Dissertations / Theses on the topic 'Clinical'
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Safari, Leila. "A clinical data analytics language (CliniDAL)." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/12858.
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This work aims to propose CliniDAL as a generic solution for a special purpose query language for Clinical Data Analytics, which can compute answers to any question that is answerable from a Clinical Information System (CIS), with a specific focus on addressing temporal issues in CISs. The research begins with the investigation of common questions in the clinical domain, which led to the definition of 6 classes of question and answer categories. A set of syntactic rules has been generated to support these query categories which enables direct question answering and supports answering research-oriented queries requiring data analytics functionalities. Also, a framework is proposed for scientific experimentation which resolves time-event dependencies in the queries. A free text search facility for string searching and semantic concept searching (using SNOMED-CT) is provided to enhance the results. In addition, a temporal model is proposed and integrated into CliniDAL which enables the use of natural language temporal expressions in query composition. A generic mapping algorithm is proposed using a similarity based top-k algorithm (accuracy of more than 84%), which automatically maps the query terms to the underlying data or schema of CISs with design models of ER, EAV or hybrid models of ER and EAV. Also, a generic translation algorithm is proposed to translate an initial text query to a set of SQL queries, mainly to resolve complexity of data extraction from CISs with an EAV model. The experimental results based on testing more than 270 clinical queries and 4 case studies reflect the capability of the language at creating the desired queries via the restricted natural language of the provided web-interface. So, it is not only much easier for naïve database users like clinicians to apply CliniDAL’s approach in comparison to an SQL approach, but also they do not need to have any knowledge of data or schema of the underlying CIS for the composition of queries.
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Schoeman, Tanya. "Clinical and clinico-pathological changes in feline babesiosis." Diss., Electronic thesis, 2001. http://upetd.up.ac.za/thesis/available/etd-03232005-133808/.
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Kumaran, Gireesh Churunal. "Pre-clinical and early clinical evaluation of GSAO." Thesis, University of Manchester, 2010. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:123698.
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Whiting, Michael Francis. "Learning in clinical contexts : clinical education in podiatry." Thesis, University of Sussex, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262305.
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Roberts, Brenda. "Clinical psychologists on clinical supervision : a Delphi survey." Thesis, Open University, 2000. http://oro.open.ac.uk/58077/.
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Background and aims In the context of historical tensions from different epistemologies and traditions, and contemporary needs for guidance and clarity, the DCP has noted `an emerging consensus' on the desirability for career long engagement in clinical supervision for clinical psychologists. The study attempts to measure this consensus and investigate current practices and beliefs. Design and participants A three-round Delphi survey was used, initially gathering semi-structured accounts of panelists' views and subsequently inviting more precise responses to a questionnaire derived from those accounts. The participants were 53 clinical psychologists, selected on the basis of their presumed interest or expertise in supervision. Measures Materials were developed for the study: - PPI collected personal and professional information, - DQI collected semi-structured accounts of opinions concerning various aspects of supervision, - DQ2 was a 62-item questionnaire derived from DQI material. Results Most panelists were both giving and receiving supervision. There was broad agreement on most issues, including the desirability of universal engagement in supervision for clinicians, the primacy of the supervisory relationship, the need for preparation for the roles of both supervisor and supervisee, and the necessity to identify supervision as an activity distinct from both management and therapy. In contrast there was little agreement on how supervision is most appropriately related to either management or therapy, nor on the relative importance of personal therapy and supervision in the training of competent therapists. Implications Most panelists were deeply engaged in both the provision and the receipt of supervision, which supports current DCP policies, but the culture is not yet strong enough to guarantee that all clinicians will he offered it routinely. More theoretical research is needed to develop models of supervision which will not assume that psychotherapy is its only legitimate focus, but will pay due heed to the wide range of tasks undertaken by both clinical psychologists and their supervisees.
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Schultz, Karen Kennedy. "What do Master Clinical (Experiential Teachers do When Teaching Clinically?" Diss., Virginia Tech, 2002. http://hdl.handle.net/10919/26957.
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An urgent need exists for balance between students learning the theory of clinical practice and becoming an expert. While theory is taught in the didactic setting, it is the experiential setting where the mastery of the clinical teacher is demonstrated. What does the master clinical teacher do that makes the studentâ s learning experience so significant? One must recognize the moment, capture the learning opportunity, and draw the student in so that learning can occur. Effective clinical teaching is paramount in creating empowered students and practitioners.
This qualitative case study of a doctoral pharmacy program identified two master clinical preceptors and shadowed one in a hospital and the other in a retail pharmacy. Interactions between clinical preceptors and students were captured through direct observation, audio-tape, and complemented with in-depth interviews. Content analysis identified emerging themes yielding an emerging model of master clinical teaching, illuminating teachable moments between student and clinical preceptor, and the manner in which they interacted with each other and the clinical environment.
The model highlights an approach for making the critical time on clinical rotations as effective as possible and offers a practical means to study interactions between students and preceptors, discerning those that lead to teachable moments. Features of the teachable moments are identified. Although expertise cannot be taught, current and future clinical teachers can use this study to improve their teaching and effectiveness in clinical teaching practice. The methodology of this study can be applied to future studies in the same discipline, other rotations, or other disciplines.
This study augmented the literature in qualitative research in pharmacy education for clinical practice by 1) utilizing a methodology that could be used in future studies 2) identifying features of teachable moments in the interactions of clinical preceptors and students 3) exploring how the clinical preceptors dealt with the changing environment of their clinical teaching 4) offering an emerging model to guide clinical preceptors for making the critical clinical teaching time as effective as possible.
Future studies could utilize this emerging model to gain further insight on clinical teaching practices thus increasing the expertise of clinical teaching.Ph. D.
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Taylor, Michael Dennis. "Prostate cancer clinical practice guidelines clinical and economic outcomes /." [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0010098.
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Thesis (Ph.D.)--University of Florida, 2005.Typescript. Title from title page of source document. Document formatted into pages; contains 99 pages. Includes Vita. Includes bibliographical references.
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Rodrigues, Clare Louise. "Physiologically-based Pharmacokinetic Modelling:Pre-clinical and Clinical Pharnmacokinetic Studies." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492740.
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Physiologically-based pharmacokinetic (PBPK) modelling is a computational technique which includes the anatomy and physiology of the study species (species-specific information), as well as the physicochemical properties of the study compound (compound-specific informafion). This data-rich situation confers many advantages on drug development and discovery, especially in the areas of extrapolation between species, route IS of administration and doses. However, it remains under-used in drug research. This thesis examines the applications of PBPK modelling in three different scenarios, in the light of recent developments in this field, in order to support its wider use in drug research in both preclinical and clinical areas.
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Dean, Emma. "Pre-clinical and clinical evaluation of apoptosis targeting drugs." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.616906.
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Lung cancer is the leading cause of cancer deaths amongst both men and women and is commonly divided into two histological groups, non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Despite advances in early diagnosis and treatment, chemotherapy provides poor response rates and rare complete remissions, warranting the development of novel therapeutic strategies. Evasion of apoptosis is a hallmark of cancer, allowing malignant cells to survive in hostile micro-environments and to resist chemotherapy with the potential for continued proliferation. This thesis evaluates four novel agents, primarily in lung cancer, in both the pre-clinical and early clinical settings which target key molecules involved in the regulation of apoptosis. Pre-clinical data for XAC 1396-11, a small molecule inhibitor of X-linked inhibitor of apoptosis protein (XIAP), showed induction of apoptotic cell death in a concentration- and time-dependent manner in NSCLC cells.
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Roche, Ayesha. "Considering ethnic diversity in clinical supervision and clinical practice." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/18011/.
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Cai, Yan. "Clinical and pre-clinical pharmacokinetics of green tea polyphenols." Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/280157.
