu.edu/uhtbin/catkey/958793.
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The purpose of the study was to examine students' perceptions of frequency of clinical teacher behaviors and whether those perceptions change by class level. The theoretical framework for the study was Bevis' paradigm of curriculum revolution.In 1993, Marilyn Simons, DNS gathered data from nursing students enrolled in clinical nursing courses at a Midwestern university. The convenience sample totaled 88 (100%). The data was not analyzed or reported. The current study was a retrospective analysis of that data.Findings of the study showed that students perceived faculty as demonstrating professional competence and interpersonal relationship behaviors in the clinical setting. No significant differences were found in these perceptions by class level on either then total scale or on the subscales.The conclusion from the study was that faculty at this particular university are perceived as practicing emancipatory education as proposed by Bevis. It was also concluded that faculty perform at the same level of competency and use similar approaches without regard to class level, and that students perceived that faculty related to them in similar ways across classes.The study was significant because it helps nurse educators understand the student perspective of clinical teacher behavior. The Clinical Teacher Behavior Tool used in the study could be used to help design a cooperative clinical learning model different from the traditional education approach and in accordance with Bevis' paradigm.School of Nursing
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Sarvananthan, Nagini. "Epidemiology and clinical study of nystagmus." Thesis, University of Leicester, 2012. http://hdl.handle.net/2381/10383.
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Nystagmus is a repetitive to and fro movement of the eyes and can affect vision and involve individuals of all ages. Previous research into the pathophysiology of this disease has been based on case series or small numbers of patients. Improvements in and standardisation of electrodiagnostics and eye movement recordings have enabled scientists to diagnose and characterise the different nystagmus types more accurately. Purpose The research into nystagmus carried out at the University of Leicester had several aims. The first population-based study on the prevalence of nystagmus was carried out within the county of Leicestershire. The second study was aimed at examining the clinical features of patients with different types of infantile and neurological nystagmus in order to characterise any specific features associated with this groups of patients. The final study was carried out with the aim of investigating the distribution of refractive errors in patients with nystagmus and to determine if the process of emmetropization in ocular development is influenced by the presence of nystagmus. Methods Ethical approval was obtained. Patients were recruited for the epidemiological study from both the community and hospitals within Leicestershire. Patients for the clinical and refractive error studies were additionally recruited from outside the county. A further 602 normal subjects volunteered to participate in the refraction study. Results The epidemiological study estimates the prevalence of nystagmus to be 16.6 per 10 000 (under 18 population) and 26.5 per 10000 (over 18 population). The clinical study showed differences in visual acuity, stereopsis, anomalous head posture and conjugacy of nystagmus amongst different clinical groups. Finally, the refractive errors study suggests that the process of emmetropization is influenced by the presence of nystagmus. Conclusion These studies provide previously unknown data about nystagmus and provide a platform for further research into this condition.
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Petty, Richard Kenneth Holdsworth. "A clinical study of mitochondrial myopathies." Thesis, University of Newcastle Upon Tyne, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.329160.
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Lipscomb, Karen Jane. "A clinical study of Marfan syndrome." Thesis, St George's, University of London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343719.
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Fennerty, A. G. "Clinical and immunological studies in hay fever." Thesis, University of Liverpool, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.382062.
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Hayden, Colleen Ann. "Clinical Judgment Regarding Suspicion of Child Sexual Abuse: A Pilot Study of Factors Associated with Differential Levels of Clinician Concern." Thesis, Boston College, 2015. http://hdl.handle.net/2345/bc-ir:104663.
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Thesis advisor: Thomas M. CreaChild sexual abuse is a major public health problem in the United States, but identifying risk, especially in young children with suspicion of abuse, poses many challenges. The aim of this study is to understand how clinicians judge the possible presence of sexual abuse in children where serious suspicion exists but without substantiated abuse. This study used data from randomly selected sexual abuse and trauma evaluations of preschool and school-aged children presenting to Boston Children’s Hospital (BCH) Outpatient Child Protection Program between 2000-2007 (N=100) to examine the association between child and family risk factors and level of clinician concern regarding likelihood of child sexual abuse. Multi-nomial logistic regression analysis was used to examine the relationship between child and family risk factors and level of clinician concern regarding suspicion of abuse, moderated by child’s gender and age. Results indicated that a child’s disclosure and trauma presentation were the key factors that clinicians considered within the higher level of clinician concern regarding likelihood of sexual abuse. Implications for future research and clinical practice include attention to methodology research to assist with the development and validation of assessments for evaluation of risk in complex cases of suspicion of sexual abuse that can be offered in clinical setting, without sole reliance on the child’s ability to disclose in order to access help. Additionally, it is essential that research focuses on the development of clinical models to help with clinical decision making protocols in ambiguous cases of sexual abuse with children who may not be in a position to disclose, but serious concerns have been raised, with focus on increasing their safety. The findings in this research strongly suggest that it is essential to continue to focus on assisting children who present with suspicion of sexual abuse in complex cases that do not fit neatly into our current forensic and child protective services systems. This is especially necessary with the most vulnerable children where disclosure is unlikely, but clinical evaluations can yield recommendations that maximize efforts at increasing safety, child mental health, and family cohesion, and build on strengths while simultaneously accounting for risks
Thesis (PhD) — Boston College, 2015
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work
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Pardo, Dona. "The culture of clinical teaching." Diss., The University of Arizona, 1991. http://hdl.handle.net/10150/185472.
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The purpose of this exploratory case study was to describe the culture of clinical teaching through a symbolic interactionist framework, by identifying the rituals, faculty behaviors, and student behaviors and characteristics valued by faculty instructing in clinical settings, using content analysis, interviews and observation. Five faculty, one from each clinical specialty, were chosen using specific criteria. College of Nursing archives were content analyzed to ascertain written valued student behaviors and characteristics and faculty were interviewed to learn their stated beliefs. Faculty/student clinical interactions were observed to assess if faculty written and verbalized beliefs were enacted, and twelve students were interviewed for verification of transmission of the values. Peer debriefing, member checking and an audit trail ensured trustworthiness of the data. Faculty used eight rituals: Preparation, Tracking, Discourse, Closet, Repast, Selection, Maneuver, and Documentation, and three types of actions: Teaching, Role Modeling, and Caretaking to transmit their values. Teaching was utilized 55 percent of the time and involved questioning, instructing, guiding, correcting and observing. Role Modeling, used 22 percent, embodied promoting independence, helping, intervening, kidding and admitting fallibility. Caretaking was evidenced 23 percent of the instructor's time and included caring, praising, diffusing anger, allowing mistakes and sharing self. Over one hundred student behaviors and characteristics that faculty valued were identified and collapsed into six descriptors, listed in descending order: assertive, therapeutic, compliant, knowledgeable, disciplined, and skillful. Faculty placed emphasis on human, interactive skills versus knowledge and psychomotor skills, and responded to students with very caring behaviors. They utilized compassion as a way of effecting conformity, and their use of caring behaviors for the exercise of their power was evident.
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Harvey, Loretta Woolum. "Clinical Educators' Perceptions of an Extended Clinical Field Experience: A Mixed Methods Case Study." Ohio University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou153276735684428.
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McAllister, Lindy. "The experience of being a clinical educator." Connect to full text, 2001. http://hdl.handle.net/2123/4017.
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Thesis (Ph. D.)--University of Sydney, 2001.Title from title screen (viewed Jan. 22, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Physiotherapy, Faculty of Health Sciences. Includes bibliography. Also available in print form.
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Hodges, Ian. "Exploring the phenomenology of clinical and non-clinical depression : a Q-methodological study." Thesis, Middlesex University, 2017. http://eprints.mdx.ac.uk/21399/.
