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Strevy, Sonia R. "Communicating with difficult patients : nurses' perceptions." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/865936.
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Communicating With Difficult Patients: Nurses' Perceptions Effective communication is paramount in any nurse-patient relationship. Nurses must develop good interpersonal skills with which to evaluate patient needs, provide therapeutic interaction and obtain mutual goals. The purpose of this study was to describe the variables present in nurses self reported communication with difficult patients.Imogene King provides the theoretical framework for this study using the concept of goal attainment as the basis. The Difficult Patient Assessment Tool (Podrasky & Sexton, 1988) was used to measure communication with difficult patients, along with the addition of an open-ended question. A convenience sample of 25 (40%) R.N.'s and L.P.N.'s from a community hospital in the Midwest was used. The procedures for the protection of human subjects were followed. Descriptive statistics were used to analyze the data.Findings of the study included that nurses perceive difficult patients as demanding, never satisfied, confused, frustrating, female, noncompliant, manipulative and uncooperative. Nurses reacted to the communication that takes place with the difficult patient, with feelings of frustration, incompetence, anger, disgust, anxiety, and at times, "O.K.". Nurses most frequently interact with difficult patients in informative, pragmatic, supportive, prescriptive and catalytic manners. The resulting transaction between the nurse and the difficult patient included feelings of frustration, fright, confusion and hurt.Conclusions were that difficult patients are perceived as making unrealistic demands on the nurses' time, and impair nursing interactions. Nurses' transactions resulted in both positive and negative reactions, depending on the situation, and the reactive patterns of the nurse. Nurses tend to take a more authoritative, rather than a facilitative role in interactions with difficult patients.Implications include the need for learned communication patterns which may or may not be effective in dealing with difficult patients. Effective communication skills involve not only acquired knowledge, but also knowledge of self and one's perceptions and values. Self knowledge of communication patterns, and how to improve on those patterns, might be helpful.School of Nursing
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Clayton, Benjamin James. "Advanced applications of cardiac computed tomography for the difficult-to-image patient." Thesis, University of Plymouth, 2015. http://hdl.handle.net/10026.1/4188.
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Throughout the development of computed tomographic (CT) imaging the challenges of capturing the heart, with its perpetual, vigorous motion, and in particular the tiny detail within the coronary arteries, has driven technological progress. Today, CT is a widely used and rapidly growing modality for the investigation of coronary artery disease, as well as other cardiac pathology. However, limitations remain and particular patient groups present a significant challenge to the CT operator. This thesis adds new knowledge to the assessment of these difficult-to-image patients. It considers patients with artefact from coronary artery calcification or stents, examining the remarkable diagnostic performance of high definition scanning, as well as material subtraction techniques using dual energy CT, alongside ways in which current technology might be revisited and refined with the use of alternative image reconstruction methods. Patients with challenging heart rate or rhythm abnormalities are considered in three studies; how to achieve diagnostic image quality in atrial fibrillation, the safety of an aggressive approach to intravenous beta-blocker use prior to coronary imaging, and the development of patient information to address anxiety as a source of tachycardia and motion artefact. Finally, the novel application of a single source, dual energy CT scanner to additional cardiac information is considered, with studies of myocardial perfusion CT and delayed iodine enhancement imaging, to identify ways in which non-coronary imaging might be exploited to more thoroughly evaluate a patient’s coronary artery status. These findings are presented in the context of developing technology and together offer a range of potential options for operators of cardiac CT when faced with a difficult-to-image patient.
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Heyman, Sara, and Huss Sara Karlsdotter. "De som kallas besvärliga : En litteraturstudie om begreppet besvärlig patient och strategier vårdare använder i mötet med dessa patienter." Thesis, Röda Korsets Högskola, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-645.
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Bakgrund: Femton procent av alla möten inom vården upplevs som besvärliga av vårdpersonal. Besvärliga möten inom vården har stora följdverkningar, inte bara för patienten utan även för vårdpersonalen. De “besvärliga” patienterna riskerar att få sämre vård och bemötas med mindre respekt än övriga patienter. Besvärliga patienter är inte någon väl definierad patientgrupp utan karaktäriseras av en mängd olika egenskaper och symptom. Det finns en kritik mot användandet av begreppet besvärlig patient då det riskerar att fungera stigmatiserande och diskriminerande. Syfte: Beskriva vilka strategier vårdpersonal har för att bemöta den “besvärliga patienten”. Metod: Uppsatsen är en litteraturöversikt av elva vetenskapliga artiklar. Artiklarna analyserades med avseende på likheter och skillnader i resultatet. Resultat: Fem kategorier framkom: Bygga relation, Kontakt och kommunikation, Närhet och distans, Stöd och support samt Undvikande och kontroll. Huvudfynden speglar de strategier som vårdpersonal använder i mötet med den “besvärliga” patienten. Där återfinns både strategier som främjar en god patientkontakt och strategier som i förlängningen leder till negativa konsekvenser för både patient och personal. Slutsats: Strategier vårdpersonal använder i mötet med patienter som upplevs som besvärliga handlar till stor del om att uppnå en fungerande kommunikation och en god relation. I detta ligger strategier som betonar att lyssna, ge tid samt uppträda empatiskt, respektfullt och ärligt. Det finns också strategier som kontrollerar patienten eller begränsar patientens personliga frihet. Klinisk betydelse: Kunskap om vilka strategier som finns ger vårdpersonalen viktiga verktyg i den kliniska vardagen i mötet med den så kallade besvärliga patienten. I slutändan kan detta leda till en ökad patientsäkerhet och en vård av högre kvalitet för en sårbar och utsatt patientgrupp, samt en förbättrad arbetsmiljö för vårdpersonalen.Background: Fifteen percent of all encounters in hospitals or health care facilities are perceived by health care staff as difficult. Difficult encounters have wide range of consequences for both the patient and health care professionals. A “difficult” patient is more likely to receive inadequate treatment and be treated with less respect. What constitutes a difficult patient is not well-defned, and they may be characterized by a broad range of personal and behavioural characteristics as well as symptoms. There are critical arguments against the verbal use of the difficult patient concept, as it may have a stigmatizing and discriminating effect on such a patient. Aim: Describe the strategies used by health care professionals when dealing with the “difficult patient”. Methods: The study is a literature review, in which the results of eleven scientific journal articles are compared and contrasted. Results: The main results reflect the strategies health care staff use when dealing with the “difficult” patient. From the litterature, five strategic categories have emerged. These categories include: Build relationship, Contact and communication, Closeness and distance, Help and support and Avoidance and control. These include both strategies that promote a good relation with the patient and strategies that lead to negative consequences for both patients and health care professionals. Conclusions: Strategies used by health care professionals when caring for patients perceived as difficult focus on achieving effective communication and a good relationship. These strategies emphasize listening, giving time and acting with empathy, respect and honesty. There are also strategies that control the patient or restrict the patient’s personal freedom. Relevance to clinical practice: This thesis presents an overview of which strategies exist for dealing with so called difficult patients, knowledge of which is vital for health care professionals working in clinical practice. This can lead to improved patient safety and health care of higher quality for a vulnerable and exposed group of patients, as well as a better working environment for the health care staff.
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Potter, Margaret J. "Evaluating the efficacy of a program developed to optimise the physiotherapist-patient interaction." University of Western Australia. School of Human Movement and Exercise Science, 2003. http://theses.library.uwa.edu.au/adt-WU2004.0012.