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Tea consumption has been suggested to have beneficial effects for human health, especially in cancer prevention. At present, epidemiological evidence of the protective effect of tea consumption against the development of human cancer is not conclusive. Interpretation of epidemiological data and extrapolation of rodent data to humans are generally hampered by inadequate information on the bioavailability and pharmacokinetics of tea constituents. We have performed studies to determine the pharmacokinetics of green tea in humans after single and multiple oral dose administration of tea polyphenols and the contribution of hepatic first-pass elimination to the low oral bioavailability of green tea catechins in animals. EGCG was present in the systemic blood in the unchanged form in humans after oral administration of two green tea polyphenol products, EGCG and Polyphenon E (a mixture of major green tea polyphenols). Oral administration of EGCG and Polyphenon E resulted in similar systemic exposure of EGCG. EGC and EC were present in glucuronic acid/sulfate conjugates in blood and urine samples after the Polyphenon E administration. Large inter-subject variations in the systemic levels of green tea catechins were observed following oral administration of green tea polyphenols. We found that it is safe for healthy human subjects to take green tea polyphenols for four weeks in amounts equivalent to those contained in 8 to 16 cups of green tea once a day or in divided doses twice a day. Systemic availability of EGCG increased more than 60% after chronic green tea polyphenol administration at high doses once a day. Oral administration of green tea polyphenols at the selected doses and dosing schedules did not elicit overall changes in the selected pharmacodynamic measurements. Oral bioavailability of green tea catechins was demonstrated to be low in animals and possibly in humans. Based on our pre-clinical study, we found that first-pass hepatic elimination of green tea catechins didn't play a significant role in the presystemic elimination of orally administered catechins. Factors within the gastrointestinal tract such as limited membrane permeability, transporter mediated intestinal secretion, or gut wall metabolism may contribute more significantly to the low oral bioavailability of green tea catechins.
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Desrosiers, Sarah. "Facilitating critical thinking and clinical judgment in clinical nursing education." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63873.
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Nurses who can critically think and make clinical judgments in the clinical setting are crucial to safe and effective nursing care. This type of critical thinking and clinical judgment is best developed during clinical education, which provides students with the opportunity to bridge the theory to practice gap. Clinical instructors guide students’ development of critical thinking and clinical judgment in the clinical setting. Despite clinical instructors having such a significant impact on critical thinking and clinical judgment there is limited research on how they facilitate students’ development of critical thinking and clinical judgment.
This qualitative analysis explored how clinical instructors facilitate the development of critical thinking and clinical judgment of nursing students. This study used interpretive description to analyze interviews with eight clinical instructors to develop themes and subthemes within the data. These themes were discussed in relation to definitions of critical thinking and clinical judgment, indicators for evaluation, clinical teaching strategies, and contextual facilitators and barriers.
Clinical instructors who took part in this study defined the concept of critical thinking as : The process that leads to clinical judgment, the decision. Evaluation was based on broad indicators of patient safety, effective communication, students’ confidence in their ability to critically think and make clinical decisions, and taking ownership of their patient care. Clinical instructors identified a variety of clinical teaching methods that they adapted and individualized to specific student needs. Clinical instructors also use multiple strategies to meet student needs, which they then adapt for each cohort. Contextual factors also impact students’ development of critical thinking and clinical judgment such as buddy nurses, the school of nursing curriculum, clinical ]instructors, and the nursing student themselves.
This study identified suggestions for curriculum development, clinical instructor development, and potential areas for future research in relation to clinical education. Clinical instructors are key components of nursing education and the development of critical thinking and clinical judgment in nursing students; as such, it is important to understand their perspectives on how they develop these student abilities.Applied Science, Faculty of
Nursing, School of
Graduate
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Malan, Jeffrey R. "Characteristics of women with clinical and non-clinical panic disorder." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0013/NQ52429.pdf.
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Jones, Simon R. "Cognitive mechanisms associated with clinical and non-clinical psychotic experiences." Thesis, Durham University, 2009. http://etheses.dur.ac.uk/2053/.
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The studies reported in this thesis were designed to address several important issues in symptom-specific cognitive models of psychosis. The design of these studies was guided by a commitment to the continuity hypothesis of psychosis, which holds that psychotic experiences exist on a continuum stretching into the healthy population. The thesis firstly examines a two-factor cognitive model of persecutory ideation, focusing primarily on the roles of thought suppression, intrusive thoughts, anxiety, social rank, and the jumping to conclusions bias. The thesis then turns to an examination of cognitive factors involved in hallucinations and, in particular, auditory verbal hallucinations. Chapters in this section describe a series of experimental and theoretical studies of the relations between intrusive thoughts and hallucinations, agency and hallucinations, and the role of inner speech in auditory verbal hallucinations. Two-factor models of persecutory delusion (PD) formation propose that in the first stage of PD formation an initial implausible idea is triggered. The second stage of Deformation is then the uncritical adoption of such a thought as a belief, which may be due to cognitive biases such as the jumping to conclusions (JTC) bias often present in those with PDs. The first study (Chapter 1) investigated whether thought suppression, and its interaction with anxiety, was associated with levels of non-clinical persecutory delusion like beliefs (PDLBs). It was hypothesised that thought suppression could play a role in the formation and maintenance of PDLBs through its tendency to lead to intrusive thoughts, and to trigger initial implausible ideas. Consistent with this proposal, thought suppression was positively associated with PDLBs only when anxiety was high. The second study (Chapter 2) examined a prediction of the two-factor model, namely that a second-stage factor, the jumping to conclusions (JTC) bias, should interact with first-stage factors, specifically social anxiety, social rank, anomalous experiences and thought suppression. Consistent with the two-factor model, the JTC bias was found not to be an independent predictor of PDLB levels, but its interaction with social rank was a significant predictor of PDLBs. It was concluded that although evidence was found for the two-factor model, the presence of the JTC bias was neither a sufficient nor necessary condition for PDLB formation. In addition to being postulated to play a role in persecutory delusion formation, intrusive thoughts have been implicated in the formation of hallucinations, and particularly auditory verbal hallucinations (AVHs). The third study (Chapter 3) created a new tool for assessing hypnagogic and hypnopompic (H&H) hallucinations, and showed that the presence of auditory H&H hallucinations, but not visual or felt-presence H&H hallucinations, was associated with a greater tendency to experience intrusions. The fourth study (Chapter 4) developed an extended model of AVHs in which rumination, as well as thought suppression, were proposed to be involved in the formation of AVHs, through their creation of intrusive thoughts. This model was tested in a healthy sample of individuals using structural equation modelling, and the proposed model was found to be a good fit to the data. The study on rumination and AVHs highlighted that agency disruption factors are likely to be involved in leading these self-generated cognitions to be experienced as alien. A theoretical analysis (Chapter 5) was made of the mechanisms likely to be involved in this disruption of agency, involving the concept of a neurocognitive action self-monitoring system (NASS) and a breakdown in the processes leading to the illusion of conscious will. A consideration was also given to how a Vygotskian conception of inner speech could contribute to inner speech models of AVHs. The next study (Chapter 6) then performed an empirical test of the proposal that the disruption of agency in AVHs is associated with a faulty NASS. Subliminal primes were used as a proxy for the predicted state proposed to exist in the NASS, which leads to the experience of agency. It was proposed that those prone to hallucinations would be less able to use primes to enhance their experience of agency, due to deficits in their NASS. A statistically significant trend was found for the more hallucination-prone to be less able to use subliminal primes, but this effect was only found in women. It was concluded that although this was a promising finding, the effect was too small and gender-specific to be practical to test in a clinical sample of patients with AVHs. The proposal that AVHs result from a breakdown in the NASS, specifically a corollary discharge deficit between speech production and reception areas, has been claimed to be supported by electrophysiological event-related potential (ERP) studies. However, only a simplistic conception of inner speech has thus far been investigated in ERP studies, and the potential confounding effects of attention have not been considered. The Nl ERP component response to auditory stimuli during inner speech was studied in as ample of healthy volunteers (Chapter 7). Although dampening of the Nl response was found during all types of inner speech, as compared to a silent baseline condition, dampening was also found during a mental rotation task. It was concluded that dampening of the Nl ERP component during inner speech is due to attention factors, and is not indicative of a corollary discharge mechanism. Finally, a theoretical analysis considers whether inner speech models of AVHs are able to satisfactorily account for the phenomenology of the experience (Chapter 8). It is concluded that subcategorisation of auditory hallucinations may be necessary, with memory-based, inner speech-based, and ictal-based models each accounting for a subcategory of auditory hallucinations. The concept of the dynamic developmental progression of AVHs is introduced and avenues for future research in this area highlighted
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Brown, Joanne. "Through the looking glass : clinical communication in the clinical workplace." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/10020802/.