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The lived experience of depression is taken as a starting point for this research which aims to document and explore the variety of experiences of depression among a diverse sample of participants who have been diagnosed with and/or self-report as having had an experience or experiences of depression, either currently or in the past. Using Q-methodology and drawing on social constructionism and existential-phenomenology (particularly the work of Kenneth Gergen, Rom Harré and Martin Heidegger), I ask the questions ‘How do participants experience (clinical and non-clinical/self-identified) depression? How do participants’ experiences resemble or differ from established psychiatric and clinical psychology accounts of depression and how might the findings be relevant to existential counselling psychology practice? There were two phases to this empirical study. Firstly, a preliminary focus group study was conducted using a ‘clinical’ and a ‘non-clinical’ group and thematic analysis was used to analyse the data which provided information and materials for the development of the concourse of statements used in the main sorting task. Secondly, the main Q-methodological study required 46 participants to sort (online) a series of 58 experiential statements along a continuum ‘most like me when I’m depressed’ to ‘least like me when I’m depressed.’ Nine of these statements were based upon the current DSM-5 diagnostic criteria for major depression. Principal component’s factor analysis produced eight interpretable factors which represent eight different (but shared) experiences of depression as follows; 1) ‘Clinical’/suicidal depression, 2) The ‘blues’/overcoming loss and bereavement, 3) Anxious/’anti-clinical’ depression, 4) Emotionally devoid/isolated depression, 5) Sadness and loss/surviving depression, 6) Alienated/helpless depression, 7) The ‘blues’/surviving through self-reliance, 8) Loss of meaning/depression as part of the cycle of life. These different experiences are explicated in detail and in relation to the placement of the DSM diagnostic statements. Only one of the factors showed a strong similarity to the DSM criteria while all the other factors revealed experiences that may not be captured by those measures. The results are considered in relation to social constructionist critiques and existential-phenomenological philosophy. Finally, the relevance of the findings for existential-phenomenological counselling psychology practice is discussed.
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Cefo, Linda M. Dr. "Qualitative Study Exploring the Development of Clinical Reasoning in Nursing's Clinical Education Settings." Cleveland State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=csu1556456523899578.
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Foulds, Barbara J. "Communities of practice : clinical teaching in professional nursing education." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=85549.
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The need to prepare and support clinical teaching faculty is identified as a priority by nurse educators. However, there is no framework for understanding the practice of clinical teaching (Benner, Tanner & Chelsa, 1996; Davis, Dearman, Schwab & Kitchens, 1992; Scanlan, 2001; Siler & Kleiner, 2001; Vollman, 1989). There is little nursing research directed to understanding the practice of clinical teaching. It is widely assumed that nurses who are experts in practice are able to make an easy transition to the role of clinical teacher (Scanlan, 2001; Silar & Kleiner, 2001).The clinical practicum is the time when students are in the clinical setting as novice nurses under the supervision of both experienced nurses and clinical teachers. The clinical setting may be hospital or community-based and students may be working directly with patients and their families or may be a member of a community-based project team. The purpose of this study was, by asking clinical teachers to describe their practice, to determine whether clinical teaching was a boundary practice bridging nursing and teaching's communities of practice (CoP). The goal of the boundary practice is to sustain a connection between the two communities of practice by dealing with conflicts, seeking common ground and resolving problems. The following research questions were asked: (1) To what extent do clinical teachers describe the characteristics of a boundary practice? (2) What are the participative connections that clinical teachers use in their professional activities? and (3) What boundary objects are transferred from one community of practice to another?
Using a qualitative research design, nine clinical teachers from diverse practice settings and with a range of years in the profession participated in a focus group interview. The focus group interview was followed by individual interviews with four clinical teachers. The conceptual framework that guided this study combined Wenger's (1998, 2002) community of practice model, and Shulman's (1987) teacher knowledge model. Additional theoretical constructs included reflective practitioner, cognitive apprenticeship and situated cognition (Brown, Collins & Duguid, 1989; Lave & Wenger, 1991; Schon, 1987).
The results suggest that clinical teaching is a boundary practice and that clinical teachers create participative connections between nursing and teaching practices through the building of relationships with fellow nurses, students and classroom teachers using strategies that involve reconciling different practice perspectives with the objective of creating supportive clinical learning environments. Clinical teachers described negotiation strategies to move students from the periphery of nursing into the community of nursing practice and using boundary objects to negotiate meaning from practice.
The results suggest that the practice of clinical teaching includes understanding how to balance relationships and reconcile competing demands. The findings also suggest that connection to the classroom teacher and understanding of the course of study are important to the practice of clinical teaching. Two key outcomes of this study are the development of a model of clinical teaching and a working vocabulary to describe the practice of clinical teaching.
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Hermiz, Mary E. "Teaching critical thinking skills to student nurses in clinical settings." Virtual Press, 2001. http://liblink.bsu.edu/uhtbin/catkey/1221272.
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What strategies are effective for clinical nurse instructors to use in developing critical thinking in student nurses? Many clinical strategies have been discussed in, literature, but only a few have been verified through research as to their usefulness.This study used the qualitative research methodology of multiple case studies. Participants were six clinical nurse instructors. Nursing experience ranged from 17-27 years, teaching experience involved 2-24 years. Four instructors had doctorates, one nurse had a masters degree, and the sixth nurse lacked two courses before completing a masters degree. The six instructors were from five areas of nursing: medical/surgical (beginning and intermediate level), maternity, mental health, community health and management.Each instructor was interviewed three times during the same semester, approximately two weeks apart. Interviews were audio recorded and transcribed. Spradley's (1979) domain and taxonomic analyses were used to analyze the data.Data analysis showed that some strategies were used by all instructors, with adaptations made for the specialty. The strategies used by all instructors were questioning, nursing care plans and clinical conferences. More than one instructor used student journals, teaching projects, research articles, milieu assessments, and case studies/scenarios.This research strongly supported the use of questioning to help the student progress in critical thinking. Contrary to some research, the present research found that questioning by the instructors was not detached but was situated in the client setting which helped the student synthesize facts into a whole. The research identified many questions used by the clinical nurse instructors.Instructors identified their role in assisting students toward critical thinking as helper, facilitator, coach and guide. Instructors also identified the following characteristics as necessary to help students: caring attitude, creativity, perseverance, knowledgeable, listener, encourager and learning attitude. The instructors motivated students as they progressed in critical thinking through verbal and nonverbal rewards. Students gained self-confidence as they experienced success in their journey towards critical thinking. Implications for nursing practice are provided. The importance of this research lies in the rich depth of discovering how these strategies, roles, characteristics, and motivators assist nursing students in developing critical thinking skills in different clinical settings.2Department of Educational Leadership
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Vuso, Virginia Zanyiwe. "Enhancing clinical preparedness of basic midwifery students: perceptions of midwifery educators." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/13204.
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Since the inception of the student supernumerary status, both globally and in South Africa, nursing and midwifery educators have been concerned about the clinical competencies of their students. Student clinical competency levels in South Africa are critical to midwifery practice, especially as most litigation against the Department of Health in South Africa concerns negligence in midwifery practice. In addition, the litigations mostly involve newly qualified midwives, thus suggesting a link with practice competency levels. Several challenges exist in the academic and practice environments regarding student learning, practice and clinical preparedness. Lack of support during clinical placement and a lack of facilities for use during clinical practice modules are among these challenges. Some students, due to the challenges they face with clinical learning and practice, fail to meet the practical competencies for examination entry requirements. Consequently, some of these students have to repeat the year or exit the programme. The current study sought to identify how to assist midwifery educators in their activities to prepare students for clinical placement readiness. The first objective of the study was to explore and describe the perceptions of midwifery educators regarding the need for additional measures to enhance the clinical preparedness of basic midwifery students before they are allocated to the clinical areas. The second objective sought to make recommendations that would further assist the midwifery educators to clinically prepare midwifery students before being allocated and placed in different clinical areas. A qualitative, explorative, descriptive and contextual research design was used for the study and the study was conducted at a nursing college in the Eastern Cape Province from August 2014 to January 2016. The research population consisted of midwifery educators at a nursing college and a purposive sampling technique was used guided by set criteria. Data were collected using focus group interviews. Four focus groups were used making a total of 17 participants. The principles applied for data analysis were those of Tesch’s method of data analysis, which were used to develop the themes and sub-themes. An independent coder assisted with the coding of the data for the purposes of trustworthiness. In addition, Lincoln and Guba’s model of trustworthiness consisting of the criteria of credibility, transferability, dependability and conformability was used to confirm the validity of the study while the ethical principles adopted were informed consent, justice, non-maleficence, privacy and confidentiality. The study found that the participants perceived numerous challenges that hindered the clinical preparedness of their students. These related to increased workload, lack of support from management and a lack of commitment on the part of students towards their studies. The participants also identified inconsistencies in clinical practice between the clinical midwives and the educators, and even among the educators themselves. This lack of consistency in turn causes confusion among the students and thus impacts negatively on their clinical practice preparedness. Based on these findings recommendations for clinical nursing practice, nursing education and research were made.
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Huson, Susan Mary. "Clinical and genetic studies of von Recklinghausen neurofibromatosis." Thesis, University of Edinburgh, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.236157.