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[Truncated abstract] This PhD project was comprised of three major studies. Study 1 utilised the Nominal Group Technique (NGT) to identify a typology of difficult patients in private practice physiotherapy and to determine strategies physiotherapists use and would like to improve, when dealing with such patients. Physiotherapists (n=37) also shared their expectations of patients and their perceptions of patient expectations of physiotherapy. Results showed that the two areas most difficult to manage were behavioural problems of patients followed by patient expectations. To assist in their interaction with difficult patients, physiotherapists identified communication skills and behaviour modification techniques as strategies they would most like to learn. While physiotherapists expressed the greatest number of expectations in the behavioural domain, identification of patient expectations was not elicited as a strategy to manage difficult patients. Results of this qualitative study contribute to the evolving literature relating to physiotherapist-patient interactions and form a useful basis for educational programs directed at improving the therapeutic relationship in private practice physiotherapy. Study 2 involved applying the NGT with separate groups of patients (n=26) to identify patient expectations of the qualities of a ‘good’ physiotherapist, and to ascertain the characteristics of good and bad experiences in private practice physiotherapy. Findings indicated that the qualities of a ‘good’ physiotherapist related to their communication ability, professional behaviour and organisational ability, and characteristics of the service provided. The most important expectations of patients were for example, symptomatic relief, self-management strategies and ‘hands on’ treatment; associated with the physical domain. When comparing equivalent groups from Study 1, with patient expectations, most patient groups identified that the most important expectations of physiotherapists would relate to patient behaviours such as; compliance, honesty, payment of their account, being punctual, cooperating, trusting and showing respect for their physiotherapist. However, physiotherapists’ rankings of the most important expectations held by patients were not congruent with patient rankings providing an explanation as to why problems may arise in the physiotherapistpatient interaction from the patient’s perspective. Based on the findings of Study 2 it was suggested that physiotherapists should actively seek to involve patients in their management. To do this effectively, physiotherapists would benefit from further training in communication skills to ensure that they can successfully adopt a patientcentred approach and to optimise the physiotherapist-patient interaction in private practice physiotherapy.
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O'Grady, Susan. "Symbolic work with clay as a technique with a difficult to reach patient: a Jungian perspective." Thesis, University of the Western Cape, 2007. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_5934_1223642323.
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This thesis explored the potential of clay work and its symbolic representations as a means to facilitate the integration and individuation of the self in psychotherapy, using a Jungian theoretical framework. A case study methodology was used, to explore a long standing pattern of environmental failure and trauma in a 16 year old female. The Edward's clay work method was utilized to guide the use of the clay work and the discussion and exploration thereof. Central to the study was the importance of a search for meaning given to each clay piece, which was achieved through a dialectical interaction and mutual exploration between therapist and client.
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Lundkvist, Anders. "”-Å nej, inte han igen!” : Varför patienter upplevs som svåra av sjuksköterskor inom den slutna psykiatriska vården." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-2018.
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Bakgrund: En del patienter som vårdas inom slutenvårdspsykiatrin ses av sjuksköterskor svårare att vårda. Dessa patienter riskerar få en sämre vård än andra patienter. Genom att belysa sjuksköterskors egna förklaringsmodeller till varför patienterna uppfattas som svåra kan fokus riktas mot en utsatt patientgrupp inom den svenska slutenvårdspsykiatrin. Syfte: Att beskriva sjuksköterskors egna uppfattningar om varför patienter upplevs som svåra att vårda inom den slutna psykiatriska vården. Metod:Fem intervjuer med sjuksköterskor arbetandes inom slutenvårdspsykiatrin genomfördes. Intervjuerna var semistrukturerade och en intervjumall användes för att beröra studiens frågeområden. De transkriberade intervjuerna analyserades med hjälp av en kvalitativ innehållsanalys. Resultat:Fem olika kategorier framträdde ur materialet vilka återspeglade de intervjuade sjuksköterskornas förklaringar till varför en patient uppfattas som svår inom den psykiatriska slutenvården: Patientens negativa beteenden, omständigheter kring patienten, personalens känslor, personalens beteenden, dåligt anpassad vårdorganisation samt lätta patienter. Diskussion: Det finns många paralleller mellan patienter som uppfattas som svåra och en icke fungerande vårdrelation mellan sjuksköterska och patient. En modell presenteras som beskriver hur patienter i den slutna psykiatriska vården uppfattas som svåra utifrån ett sjuksköterskeperspektiv.
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Novosel, Lorraine Marie. "Depressive symptomatology, patient-provider communication, and patient satisfaction : a multilevel analysis." [Tampa, Fla] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0001866.
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Jepsen, Linda, and Ilda Agovic. "Sjuksköterskans/Vårdpersonalens bemötande av patienter som tar emot svåra besked." Thesis, Högskolan Väst, Avd för sjuksköterskeutbildning, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-4180.
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Background: Health care is a strange place for the patient. To make this enviroment as good as possible, would the patient be well informed. The patient has right to know if it is a bad mews and often he/she needs caring after the information. Nurse´s basic responsibility is caring, for her/him it´s important to prevent the shock for the patient that can appear. Aim: Describe the nursing staff responses to the patient, using the patient´s perspective in relation to bad news. Method: A litterture review has been made with nine articles. Current research materials that meet the study´s purpose has been applied in databases and analyzed. Four themes and nine subthemes was emerged. Results: Nurse should allow patient to talk, when bad news had been given. Conversation is important for the patient, because they want information to be able to participate in care. Good communication skills are important for the nurse in connection with bad news. Patient wants information in an honest, peaceful and transparent manner. Time is often in short supply in this conversation. To have the family in care is a good support for the patient, but not all patients want the family to participate. Conclusion: Patients desire individually aids at handover of bad news. It gives them a safety. The most common mould of aids according to patients where that the nurse shows that she/he has time for them.
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Andersson, Lisa, and Sara Nilsson. "Svåra samtal - en del av sjuksköterskans vardag : En intervjustudie." Thesis, University of Skövde, School of Life Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-1102.
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I det dagliga arbetet och som en del av omvårdnaden måste sjuksköterskan samtala med patienterna. Samtal kan vara väldigt svåra, vissa samtal är svårare än andra. För att oerfarna sjuksköterskor lättare skall kunna relatera och hantera dessa samtal i yrkeslivet var syftet med studien att beskriva vad sjuksköterskor anser vara det svåraste i svåra samtal. Ett fåtal studier beskriver vad sjuksköterskor anser vara svåra samtal och ingen studie har funnits som beskriver vad de anser vara det svåraste i dessa samtal. En kvalitativ metod valdes och innehållsanalys användes som metodanalys. Studien innefattar intervjuer med sex sjuksköterskor från ett sjukhus i västra Sverige. Resultatet av analysen visar sex huvudkategorier som innehåller sex sjuksköterskors beskrivning av vad det svåraste är i svåra samtal. Kategorierna är: samtal när personkemin inte stämmer, hoppfulla samtal vid negativa besked, samtal med arga patienter, känsliga samtal, försonande samtal med anhöriga och närvara i samtal under tidsbrist. Alla sjuksköterskorna upplevde att det svåraste i alla samtalen var att vara närvarande i samtalet för att behålla patientens hopp och få patienten att försonas med sin situation.
In the daily work of a nurse, talking to patients is part of the nursing care. Communication can be very difficult, and some conversations are harder than others. To make it easier for inexperienced nurses to relate and handle these conversations it’s important to establish what conversations nurses consider difficult and what the most challenging aspects are, and this was the aim of this study. Only a few previous studies describe what nurses consider difficult communication, and none of them focus on what the nurses perceive as the most challenging aspects. A qualitative method was chosen and content analysis was used as an analyze method. The study comprises interviews with six nurses in one hospital in the west of Sweden. The results of the analysis show six main categories which contain six nurses’ descriptions of what they consider to be the most difficult communication. The categories are: communication when the personal chemistry don’t match, hopeful communication when delivering negative notification, communicating with angry patients, sensitive communication, conciliating communication with relatives, and being presence in communication under stress. What all nurses found most challenging was, to be present in the conversation to keep the patients hope and help the patient accept their situation.
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Abels, Carlyn. "The therapist's difficult emotional experience and racism a modified systematic literature review : dissertation [thesis] submitted to Auckland University of Technology in partial fulfillment of the degree of Master of Health Science (Psychotherapy), 2004." Full thesis. Abstract, 2004.
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Falkenstrom, Mary Kate. "Exploratory Study of Nurse-Patient Encounters in Home Healthcare: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/45.