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This qualitative study investigates the subject of Clinical Communication and how it is taught, learned and practised in one London Medical School and Hospital. It is informed by theoretical perspectives from workplace learning and in particular the theoretical construct of Recontextualisation. Five clinical communication teachers and five fourth year medical students took part in a series of semi structured interviews and ward observations over a period of four months. Teachers were interviewed about their teaching practice, they were asked to observe students in the clinical workplace and finally were asked to reflect upon whether these observations had informed their teaching practice. Students were interviewed about how they had learned and subsequently practised clinical communication in the clinical workplace. In total fifteen interviews and nine ward observations were carried out and nine reflective accounts were collected. Data from the interviews and observations were analysed using Responsive Interviewing Analysis. Results suggest that teachers wished to develop a more authentic and integrated teaching practice focused on the clinical workplace and wanted to go beyond the traditional notion of clinical communication as 'skills' based only. Students seemed able to apply the clinical communication skills they had been previously taught to the clinical workplace, but the patient centred philosophy underpinning these was lost and was also not reflected in the clinical workplace culture. Conceptually, the research shifts focus to the clinical workplace as the legitimate location for teaching and learning clinical communication and proposes a new and expanded way of understanding learning in this context. Significant implications for discussion are raised about the theoretical stance taken by the clinical communication community of practice and the way in which it understands and articulates fundamental beliefs about clinical communication.
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Farrica, Anabela de Jesus Prates. "Internship in clinical data management at a clinical research organization." Master's thesis, Universidade de Aveiro, 2015. http://hdl.handle.net/10773/15136.
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Mestrado em Biomedicina FarmacêuticaThe aim of this report is to describe the training activities carried out at the Data Management Sub-Unit of Eurotrials, Scientific Consultants, as part of the 2nd year of the Master’s Program in Pharmaceutical Medicine. This internship was focused on the development of skills and on gaining experience in Clinical Data Management activities. Over the course of this internship, I had the opportunity to build upon the knowledge obtained in the Bachelor’s Degree in Biomedical Sciences and in the Master’s Program in Pharmaceutical Medicine. Concepts, requirements and practices related to Clinical Data Management were explored and strengthened throghout. Furthermore, an unique perspective on the lifecycle of clinical research projects was obtained – that of a CRO. Besides the acquisition of theoretical knowledge, this training period was paramount for the development of a number of social and personal skills that contributed for my profissional growth within the host institution. This document begins by a description of the theoretical principles that set the ground for the Clinical Data Manager’s work. Then, the generic and specific training elements of the curricular training are detailed. After presenting my training activities, I discuss the various challenges I had to overcome during these 9 months. Finally, some personal remarks and conclusions are presented.
Este relatório tem como objetivo descrever as atividades de estágio realizadas na Unidade de Gestão de Dados da Eurotrials, Consultores Científicos, como parte do 2º ano do Mestrado em Biomedicina Farmacêutica. Este estágio focou-se no desenvolvimento de competências e obtenção de experiência em atividades de Gestão de Dados Clínicos. No decurso do estágio tive oportunidade de complementar o conhecimento obtido na Licenciatura em Ciências Biomédicas e no Mestrado em Biomedicina Farmacêutica. Foram aprofundados e explorados os conceitos, requisitos e práticas inerentes à Gestão de Dados Clínicos e obteve-se uma visão única do ciclo de vida de um projeto de investigação clínica – a de uma CRO. Para além da aquisição de conhecimentos teóricos, este período de estágio foi fundamental para o desenvolvimento de um conjunto de aptidões sociais e pessoais que contribuíram para o meu crescimento profissional dentro da instituição de acolhimento. O presente documento começa por expôr os príncipios teóricos que servem de base à atividade do Gestor de Dados Clínicos. Seguidamente, são detalhados os componentes genéricos e específicos de treino adquiridos durante o período de estágio. Depois da apresentação das atividades de estágio, são discutidos os vários desafios enfrentados e é feito um balanço pessoal desta experiência.
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Peterson, Colleen Margaret. "Couple Cohesion: Differences Between Clinical and Non-Clinical Mormon Couples." Diss., CLICK HERE for online access, 1988. http://patriot.lib.byu.edu/u?/MTNZ,10566.
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Butler, Karen Lee. "Impulsivity and risk-taking in clinical and non-clinical populations." Thesis, University of Greenwich, 2002. http://gala.gre.ac.uk/8727/.
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Various aspects of impulsivity, including risk-taking, were investigated by comparing the responses of control groups with those of three populations that were believed to exhibit problems with impulse regulation: those with eating disorders, attention deficit hyperactivity disorder (ADHD) and recreational drug users. Impulsivity was regarded as a multi-dimensional construct, tests were selected or developed to tap into various aspects of impulsivity, including self-report questionnaires, a novel discrete trials delayed reinforcement operant choice paradigm, a novel measure of financial risk-taking, and the continuous performance test which provides measures of both inattention and impulsivity. These tests varied in their ability to discriminate between groups, and the correlations between measures, as in previous studies, were typically low and mostly non-significant. Findings supported the proposal that impulsivity is a multidimensional construct that must be assessed using a wide range of measures including self-report questionnaires and more objective behavioural measures. The profile of effects found in the three targeted groups supported the proposal that impulsivity manifests itself differently in different populations. Women with anorexia nervosa scored low on impulsiveness and venturesomeness, and demonstrated behavioural impulsivity. Recreational drug users scored high on impulsiveness, venturesomeness and risk-taking, whereas ADHD individuals were inattentive and scored high on impulsiveness and risk-taking taking, but not venturesomeness. Overall the findings highlight the complexity of the impulsivity concept and demonstrate the need to acknowledge its multi-dimensional nature by using a variety of tests to capture its variable expression. Whether impulsivity in particular groups reflects state or trait remains to be determined.
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Burwitz, Martin. "Integrated Clinical Pathways." Doctoral thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-226773.
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Against the background of increasing multidisciplinarity as well as the focus on quality, transparency and economic efficiency of medical services, clinical pathways (CPs) have been established as a promising tool at the organizational level in recent years. They are primarily intended to ensure an adequate description of the care processes and to manage the balance between best treatment practice and economic viability. CPs standardize the internal care services by explicating the institution-specific knowledge with regard to recommendations for action, service portfolio, organizational structures, infrastructure, etc. of a specific service provider.
The development of hospital information systems (HIS) has so far been characterized by an evolutionary development of modules in the field of laboratory, radiology, nursing and picture archiving systems as well as in the area of administrative systems. As one result of this development, the HIS usually comprises a heterogeneous network of software systems of different types and manufacturers. However, the actual control of patients by means of evidence-based processes and integration of CPs into HIS was not addressed until the recent years, when HIS manufacturers started developing modules for CP modeling and workflow support.
The objective of this thesis is to provide a holistic methodical support for the description of clinical pathways and their integration into a hospital information system to finally improve the compliance of daily care to standard process definitions. Therefore, conceptual models provide an adequate mean to describe and communicate complex matters in a comprehensible form as well as to configure IT systems due to their semi-formal nature.
Hence, a first research thread investigates the question, how clinical pathways can be described adequately using conceptual models. This results in an iterative design of adequate modeling languages for clinical pathways. A second research thread further investigates the question, how conceptual models of clinical pathways can be used to configure process-oriented application systems in health care. This thread therefore describes the design of a model-based method, that enables a consecutive transformation of CPs into technical (workflow) specifications, based on the principles of the Model-Driven Architecture.
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Bell, Ian Douglas, and ian bell@deakin edu au. "Improving clinical judgements." Deakin University. School of Psychology, 2003. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20070119.100737.
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This portfolio explored issues that are relevant to the judgements routinely made by clinical psychologists. The first chapter provides a theoretical overview of relevant issues. In this chapter, firstly, the debate over the relative merits of clinical and statistical approaches to clinical judgement (Meehl, 1954) is reviewed. It is noted that, although much of the empirical evidence supports the greater accuracy of statistical approaches to making judgements (where appropriate methods exist), they are rarely routinely used, and clinical approaches to making judgements continue to dominate in the majority of clinical settings. Secondly, common sources of errors in clinical judgement are reviewed. These include the misuse of cognitive heuristics, the presence of clinicians biases, the limitations to human information-processing capacities and the over-reliance on clinical interviews. Finally, some of the basic strategies that can be useful to clinicians in improving the accuracy of clinical judgement are described. These include undertaking advanced level training programs, using quality instruments and procedures, being wary of over-reliance on theories, adhering to the scientist-practitioner approach and being selective in the distribution of professional efforts and time. In the subsequent chapters these strategies are explored further through four clinical case studies. These cases were collected during the university placement program and they have been selected to illustrate some of the approaches as clinician may use in attempting to optimise the accuracy of judgements necessary in the context of clinical psychological practice. The final chapter provides a brief overview and discussion of these cases in relation to the issues identified in Chapter One,
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Karagiannis, Stefanos E. "Clinical stress echocardiography." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10524.