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A population-based study in South East Wales (population 668,100) identified 69 families with 135 affected members with von Recklinghausen neurofibromatosis (NF-1), giving a disease prevalence of 20/105 of population. In these families penetrance of the NF-1 gene was 100% by the age of five years. 41/135 cases were judged to represent new disease mutations and the mutation rate was estimated to lie between 3.1x10-5 and 10.4x10-5. A parental age effect for new mutations was not demonstrated, nor was a maternal effect on disease severity. The clinical features and natural history of NF-1 in this cohort were used to derive data for genetic counselling and recommendations for the management of affected individuals. For counselling purposes the complications of NF-1 can be usefully divided into 4 categories (the frequency of each, based on this study, are shown in parentheses): intellectual handicap (33% overall, moderate/severe retardation 3.2%, minimal retardation/ learning difficulties 29.8%); complications developing in childhood and causing lifelong morbidity, e. g. facial plexiform neurofibromas, scoliosis, pseudoarthrosis (8.5%); 'treatable' complications which can develop at any age, e. g. benign disorders of the nervous system, visceral and endocrine tumours, renal artery stenosis (15.7%) and malignant or CNS tumours (4.4-5.2%). The study population indicates that sufferers are not being diagnosed sufficiently early, nor receiving appropriate follow-up and counselling. It is recommended that patients with NF-1 have regular clinical assessments to monitor for the development of complications, although none occur often enough to warrant biochemical or radiological screening. As many of the complications develop early in life, children should have biannual review; in adults, unless a particular complication indicates more frequent review,annual clinical examination is sufficient. Alongside the population survey, genetic linkage studies were undertaken in selected large families to determine the chromosomal localisation of the NF-1 gene. At the outset of this work, two families had been reported in which NF-1 and Myotonic Dystrophy (DM) appeared to co-segregate, suggesting that the two genes were closely linked and on chromosome 19. However, linkage studies of 3 chromosome 19 markers linked to DM showed significantly negative lod scores, therefore excluding this possibility. Other chromosomes were then studied using random unique sequence DNA probes and samples from the largest families were made available to collaborators in the USA for linkage studies using possible candidate genes (ß nerve growth factor and oncogenes). No marker studied showed evidence of linkage. The negative data were used to produce an exclusion map for NF-1, using the computer program 'EXCLUDE'. The presentation of this work was one of the factors which precipitated the formation of an international consortium for NF-1 linkage in February 1987; the first task of the consortium was to produce an expanded exclusion map. A small positive lod score for a marker on chromosome 17, taken with the exclusion data, showed that NF-1 was seven times more likely to be on chromosome 17 than any other chromosome; this was rapidly confirmed by two North American groups, one of which was using samples from the 5 largest families presented in the thesis. Subsequent linkage analysis of pericentromeric chromosome 17 markers in the Welsh family panel showed no evidence of non-allelic heterogeneity and identified closely linked flanking markers for the NF-1 gene suitable for prenatal/presymptomatic diagnosis. The chromosomal localisation of NF-1 represents a major step towards the eventual understanding of the disease pathogenesis and the development of possible treatments.
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Mattila, M. L. (Marja-Leena). "Autism spectrum disorders:an epidemiological and clinical study." Doctoral thesis, Oulun yliopisto, 2014. http://urn.fi/urn:isbn:9789526203386.
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Abstract Background: Autism spectrum disorders (ASDs), defined as pervasive developmental disorders (PDDs) in DSM-IV and ICD-10, become manifest in childhood, ranging from a severe form, autism, to milder forms, Asperger syndrome (AS) and pervasive developmental disorder not otherwise specified (PDD-NOS)/atypical autism. AS is also specified in criteria by Gillberg and by Szatmari et al. Different diagnostic criteria sets, overlaps, inaccuracies and exclusion criteria of many comorbid psychiatric disorders in PDDs have caused confusion. In DSM-5, PDDs were replaced by one diagnosis called ASD. Aims and methods: This is an epidemiological study of 8-year-old children and a clinical study of 9- to 16-year-old high-functioning outpatients with AS/autism (HFA). The epidemiological target population (n = 4,422) was rated via the Autism Spectrum Screening Questionnaire (ASSQ) by parents and/or teachers and a screened sample was examined in order to estimate the prevalence of ASDs, to discover deficits in the diagnostic criteria of ASDs, to evaluate DSM-5 draft criteria for ASD, and to assess cut-off scores for the Finnish ASSQ. Comorbid psychiatric disorders were identified and overall level of functioning rated in 50 subjects with AS/HFA. Results: The prevalence of AS according to DSM-IV was 2.5, to ICD-10 2.9, to Gillberg 2.7, and to Szatmari et al. 1.6 per 1,000. The prevalence of autism was 4.1 and that of ASDs 8.4 per 1,000 (DSM-IV). DSM-5 draft criteria were less sensitive in detecting AS/HFA. For 7- to 12-year-old children (IQ ≥ 50), the optimal cut-off scores were 30 in clinical settings and 28 in total population screening using summed parent-rated and teacher-rated ASSQ scores. Comorbid psychiatric disorders were common (prevalence 74%) and often multiple; behavioral disorders in 44%, anxiety disorders in 42%, and tic disorders in 26%. Oppositional defiant disorder, depressive disorder and anxiety disorders as comorbidities indicated significantly lower levels of functioning. Conclusions: Our results indicate the need to standardize the diagnostic criteria. The ICD-11 criteria should be uniform and harmonize with DSM-5. Determining cut-off scores for ASD screening instruments in different languages and cultures is of utmost importance. Clinicians are reminded to investigate psychiatric comorbidity in ASDs in order to target treatment and rehabilitation preciselyTiivistelmä Lähtökohdat: Autismikirjon häiriöt, ICD-10:ssä ja DSM-IV:ssä nimellä laaja-alaiset kehityshäiriöt, ilmenevät lapsuudessa. Niihin luetaan autismi, Aspergerin oireyhtymä (AS) ja tarkemmin määrittelemätön laaja-alainen kehityshäiriö/epätyypillinen autismi. Gillberg sekä Szatmari työtovereineen ovat myös määritelleet AS:n kriteerit. Useat diagnostiset kriteerit, päällekkäisyydet, epätarkkuudet ja monien psykiatristen liitännäishäiriöiden poissulkeminen laaja-alaisissa kehityshäiriöissä ovat aiheuttaneet sekaannuksia. DSM-5:ssä laaja-alaiset kehityshäiriöt korvattiin yhdellä diagnoosilla: autismikirjon häiriö. Menelmät ja tavoitteet: Väitöstyö muodostui 8-vuotiaita lapsia koskeneesta epidemiologisesta tutkimuksesta sekä 9–16-vuotiaita AS- ja autistisia (HFA) lapsia ja nuoria koskeneesta kliinisestä tutkimuksesta. Vanhemmat ja/tai opettajat täyttivät epidemiologisen kohderyhmän lapsista (n = 4 422) suomennetun autismikirjon seulontalomakkeen (ASSQ), ja seuloutuneille tehtiin diagnostiset tutkimukset. Tämän jälkeen määritettiin autismikirjon esiintyvyys, kartoitettiin diagnostisten kriteerien puutteita, arvioitiin DSM-5-luonnoskriteerit autismikirjon häiriölle ja määritettiin ASSQ:n seulontarajat. Psykiatrinen komorbiditeetti ja sen merkitys toiminnalliseen tasoon tutkittiin AS-/HFA-lapsilla ja -nuorilla (n = 50). Tulokset: AS:n esiintyvyys oli 2,5/1000 DSM-IV:n, 2,9/1000 ICD-10:n, 2,7/1000 Gillbergin ja 1,6/1000 Szatmarin mukaan. Autismin esiintyvyys oli 4,1/1000 ja koko autismikirjon 8,4/1000 (DSM-IV). DSM-5-luonnoskriteerit olivat epäherkät tunnistamaan AS:ää ja HFA:ta. Parhaiten soveltuviksi ASSQ:n seulontarajoiksi alakouluikäisille (ÄO ≥ 50) osoittautuivat 30 kliinisiä tilanteita ja 28 väestöseulontoja varten laskemalla yhteen vanhempien arvioinnin ja opettajan arvioinnin pisteet. Psykiatrisia liitännäishäiriöitä oli 74 %:lla, ja monilla oli useita. Käytöshäiriöitä oli 44 %:lla, ahdistuneisuushäiriöitä 42 %:lla ja tic-häiriöitä 26 %:lla. Uhmakkuus- ja masennushäiriö sekä ahdistuneisuushäiriöt alensivat merkitsevästi toiminnallista tasoa. Päätelmät: Tulokset osoittivat diagnostisten kriteereiden yhtenäistämistarpeen. ICD-11:een on syytä laatia yhdenmukaiset kriteerit DSM-5:n kanssa. Autismikirjon seulontalomakkeille on tarpeen määrittää eri kieliin ja kulttuureihin soveltuvat pisterajat. Psykiatrisen komorbiditeetin selvittäminen autismikirjon häiriöissä on tärkeää, jotta hoito ja kuntoutus voidaan kohdentaa oikein
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Pelkonen, O. (Outi). "Cervicocephalic artery dissection:radiological study with clinical outcome." Doctoral thesis, University of Oulu, 2004. http://urn.fi/urn:isbn:9514272706.