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The purpose of this study was to explore nurse-patient encounters from the perspective of the Home Healthcare Registered Nurse. A qualitative descriptive design was used to collect data from a purposive sample of 20 home healthcare registered nurses from Connecticut, Massachusetts, and Rhode Island currently or previously employed as a home healthcare nurse. Four themes and one interconnecting theme emerged from the data: Objective Language; Navigating the Unknown; Mitigating Risk; Looking for Reciprocality in the Encounter; and the interconnecting theme of Acknowledging Not All Nurse-Patient Encounters Go Well. One goal of the study was to propose an empirically informed definition of what constituted a difficult encounter. An important early finding was that the terms difficult patient and difficult encounter were not generally used by study participants. HHC RNs voiced a preference for objective and nonjudgmental language to communicate outcomes of nurse-patient encounters. Three types of HHC RN-patient interactions emerged from the data, with constructive encounters the norm and non-constructive or destructive encounters less frequent. A constructive encounter is when two or more human beings, the nurse on the one side, and the patient, caregiver, or both on the other, interact to achieve a mutually agreed upon outcome. A nonconstructive encounter is when one or more human beings obstruct efforts to achieve at least one positive outcome. A destructive encounter is when one or more human beings direct anger at or physically aggress toward another human being. Strategies to promote reciprocality are routinely employed during HHC RN-patient encounters, but HHC RNs who miss cues that a strategy is ineffective or failed may be at risk in the home. Study data lend support to key concepts, assumptions, and propositions of Travelbee’s (1971) Human-to-Human Relationship Model. Study results provide a foundation for further research to increase the understanding, recognition, and development of empirically derived responses to non-constructive or destructive encounters such that HHC RNs are safe and best able to meet patients’ healthcare needs.
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Blomster, Else, and Westin Maria Sääf. "Distriktssköterskors erfarenhet av svåra situationer i hemsjukvården." Thesis, Karlstads universitet, Institutionen för hälsovetenskaper (from 2013), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-31901.
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Bakgrund: Distriktssköterskor i hemsjukvården arbetar självständigt i ett växande arbetsfält med allt sjukare patienter och mer avancerad vård. Teamarbete, samverkan och arbetsledning ställer höga krav på distriktssköterskans arbete vilket har väckt uppmärksamhet och forskning kring arbetssituationer som ställer så pass höga krav på distriktssköterskan att det inverkar negativt på distriktssköterskans hälsa och riskerar patientsäkerheten. Syfte: Att undersöka distriktssköterskors erfarenhet av svåra situationer i hemsjukvården. Metod: Studien har en kvalitativ ansats. Tolv distriktssköterskor verksamma inom kommunal hemsjukvård har deltagit i studien och med hjälp av semistrukturerade intervjuer har data insamlats. Därefter har data analyserats genom induktiv innehållsanalys. Resultat: Distriktssköterskor i hemsjukvården erfar svåra situationer i en bristande arbetsmiljö, i svårigheter i rollen som omvårdnadsledare, i bristande samsyn inom vårdorganisationen samt svårigheter i relationen med anhöriga och patient. För varje kategori finns underkategorier såsom hot och våld, ensamarbetets baksida, tidsbrist, svårt att leda arbetet när personalen brister i sin yrkesutövning, baspersonal som bedömer patienten ur ett annat perspektiv, stöttande av personal i svåra situationer, samverkan med andra professioner, svårt att få kontakt med läkare, anhörigas behov av bekräftelse och försummande av egenvårdsansvaret. Konklusion: Distriktssköterskorna erfor flera svåra situationer inom den kommunala hemsjukvården. För att säkerställa distriktssköterskors hälsa och trygga patientsäkerheten behöver dessa situationer synliggöras och åtgärdas.Background: District nurses in home care work independently in a growing field of work with increasingly ill patients and more advanced care. Teamwork, collaboration and staff management demand high quality in the district nurse performance, which has drawn attention and research to work situations demanding so much that the district nurse health and patient safety are adversely affected. Purpose: To investigate the district nurses' experience of difficult situations in home caring. Method: The study has a qualitative approach. Twelve district nurses working in municipal home care participated in the study and data was collected through semi-structured interviews. Data has been analyzed through an inductive content analysis. Results: District nurses in home care experience difficult situations in a lacking work environment, difficulties in the role as nursing leader in a lacking consensus in the caring organization, as well as difficulties in the relation between dependent and patient. Each area is divided in sub categories, such as threat and violence, working alone, time constraints, difficulties in management when personnel is lacking in performing nursing care, collaboration with other profession, supporting personnel, difficulties of getting in touch with doctors, caring staff assessing patients in another perspective, dependents’ need of confirmation and patients lacking in self-care. Conclusion: District nurses experience difficult situations in nursing homecare. To ensure the district nurses´ health and ensure patients safety requires these situations have to be made visible and addressed.
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Bitter, James Robert. "Working with Difficult Families." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5229.
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Gamble, Jacqueline Margaret. "Medication adherence in patients with difficult asthma." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.527931.
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Bitter, James Robert. "Working with Difficult Families." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5237.
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Adlerian family counseling was developed and systematized by Rudolf Dreikurs and carried into the world by his many student/colleagues, including Oscar Christensen and Manford Sonstegard. This is an experiential workshop using Dreikurs’ model in multiple family consultation demonstrations. Interventions include assessments of family constellation, mistaken goals, typical days, goal disclosure, and the use of encouragement and natural and logical consequences.
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Islam, Jasmin. "Evaluating patient susceptibility in Clostridium difficile infection." Thesis, University of Brighton, 2013. https://research.brighton.ac.uk/en/studentTheses/059dba8c-ad37-4d2a-9f0e-13b94f843e0e.
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Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhoea and causes substantial morbidity and mortality. Efforts to reduce the impact of CDI have succeeded in reducing rates through antibiotic stewardship, improved diagnostic testing and optimisation of infection control measures. Further reductions in CDI could be achieved through a better understanding of what makes patients susceptible to CDI. Such knowledge would support interventions targeting patients most at risk and help develop treatments to reduce susceptibility. The aim of this thesis was to further our understanding of patient susceptibility to CDI by investigation of three specific areas. The first study investigated the role of the probiotic Lactobacillus casei DN114001 in preventing antibiotic associated diarrhoea (AAD), including CDI, as part of a large multicentre, double-blind, randomised placebo-controlled trial. Probiotics are live microorganisms that may help restore antibiotic disruption to the host microflora and prevent C. difficile colonisation. The final results were not available at the time of writing this thesis and therefore a descriptive analysis of the first 650 blinded cases is provided. This is the largest probiotic study ever conducted and will contribute significantly to the existing literature in the field. The humoral immune response has been implicated in determining outcome in CDI. Previous studies have focused on recurrence of CDI and toxin A (TcdA), which was originally thought to be the most important virulence factor in CDI. However, recent studies have suggested toxin B (TcdB) may be essential for CDI pathogenesis. Therefore, the second study tested the hypothesis that antibodies to TcdB determine patient susceptibility in CDI. A case-control laboratory based study was conducted using a novel antibody ELISA and antibody responses to both toxins were assessed in two cohorts recruited in Brighton, UK and Michigan, USA. Lower antibody levels to TcdB, but not TcdA, were found in cases of acute CDI compared to controls. These novel findings are in contrast to previous studies and confirm the importance of TcdB in CDI pathogenesis. In addition, the antibody response to TcdB could be used as a surrogate marker for the efficacy of novel therapeutic agents. The third study sought to identify risk factors predicting recurrence of CDI. A longitudinal cohort study of 248 patients with confirmed CDI was conducted that confirmed the previously observed relationship between concomitant antibiotic treatment and risk of recurrence. The study also identified a novel risk factor namely that treatment on a cohort ward was associated with recurrence of CDI. This is likely to be a result of reinfection of patients who remain susceptible to CDI after treatment. This is the first study to demonstrate an association between cohorting of patients and recurrence of CDI and raises important questions about current infection control policies in hospitals. Efforts to combat CDI have focused on reducing exposure of patients to infection. The data presented here contribute to a rapidly emerging understanding that patient susceptibility is a crucial factor in determining risk of infection, risk of severe disease and risk of recurrence following treatment. In the near future interventions targeting susceptibility including probiotics, specific antibiotics such as fidaxomicin and immunotherapies such as vaccines may all have a role to play in combatting this devastating disease.
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Audemard-Gret, Géraldine. "Difficulté de diagnostic de la tuberculose chez le patient hémodialysé." Montpellier 1, 1997. http://www.theses.fr/1997MON11172.