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Faramarzi, Oghani Sohrab. "Clinical laboratory optimization." Thesis, Lille 1, 2018. http://www.theses.fr/2018LIL1I072.
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Cette thèse porte sur l'optimisation de la conception et des décisions opérationnelles des laboratoires d'analyses médicales. Dans cette thèse, un outil d'aide à la décision comprenant des modèles mathématiques, un algorithme heuristique et un modèle de simulation personnalisé est développé pour aider les décideurs à résoudre les principaux problèmes stratégiques, tactiques et opérationnels en conception et gestion des opérations des laboratoires d'analyses médicales. Dans cette thèse, la sélection des machines et la disposition des instruments sont étudiées en tant que principaux problèmes stratégiques, le problème de configuration des analyseurs en tant que problème tactique et l’affectation, l’aliquotage et l'ordonnancement en tant que principaux problèmes opérationnels. Un modèle de simulation personnalisé et flexible est développé dans FlexSim pour étudier le laboratoire d'analyse médicale conçu à l'aide des résultats de modèles mathématiques et d'un algorithme de layout développés. Le modèle de simulation aide le concepteur à construire et à analyser un laboratoire complet en tenant compte de toutes les principales caractéristiques du système. Cet attribut de simulation permet d'analyser le comportement du système et de déterminer si le système conçu est efficace. Pour vérifier la validité du cadre proposé, les données extraites d’un cas réel sont utilisées. Les résultats de sortie scellent l'applicabilité et l'efficacité du cadre proposé ainsi que la compétence des techniques proposées pour traiter chaque problème d'optimisation. À notre connaissance, cette thèse est l’une des principales études sur l’optimisation des laboratoires d'analyses médicalesThis thesis focuses on the optimization of clinical laboratory design and operating decisions. In this thesis, a decision support tool including mathematical models, a heuristic algorithm and a customized simulation model is developed to aid decision makers for the main strategic, tactical and operational problems in clinical laboratory design and operations management. In this thesis, machine selection and facility layout are studied as the main strategic problems, analyzer configuration problem as the tactical problem, and assignment, aliquoting, and scheduling as the principal operational problems. A customized and flexible simulation model is developed in FlexSim to study the clinical laboratory designed through the outputs of developed mathematical models and layout algorithm. The simulation model helps the designer to construct and analyze a complete clinical laboratory taking into account all major features of the system. This simulation attribute provides the ability to scrutinize the system behaviour and to find out whether the designed system is efficient. Furthermore, simulation model can be fruitful to decide on scheduling, aliquoting and staffing problems through the evaluation of various scenarios proposed by decision maker for each of these problems. To verify the validity of the proposed framework, data extracted from a real case is used. The output results seal on the applicability and the efficiency of the proposed framework as well as competency of proposed techniques to deal with each optimization problem. To the best of our knowledge, this thesis is one of the leading studies on the optimization of clinical laboratories
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Cumming, Jonathan. "Clinical decision support." Thesis, Durham University, 2006. http://etheses.dur.ac.uk/1814/.
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Grynko, N. V. "Early clinical experience." Thesis, БДМУ, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/17029.
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Grynko, Natalia Valerianivna. "Early clinical experience." Thesis, ВДНЗ України "Буковинський державний медичний уніврситет", 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/14062.
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Lipp, Allyson. "Developing clinical effectiveness." Thesis, University of South Wales, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.494482.
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Jackson, Rebecca L. "Contextualized Risk Assessment in Clinical Practice: Utility of Actuarial, Clinical, and Structured Clinical Approaches to Predictions of Violence." Thesis, University of North Texas, 2004. https://digital.library.unt.edu/ark:/67531/metadc4603/.
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Assessing offenders' risk of future violent behavior continues to be an important yet controversial role of forensic psychologists. A key debate is the relative effectiveness of assessment methods. Specifically, actuarial methods (see Quinsey et al., 1998 for a review) have been compared and contrasted to clinical and structured clinical methods (see e.g. Hart, 1998; Webster et al., 1997). Proponents of each approach argue for its superiority, yet validity studies have made few formal comparisons. In advancing the available research, the present study examines systematically the type of forensic case (i.e., sexual violence versus nonsexual violence) and type of assessment method (i.e., actuarial, structured clinical, and unstructured clinical). As observed by Borum, Otto, and Golding (1993), forensic decision making can also be influenced by the presence of certain extraneous clinical data. To address these issues, psychologists and doctoral students attending the American Psychology Law Society conference were asked to make several ratings regarding the likelihood of future sexual and nonsexual violence based on data derived from actual defendants with known outcomes. Using a mixed factorial design, each of these assessment methods were investigated for its influence on decision-makers regarding likelihood of future violence and sexually violent predator commitments. Finally, the potentially biasing effects of victim impact statements on resultant decisions were also explored.
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Carvalheira, Ivana Magaly Lima Alencar. "Re-significando a ação clínica psicológica na assistência à criança queimada." Universidade Católica de Pernambuco, 2003. http://www.unicap.br/tede//tde_busca/arquivo.php?codArquivo=85.
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Considerando a experiência de aflição da criança queimada hospitalizada, buscou-se pensar, como maior propriedade, sobre os modelos assistenciais clínicos instituídos, disponibilizados no atendimento a sua demanda psicológica. Nessa perspectiva, ao pesquisar sobre o saber/fazer clínico psicológico, revelaram-se múltiplas atitudes, ações, intervenções, orientações, interpretações, possíveis e cabíveis, ao psicológico na relação/cuidado com o sujeito. Lançando como profissional e/ou pesquisador no vasto campo da clínica psicológica , é importante compreender o que facilita ou dificulta uma ação situada. Parte-se de uma compreensão de ação implicada como constituinte no modo de ser humano: sujeito que age. Assim, este trabalho visa, a partir de uma experiência específica, trazer um outro olhar, ressignificando o fazer clínico psicológico no contexto do hospital, à luz da fenomenologia existencial e de dispositivos para a ação clínica psicológica. Recorreu- se à metodologia qualitativa, inspirada na figura do narrador e amparada no método fenomenológico para interpretação. A matéria-prima desta obra consiste em narrativas da experiência do psicólogo/pesquisador e dos interlocutores nos atendimentos, criança e sua mãe, no Centro de Tratamento de Queimados, além de relatos de profissionais dessa mesma equipe de saúde. Ao final, procurou-se uma articulação entre o conhecimento vivido/afetivo e o conhecimento teórico, a partir do diálogo com autores. Vislumbrou-se que a ação psicológica no C.T.Q. situa-se no campo teórico-prático do Aconselhamento Psicológico, como prática clínico- psicológica e educacional, numa dimensão interdisciplinar de ação social clínica. Foram, ainda, evidenciadas peculiaridades da comunicação entre a psicóloga, a criança e sua mãe, compreendidas como utensílios/utilitários facilitadores da intervenção psicológica. Espera-se, com este trabalho, apontar aberturas para ousadias responsáveis na atuação clínica, com implicações para o estudo e prática interdisciplinarConsidering the pain and suffering of the burned child who is in hospital, this author was concerned mostly with the kinds of current clinical help which are offered by the psychology professionals staff. From this view point when one researched about the saber fazer, that is, the psychological and clinical know-how, there were a great number of possibilities as to the fazer saber, e.g. how to reach the suffering child in his/her innerself and let him/her know that there is someone who in fact can help. It was found out that there were a number of attitudes, actions, interventation and interpretation which the psychologist could make use of in his relationship and care for the subject, the burned child. Therefore, the psychologist and/or researcher should be conscious about how broad the psychological clinical field is, and further he/she needs to understand clearly what may help as well as what may prevent a certain contextual action. One should start from understanding the subjects individual experience as a unique human being. This study aims to take a rather different look at the burned child specific experience, and tries to provide a new meaning to the psychological clinical action, inside a hospital, enlightened by both the existential phenomenon and attitudes for the psychological clinical action. The qualitative methodology was chosen, and it was inspired by the narrator himself. It was also supported by the phenomenal method for interpretation. The material analysed is made up of narratives based on the psychologist/researcher experiences, as well as from the burned child and the mother, who were in the Burned Treatment Center (BTC). In addition, reports from professionals belonging to the same health staff were considered. Finally , special attention was given to both the experienced/affectionate knowledge and the theoretical one, all deriving from talks to area field experts. It was discovered that the psychological action done at the BTC is in the pratical-theoretical field from the Psychological Advice, and it is deemed as an educational and psychological-clinical practice, in an interdisciplinary dimension of a clinical social action. M oreover, some special peculiarities were found from the communication among the professional psychologist, the burned child and the mother. Those peculiarities were the tools which facilitated the psychologist
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Hon, Wai-fan. "Fraud in clinical research : perceptions among clinical investigators and biomedical researchers /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38478584.