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Abstract
The aim of this study was to analyze angiographic findings and the presence and topography of cerebral ischemic and/or hemorrhagic lesions in cerebral CT or MRI, and to assess the long-term clinical outcome of a series of 136 consecutive cervicocephalic artery dissection (CCAD) patients. Pulsatile tinnitus was evaluated as a symptom of CCAD. Medical records and films were reviewed retrospectively.
Irregular stenosis was found in angiography in 50% and occlusion in 33% of the dissected cervicocephalic arteries. Irregular stenosis normalized in 81% and occlusion recanalized in 34%. Other findings, such as pseudoaneurysms, intimal flaps, double lumens, and irregular dilatations were rare and often remained unchanged in follow-up.
Pulsatile tinnitus was a presenting symptom in 12% of the CCAD patients, but the majority of patients had concomitant head or neck pain, ischemic brain symptoms, Horner's syndrome, or cranial neuropathies.
Of the 131 patients who underwent brain imaging, 73 (56%) had signs of infarction in cerebral CT or MRI. Occlusion of the dissected vessel was accompanied by infarction in 76%, irregular stenosis in 40%, and other findings only rarely. Of the anterior circulation infarctions, 95% (39/41) were territorial, subcortical, or territorial infarctions with fragmentation and could thus be considered embolic. Subarachnoid hemorrhage was found in CT in 5 of the 22 patients (23%) with intracranial dissection.
The patient's long-term clinical outcome was assessed using two methods: a classification into categories based on neurological symptoms and defects and the modified Rankin Scale (mRS). Of the 136 CCAD patients, 60% recovered with no or mild disability and 79% scored 0–2 on mRS. In the case of dissection of one or more cervicocephalic arteries without occlusion, the figures were 75% and 89%. In the case of occlusive dissection of one or more arteries, only about 35% of the patients recovered well, having no or mild disability, and 61% scored 0–2 on mRS. No significant differences were seen in recovery after intra- and extracranial dissections.
In conclusion: irregular stenosis, which is the most common angiographic finding in CCAD, is associated with brain infarction less frequently than occlusion, and the long-term clinical outcome is good in most cases. Occlusion of the dissected vessel causes more brain infarctions, and only about 35% of the patients recover well, having no or mild disability. More than 10% of CCAD patients have pulsatile tinnitus as a presenting, and sometimes the only symptom.
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Laurila, née Kostamovaara P. (Päivi). "Pain relief after joint surgery:a clinical study." Doctoral thesis, University of Oulu, 2002. http://urn.fi/urn:isbn:9514267958.
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Abstract
Excessive pain after surgery causes many kinds of endocrine, metabolic and inflammatory responses, which may increase postoperative morbidity and mortality - especially among elderly patients. This study evaluated the effect of peripheral and central pain relief techniques after joint surgery.
Intravenously administered doses of 100 mg, 200 mg and 300 mg of ketoprofen decreased the requirement for opioid (fentanyl) in a dose-dependent manner by 38%, 45% and 53%, respectively, compared with a placebo, without any noticeable ceiling-effect, when administered after hip and knee arthroplasty. Patients receiving a 300 mg dose of ketoprofen had significantly lower postoperative pain scores than those receiving a placebo. There were no significant differences in incidences of nausea and vomiting, or in the amount of bleeding between the ketoprofen and placebo groups.
Intravenous doses of 200 mg of ketoprofen, 150 mg of diclofenac, and 120 mg of ketorolac produced similar postoperative pain scores and requirement for opioid (fentanyl) with no intergroup differences in the incidence of nausea and vomiting and in the amount of bleeding, when administered after hip arthroplasty.
The addition of ropivacaine, 1 mg·ml-1, did not decrease the requirement for epidural fentanyl administered via a patient-controlled analgesia device for postoperative pain relief after hip arthroplasty. Both drug infusions provided effective pain relief. The most common adverse effect was pruritus, which occurred in a similar number of patients in both groups.
An interscalene brachial plexus block with ropivacaine decreased the dose of PCA-delivered oxycodone by 78% after arthroscopic shoulder surgery while subacromial bursa blockade with ropivacaine decreased it by only 11 % compared to a placebo during the 20 hour study period. Postoperative pain scores were significantly lowest with a interscalene brachial plexus block.
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Carlsson, Göran. "Kostmann syndrome : a clinical and pathophysiological study /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-059-1/.
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Otri, Ahmad Muneer. "Infectious keratitis : a molecular and clinical study." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/13408/.
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Infectious keratitis is a sight threatening disease which can cause permanent visual loss if not diagnosed and treated at an early stage. It can be caused by different types of microbes which are either commensals or transferred from the environment. To fight against these threats, the ocular surface (OS) has developed innate and adaptive immune mechanisms. Antimicrobial peptides (AMPs) are natural effectors on the OS with actions that range from microbicidal effects to cell signalling. Human beta defensin (hBD) 1-3 and 9, Liver expressed antimicrobial peptide (LEAP) 1 and 2, human cathelicidin (LL37), ribonuclease7 (RNase7) are the main AMPs on the OS. In this work, the pattern of ocular AMPs gene expression in human OS cells treated with Acanthamoeba castellanii, Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) was studied and established. This was examined by quantitative real-time PCR (RT-PCR) using the Taqman assay. Among the studied AMPs, hBD3 gene showed the most significant increase in human OS cells infected with Acanthamoeba. LL37 demonstrated the highest level of gene expression in the samples infected with bacteria. In a different study, the gene expression of two AMPs (hBD3 and 9) was studied in OS samples taken from patients with different types of infectious keratitis both during and after the infection. This was compared with the expression in healthy subjects. Impression cytology (IC) was used to obtain samples of OS epithelium from recruited subjects. An optimized method for RNA extraction of IC samples was developed. Corresponding to the results of the in vitro study, hBD3 showed an overall up-regulation in all categories whereas hBD9 was down-regulated. These changes were most significant in patients with acute Acanthamoeba keratitis. The gene expression of both hBD3 and 9 showed a tendency towards returning to the levels found in healthy subjects when healing of the corneal infection was complete. In another study carried out to examine the antimicrobial activity of hBD3 we were surprised to find that we could not replicate this. We were unable to reproduce the previously reported antimicrobial activity of hBD3 but were able to demonstrate that the antimicrobial effect could be attributed to the acidic solvent used in preparing the hBD3 protein. The clinical significance of application of corneal densitometry as measured by the Pentacam system was assessed for the first time in patients with infectious keratitis. We demonstrated that corneal densitometry varied with levels of inflammation and was not confined to the site of infection only. It affected the whole cornea and reverted towards normal values as the inflammation settled when the infection was brought under control. We were able to demonstrate that densitometry can be used as a measure of the corneal response to infection and inflammation and could be used to monitor response to therapy. Finally, separate comprehensive prospective and retrospective studies of the clinical profile of severe infectious keratitis in Nottinghamshire were conducted. These two studies covered a total period of 7 years. The results of both studies were similar. Indeed, OS disease, CL wear and previous ocular surgery were found to be the most common risk factors. Positive results of corneal scraping were obtained only in about 40% of cases. Acanthamoeba, S. aureus, and P. aeruginosa were the most frequent causative organisms. Fortified topical antibiotics were effective in treating most cases. Therapeutic corneal grafting was found to be an effective and safe procedure in refractive infectious keratitis.
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Valente, Enza Maria. "Movement disorders : a clinical and genetic study." Thesis, University College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405854.
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Kitley, Joanna Louise. "A clinical/immunological neuromyelitis optica association study." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:274bb81c-edce-4f6f-8330-172659ba99fc.