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Rickel, Katie Allison. "The influence of participant preference and perceived difficulty on exercise adherence." [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0010241.
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Thesis (M.S)--University of Florida, 2005.Typescript. Title from title page of source document. Document formatted into pages; contains 35 pages. Includes Vita. Includes bibliographical references.
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Aslam, Adam Joshua. "EEG Characterization During Motor Tasks That Are Difficult for Movement Disorder Patients." DigitalCommons@CalPoly, 2017. https://digitalcommons.calpoly.edu/theses/1822.
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Movement disorders are a group of syndromes that often arise due to neurological abnormalities. Approximately 40 million Americans are affected by some form of movement disorder, significantly impacting patients’ quality of life and their ability to live independently. Deep brain stimulation (DBS) is one treatment that has shown promising results in the past couple decades, however, the currently used open-loop system has several drawbacks. By implementing a closed-loop or adaptive DBS (aDBS) system, the need for expensive parameter reprogramming sessions would be reduced, side-effects may be relieved, and habituation could be avoided. Several biomarkers, for example signals or activity derived from electroencephalogram (EEG), could potentially be used as a feedback source for aDBS. Here, we attempted to characterize cortical EEG potentials in healthy subjects performing six tasks that are difficult for those with movement disorders. Using a 32-channel EEG cap with an amplifier sampling at 500 Hz, we performed our protocol on 11 college-aged volunteers lacking any known movement disorder. For each task, we analyzed task-related power (TRP) changes, spectrograms, and topographical maps. In a finger movement exercise, we found task-related depression (TRD) in the delta band at the F4 electrode, as well as TRD at the C3 electrode in the alpha band during a pencil-pickup task, and TRD at the F3 electrode in the beta band during voluntary swallowing. While delta-ERD in the finger movement exercise was likely due to ocular artifact, the other significant results were in line with what relevant literature would predict. The findings from the work, in conjunction with a future study involving movement disorder patients, can provide insight into the use of EEG as a feedback source for aDBS.
Keywords: EEG, electroencephalography, neurostimulation, deep brain stimulation, movement disorders, closed-loop DBS, adaptive DBS, aDBS
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Rexach, Carmen Elisabeth. "The epidemiology of Clostridium difficile in pediatric patients /." For electronic version search Digital dissertations database. Restricted to UC campuses. Access is free to UC campus dissertations, 2002. http://uclibs.org/PID/11984.
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Holchaker, Odile. "Traitements de la ménopause : de la difficulté de bien informer." Bordeaux 2, 1993. http://www.theses.fr/1993BOR2PE78.
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Koch, Katja [Verfasser]. "Antihistamine updosing reduces disease activity in difficult-to-treat cholinergic urticaria patients / Katja Koch." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2017. http://d-nb.info/1127579959/34.
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Coltri, Julia Anne. "Transgender male patients and hereditary breast cancer risk: broaching difficult topics to reduce healthcare disparities." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1555683611281611.
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Vivant, Patrick Pascal. "Le médecin généraliste et l'adolescent en difficulté en 1998 : essai d'écologie relationnelle médecin généraliste-adolescent." Bordeaux 2, 1998. http://www.theses.fr/1998BOR2M097.
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Peterson, Stephanie, and Grant Skrepnek. "Inpatient Cases of Clostridium difficile-Associated Disease in Oncology Patients throughout." The University of Arizona, 2012. http://hdl.handle.net/10150/614513.
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Class of 2012 AbstractSpecific Aims: To identify the number of Clostridium difficile-associated disease (CDAD) cases in hospitalized oncology patients between 2005 and 2009. To identify the occurrence of mortality, comorbidities, and the amount of hospital charges in this patient population. Predictive variables for mortality and hospital charges were also identified. Methods: Data retrieved from the Nationwide Inpatient Sample were used to retrospectively identify the number of CDAD cases in hospitalized oncology patients, the occurrence of mortality and comorbidities, and the amount of hospital charges incurred between 2005 and 2009. Multivariate logistic regression was used to identify predictors of mortality and a lognormal regression was used to identify predictors of inpatient charges. Main Results: From 2005 to 2009, we identified 210,449 cases of CDAD in hospitalized adult patients with cancer. Total inpatient charges for all CDAD cases over the five-year period exceeded 18 billion dollars. The percentage of cases that resulted in death was 13%. Variables that were found to be predictors of mortality included increased age (OR 1.019, CI 1.018-1.020), chronic pulmonary disease (OR 1.231, CI 1.191-1.272), coagulopathy (OR 2.085, CI 2.011-2.162), liver disease (OR 1.159, CI 1.072-1.253), fluid and electrolyte disorders (OR 1.561, CI 1.518-1.605), renal failure (OR 1.405, CI 1.349-1.462), and weight loss (OR 1.408, CI 1.362-1.456)(all p<.001). Conclusions: This study identified a large number of CDAD cases in hospitalized adult cancer patients. Several factors that appeared to be predictive of mortality and inpatient charges were also identified, which may be useful knowledge for clinicians who need to identify at-risk patients.
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Costa, CecÃlia Leite. "Clostridium difficile: incidÃncia da infecÃÃo e caracterizaÃÃo das cepas isoladas de pacientes com diarreia internados em um hospital oncolÃgico de Fortaleza, CearÃ." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=13125.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorClostridium difficile à um bacilo Gram positivo, anaerÃbio estrito, formador de esporos e produtor de toxinas. Atualmente, representa a principal causa de diarreia hospitalar associada ao uso de antibiÃticos. Pacientes oncolÃgicos sÃo um dos principais grupos de risco para infecÃÃo por C. difficile (CDI), visto que o uso de agentes quimioterÃpicos pode alterar a mucosa intestinal. AlÃm disso, estes pacientes normalmente sÃo imunodeprimidos e frequentemente utilizam antibiÃticos de largo espectro. Tendo em vista a patogenicidade do C. difficile e a importÃncia da doenÃa induzida por essa bactÃria em ambiente hospitalar este estudo visou determinar a incidÃncia e caracterizaÃÃo fenotÃpica e genotÃpica de cepas de C. difficile isoladas de pacientes oncolÃgicos internados do Hospital Haroldo JuaÃaba, Fortaleza, CearÃ. Durante o perÃodo de 12 meses (maio/2013 a maio/2014) foram coletadas 41 amostras de fezes diarreicas. Toxinas A e/ou B foram detectadas a partir das fezes por meio de um kit de detecÃÃo comercial ELISA. Em seguida, as amostras foram cultivadas em Agar Cicloserina, Cefoxitina, Frutose (CCFA) e incubadas em anaerobiose. As cepas isoladas foram processadas e realizadas identificaÃÃo fenotÃpica e anÃlise de detecÃÃo dos genes das toxinas e do fragmento do gene tpi (identificaÃÃo definitiva) por PCR convencional. A sensibilidade das cepas isoladas a 12 antimicrobianos foi determinada por meio de E-test. TambÃm foi realizado a genotipagem das cepas por meio da anÃlise molecular PFGE. 46,3% (19/41) das amostras foram positivas para presenÃa das toxinas A/B por ELISA e/ou cultura do C. difficile. Dessas amostras, foram isolados C. difficile de trÃs amostras (15,8% - 3/19). Em todos os isolados foram detectados os genes tpi, tcdA e tcdB. O domÃnio de ligaÃÃo da toxina binÃria (cdtB) nÃo foi detectado assim como tambÃm nÃo foram observadas deleÃÃes no gene tcdC nos isolados. Todas as cepas apresentaram o mesmo genÃtipo, NAP4. Com relaÃÃo à sensibilidade das cepas aos antimicrobianos foi verificado resistÃncia a dois ou mais antimicrobianos (azitromicina, tetraciclina, ciprofloxacina, levofloxacina, ceftriaxona e cefotaxima). 57,9% (11/19) faziam uso de antibiÃticos e quimioterÃpicos. Este trabalho descreveu a incidÃncia de CDI em pacientes oncolÃgicos, e evidenciou pela primeira vez a presenÃa de C.difficile em casos associados a comunidade (CA-CDI) nesses pacientes no Brasil, ressaltando a importÃncia do estudo dessa bactÃria para a compreensÃo da situaÃÃo epidemiolÃgica dessa infecÃÃo e de sua dispersÃo entre unidades hospitalares brasileiras.