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Campanile, Loredana. "Effective clinical instruction : selection of behaviours by occupational therapy clinical supervisors." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=56962.
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The present study surveyed occupational therapy clinical supervisors working in a number of university affiliated hospitals in the Montreal area, via a mail questionnaire. Therapists were first asked to rate the importance of behaviours in facilitating student learning during clinical instruction. Then they were asked to report their attendance at continuing education courses on clinical instruction. The relationship between attendance at these courses, number of years of clinical experience and rating of behaviours was investigated. Therapists with few years of clinical experience had a low rate of attendance and rated behaviours as important more frequently. Therapists who attended a course rated behaviours as important less frequently. Behaviours rated as most important belonged to the area of communication, followed by the areas of teaching and interpersonal relationships. The results of this study demonstrated that a workshop on clinical instruction would benefit therapists by improving their clinical supervisory skills.
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Clarke, Amanda. "Two professional issues in clinical psychology : reflective practice and clinical effectiveness." Thesis, University of Warwick, 2010. http://wrap.warwick.ac.uk/36732/.
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This thesis contributes knowledge to the areas of Reflective Practice and Clinical Effectiveness, both professional issues in clinical psychology, which have a direct link to patient care in the National Health Service (NHS). The literature review presented in Chapter 1 focuses on reflective practice. The review aimed to identify all published empirical research, which investigated the application and usefulness of reflective practice for staff qualified in healthcare professions, and working in health services specifically, including the NHS. The findings have clinical and professional implications for health care staff, their managers, and the broader organisations in which they work. The use of reflective practice has been linked in the literature to increased clinical effectiveness, which is the second professional issue. The empirical paper presented in Chapter 2 explored the measurement and demonstration of clinical effectiveness as experienced by clinical psychologists working within NHS using a qualitative methodology. Demonstrating clinical effectiveness was found to be particularly relevant given the current, changing financial climate of the NHS and a context in which clinical psychologists are expected to prove their professional worth. The review and empirical paper highlight the importance of practice-based evidence. Chapter 3 presents a reflective paper, which explores the impact of the review and research findings on the author who is approaching the end of her clinical psychology training. This paper may be of interest to more experienced clinicians who wish to understand the issues from a newly qualified perspective, or to readers interested in the transition from training to professional practice.
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Wigram, Anthony Lewis. "The effects of vibroacoustic therapy on clinical and non-clinical populations." Thesis, St George's, University of London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242997.
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Waters, Helen. "Clinical and non-clinical food restriction and its effect on cognition." Thesis, University of Reading, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312571.
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Hartland, William Jr. "PERCEIVED IMPORTANCE OF CLINICAL TEACHING CHARACTERISTICS FOR NURSE ANESTHESIA CLINICAL FACULTY." VCU Scholars Compass, 1993. http://scholarscompass.vcu.edu/etd/5078.
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This study examined the perceived importance of the 22 characteristic of effective clinical instructors as identified by- Katz in 1982. The effect of various demographic variables on these perceived values of importance was also investigated.
Data were collected by means of a questionnaire survey instrument. A random sample of 354 nurse anesthesia program directors, CRNA clinical instructors and nurse anesthesia students from across the United States participated in this study. A 73 percent return rate was achieved.
Characteristic mean scores of importance demonstrate that respondents perceived all 22 characteristics as either "very important" or "highly important." When all 22 characteristic mean scores for each group were arranged in descending order by the researcher, no significant difference was found between groups. Chi-square tests were significant between the professional groups and the perceived values
of importance for four of the characteristics: Evaluation / Counseling, Positive Role Model, Flexibility, and Timely Feedback. No significant relationships were found among the demographic variables and the perceived importance of the 22 characteristics. Multiple regression analysis indicated that the demographic variables accounted for only an extremely small percent of the variance.
In conclusion, since many of the mean scores were relatively close to each other, it seems reasonable to conclude that all four professional groups highly valued these characteristics and perceived them as critically important to clinical instruction. There was no significant difference in the way each professional group rank ordered the 22 characteristics. No previously reviewed study exhibited this same level of homogeneity among respondents. The researcher suggests that this homogeneity may be the result of previous clinical nursing experience and/or the nature of the anesthesia clinical environment itself.
Findings in this study have implications for the continuing education and evaluation of nurse anesthesia faculty along with possible impacts on employment decisions.
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van, Kralingen Josie Charlotte. "MicroRNAs and extracellular vesicles in pre-clinical and clinical stroke studies." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/7937/.
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Stroke is a leading cause of death and disability worldwide and remains a largely unmet clinical need. Despite decades of pre-clinical stroke research there are only two licensed interventions: intravenous delivery of thrombolytic recombinant tissue plasminogen activator (rt-PA) within 4.5 hours of stroke or mechanical thrombectomy. However, the number of patients eligible to receive either treatment is limited. An alternative intervention is needed, one which directly address specific aspects of stroke pathophysiology. Through their ability to alter the expression of multiple genes involved in stroke pathophysiology microRNAs (miRNA or miR) offer a novel therapeutic intervention. miRNA expression is altered both in experimental stroke and in patients with stroke. It was initially hypothesised that modulation of specific dysregulated miRNAs would be therapeutically beneficial in pre-clinical experimental ischaemic stroke. Recently, active transport of miRNAs in extracellular vesicles (EV), such as exosomes, has been demonstrated pre-clinically between cells in atherosclerosis and cardiac hypertrophy disease settings. It was therefore hypothesised that miRNAs packaged in exosomes would differ between patients with stroke and patients without stroke, raising the potential for novel exosomal miRNAs to be used as biomarkers or therapeutic agents for modulation. In Chapter 3, investigations were carried out to test the hypotheses that modulation of either miR-494 or miR-21 would be therapeutically beneficial in pre-clinical in vitro models of stroke. While miR-494 expression was unchanged in brain tissue of spontaneously hypertensive stroke prone rats (SHRSP) harvested at either 24 or 72 hours following transient middle cerebral artery occlusion (tMCAO) its expression was successfully up-regulated in B50 neuronal and GPNT cerebral endothelial cell lines following delivery of miR-494 mimic in combination with siPORT, a lipid based transfection reagent. mRNA expression of putative miR-494 target genes (PTEN, MMP2 and MMP9) was investigated post-miR-494 modulation but there was no obvious change in their expression. Modulation of miR-494 expression did not appear to be therapeutically beneficial (or detrimental) when assessed by a cell survival assay (MTS). As the balance of evidence did not indicate that miR-494 would be a suitable target for modulation in experimental stroke subsequent similar experiments investigated the therapeutic potential of miR-21. Its expression was significantly increased in SHRSP brain tissue at 72 hours following ischaemic stroke. miR-21 expression was successfully increased in cerebral endothelial cells following delivery of miR-21 mimics (with siPORT). mRNA expression of putative target genes (PDCD4 and PTEN) was unchanged following miR-21 modulation and cell survival (assessed by MTS assay) was unaffected. Subsequent experiments looked at vessel reactivity of aortae taken from miR-21+/- and miR-21-/- mice in comparison to wild type (WT) mice. Treatment of vessels with L-NAME to block endogenous nitric oxide (NO) bioavailability resulted in unopposed contraction to U46619 in WT mice while there was no change in contraction in miR-21-/- mice aortae, consistent with reduced basal NO bioavailability, and a detrimental phenotype associated with the loss of miR-21 expression. As the data generated in this study were primarily neutral and gave no indication that either miR-494 or miR-21 would be therapeutically beneficial in the setting of ischaemic stroke, subsequent studies focussed on investigating exosomal miRNA in ischaemic stroke. In Chapter 4, exosomal miRNA expression was profiled in blood samples from stroke patients and subsequently in pre-clinical rodent stroke models. Patients with suspected stroke were recruited and a blood sample taken at 48 hours post-stroke. All participants gave full informed consent and the study was approved by the Scotland A Research Ethics Committee. Exosomes were isolated from 200 μL serum before RNA was extracted. A miRNA microarray was performed (OpenArray™ platform) on samples from 39 patients. Validation of results was performed by real-time quantitative polymerase chain reaction using samples from 173 patients to determine the expression levels of specific miRNAs. Microarray experiments identified 26 exosomal miRNAs that were significantly dysregulated between stroke and non-stroke patients or between specific TOAST subtypes and non-stroke controls. Of these, changes in 13 miRNAs were validated in the larger cohort and levels of 9 miRNAs (-27b, -93, -20b, -17, -199a, -30a, let-7e, -218 and -223) were found to be significantly increased in definitively