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Neuromyelitis optica (NMO) and NMO spectrum disorders (NMOSD) are associated with the disease-specific autoantibody aquaporin-4 (AQP4-Ab), which is thought to be pathogenic. Some NMO/NMOSD patients do not have this antibody and may have different clinical and immuno-pathological disease characteristics, but previous clinical NMO/NMOSD studies have been confounded by inclusion of such patients. To define better the characteristics of AQP4-Ab disease, disease course, outcomes and predictors of disability were investigated in 106 AQP4-Ab positive NMO/NMOSD patients from the UK and Japan. AQP4-Ab positivity conferred a high risk of relapsing disease and substantial disability; age at disease onset and ethnicity were important predictors of disability type. Visual disability was more common in younger patients and those of Afro-Caribbean ethnicity whilst older patients and Caucasian patients were more at risk of motor disability. To determine whether disease characteristics were influenced by AQP4-Ab binding specificities, the differential binding of patient AQP4-Ab against the two main AQP4 isoforms was investigated. Although the relative binding to the two isoforms differed between patients, there was no association between these differences and clinical features such as relapse type, severity, onset age and ethnicity. The clinical and in vitro characteristics of AQP4-Ab negative NMO/NMOSD patients were studied. It was shown that these patients represent an aetiologically heterogeneous group. Some have other inflammatory and infectious disorders, some have low levels of AQP4-Ab and a significant proportion have antibodies to myelin oligodendrocyte glycoprotein (MOG-Ab). Others have antibodies that bind to neurons or oligodendrocytes in primary cultures. Attempts to identify novel antigens by immunocapture techniques were made, but were not successful. Patients with MOG-Ab showed differences when compared to those with AQP4-Ab including higher proportion of males, younger age at disease onset and greater likelihood of conus involvement on imaging. Additionally, patients with MOG-Ab appear to have more favourable outcomes, with better improvement from the onset attack and a lower probability of subsequent relapses. In conclusion, the work in this thesis has shown that AQP4-Ab disease is not synonymous with the term NMO and that seronegative NMO/NMOSD patients represent a clinically and aetiologically heterogeneous group and should therefore be classed separately from those with AQP4-Ab.
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Zhuang, Wenjie. "Query Expansion Study for Clinical Decision Support." Thesis, Virginia Tech, 2018. http://hdl.handle.net/10919/82068.
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Information retrieval is widely used for retrieving relevant information among a variety of data, such as text documents, images, audio and videos. Since the first medical batch retrieval system was developed in mid 1960s, significant research efforts have focused on applying information retrieval to medical data. However, despite the vast developments in medical information retrieval and accompanying technologies, the actual promise of this area remains unfulfilled due to properties of medical data and the huge volume of medical literature.
Specifically, the recall and precision of the selected dataset from the TREC clinical decision support track are low. The overriding objective of this thesis is to improve the performance of information retrieval techniques applied to biomedical text documents. We have focused on improving recall and precision among the top retrieved results. To that end, we have removed redundant words, and then expanded queries by adding MeSH terms in TREC CDS topics. We have also used other external data sources and domain knowledge to implement the expansion. In addition, we have also considered using the doc2vec model to optimize retrieval. Finally, we have applied learning to rank which sorts documents based on relevance and put relevant documents in front of irrelevant documents, so as to return the relevant retrieved data on the top. We have discovered that queries, expanded with external data sources and domain knowledge, perform better than applying the TREC topic information directly.Master of Science
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Harker, Emil F. "Clinical Homework Directives: A Qualitative Exploratory Study." DigitalCommons@USU, 2000. https://digitalcommons.usu.edu/etd/2717.
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A qualitative study was conducted to better understand how marriage and family therapists use homework directives in their work with couples. Eleven therapists of different marital therapy orientations were interviewed. Remarkably, all of the therapists reported using clinical homework directives in their practice with couples, including those clinicians who primarily identify themselves with psychodynamic models- -models that do not typically include homework in their constructs. Four themes emerged as to why homework is given: (a) to augment or extend the therapy session outside of therapy, (b) to help the clients focus on the therapy process between session, (c) to assess client problems or dynamics for the therapist and the client, and (d) to communicate clients' responsibility for change. Themes concerning the types of homework clients used are (a) behavioral--specific physical actions to do between sessions; (b) communication exercises; (c) writing assignments; and (d) combinations of behaviors, communication exercises, or writing assignments. Results also indicate that most of the therapists in the study subscribe to more than one model of therapy in their clinical work with couples.
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Kotimäki, J. (Jouko). "Meniere's disease in Finland:an epidemiological and clinical study on occurrence, clinical picture and policy." Doctoral thesis, University of Oulu, 2003. http://urn.fi/urn:isbn:9514271130.
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Abstract
The symptom complex originating from the inner ear, known as Meniere's disease, was studied especially from the epidemiologic point of view. A total of 442 patients' charts were retrospectively analysed in several hospital districts of Finland. The period of 1992-1996 was covered. The main focus was on the epidemiological assessment of the disease in Finland. To clarify the epidemiological figures, the validity of the diagnostic assessment was examined using the latest guidelines (1995) of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) as a gold standard.
The diagnostic tools used in the different hospitals were documented and evaluated, and diagnostic accuracy at the different levels of the health care system was evaluated. The clinical picture of Meniere's disease was characterised, and the therapeutic modalities used were evaluated. The audiometric configurations were classified according to two principles. The prognosis of hearing impairment was specified by creating a multivariable model.
Half of the patients (N = 221) fulfilled the AAO-HNS criteria for definite disease. The prevalence and incidence of definite cases of Meniere's disease appeared to be lower in Finland than could be expected based on previous international studies. A prevalence of at least 43 per 100,000 and an average annual incidence of 4.3 per 100,000 were obtained. The prevalence rates in the catchment areas of the university and central hospitals did not differ statistically, but a significant (p < 0.001) difference was found between the average prevalences in the northern and southern Finnish hospital districts.
Fluctuation of hearing in repeated audiometric measurements appeared to be a highly sensitive (94%) diagnostic test to detect definite Meniere's disease. According to the multivariable model created in this study, the hearing impairment in Meniere's disease affects equally males and females, and the deterioration is about 1 dB per year due to the duration of the disease and 0.5 dB per year due to aging. The disease was controlled conservatively in 69% of the cases. A gently sloping high-frequency audiometric pattern was most prevalent according to the EU Work Group classification and a flat pattern according to the mid-frequency-based classification.
The variability of diagnostic criteria, diagnostic tools and therapeutic modalities shows an evident need for up-to-date therapy recommendations for Meniere's disease in Finland.
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Cash, Penelope Anne, and mikewood@deakin edu au. "Women clinical nurses' constructions of collegiality: An ethnomethodological study." Deakin University. School of Nursing, 2000. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20051123.122031.
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This research is about a shared journey of being together. It involved thirteen women nurses (including myself) in a process approach to working with data collected through audio transcriptions of conversations during group get-togethers, field notes and journalling over twelve months. The project was conducted in a large acute care metropolitan hospital where the ward staff interests lie in a practice history of the medical specialty of gynaecology and women's health.
Prior to commencement ethical approval was gained from both the University and hospital ethics committees. Accessing the group was complicated by the political climate of the hospital, possibly exaggerated further by the health politics across the state of Victoria, at a time of major upheaval characterised by regionalism, rationalisation and debt servicing.
In order to ascertain women clinical nurses' constructions of collegiality I adopted an ethnomethodological approach informed by a critical feminist lens to enable the participants to engage in a process of openly ideological inquiry, in critiquing and transforming practice. I felt the choice of methodology had to be consistent with my own ideological position to enable me to be myself (as much as I could) during the project. I wanted to work with women to illuminate the ways in which dominant ideologies had come to be apprehended, inscribed, embodied and/or resisted in the everyday intersubjective realities of participants. The research itself became a site of resistance as the group became aware of how and in what ways their lives had become distorted, while at the same time it collaboratively transformed their individual and collective practice understandings, enabling them to see the self and other anew.
Set against the background of dominant discourses on collegiality, women's understandings of collegiality have remained a submerged discourse. Revealed in this work are complex inter-relationships that might be described by some as collegial!, but for others relations amongst these women depict alternative meanings in a rich picture of the fabric of ward life. The participants understand these relations through a connectedness that has empathy as its starting point.
In keeping with my commitment to engage with these women I endeavoured to remain faithful to the dialogical approach to this inquiry. Moreover I have brought the voices of the women to the foreground, peeling away the rhizomatic interconnections in and between understandings. What this has meant in terms of the thesis is that the work has become artificially distanced for the purposes of academic requirements. Nevertheless it speaks to the understandings the participants have of their relationships; of the various locations of the visible and invisible voices; of the many landscapes and images, genealogies, subjectivities and multiple selves that inform the selves with(in) others and being-in-relation. Throughout the journey meanings are revealed, revisited and reconstructed. Many nuances comprise the subtexts illuminating the depths of various moral locations underpinning the ways these women engage with one another in practice. The process of the research weaves through multiple positions, conveying the centrality of shared goals, multiple identities, resistances and differences which contribute to a holding environment, a location in which women value one another in their being-in-relation and in which they stand separately yet together.
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Ajayi, A. A. L. "Clinical and pharmacological studies on angiotensin-I-converting enzyme inhibitors." Thesis, University of Glasgow, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.374510.