Clostridium difficile is a strictly anaerobic, spore-forming, toxin-producing Gram positive bacillus. Currently, it is the main cause of nosocomial diarrhea associated with antibiotic use. Cancer patients are a major risk group for C. difficile infection (CDI), since the use of chemotherapeutic agents can alter the intestinal mucosa. Furthermore, these patients are often immunosuppressed and often use broad spectrum antibiotics. Considering the pathogenicity of C. difficile and the importance of this infection in hospitalized patients, this study aimed to determine the incidence and the phenotypical and genotypical characterization of strains of C. difficile isolated from cancer patients at Haroldo JuaÃaba Hospital, Fortaleza, CearÃ. During the 12 month period (May/2013 to May/2014) 41 diarrheic fecal samples were collected. Toxins A/B were detected from feces through a commercial ELISA detection kit. Then, the samples were cultivated on cefoxitine-cycloserine-frutose agar (CCFA) and incubated anaerobically. Isolates were submitted to several analyses, including phenotypical identification, detection of toxin genes and of a fragment of the tpi gene (definitive identification) by conventional PCR. The susceptibility of the strains to 12 antimicrobial agents was determined by E-test. Genotyping of the strains was also performed through molecular PFGE analysis. Out of 41 samples, 46.3% (19/41) were positive for either one or both of the performed tests: detection of toxin A/B and/or culture of C. difficile. C. difficile was recovered from three samples (15.8% - 3/19). The tpi, tcdA and tcdB genes were detected in all of the isolates. The binding domain of the binary toxin (cdtB) was not detected as well as no deletions were observed in the tcdC gene of the analysed isolates. All strains belonged to the same genotype, NAP4. Regarding the antimicrobial susceptibility of the strains, resistance to two or more antibiotics (azithromycin, tetracycline, ciprofloxacin, levofloxacin, ceftriaxone and cefotaxime) was observed. Out of the 19 positive patients, 57.9% (11/19) were using antibiotics and under chemotherapy. This paper describes the incidence of CDI in patients with cancer, and shows for the first time the detection of community-associated Clostridium difficile infection (CA-CDI) in those patients in Brazil, highlighting the importance of studying this bacterium for understanding the epidemiological situation of this infection and its spread among Brazilian hospitals.
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Andersson, Sanne, and Claes Tomtlund. "Sjuksköterskors erfarenheter av omvårdnaden vid vårdrelaterade infektioner med fokus på Clostridium difficile." Thesis, Blekinge Tekniska Högskola, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-11511.
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Bakgrund: Socialstyrelsen beskriver en vårdrelaterad infektion som en infektion en patient kan få i samband med behandling eller vård inom alla olika former av vård och omsorg. Vårdrelaterade infektioner anser Socialstyrelsen utgör ett problem som orsakar onödigt lidande och stora kostnader för samhället. Det finns få studier som fokuserar på omvårdnaden av patienter som drabbats av den vårdrelaterade infektionen Clostridium difficile. Det finns mycket medicinsk forskning kring Clostridium difficile infektioner men forskning inom sjuksköterskans huvudområde omvårdnad är begränsad. Syfte: Syftet är att belysa sjuksköterskors erfarenheter av omvårdnaden av patienter med vårdrelaterade infektioner med fokus på infektioner orsakade av Clostridium difficile. Metod: Kvalitativ empirisk intervjustudie utgående från intervjuer med sex sjuksköterskor från en infektionsavdelning. Innehållsanalysen genomfördes i enlighet med Granheim och Lundmans (2004) tolkning av Krippendorffs kvalitativa bearbetningsmetod. Resultat: Studien resulterade i två huvudkategorier. Vikten av att observera patientens omvårdnadsbehov belyser betydelsen av sjuksköterskors erfarenheter för att kunna utföra personcentrerad omvårdnad. Kommunikation med patienten och anhöriga belyser betydelsen av att lyssna och se människan såväl patienter som anhöriga. Slutsats: Sjuksköterskans förmåga att observera patienters omvårdnadsbehov är ett viktigt redskap vid utformningen av patienters omvårdnad i samband med en CDI. Betydelsen av information om CDI till såväl patienter som anhöriga beträffande de särskilda hygienrutiner som ska tillämpas med syftet att uppnå säker vård. Sjuksköterskor som arbetar på en infektionsavdelning har erfarenhet av att vårda isolerade patienter vilket innebär att de intervjuade sjuksköterskorna ansåg att merarbetet med omvårdnaden av isolerade patienter med en CDI inte var något större problem.
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Krajewski, Christina [Verfasser]. "Korrelation der Typisierung von Clostridium difficile Isolaten und klinischen Daten der Patienten mit Clostridium difficile Infektion / Christina Krajewski." Düsseldorf : Universitäts- und Landesbibliothek der Heinrich-Heine-Universität Düsseldorf, 2018. http://d-nb.info/1168900581/34.
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Van, Der Walt Sarel. "Outcome evaluation of an in-patient psychotherapy program: mindfulness, difficulty with emotion regulation, and mood and anxiety symptoms." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31324.
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This exploratory enquiry into the effectiveness of an in-patient psychotherapy program measured the changes in mood and anxiety symptoms, difficulty with emotion regulation, and dispositional mindfulness in a clinical population with diverse psychiatric morbidity. Participants were 53 adults (74.5% female, mean age = 35 years) who participated in a 4-week in-patient psychotherapy program offering a variety of interventions, including mindfulness skills training, and Dialectical Behaviour Therapy-psychosocial skills training. Program input data, demographic variables, psychiatric morbidity, and medication on discharge were tracked. There was an average improvement of 29.86 ± 20.56 on the Mood and Anxiety Symptoms Questionnaire-D30 and 12.43 ± 17.75 on the Difficulty with Emotion Regulation Scale-Short Form, indicating an improvement in mood and anxiety symptoms and emotion regulation post-intervention. There was an average improvement of 17.6 ± 23.66 on the Five Facets of Mindfulness Questionnaire, indicating an increase in dispositional mindfulness post-intervention.
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Capstick, Toby Gareth David. "The effectiveness of pharmacist interventions in improving asthma control and quality of life in patients with difficult asthma." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13962.
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Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma. Fifty-two patients attending a hospital difficult asthma clinic were randomised (1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists. Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50). At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates < 80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020). This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.
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Capstick, Toby G. D. "The Effectiveness of Pharmacist Interventions in Improving Asthma Control and Quality of Life in Patients with Difficult Asthma." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/13962.
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Despite national guidelines, the management of difficult asthma remains suboptimal, and there may be opportunities for pharmacists to improve asthma outcomes. This six-month prospective, randomised, open study investigated the effects of pharmaceutical care across primary and secondary care on difficult asthma.
Fifty-two patients attending a hospital difficult asthma clinic were randomised
(1:1) to receive usual medical care (UC), or pharmacist interventions (PI) comprising asthma review, education, and medicines optimisation from a hospital advanced clinical pharmacist, plus follow-up targeted Medicines Use Review (t-MUR) from community pharmacists.
Forty-seven patients completed the study. More interventions were performed in the PI group at baseline (total 79 vs. 34, p<0.001), but only six patients received a t-MUR. At six-months, PI were non-inferior to UC for all outcomes. The primary outcome measure was Juniper’s Asthma Control Questionnaire score and reduced (improved) from a median (IQ) score of 2.86 (2.25, 3.25) and 3.00 (1.96, 3.71) in the PI and UC groups respectively to 2.57 (1.75, 3.67) and 2.29 (1.50, 3.50).
At baseline, 58.8%, 46.9% and 17.6% of patients had optimal inhaler technique using Accuhalers, Turbohalers or pMDIs; education improved technique but this was not maintained at six-months. Adherence rates <80% were observed in 57.5% of patients at baseline, and was improved in the PI group at six-months (10/20 PI vs. 3/21 UC had adherence rates of 80-120%, p=0.020).
This study demonstrates that the management of difficult asthma by specialist pharmacists is as effective as usual medical care. Future research should investigate whether pharmacist-led follow-up produces further improvements.The Pharmaceutical Trust for Educational and Charitable Objects (PTECO) (now known as Pharmacy Research UK).