diagnosed stroke patients as compared to non-stroke patients. Differences in exosomal miRNA expression were observed between TOAST subtypes with small vessel disease patients consistently having the highest levels of these miRNAs. miRNA expression did not correlate with baseline or day 7 NIHSS score, although there was a trend towards patients with better functional outcome post-stroke (as assessed by modified Rankin Score at 1 month) having a higher level of some exosomal miRNAs. Subsequently total and exosomal miR-17 family (miRNAs -17, -93 and -20b) expression was investigated in pre-clinical models of hypertension and stroke. Total circulating miR-17 expression was unchanged between the serum of normotensive WKY and hypertensive SHRSP rats, whilst exosomal miR-17 expression was significantly increased in SHRSP vs. WKY. miR-17 family expression was unchanged in peri-infarct brain tissue of SHRSP at both 24 and 72 hours post-tMCAO. Experiments profiling total and exosomal circulating miR-17 family expression in serum of SHRSP post tMCAO or permanent MCAO revealed that expression was variable and changes observed were not significant. Cellular expression of miR-17 family miRNAs was unchanged following hypoxic challenge in neuronal, glial and cerebral endothelial cell lines and exosomal miRNA expression was highly variable, with no changes detected as significant. This study both identified and validated (for the first time) changes in exosome packaged miRNA expression in patients with stroke across differing stroke subtypes. The pre-clinical experimental findings corroborate the human data and support a functional role for these findings. In Chapter 5 exosomal packaged miR-17 family miRNAs were delivered in pre-clinical models of ischaemic stroke (both in vivo and in vitro) to test the hypothesis that they would be therapeutically beneficial following in vitro hypoxic challenge or in vivo experimental stroke. Bioinformatics analysis highlighted a number of important target genes implicated in stroke pathophysiology for each miRNA including genes involved in the regulation of the cellular response to stress, apoptosis and angiogenesis. miRNAs were artificially loaded (by electroporation) into EVs harvested from SHRSP brain. While miRNA loaded EVs did not successfully modulate miRNA expression either in vivo or in vitro it is believed that this is a result of technical issues with the loading of the miRNAs into the EVs. This study should be repeated when miRNAs have been successfully loaded into EVs, as these experiments remain of interest. In summary, the findings presented in this thesis confirm that packaging of miRNAs into exosomes is significantly dysregulated in stroke patients and that as a result the circulating exosomal miRNA profile is altered. This will direct future studies looking into paracrine signalling in the setting of stroke and the modulation of specific miRNAs as a novel therapy in the setting of experimental stroke.
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Elchert, Lindsay. "Student and clinical instructor perceptions of credentialed and noncredentialed clinical instructors." Diss., NSUWorks, 2014. https://nsuworks.nova.edu/hpd_pt_stuetd/45.
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LeGrande, Stefanie Lynn. "Evaluation of Clinical Reasoning of Nursing Students in the Clinical Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3110.
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The primary focus of nursing education in the 21st century is to graduate students with well-developed critical thinking and clinical reasoning skills. This descriptive case study explored the perceptions of 6 faculty and 6 unit staff nurses concerning the assessment of critical thinking and clinical reasoning skills of nursing students in the clinical setting. Benner's novice to expert theory served as the conceptual framework for the research. The guiding research questions focused on faculty and staff perceptions concerning unit staff nurses' level of preparedness to assess the critical thinking and clinical reasoning ability of nursing students, and explored how faculty and unit staff nurses perceived the process of evaluating nursing students' clinical reasoning and critical thinking skills in the clinical setting. Data were collected using semi structured interview questions, then coded and analyzed following Creswell's approach. This analysis identified six themes: (a) lack of consistency, (b) faculty and staff clinical expectations of students, (c) barriers to clinical education, (d) faculty and staff differences in educational definitions, (e) faculty and staff comfort level with students, and (f) resources needed for clinical education. Learning how faculty and staff nurses assess student nurses' ability to demonstrate effective clinical reasoning and critical thinking skills can positively impact social change in nursing education on the local and state level by informing best practice in how critical thinking and clinical reasoning are taught and assessed in nursing education. This facilitates graduating nurses who are prepared to deliver patient care that affect positive outcomes.
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Denney, Kimberly B. "Assessing Clinical Software User Needs for Improved Clinical Decision Support Tools." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1563.
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Consolidating patient and clinical data to support better-informed clinical decisions remains a primary function of electronic health records (EHRs). In the United States, nearly 6 million patients receive care from an accountable care organization (ACO). Knowledge of clinical decision support (CDS) tool design for use by physicians participating in ACOs remains limited. The purpose of this quantitative study was to examine whether a significant correlation exists between characteristics of alert content and alert timing (the independent variables) and physician perceptions of improved ACO quality measure adherence during electronic ordering (the dependent variable). Sociotechnical theory supported the theoretical framework for this research. Sixty-nine physician executives using either a Cerner Incorporated or Epic Systems EHR in a hospital or health system affiliated ACO participated in the online survey. The results of the regression analysis were statistically significant, R2 = .108, F(2,66) = 3.99, p = .023, indicating that characteristics of alert content and timing affect physician perceptions for improving their adherence to ACO quality measures. However, analysis of each independent variable showed alert content highly correlated with the dependent variable (p = .007) with no significant correlation found between workflow timing and the dependent variable (p = .724). Understanding the factors that support physician acceptance of alerts is essential to third-party software developers and health care organizations designing CDS tools. Providing physicians with improved EHR-integrated CDS tools supports the population health goal of ACOs in delivering better patient care.
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Carlson, Robin. "Clinical Significance of Response Shift in a Spine Interventional Clinical Trial." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/231.
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The effectiveness of treatments for degenerative spine conditions, where the primary symptom is back pain, is typically determined using patient-reported quality of life (QoL) measures. However, patients may adjust their internal standards when scoring QoL based on factors other than their health. This response shift phenomenon could confound the interpretation of study data and impact effectiveness conclusions. In the current study, response shift was examined using structural equation modeling (SEM) and previously collected clinical trial data comparing 2 minimally invasive medical devices in lumbar spinal stenosis patients through 1 year postintervention. In subject QoL results, reprioritization shift between 3 months and 12 months that could confound standard analysis was identified. Treatment group did not influence response shift identified at 12 months. SEM provided an effective and practical tool for clinical investigators to assess response shift in available clinical study data. As response shift could lead to invalid conclusions when QoL measures are analyzed, clinical investigators should include response shift assessment in the design of clinical trials. This research into how response shift phenomenon can impact clinical trial results improves the ability of clinical investigators to interpret clinical trial data, potentially preventing erroneous conclusions. This research may also assist researchers and government regulators in the identification and reimbursement of beneficial, cost-effective medical treatments for patients worldwide. For clinical research designers, this study demonstrates a practical application of response shift assessment.
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Shiau, Shwu-Huey. "Clinical and Educational Efficacy of a University-Based Biofeedback Therapy Clinic." Thesis, University of North Texas, 2003. https://digital.library.unt.edu/ark:/67531/metadc4391/.
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This study is a qualitative analysis and a quantitative analysis of all peripheral biofeedback client data files of the University of North Texas Biofeedback Research and Training Laboratory since its establishment in 1991 and through the year of 2002. The purpose of this study is to evaluate the clinical and educational efficacy of the BRTL. Clients' electromyography and temperature measures, self-report of homework relaxation exercises and progress, and the pre- and post-Stress Signal Checklist were reviewed and analyzed. In regard to clinical efficacy, results indicate statistically significant changes in both temperature training and muscle tension training as a whole group. When divided into subtypes based on the clients' primary presenting problem, findings indicate statistical significance in chronic pain, tension headache, and temporomandibular jaw pain on temperature training, and show statistical significance in chronic pain, tension headache, hypertension, migraine headache, stress, and temporomandibular jaw pain on muscle tension training. When analyzing the Stress Signal Checklist, only 25% of clients had complete information on both pre- and post-Stress Signal Checklist. For these 25%, 87.5% reported symptoms decreased. When reviewing the clients' self-reported progress in therapist's session notes, there is no procedure for computing a treatment success to failure ratio due to the inconsistency of therapists in recording clients' statements. This study also identifies three basic biofeedback learning curves that show how people learn self-regulation skills in biofeedback therapy: 1) steady state and trainable (low variability), 2) phasic state and trainable (high variability), and 3) phasic state and low trainable (high variability).