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Nugent, Lynn Louise Bartlett. "Factors influencing implementation of innovations in clinical nursing education." Diss., The University of Arizona, 1992. http://hdl.handle.net/10150/185822.
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The purposes of this study were to determine whether associate degree nursing (ADN) programs were implementing innovations in their clinical curricula, to identify recent clinical innovations in these nursing programs, and to identify attributes of innovations that influence innovation adoption. Data were obtained from two questionnaires to all directors of ADN programs in six southwestern states. The first questionnaire asked respondents to identify clinical innovations they had considered recently. The second questionnaire used a Likert Scale to seek respondents' perception of six attributes of innovations--Relative Advantage, Compatibility, Complexity, Observability, Trialability, and Cost--that come from diffusion theory. Analysis of data indicated that 77% of the respondents had implemented changes in their clinical curriculum during the past six years. The most frequently implemented innovations were computer assisted instruction, preceptorship experiences, clinical competency exams, initiating or increasing use of skills labs, and workstudy/externship experiences. Likert Scale values for perceptions of the six attributes, along with a variable created to represent the influence of the Environment, were analyzed by principal component analysis and logistic regression analysis. These analyses led to the conclusion that no one or two variables can be used to predict adoption of an innovation. Instead, a model with each of the attributes should be used in predicting adoption. These findings generally supported the model provided by diffusion theory. However, the influence of Trialability was negligible. Additionally, the Environment variable was found to be an important influence in a favorable adoption decision. Nursing program directors who seek to implement innovations could enhance successful implementation by emphasizing the positive aspects of all attributes of a proposed innovation.
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Latham, Linda Ann. "Clinical governance : a study of implementation : a study of change." Thesis, University of Birmingham, 2003. http://etheses.bham.ac.uk//id/eprint/291/.
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The concept of clinical governance was first introduced to the National Health Service in the White Paper published in 1997 (Department of Health); it has been described as the 'linchpin' of the quality reforms and, as of April 1999, is one of the statutory duties placed on NHS Trust Boards. Clinical governance is defined as: 'A framework through which NHS organisations are accountable for continuously improving the quality if their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.' (Department of Health, 1998; p33). The research project upon which this thesis is based took place over an 18 month period and has followed one NHS Trust as it implemented this new policy. Implementation may be conceptualised as both a change process and an end state; to capture this duality, two broad research questions are posed namely: what constitutes the local clinical governance agenda (content) and how has clinical governance been implemented (process). Given that the main purpose of these research questions is to explore and describe, an overarching qualitative framework has been adopted and, within this, an action research approach utilised
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Makani, Julie. "Defining the clinical spectrum of sickle cell disease in Tanzania : a clinico-epidemiological study." Thesis, Open University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.545678.
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Roberts, Kirsten Colleen. "A validity and reliability study of the objective structured clinical examination /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/7727.
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Liu, Yifen. "Clinical study on apolipoprotein E distribution, metabolism and glycation." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/clinical-study-on-apolipoprotein-e-distribution-metabolism-and-glycation(eb78d989-b218-437d-83da-c357b713680f).html.
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Apolipoproteins have important roles in the transport of lipids and the regulation of lipoprotein metabolism as cofactors for enzymes and ligands for receptor-binding. Their function and metabolism are closely related to the development of many diseases. This dissertation describes the investigation of the distribution and metabolism of apoE and glycated apoE in diabetes, obesity and hyperlipidaemia in comparison with healthy people. In order to carry out the research, I developed several robust laboratory methods and techniques for the isolation and measurement of apoE and glycated apoE. These included (1) a modified in-house ultracentrifugation for isolation of lipoprotein fractions (2) high sensitivity sandwich enzyme-linked immunosorbent assay (ELISA) for apoE and (3) m-aminophenylboronate affinity chromatography for the separation of glycated and non- glycated apoE.In healthy people the apoE concentration in different lipoprotein fractions is influenced by age, gender and apoE genotype. The effect of atorvastatin on serum apoE concentration in patients with type 2 diabetes with nephropathy was dependent on the dose of atorvastatin and apoE genotype and was strongly correlated with the reduction in triglycerides (TG) in very low density lipoprotein (VLDL).The effect of bariatric surgery on obese patients with and without diabetes demonstrated that after bariatric surgery, VLDL-apoE increased and apoE in low density lipoprotein (LDL), high density lipoprotein (HDL) and d>1.21g/ml fractions decreased; both glycated LDL-apoE and glycated HDL-apoE decreased. Total apoE and glycated apoE concentrations in plasma decreased to levels comparable to those of healthy controls. However, the distribution within the lipoprotein fractions was very different. The effect of niacin/laropiprant (LRPT) on lipoproteins in hyperlipidaemia patients was assessed in a blind crossover trial. Niacin/LRPT slightly decreased VLDL-apoE and LDL-apoE. It had no effect on apoE in HDL. Glycated apoE did not change in hyperlipidaemia. These results show that, compared with healthy people, the apoE distribution in obese and hyperlipidaemia patients is abnormal despite no change in total apoE concentration in some cases. The results also demonstrate that glycated apoE originates preferentially from VLDL. Various mechanisms for these results and relationships with other lipids are discussed. Furthermore, I suggest several potential directions, especially in vitro, for further research on apoE function and metabolism.
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McNaught, Janet ??? "A clinical and archaeological study of Schmorl’s nodes : using clinical data to understand the past." Thesis, Durham University, 2006. http://etheses.dur.ac.uk/2689/.
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This study of Schmorl 's nodes in British populations past and present attempts to reach a better understanding of the origins and aetiology of Schmorl' s nodes and their impact upon the vertebral column in relation to age, sex, pre-existing skeletal lower limb asymmetry, and work patterns. Georg Schmorl has been accepted as the leading authority on the nodes he named. Eighty years later modem diagnostic radiographic imaging and macroscopic studies are used to reach informed answers to the questions of prevalence, relationship to other degenerative joint diseases of the spine, and the possibility of Schmorl's node recognition by clinicians when presented with specific pain location. The clinical samples studied were from Pinderfields Hospital, Wakefield, and the Royal Hospital for Sick Children, Edinburgh. The archaeological samples studied were from Captain's Cabin, Dunbar, The Hirsel, Coldstream and Whithom Priory, Galloway, all in Scotland, and St. Andrew, Fishergate, York, and Tanners Row, Pontefract in England, and dated to between the 6th and 16th centuries AD. The archaeological samples were from military and monastic settlements in urban and rural contexts. Congenital disorders and acute trauma affecting the spine, and alterations to the normal primary and secondary vertebral curves were studied in an attempt to prove or disprove a relationship to Schmorl's nodes. Macroscopic study of the vertebral columns from the archaeological samples, and radiographs of the clinical samples, were analysed, along with clinical case histories and known background information of the demography, settlement type and, the geographic and topographic locations for each sample. No weak area was found in the vertebral end plate. Positive proof for symptomatic Schmorl's nodes was found in the clinical samples. The greatest numbers of Schmorl' s nodes were not formed in the first two decades of life, but in the third and fourth decades. Scheuermann's disease may be indirectly attributable to subadult Schmorl's nodes. However, Schmorl's nodes may or may not precede scoliosis. Males and females Of similar ages from the same settlements did not produce. Similar frequencies, nor were similar patterns observed between samples. Further studies using larger and better-preserved samples, with good contextual evidence may help to provide clearer positive or, negative evidence for work related Schmorl's nodes.
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Mkwebu, Tribe. "Clinical pedagogy : a systematic review of factors influential in the establishment and sustainability of clinical programmes and a grounded theory explication of a clinical legal education case study in Zimbabwe." Thesis, Northumbria University, 2016. http://nrl.northumbria.ac.uk/33653/.