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Khanafer, Nagham. "Épidémiologie des infections à Clostridium difficile chez les patients hospitalisés dans un centre hospitalo-universitaire." Thesis, Lyon 1, 2013. http://www.theses.fr/2013LYO10136/document.
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Clostridium difficile est responsable de 15 à 25% des cas de diarrhées post-antibiotiques (ATB) et de plus de 95% des cas de colite pseudomembraneuse. Depuis 2003 et suite à l'émergence du clone 027, les ICD sont devenues plus fréquentes et plus sévères. Compte tenu des conséquences, il a été décidé d'explorer en détail et prospectivement cette maladie au Groupement Hospitalier Edouard Herriot L'inclusion des patients a débuté fin février 2011 et devrait s'arrêter fin février 2014. Dans une méta-analyse, nous avons montré que l'ICD communautaire est associée à l'exposition aux mêmes ATB qu'une ICD nosocomiale. Une analyse de la littérature, en utilisant la grille ORION comme outil, nous a permis de synthétiser les connaissances sur la prévention et le contrôle d'ICD en milieu hospitalier. Par la suite sur la base d'une étude rétrospective, le sexe, la CRP et l'exposition aux fluoroquinolones ont été identifiés comme associés à une ICD sévère chez les patients hospitalisés en réanimation. Entre 2011 et 2013, 430 patients ont été inclus dans notre cohorte. L'analyse des données de la prise en charge thérapeutique de 118 cas d'ICD a montré un niveau insuffisant de la connaissance des recommandations actuelles concernant le traitement de cette infection. L'analyse pronostique a montré un taux de mortalité de 19,5% dans les 30 jours qui suivent le diagnostic. L'ICD était indiquée comme une cause principale ou contributive de décès dans quinze cas (65,7% des décédés). Les analyses multivariées ont montré que les facteurs associés au décès sont différents entre les patients avec une ICD et les patients présentant une diarrhée non liée au Clostridium difficileClostridium difficile is responsible for almost all cases of pseudomembranous colitis and for 15%-25% of cases of post-antibiotic (ATB) diarrhea. Since 2003 and the emergence of 027 strain, CDI epidemiology is changing, with evidence of rising incidence and severity. In response to the alarming situation we decided to conduct a prospective study at Eduard Herriot Hospital to explore in details this infection. Patient’s inclusion has started in February 2011 and will end in February 2014. In a meta-analysis we found that the risk profiles for antimicrobial classes as risk factors for community-acquired CDI are similar to those described for nosocomial CDI. We used the ORION statement (Outbreak Reports and Intervention Studies Of Nosocomial infection) to synthesize knowledge of interventions to reduce and to control CDI in hospitals. Then in a retrospective study, we found that male gender, rising serum C-reactive protein level, and previous exposure to fluoroquinolones were independently associated with severe CDI in ICU. Between 2011 and 2013, 430 patients were included in our prospective cohort study. Data analysis of 118 cases of CDI showed an inefficient knowledge of current recommendations of CDI treatment. The crude mortality rate within 30 days after CDI diagnosis was 19.5%, with 15 deaths (65.7% of deceased patients) related to CDI. In a multivariate cox regression model, gender, serum albumin, antidiarrheal medications, cephalosporins, peritonitis and septic shock were independently associated with mortality in CDI patients. When diarrhea was not related to C. difficile, mortality was rather associated with cancer and high WBC level
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Åström, Gunilla. "The meaning of caring as narrated, lived, moral experience." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 1995. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100560.
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The purpose of this research was to understand the meaning of caring as narrated, lived, moral experience. Forty-five good nurses experienced in the care of patients in surgical, medical and geriatric wards were interviewed. They described their experience of; caring, caring abilities, the worthwhile of caring, the strength related to caring and narrated situations (n=88) in which they had experienced that their caring had made a difference to the patient. Surgical nurses described care and cure as an integrated whole, medical nurses described care as integrated with the patients' social context and geriatric nurses described care as enhancing the autonomy of patients (I). The nurses' narrated, lived, experiences of caring situations revealed ways of intervening and interacting with the patient including caring actions (II). Eighteen good nurses experienced in the care of cancer patients were also interviewed. Their narrated, lived experiences of morally difficult care situations i.e. situations where it had been hard to know what was the right and good thing to do for the patient (n=60), revealed that relationships with their co-workers were very important for their possibility to act according to their moral reasoning and feelings(III). The situations for the nurses were either disclosed as overwhelming or possible to grasp. When narrating about these situations the nurses used different terms about themselves and their co-workers (One, They, I and We). The nurses viewed the patients either as a task to be accomplished or as a valuable unique person. In the latter situations ethical demands were interpreted, judged and acted upon (IV). Interpretations of these nurses' skills in managing morally difficult care situations disclosed two levels; one group of nurses who described positive paradigm cases, liberating maxims and disclosed open minds, while the other group described negative paradigm cases, restrictive maxims and revealed closed minds. The latter nurses were mostly the nurses who disclosed in Paper III that they used the term "one" about themselves and "they" about their co-workers (V).en patients recently cared for at surgical and medical wards were interviewed(IV). They narrated lived experiences of receiving/not receiving the help they needed or wanted when suffering from pain and anxiety/fear. The patients revealed that the most important thing for them to feel cared for in these situations was to be listened to, taken seriously and trusted, if they were not treated in this way the patients revealed that they felt they were in the hands of somebody who was uncaring. The findings are interpreted within the framework of Paul Tillich's philosophy concerning love, power, justice and courage, thereby showing the tension between these phenomena in the narrated, lived, moral experience. Light is also thrown on the dynamics of openness, vulnerability, fallibility, forgiveness, affirmation as well as powerlessness, meaninglessness, insufficiency, dissociation and exclusion. Reflections are made concerning practical wisdom.S. 1-60: sammanfattning, s. 61-151: 6 uppsatser
digitalisering@umu
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Edman, Wallér Jon. "Vårdplatsbyten och Clostridium difficile-infektion : En fall-kontroll-studie." Thesis, Högskolan i Skövde, Institutionen för hälsa och lärande, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-16635.
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Introduktion: Clostridium difficile är en bakterie som bildar tåliga sporer som kan överleva länge i sjukhusmiljön trots goda rutiner. De flesta Clostridium difficile-infektioner (CDI) är sjukhusförvärvade. Att tarmen koloniseras av sporer eller bakterier är en förutsättning för infektion, risken att sedan insjukna beror på tarmflorans och immunförsvarets tillstånd. I modern sjukvård sker regelmässigt patientomflyttningar inom och mellan avdelningar, vilket gör att patienten exponeras mot en större del av sjukhusmiljön där C. difficile-sporer kan finnas. Syfte: Att undersöka om byte av vårdplats inom och/eller mellan avdelningar är en riskfaktor för att insjukna i CDI när hänsyn tas till andra kända riskfaktorer. Metod: En fall-kontroll-studie på alla sjukhusförvärvade fall hos vuxna på Södra Älvsborgs Sjukhus i Borås under två år, 2012 och 2015. Beräkning av odds ratio med univariat logistisk regression följt av multivariat logistisk regression för statistiskt signifikanta variabler. Resultat: Vårdplatsbyten var inte vanligare i fallgruppen när hänsyn togs till övriga riskfaktorer. I den multivariata modellen var vårdtid innan provtagning den enda variabel som utföll statistiskt signifikant (OR per vårddygn: 1,07, konfidensintervall: 1,02–1,12). Slutsats: Studien kunde inte påvisa att vårdplatsbyten är en oberoende riskfaktor för CDI, men att genomföra undersökningen på ett större studiematerial kan vara av värde.Introduction: Clostridium difficile is a spore-forming bacterium; the spores are highly resilient and can survive for long periods of time in the hospital environment. Most Clostridium difficile infections (CDI) are hospital-acquired. Colonization of spores or vegetative bacteria in the large intestine is necessary for infection to occur; the risk of infection is modulated by the state of the intestinal microbiome and the host´s immune status. Patient-to-patient transmission within and between wards are commonplace in modern healthcare, exposing patients to more of the hospital environment where spores may exist. Aim: To determine whether changing room and/or ward is a risk factor for developing CDI when adjusted for other known risk factors. Method: A case-control study of all hospital-acquired CDI cases at Södra Älvsborg Hospital, Borås, Sweden, during two years: 2012 and 2015. Odds ratios were calculated using univariate logistic regression analysis followed by multivariate logistic regression analysis to evaluate statistically significant (p<0,05) variables identified by the univariate analysis. Results: Patient transfers were not more common in the case group when data was adjusted for other known risk factors. In the multivariate model, length of stay [A1] alone was the only statistically significant variable (OR per additional day of care: 1.07, 95 % confidence interval: 1.02-1.12). Conclusion: The study could not demonstrate patient transfers as an independent risk factor for CDI, though replicating the study on a larger patient sample might be valuable.