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Dunn, Elizabeth. "Clinician experiences of treating eating disorders and the use of clinical supervision." Thesis, Canterbury Christ Church University, 2017. http://create.canterbury.ac.uk/16422/.
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Objective: Clinicians working with individuals with eating disorders encounter unique emotional, cognitive and behavioural responses. Such responses may impact on clinician self-care and wellbeing, and are linked to clinician burnout and poor treatment outcomes. Supervision can protect against such deleterious consequences. At present there is limited theoretical literature and no empirical literature relating to the supervision of eating disorder clinicians. Method: A three round Delphi Methodology was employed to explore the experiences of clinicians from a range of professional backgrounds who work therapeutically with individuals with anorexia nervosa, along with the role of supervision and relevant key supervision requirements. Results: Positive experiences were more frequently reported than negative experiences. Key negative emotions comprised sadness, anxiety, frustration and inadequacy. The impact on clinicians thinking about food and their own body-image were divergent. A large number of statements reflecting the core elements of supervision including areas of discussion, reflection, outcomes, supervisor qualities, the supervisory relationship, barriers and facilitators reached consensus. No consensus was reached regarding discussing clinicians’ thoughts about food, body-image or personal eating disorder history. Discussion: Implications for clinical practice include using these findings to challenge persistent beliefs that individuals with anorexia nervosa are undesirable to treat, and to help identify appropriate support where challenging experiences arise. Results relating to supervision can form the basis of future supervision guidelines in this field. Study limitations and implications for future research are discussed.
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Rosser, Daniel Ashley. "Improving the measurement of visual acuity in clinical practice and clinical research." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1446798/.
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This thesis considers the relationship between the design of a visual acuity test and various aspects of its performance. Using contemporary test design theory, novel tests are developed and evaluated in an attempt to better meet the requirements of a visual acuity test most pertinent to clinical practice, clinical research, and population based surveys. The acuity test of choice in clinical practice is the Snellen chart, a test whose usefulness is limited by several design flaws. Clinical researchers favour the ETDRS logMAR chart which employs robust design principles, but is time consuming to use. A chart featuring an abbreviated ETDRS design was developed and its performance compared with that of the ETDRS and Snellen charts. The prototype chart allows acuities to be measured in half the time of the ETDRS chart with greater precision than the Snellen chart. A tumbling-E version of this chart has been successfully employed in population based surveys in Thailand, Bangladesh and Mongolia. It was noted during the study that the precision of even ETDRS acuities was relatively poor. A computerised version of the ETDRS test was developed and used to investigate the repeating and averaging of acuities as a means to improve precision. Whilst prolonging test time, the computerised test allowed acuities to be measured with improved precision. Optical defocus was investigated as a potential source of reduced precision in visual acuity testing. It was shown that even small degrees of defocus may significantly reduce test precision. An approach which considers test performance in terms of sensitivity and specificity was developed. A mathematical model was used to show that current methods of using estimates of precision to identify clinically important change, are overly optimistic. Predictions derived using the model were shown to agree well with empirical findings.
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Freemantle, Jane. "The impact of clinical practice guidelines for preterm labor on clinical care /." Title page, table of contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmf855.pdf.
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King, Andrew. "Developing DNA fusion gene vaccines : from pre-clinical models to clinical studies." Thesis, University of Southampton, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442872.
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Baumeister, David. "Adversity, distress and stress-function in clinical and non-clinical voice-hearers." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/adversity-distress-and-stressfunction-in-clinical-and-nonclinical-voicehearers(9af1f80e-0838-472c-aa7f-cfcf6c7bd0c9).html.
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The present PhD project investigated the role of psychophysiological stress-function and adversity exposure in auditory verbal hallucinations and the clinical status of voice-hearers. Psychosis is associated with several alterations in biological stress systems, including the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis, as well as subjective stress levels and -reactivity. Exposure to childhood trauma has been particularly linked to the emergence of auditory verbal hallucinations in psychosis, as well as a dysregulation of stress-psychophysiology. However, it remains unclear whether changes in stress-function and -reactivity are related to auditory hallucinations specifically, or only to psychosis more generally. Further, auditory verbal hallucinations occur in both clinical and non-clinical populations. Voices in healthy and clinical voice-hearers share many characteristics, including phenomenological (such as loudness) and neurophysiological correlates of auditory verbal hallucinations. However, healthy voice-hearers do not experience distress in response to their voices, and their voices contain less negative content. It remains unknown whether psychophysiological stress-function may also discriminate clinical and non-clinical voice-hearers, and whether dysregulated stress-function is associated with the experience of hearing voices, and/or need for care. Evidence suggests there is increased childhood trauma exposure in healthy voice-hearers, at similar rates to clinical voice-hearers. However, adolescence/adulthood adversity remains largely unexplored in healthy voice-hearers, as does exposure to other risk factors including socioeconomic adversity and substance use. A more recent version of the diathesis-stress model, the three hit model, has highlighted the role of adversity after childhood in shaping pathological trajectories, which may partially explain the difference in distress and need for care in clinical and healthy voice-hearers. Lastly, it is not known whether, and to what degree, voice content contributes to psychophysiological dysregulation in clinical voice-hearers. To address these issues, the present project investigated three key research questions: 1. Does adolescent/adulthood adversity exposure differ between healthy voice-hearers and clinical voice-hearers, and is the differential adversity exposure associated with increased stress-sensitivity? 2. Does the content of voices exacerbate stress-reactivity? 3. Does psychophysiological stress-function in clinical voice-hearers differ from those of healthy voice-hearers and healthy controls without voices? Methods: Three individual studies are reported to assess these research questions: 1. A cross-sectional study of clinical and healthy voice-hearers was carried out to assess the role of familial risk and adversity exposure in childhood, and adolescence/adulthood in the context of the three hit model. Further, the association of adversity exposure with perceived stress was examined. 2. A cross-sectional design with a healthy non-voice hearing sample was carried out using simulated auditory hallucinations with negative and neutral content to assess their impact on psychophysiological stress-reactivity during psychosocial stress exposure. The potential buffering effects of mindful appraisals of voices on psychophysiological stress-reactivity were also assessed. 3. A cross-sectional study of clinical and healthy voice-hearers, as well as a healthy control group with no voices, was carried out comparing the three groups on diurnal HPA and ANS activity, HPA response to pharmacologically induced negative feedback, and HPA and ANS responses, as well as subjective reactivity, to a psychophysiological stress paradigm. Results: The cross-sectional study on adversity exposure showed that, unexpectedly, victimisation and discrimination experiences were similar in clinical and healthy voice-hearers in both childhood and adolescence/adulthood. However, the two groups differed on familial psychosis risk, adolescence/adulthood socioeconomic status, and substance use, with the clinical group reporting greater rates of adversity exposure. These variables were further predictive of perceived stress, after controlling for group. The analogue voice study demonstrated that negative voices exacerbated subjective, but not physiological, stress-reactivity, compared to neutral voices and ambient sounds. Having a mindful stance towards the voices during the task was associated with lessened stress-reactivity. Finally, as predicted, clinical voice-hearers showed several indices of aberrant psychophysiological stress-function of the HPA axis, compared to both healthy voice-hearers and controls without voices, although not always in the predicted direction. Contrary to our predictions, there were no differences between groups on parameters of the ANS. However, there was some evidence to suggest stress-function in healthy voice-hearers also diverges from non-voice-hearing controls on some HPA parameters, including reduced cortisol levels during stress exposure, slower speed of cortisol recovery from the stressor, and lower HPA negative feedback capacity. Conclusion: The present thesis found evidence to suggest that specific types of adversity exposure and stress-function are related to the need for care of clinical voice-hearers and may be involved in pathological outcomes of voice-hearing. Differential adversity exposure, and its relationship to stress-sensitivity may therefore partially relate to psychopathological trajectories in voice-hearing. The negative content of voices may further contribute to the maintenance of need for care through exacerbated stress-reactivity. Finally, dysregulated psychophysiological stress-function is present in clinical voice-hearers, and partially discriminates them from healthy voice-hearers. Overall, the present findings identified specific potential psychophysiological markers of risk and resilience in auditory verbal hallucinations and need for care. This thesis provides an initial stepping stone for future research developments to explore precise causal and mechanistic relationships of adversity exposure, psychophysiological stress-function and need for care in voice-hearing.