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Background/purpose: This thesis investigates the factors that have been influential in either promoting or impeding the establishment and sustainability of clinical legal education in Zimbabwe (Mkwebu, 2015; 2016). Previous work on clinical legal education in other jurisdictions suggest that clinical programmes within law schools can help law students gain practical lawyering skills essential for legal practice. Literature suggests that law clinics have the potential to provide a platform upon which indigent members of the community can access free legal advice. However, the cost of running clinical programmes has been found, amongst others, to be the most influential factor inhibiting the creation and expansion of clinical legal education. Prior to this doctoral study, there had never been any comprehensive study carried out to investigate clinical activity in Zimbabwe. The purpose of this study was to test the hypothesis that, amongst other factors, the resource-intensive nature of clinical legal education is the highly influential factor in the establishment and sustainability of clinical programmes within law schools. Research methodology: The researcher adopted a systematic search strategy through the review question: What factors have been influential in the establishment and sustainability of clinical legal education? The search strategy undertaken between January 2014 and April 2014 resulted in the selection of a batch of 91 journal articles. Articles were analysed using a grounded theory coding system that identified several factors as having been influential in the establishment and sustainability of clinical programmes in other jurisdictions. To gain theoretical sensitivity in the field, the various factors identified from literature generated questions for exploration during fieldwork. Fieldwork commenced in Zimbabwe in May 2015 and lasted for three weeks. The legal aid clinic at Case A has a complement of five members of staff and they all participated in an audio-taped interview process. Transcripts were analysed using grounded theory. Results and Discussion: An analysis of the selected clinical scholarship identified 20 influential factors. Grounded in the data collected from Zimbabwe were 25 factors that have been influential in either promoting or inhibiting the expansion of clinical legal education at Case A. In general, the identified factors were broadly similar to the various factors identified from the systematic review undertaken before fieldwork commenced. However, the differential impact of factors in the Zimbabwean context was revealed, suggesting a more complex model. Conclusions: Firstly, the research findings support the notion that a systematic review is a method with benefits and could be used effectively in the field. Secondly, establishment and sustainability factors have been identified from the systematic review and from the data collected in Zimbabwe. Thirdly, the importance of the local context in the operation of these factors has been verified. Fourthly, sustainability is fragile and the researcher offers a series of recommendations drawn from literature. Developing receptivity to ideas from other interested stakeholders may be helped by adopting a robust institution-stakeholder partnership that fosters collaboration of ideas for sustainability as a framework.
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Kazemekas, Lynn M. "The Development of instructional strategies by clinical medical school faculty." Diss., Virginia Tech, 1991. http://hdl.handle.net/10919/37230.
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This study described the instructional practices of selected clinical medical school faculty. It addressed the following questions:
- how do medical and surgical clinical faculty select/design and combine instructional methods and media in teaching clinical content?
- what influences clinical faculty use of a particular method or medium for clinical teaching?
The primary purpose of this research was to investigate how clinical medical school faculty make pedagogical decisions and carry out their instruction in clinical patient care settings. The research described the clinical faculty members' instructional practices with medical students and how the medical apprenticeship system is used for their clinical instruction.
The research involved two medical schools and a sample of four clinical faculty representing surgical and medical practice. A general method of descriptive research was employed including the data-gathering techniques of participant observation, interviewing, and collection of documents. Strategies developed by Spradley (1980) and Erickson (1986) were used for data analysis.
Findings indicated that the sample clinical faculty do not use an instructional planning process such as described by Gagne and Briggs (1979) or Wildman and Burton (1981). Instead, they select instructional methods and media intuitively, carefully monitoring the medical students' reactions to their instruction. The data show the instructional techniques that include the human element -- defined here as personcentered methods -- are selected most often.Ed. D.
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Alenius, Gerd-Marie. "A Clinical and Genetic Study of Psoriatic Arthritis." Doctoral thesis, Umeå universitet, Reumatologi, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-78.
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Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. PsA has a heterogeneous pattern, expressed by different manifestations such as mild mono-oligoarthritis or very severe, erosive and destructive polyarthritis. Measurable inflammatory activity is not always prominent. The aetiology is unknown but genetic factors are believed to be of importance. The pattern of inheritance is proposed to be polygenic. The aim of this study was to estimate the prevalence of joint and axial manifestations, characterise the disease in relation to inflammatory and genetic markers, and to identify disease susceptibility gene(s) for PsA in patients from northern Sweden. All patients from the city of Umeå (n=276), selected from a community and hospital based psoriasis register (n=1737) at the Dept of Dermatology, were invited to a prevalence study. Two hundred-two patients were examined and 97 (48%) had inflammatory manifestations such as peripheral arthritis, axial disease, undifferentiated spondylarthropathy (uSpA) and enthesopathies. Of the 67 patients (33 %) with peripheral arthritis and/or axial disease, 30 were not previously diagnosed. The association of clinical manifestations and potential markers of aggressive joint disease with HLA associations were analysed in 88 patients with PsA. We were not able to confirm findings of other groups reporting strong association with several HLA-antigens. The prevalence of HLA-B17, B37 and B62 was increased compared with controls, but the strongest predictive factors among our patients for an aggressive disease, in a multiple logistic analysis, were polyarthritic disease and distal interphalangeal engagement. In order to investigate for disease susceptibility genes, five genetic loci were analysed with microsatellites and single nucleotide polymorphisms in an association study of 120 patients with PsA. There was a significant association with the TNFB locus on chromosome 6p but not with any other loci examined; 1q21 (PSORS4), 3q21 (PSORS5), 8q24 and CTLA4. When stratifying for the TNFB alleles the association was confined to allele 123. In a subgroup of patients who were HLA-typed (n=83), we were not able to verify linkage disequilibrium with the TNFB allele 123 and the HLA antigens; B17, B27, B37, B62 or Cw*0602. The presence of renal abnormalities was evaluated as a manifestation of systemic inflammation in 73 patients with PsA. Renal abnormalities defined as decreased creatinine-clearance (≤ mean - 2SD) and/or urinary albumin >25 mg/24 h was found in 23% of the patients. The predictive factors for renal abnormalities was inflammatory activity (ESR > 25 mm/h and/or CRP >15 mg/L) indicating a systemic effect in some of the patients. In conclusion, we found high prevalence of inflammatory manifestations in patients with psoriasis. There was no strong association between PsA and HLA antigens and predictive factors for aggressive disease were polyarthritic disease and DIP joint engagement. The TNFB locus was associated with PsA and there were no linkage disequilibrium with the HLA antigens B17, B27, B62 or Cw*0602. There were evidence for systemic effects as renal abnormalities in patients with PsA and measurable inflammatory activity.
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Burstedt, Marie. "Bothnia dystrophy, a clinical, genetical and electrophysiological study." Doctoral thesis, Umeå universitet, Oftalmiatrik, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-179.
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A high frequency of retinitis pigmentosa (RP) is found in Northern Sweden. In an inventory of autosomal recessive RP patients in Västerbotten County, a great number of cases with a unique phenotype was noticed, denoted Bothnia Dystrophy (BD). The aim of the study was to describe the phenotype, to determine the chromosomal location, and to identify the gene. Patients typically show night blindness from early childhood. Symptoms of defect macular function with a decrease of visual acuity can appear in early adulthood. The retinal fundus shows irregular white spots in a central, and parafoveal pattern along the arcades. Centrally areolar maculopathy develops and round circular atrophies are observed in the periphery. The disease was shown to be associated with a missense mutation in the RLBP1 gene resulting in an amino acid substitution (R234W) in the cellular retinaldehyde-binding protein (CRALBP). The R234W mutation was found in a homozygous state in 61 patients affected with BD. Ten patients were heterozygous for the R234W mutation, and presented a similar phenotype. No additional mutations in the coding sequence or exon-intron junctions were found. CRALBP is localised in retinal pigment epithelium (RPE), and Müller cells of the retina. In the RPE, CRALBP functions as a carrier protein for endogenous retinoids. Dark adaptometry and electrophysiologic testing showed an initial loss of rod function followed by a progressive reduction of the cone responses in older ages. A compromised rod function, dysfunction of the Müller cells, and indications of a disturbed function of the inner retina were found. With prolonged dark adaptation, a gradual increase in retinal sensitivity to light and an improvement of the ERG components occurred. The findings indicate a prolonged synthesis of photopigments, retardation of the visual process in the retinal pigment epithelium and a loss of retinal cells probably starting at a relative early age in BD. To evaluate the subjective visual function in BD patients, a battery of objective tests of visual function and composite score of the 25-item NEI-Visual Function Questionnaire (VFQ-25) were analyzed. We found that weighted distance logMAR visual acuity (WVA), had the strongest association with subjective visual function, and that there was a considerable loss of subjective and objective visual function with increasing age in BD patients. The prevalence of BD is as high as 1:3600 in Västerbotten County. The possibility that recycling of retinoids localized in the RPE might be impaired in BD might give future therapeutic possibilities. Due to the large and clinically well-characterized set of patients with this disease, they constitute a suitable study group.
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Lima, Denio. "A clinical study of psychogenic pain in children." Thesis, Imperial College London, 1995. http://hdl.handle.net/10044/1/7375.
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Pang, Kian Tiong. "A laboratory and clinical study on vitreous fluorophotometry." Thesis, University of British Columbia, 1986. http://hdl.handle.net/2429/26022.
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The optical, electronic sensoring and data acquisition systems were assembled and the software developed for a vitreous fluorophoto-meter which was then calibrated and used to quantify the integrity of the blood-retinal barrier in a pilot study of diabetic retinopathy and multiple sclerosis compared to normal controls.