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Parker, Nicola Sarah. "The psychological impact of nosocomial infection : a phenomenological investigation of patients’ experiences of Clostridium difficile." Thesis, University of Leicester, 2011. http://hdl.handle.net/2381/9893.
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Whilst the genesis and management of healthcare-associated infections (HAIs) is well represented in health literature, less attention has been given to patient experiences. The review of literature is a narrative synthesis of eight qualitative research studies focusing on patients’ experiences of healthcare associated infections. Results indicated that psychological needs of patients with iatrogenic infections are often inadequately addressed, and that patients’ experiences of iatrogenic infection were characterised by fears, worries, stress and guilt. Furthermore it highlighted inadequate information-giving practices, in some cases due to staff concerns about frightening patients, or because they assumed patients already knew they were infected. This impeded patient adjustment to infection, and may have consequently developed a double iatrogenic effect on those patients. The research report investigates patients’ experiences of hospital acquired Clostridium difficile using interpretative phenomenological analysis to interrogate interview data collected from six inpatient participants. Emergent themes were lack of information, psychological distress and concerns over possible future hospitalisation. Patients also reported observing poor adherence to hygiene protocol by hospital staff and anxiety about making complaints due to fear of possible reprisals. Results indicated that poor information sharing practices can inadvertently place an additional burden of anxiety and confusion on iatrogenically infected patients. Systems of staff training need more emphasis on explaining diagnoses and its implications for patients to mitigate some of these avoidable problems. Attention also needs to be paid to HAIs as deterrents of future engagement with health services, potentially putting patients’ health at risk. In reflecting on the process of conducting this research, the critical appraisal addresses several key areas of learning and development that have been pertinent for the author; these being reflections of epistemological and methodological issues throughout, consideration of aspects of researcher safety, a critique of the limitations of the study and proposals for future research.
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Alhammad, Ali. "THE USE OF LACTOBACILLUS IN THE TREATMENT OF CLOSTRIDIUM DIFFICILE INFECTION IN HOSPITALIZED ADULT PATIENTS." VCU Scholars Compass, 2009. http://hdl.handle.net/10156/2447.
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Eriksson, Sandra. "Fönster med utsikt : Patienters upplevelse av att vårdas under isolering inom somatisk slutenvård." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-14639.
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Inom sjukvården finns det två former av isolering. Smittskyddsisolering är till för att hindra smittspridning när en person blir smittad av en infektion som kan vara farlig för allmänheten och skyddsisolering används när en person är extra infektionskänslig, exempelvis efter cytostatikabehandling för cancer. Syftet med studien var att beskriva hur patienter upplever isoleringsvård inom den somatiska slutenvården. Vald metod var en litteraturstudie där åtta kvalitativa artiklar användes. Sex teman identifierades i resultatet: Behov av anhöriga, Behov av stöd från sjuksköterskan, Känsla av instängdhet, Behov av kontroll, Behovet av information och Känslan av frihet. Studien visade att isolering leder till känslor av ensamhet, känslan av övergivenhet, psykisk ohälsa och skam. Det visade sig att behovet av medmänsklig kontakt och information var av stor betydelse för patienter för att kunna hantera sin tid under isolering. Många beskrev att det inte bara var negativt att ha ett eget rum utan det gav känslor av ro och underlättade vid besök. Att ha tillgång till tv, telefon och internet var för patienterna olika sätt för att få stimulans och få tiden att gå, som annars kunde kännas långsam. Sjuksköterskan var ett viktigt stöd och en källa till medmänsklighet. Att ha ett fönster med utsikt över omgivningen gjorde upplevelsen mer uthärdlig för flertalet av patienterna.
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Bras, da Costa Sabrina. "Utilisabilité des dispositifs médicaux : diagnostic des difficultés de compréhension et d'application de la norme IEC 62366." Thesis, Université de Lorraine, 2015. http://www.theses.fr/2015LORR0084.
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Pour assurer la sécurité et la santé du patient et des utilisateurs de Dispositifs Médicaux (DM), l'Union Européenne introduit « l'ergonomie » comme une exigence essentielle pour le marquage CE des DM. Pour se conformer à cette exigence, la norme IEC 62366 a été publiée pour guider l'implémentation d'un Processus d'Ingénierie d'Aptitude à l'Utilisation (PIAU) dans le cycle de conception et développement du DM. Cependant, les normes sont connues pour leurs difficultés d'application que ce soit pour la conception et/ou l'évaluation de différents systèmes (dispositifs, systèmes interactifs, etc.). L'objectif principal de ce travail est d'identifier les difficultés de compréhension et d'application de la norme IEC 62366 afin de proposer d'éventuelles pistes de remédiation. Grâce à une triangulation de méthodes, cette recherche aboutit à un diagnostic des difficultés de compréhension et d'application de la norme IEC 62366, qui pourrait mener à la sous-estimation des risques d’erreurs d’utilisation des DM. Les principaux résultats de cette thèse sont que : (i) La norme IEC 62366 requiert une expertise pluridisciplinaire pour être maîtrisée, (ii) Le cadre et les choix d'élaboration (i.e. présentation, organisation et contenu) de la norme IEC 62366 entravent sa compréhension et l'atteinte de ses objectifs. Les résultats de cette recherche permettent de fournir des recommandations et des perspectives qui devraient assurer un accompagnement approprié des différents utilisateurs de la norme IEC 62366. Cette thèse constitue un véritable enjeu de recherche translationnelle et offre à long terme l’opportunité à la communauté des Facteurs Humains, aux fabricants de DM et aux organismes de certification de DM de surpasser les difficultés d’application de la norme IEC 62366, d’augmenter la fiabilité et la qualité des DM et surtout d’éviter tout incident lié à leur utilisationTo ensure patient and users’ health and safety while using Medical Devices (MD), European Union introduced “ergonomics” as an essential requirement for the CE marking of MD. To comply with this requirement, the IEC 62366:2007 standard has been published to guide the implementation of the Usability Engineering Process (UEP) into the medical device design and development cycle. However, ergonomics standards are known to be difficult to apply to design and evaluate systems (devices, interactive systems, etc.). Thus, the main objective of this work is to identify difficulties in understanding and applying the IEC 62366 standard so as to provide better user guidance. Based on a triangulation of methods, this research identifies difficulties in understanding and applying the IEC 62366 standard, difficulties which could lead to an underestimation of risks of use errors of MD. The main results of this thesis are that: (i) The IEC 62366 standard required a pluridisciplinary expertise to be correctly mastered, (ii) The way the IEC 62366 standard has been designed (presentation, structure and content) is impeding its understanding and the achievement of its objectives. The results of this research allow providing guidelines and research opportunities which should ensure an appropriate support to the proper application of the IEC 62366 standard requirements by his users. This thesis represents real translational research issue and offers long-term possibilities to the Human Factors community, MD manufacturers and MD certification bodies to overcome difficulties in applying the IEC 62366 standard, in improving the reliability and the quality of MD and above all in avoiding incident related to use errors
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Menecier, Pascal. "Attitudes et croyances de soignants hospitaliers envers des sujets âgés en difficulté avec l'alcool." Thesis, Lyon 2, 2015. http://www.theses.fr/2015LYO20016.