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Barnes, Elizabeth. "Faculty Perceptions of the Effects of Clinical Simulation on Students' Clinical Performance." Thesis, Capella University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10841491.
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Simulation has been used in nursing education for many years in order to show students complex patients, allow practice of new skills without allowing actual harm to come to the patient, as well as being able to build up student confidence in abilities. The primary focus for this qualitative study was associate degree nursing faculty perceptions of their students transferability of knowledge gained through participating in simulation activities in the clinical setting and, may assist in planning future educational activities. The nursing faculty provided insight to what they felt the students needed to know and reflected on what they actually saw students do in actual clinical situations. The research question addressed in this study was the following: What are associate degree nursing faculty perceptions on student transferability of knowledge to an actual clinical setting after having experience in simulation activities? There was also a research sub question addressed, which was, What do associate degree nursing faculty perceive as barriers to becoming successful in clinical performance and knowledge retention? The study used a basic qualitative design. A basic qualitative design was appropriate for this study because it examined simulation use by nursing faculty at multiple chosen schools and their experiences with knowledge transferability. The study sample consisted of associate degree nursing faculty from the East South Central and West South Central regions of the United States. The study participants ranged in age from 30–66 years of age, and they all have been teaching for at least one year. The guided face-to-face interviews by the participants revealed the following themes, providing a safe environment, clinical experiences/nursing skills, simulation integration in course content, and faculty development and training regarding simulation use. The purpose of the study was to examine transferability of knowledge gained through simulation activities on student clinical performance, and this was actually not addressed in any of the participants’ answers. The researcher found that all the faculty participants are able to work together in all areas where simulation is utilized, in order to produce competent graduates who will be able to enter the workforce as nurses. Recommendations for further research include using a larger sample size and from other geographical regions in order to have a more diverse sample of nursing faculty.
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Salgueiro, Ana Cláudia Marques. "Curricular training in coordination of clinical trials in a clinical research unit." Master's thesis, Universidade de Aveiro, 2014. http://hdl.handle.net/10773/14285.
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Mestrado em Medicina FarmacêuticaThis report describes several activities and projects developed in the context of a curricular training in a clinical research unit, Centro de Investigação Clínica (CIC), led by Professor Joaquim Ferreira. The CIC is one of the research groups of Instituto de Medicina Molecular (IMM) and it is also a group of the Centro Académico de Medicina de Lisboa (CAML) consortium. The principal area of training was the coordination of clinical trials and observational studies. Additionally, other research activities were conducted during the training such as, pharmacovigilance, monitoring, data entry, medical writing and some language coordination activities in a European observational study about Huntington’s Disease founded by European Huntington’s Disease Network (EHDN). It is mention on the State of the Art the Research & Development Process of a new drug and it is characterised some issues about clinical research in Portugal, including advantages in the establishment and organisation of clinical networks. During the training, with the duration of 10 months (that started on 1st September 2013 and finished on 1st July 2014) I deepened my knowledge in clinical research area, understand the importance of the clinical research units, the importance and the role of the study coordinators and expand my areas of interest. The specific training focused in neurological clinical. I had opportunity to understand the practical and logistical difficulties that a research unit faces during the conduction of clinical studies I consider that this training was a valuable experience of introduction of the practice of clinical research. I finished this training with the motivation and interest in working in the area of coordination and monitoring of studies.
Este relatório descreve as actividades e projectos desenvolvidos no âmbito de estágio curricular numa unidade de investigação clínica, o Centro de Investigação Clínica (CIC), liderada pelo Professor Doutor Joaquim Ferreira. O CIC faz parte dos grupos de investigação do Instituto de Medicina Molecular (IMM) inserindo-se na iniciativa do consórcio Centro Académico de Medicina de Lisboa (CAML). A principal área de estágio foi a coordenação de ensaios clínicos e estudos observacionais. Adicionalmente foram abordadas outras actividades durante o estágio, tais como farmacovigilância, monitorização, preenchimento de bases de dados, escrita científica e algumas actividades de coordenação a nível nacional de estudo observacional europeu sobre a doença de Huntington financiado por European Huntington’s Disease Network (EHDN). Refere-se no estado da arte o Processo de Investigação e Desenvolvimento de novos medicamentos e caracteriza-se alguns aspectos da investigação clínica em Portugal incluindo vantagens na organização de redes clínicas de investigação. Ao longo do estágio, com 10 meses de duração (início a 1 Setembro de 2013 e fim a 1 de Julho de 2014) aprofundei o conhecimento na área de investigação clínica, percebi a importância de unidades de investigação clínica, a importância e papel de coordenadores clínicos e expandi as minhas áreas de interesse. O treino específico centrou-se em estudos clínicos na área da neurologia, nomeadamente ensaios de clínicos de fase II e III, e estudos observacionais. Tive ainda oportunidade de compreender a realidade prática e logística da condução de estudos clínicos num centro de investigação. Considero que este estágio foi uma experiência valiosa de introdução á prática de investigação clínica. Desta forma, termino o estágio com motivação e interesse em trabalhar na área de coordenação ou monitorização de estudos.
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Perrin, Jennifer Suzanne. "Marital satisfaction and psychological well-being in clinical and non-clinical samples." [Ames, Iowa : Iowa State University], 2008.
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Galper, Jasmin. "Inflammatory and lipid markers in clinical and pre-clinical Parkinson’s disease patients." Thesis, The University of Sydney, 2021. https://hdl.handle.net/2123/27967.
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Parkinson’s disease (PD) risk gene discoveries have implicated lipids and inflammation in pathology. However, most research to date has been protein-centric. Therefore, the extent of lipid involvement in PD and relationships between inflammatory and lipid pathways are unclear. Research into these areas may provide novel insights into PD pathology, therapeutic targets and biomarkers for an earlier diagnosis and monitoring disease progression in clinical trials.
To investigate lipid dysregulation in PD and in mutation carriers of the PD risk gene LRRK2, untargeted mass spectrometry was performed using serum (N = 221) and cerebrospinal fluid (CSF, N = 88) from controls, pre-clinical and clinical PD LRRK2 G2019S carriers and sporadic PD patients. Findings were then validated in a second cohort (N = 315) using serum from the same groups. Significant lipid alterations were found in mutation carrier and PD patient serum and CSF. Altered lipids implicated sphingolipid metabolism and insulin signalling pathways in PD. Further, altered serum and CSF lipids correlated with cytokines involved in insulin/glucose signalling. Pre-clinical PD biofluid changes suggest that lipids are worthwhile candidates for longitudinal studies assessing whether baseline markers predict PD. Correlation analysis indicated that although serum lipids did not robustly associate with clinical severity, CSF lipids were associated.
Finally, whether mutations in the lipid-related risk gene, GBA, affected inflammatory markers was assessed in plasma (N = 371) from clinical and pre-clinical GBA mutation carriers, sporadic PD patients and controls. Inflammatory markers were overall unchanged in GBA mutation carriers, suggesting these are not promising biomarker candidates.
These findings strongly support a role for lipid dysregulation in PD. These results indicate that lipids are promising candidates to pursue for understanding PD aetiology, as well as potential novel biomarkers for genetic and sporadic PD.
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Jackson, Bridgett Alveta. "Nursing Students' and Novice Clinical Instructors' Experiences With Clinical Instruction and Assessment." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1264.
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Adjunct faculty members make up a growing proportion of nursing school clinical faculty in the United States due to a nurse educator shortage in higher education. Many of the nurses hired as clinical faculty members have years of experience providing patient care, but they lack experience in clinical instruction and assessment. At a state community college in the southeastern United States, nursing students have expressed dissatisfaction in their course evaluations with inexperienced faculty in clinical programs. The experiences of both nursing students under the guidance of novice clinical instructors and clinical faculty were examined in this case study. The National League for Nursing's (NLN) standards for practice for academic nurse educators served as the conceptual framework for this study and was used to develop research questions related to clinical practice and assessment. Data were collected from 9 students and 6 clinical nursing faculty members who participated in anonymous, open-ended electronic questionnaires regarding use of the standards in instruction and assessment. Student clinical experience collective evaluations from 3nursing programs across the state were also used for data collection and analysis. Data were coded and themes were identified and verified through triangulation. Themes were inconsistent with the NLN standards and included no formal orientation, no preparation for the clinical instructor role, use of subjective instructor evaluations, and lack of instructor feedback. Results were used to develop a professional development program to prepare novice clinical instructors for the clinical environment according to the NLN standards. This study may result in positive social change by improving clinical experiences for nursing students in community colleges, resulting in better patient care as they assume their roles in the larger medical community.