Breakdown of the blood-retinal barrier was quantified by measuring fluorescence in the vitreous at standard time intervals over one hour following intravenous injection of sodium fluorescein. The plasma dye concentration was measured throughout the procedure. Leakage was expressed as a penetration ratio of the average concentration at 3mm from the retina to the total plasma dye concentration.
The results from diabetic subjects showing well defined stages of retinopathy severity demonstrated the proper functioning of the instrument by showing values in approximate agreement with retinopathy severity, thus confirming the findings of previous observers.
Of 16 multiple sclerosis subjects, results showed no significant difference between activity categories or level of current activity. Abnormally high penetration ratio was associated with active periphlebitis. A new finding was the presence of abnormally high leakage in 2 subjects showing no ocular signs of disease. Subjects without or with inactive periphlebitis showed breakdown of the blood-retinal barrier comparable in severity to diabetic subjects showing no or mild retinopathy. The vitreous diffusion constant of the dye for normal controls and multiple sclerosis subjects was not significantly different from that in water.Science, Faculty of
Physics and Astronomy, Department of
Graduate
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Woodley, Stephanie Jane, and n/a. "Lateral hip pain : an anatomical and clinical study." University of Otago. Department of Anatomy & Structural Biology, 2006. http://adt.otago.ac.nz./public/adt-NZDU20061206.162321.
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Lateral hip pain (LHP), characterised by non-specific symptoms in the region of the greater trochanter, is a condition frequently encountered by physiotherapists and other health professionals. However, the pathogenesis of LHP is not well understood. Although pathology of the gluteal tendons and their associated bursae have long been implicated in the cause of this problem, trochanteric bursitis has emerged as the primary clinical diagnosis. In order to determine a differential diagnosis, clinicians are reliant on information collated from the patient history and physical examination, yet the validity of many of the tests used to diagnose LHP has not been established. Abnormalities of the gluteal bursae may give rise to LHP and therefore to ensure precision of clinical assessment and treatment techniques, knowledge of bursal morphology is essential. However, a review of the literature revealed that there are no complete morphological accounts of all the bursae in this area. Therefore, the main purposes of this study were (a) to determine the morphology of the bursae associated with the greater trochanter and (b) to examine the physiotherapy and radiological diagnoses of LHP, and the validity of selected tests used in the diagnosis of LHP.
In the anatomical study, the bursae deep to each of the layered gluteal tendons were examined in 21 embalmed human hips (9 male, 12 female; mean age 79 years, SD 9.4 years) using macro-dissection and histological techniques. Morphological associations, size, positions and histological characteristics of the bursae were recorded. A total of 121 bursae were identified in ten different locations, with an average of six bursae per hip. Variation was evident, but it was typical that at least two bursae were found deep to gluteus maximus (GMax) and the fascia lata, and gluteus medius (GMed). In approximately two-thirds of specimens a single bursa was situated deep to the tendon of gluteus minimus (GMin). All of these bursae demonstrated a synovial lining, which was predominantly areolar in type. This study revealed that numerous bursae are intimately associated with the greater trochanter, and provides new morphological detail which is of significance when considering clinical and biomechanical models of LHP.
A clinical study was undertaken whereby 40 consecutive patients (37 female, 3 male; mean age 54.4 years, SD 9.5 years) with unilateral LHP were recruited prospectively. Each eligible participant underwent a standardised physiotherapy assessment followed by a magnetic resonance (MR) imaging study of the pelvis and both hips. The MR images were analysed in random order by three radiologists blinded to clinical findings and symptomatic side, and the intra-and inter-observer reliability for image analysis was examined using the kappa statistic. To determine the validity of selected clinical tests as evaluated against MR imaging, sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated, and the chi-squared test was used to determine association. As demonstrated by MR imaging, GMed tendon pathology, bursitis, osteoarthritis (OA) and gluteal muscle atrophy are all associated with the report of LHP. Interestingly, these various pathologies were identified in asymptomatic as well as symptomatic limbs. However, while bursitis was equally prevalent in symptomatic and asymptomatic hips, GMed tendon pathology and OA were observed more frequently on the symptomatic side. Furthermore, muscle atrophy which predominantly affected GMin, was specific to symptomatic hips.
Large variation was evident in the strength of agreement between radiologists and there was little agreement between physiotherapy and radiological diagnoses of pathology. Physiotherapists frequently diagnosed trochanteric bursitis as a cause of LHP and while palpation was identified as the most provocative test for reproducing patients complaint of LHP, it was not shown to be a valid technique. Instead, the outcomes pertaining to the validity of the clinical tests indicate that attention should be focused towards the assessment and treatment of gluteal tendon pathology. The two tests that appeared to be most useful for diagnosing gluteal tendon pathology were pain reproduction with passive hip abduction and resisted testing of GMed and GMin. While these findings demonstrate that various pathologies are associated with the report of LHP, they also highlight some problems associated with the use of MR imaging as a reference standard. Before further clinical validation studies of LHP are undertaken in larger populations, it is recommended that verification of MR imaging outcomes are performed against surgical and histological findings.
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Pottie, Robert George. "A CLINICAL STUDY OF INHALANT ANAESTHESIA IN DOGS." University of Sydney, 2004. http://hdl.handle.net/2123/559.
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A clinical trial was undertaken using three different inhalant anaesthetic agents and one intravenous anaesthetic agent in dogs undergoing routine desexing surgery. Healthy adult dogs undergoing either ovariohysterectomy or castration were assessed as to their demeanour, with the more excitable dogs being placed in groups receiving premedication with acepromazine and morphine. All dogs were then randomly assigned an anaesthetic agent for induction of general anaesthesia. The agents were the inhalants halothane, isoflurane and sevoflurane, and the intravenous agent propofol. Inhalant inductions were undertaken using a tight fitting mask attached to a standard anaesthetic machine with a rebreathing circuit, with the maximum dose of inhalant available from a standard vaporiser. Propofol inductions were undertaken via intravenous catheter. Dogs induced with propofol were randomly assigned one of the three inhalant agents for maintenance. Those induced by inhalant agent were maintained using the same agent. The surgical procedure was undertaken in standard fashion, as was recovery from anaesthesia. All dogs received the non-steroidal anti-inflammatory agent meloxicam. Data collection was divided into three stages: induction, maintenance, and recovery from anaesthesia. Variables measured at induction of anaesthesia were time to intubation, number of intubation attempts, tolerance of mask, quality of induction and quality of transfer to the maintenance stage. Standard variables for monitoring of anaesthesia were recorded throughout the maintenance of anaesthesia. Variables measured at recovery were time to righting, time to standing and quality of recovery. The mean time to intubation when using the newer inhalant sevoflurane (196.2 � 14.8sec, mean � SE) was not significantly different to that for halothane (221.4 � 14.0sec) or isoflurane (172.4 � 15.0sec). Time to intubation with isoflurane was significantly faster than with halothane. Mean time to intubation with propofol (85.4 � 7.7sec) was significantly faster than that for any of the three inhalants. Choice of inhalant had no effect on quality of induction. The use of premedication significantly improved the quality of induction. The use of propofol for induction likewise significantly improved the quality of induction. Standard cardiorespiratory variables measured during the maintenance phase of anaesthesia remained within normal clinical ranges for all three inhalants, and were therefore not further analysed. Choice of inhalant agent had no significant effect on the time to righting or standing in recovery. The use of propofol for induction had no effect on these variables. Animals placed in groups receiving premedication had significantly longer times to righting and standing. The oesophageal temperature at the end of the procedure had a significant effect on times to righting and standing, with lower temperatures contributing to slower recoveries. Independent of procedure time, male dogs had shorter times to righting than female dogs.
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Fisher, Andrea. "Niacin, aspirin and homocysteine interrelationships, a clinical study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0017/MQ47027.pdf.
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Boiten, Jelis. "Lacunar stroke a prospective clinical and radiological study /." Maastricht : Maastricht : Rijksuniversiteit Limburg ; University Library, Maastricht University [Host], 1991. http://arno.unimaas.nl/show.cgi?fid=5666.
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Kurvers, Henricus Anna Johannes Maria. "Reflex sympathetic dystrophy a clinical and experimental study /." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 1997. http://arno.unimaas.nl/show.cgi?fid=5817.
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Luijckx, Gert-Jan Reinier. "Lacunar brain infarcts a clinical and pathogenetical study /." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1995. http://arno.unimaas.nl/show.cgi?fid=7285.
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Uustal, Fornell Eva. "Pelvic floor dysfunction : a clinical and epidemiological study /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med822s.pdf.
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