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Aborder puis accompagner dans les soins des sujets âgés en difficulté avec l'adolescent complexe pour tout soignant : infirmier ou médecin. le maintien d'une prévalence élevée du mésusage d'alcool chez les aînés, associée au vieillissement en cours de la population rendent cette question de plus en plus fréquenté à l'höpital et en établissement d'hébergement pour personnes âgées.le mésusage d'alcool est peu abordé chez les sujets âgés, peut-être moins car il est rare ou difficile à repérer, mais surtout par dénégation des troubles et contre-attitudes soignantes envers ces ainés. afin d'éviter l'âgisme et le rejet des ainés en difficultés avec l'alcool, les attitudes soignantes peuvent être prises en considération. pour cela, une étude d'observation descriptive sera menée en trois chapitres :- etude exploratoire auprès de sujets âgés en difficultés avec l'alcool : décrire les attitudes des soignants.- enquête auprès d'environ 750 soignants (625 infirmiers et 130 médecins de 8 hôpitaux à propos de leurs ressentis, attitudes et habitudes de soins avec des sujets âgés en difficulté avec l'alcool.- etude complémentaire par des entretiens directs d'un échantillon représentatif de soignants.sur ces bases, une réflexion théorique sera conduite autour de la vieillesse, du mésusage d'alcool et des représentations ou croyances des soignants, dans la perspective d'identifier des marqueurs ou facteurs d'attitudes positives et envisager des propositions de recours en prévention de contre-attitudesIntroduction: Old age and alcohol misuse are only rarely considered together. While the prevalence of alcohol use disorder is located around 10% in the over 65 age bracket and while such situations are encountered daily by hospital or nursing-home caregivers, these elderly people suffering from alcohol misuse are often overlooked. Is it possible to consider this apparent neglect as a translation of negative counter-attitudes on the caregivers’ part?Methods: Two cross-sectional surveys, by means of questionnaires then by research interviews, were conducted among 582 nurses and 116 physicians working in 8 health facilities around Macon. The main objective was to approach the feelings, beliefs and attitudes of caregivers with older individuals who misuse alcohol. These variables were observed according to several socio-professional criteria and to the care provider’s level of knowledge in alcohology. The interviews were recorded and the dialogue was processed by Alceste® software.Results: The 315 completed questionnaires (response rate: 45%) of whom 81% were nurses and 19% physicians and of this number 84% were women. More than nine out of ten agents report meeting elderly alcohol misusers and this number is estimated at 12% of those cared for. The feelings then declared by the care-givers were shared out over 75% to listening or availability, 39% to aid or demonstration of skill, 32% to malaise, weakness or avoidance and 7% to aggression, repression or moralizing. Among the reasons which could oppose the development of appropriate care, only appear lack of training or lack of time. Correlations were objectified between positive attitudes and high level of knowledge, having had a life experience close to a familiar person misusing alcohol or to be himself an alcohol consumer. The 45 research interviews were conducted with 16 physicians and 29 nurses, of whom 69% were women. Discourses analysis has highlighted some specific extracts out of them: a less threatening perception of alcoholized elderly individual, the use of humor appearing specifically when alcohol is mentioned and questioning lack of time or training. The interviews allowed the highlighting of negative feelings and emotions and also emphasized the important role and the favorable impact of familiar experiences with sufferers of alcohol misuse in the life of the care provider.Discussion: Despite the limitations of non-validated questionnaires and the lack of focus groups, these two complementary studies confirm the significant frequency with which caregivers come into care situations with elderly individuals misusing alcohol. This point calls into question the ignorance which surrounds these situations which helps us to better understand their negligence and which may explain the small percentage of skilled addictological help given to the elderly person after early screening. The frequent allegation of lack of time or knowledge (and training) seems to be contradicted during the interviews by levels of knowledge that appear to be good. These claims can be caregivers’ defensive rationalizations concerning situations experienced as difficult. The question of denial may be considered in the same way: often referred to without being wary of its repercussion. Computerized speech analysis has led to crosschecking, studied in the light of several theories about narcissistic identification, dissimilarity / similarity, empathy or attachment.Conclusion: Caregivers’ attitudes about the elderly misusing alcohol appear to be variable, multifaceted, complex, according to the modes of observation, being neither good nor bad. Beyond the phenomenology of attitude, there is the consideration of internal elements of the caregivers’ thinking and those cared for which undergird care providers’ behavior. This approach seeks to promote a psychodynamic regard on the elderly who misuse alcohol trough the care-givers approach
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Burger, Adrian. "Predictors of difficult intubation in obstetric cohort of patients: an analysis of the prospective obstetric airway management registry (OBAMR) (substudy – R025/2018)." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33677.
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Abstract Background: Hypoxaemia during tracheal intubation in obstetrics remains a lifethreatening complication. This study aimed to identify common clinical preinduction predictors of difficult intubation. Methods: A retrospective analysis was performed of data pertaining to tracheal intubation in patients requiring general anaesthesia for caesarean delivery, with a gestational age from 20 weeks, and until 7 days post-delivery, obtained from an obstetric airway management registry (ObAMR) at the University of Cape Town. Data was entered anonymously into a secure UCT REDCap database. Data categories were: patient and pregnancy characteristics, airway characteristics, details of management, and operator experience. The primary aim of the study was to identify anatomical and physiological risk factors for hypoxaemia. The primary outcome was defined as arterial desaturation to < 90% during obstetric airway management. For this purpose, multivariable binary logistic regression was performed. Hypoxaemia was thus used as a composite indicator of anatomical and physiological difficulty. Results: Data was collected for 1095 general anaesthetics in the ObAMR. Overall, 143/1091 of patients (13.1%, 95%CI 11.1 to 15.4%) experienced peripheral oxygen saturation below 90%. Univariate analysis showed that 91/142 (64.1%) of patients who desaturated were obese (body mass index [BMI]> 30 kg/m2 ), compared with 347/915 (37.9%) who were obese and did not experience desaturation (p< .001). A receiver operating curve (ROC) was constructed post hoc, which showed a cut-point for BMI of 29.76, and a sensitivity of 0.66, and specificity 0.62 for the prediction of hypoxaemia. Desaturation occurred in 17.0% of patients with hypertensive disorders of pregnancy, versus 11.0 % without (p=0.005). Increasing Mallampati class was associated with an increased incidence of hypoxaemia. The incidence of hypoxaemia was 25.8% for interns, compared with 8.0 % for consultant anaesthesiologists (p=0.005). In the multivariate analysis of factors associated with hypoxaemia, body mass index (p< 0.001), room air saturation prior to preoxygenation (p=0.008), and the presence of airway oedema (p=0.027), were independently associated with hypoxaemia. Conclusions: In this study, both anatomical and physiological predictors of hypoxaemia were identified. Using this concept, a predictive tool could be developed to aid in the identification of a difficult airway in obstetrics. Simple interventions such as face mask ventilation and the use of high flow nasal oxygenation, could be introduced to protect the parturient from the consequences of life-threatening hypoxaemia.
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Reddy, Surekha Nemakallu. "Clostridium difficile in colorectal surgery : a study of local epidemiology, asymptomatic carriage, in-patient disease and surface environmental contamination." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/24253.
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Clostridium difficile was identified as an infective agent in the late 1970s and early 1980s and causes a spectrum of disease ranging from asymptomatic carriage, mild colitis, pseudomembranous colitis (PMC) to fulminant colitis and even death. Since its recognition as an infective pathogen, C. difficile has become the principal cause of nosocomial diarrhoea in adults. The main aims of this four-part thesis were to determine the extent of Clostridium difficile infection (CDI) within the local in-patient population and to establish the epidemiology of CDI within the specialty of colorectal surgery. The first study focused on the burden of CDI to the diagnostic laboratory and the relative incidence of disease in different clinical specialties over an 8-year period (2000 to 2007) in a region that had not been affected by the hypervirulent 027 strain. A 27-fold increase in the number of faecal samples analysed by the enteric laboratory occurred from 2000 to 2006 and the total number of potential CDI cases increased over the same period, with a decline finally seen in 2007. One-fifth of all toxinpositive samples were from age groups under 60 years of age providing further evidence that CDI was not just a disease of the elderly. Although Medicine of the Elderly provided the greatest faecal analysis workload; Renal Medicine/Transplant Surgery, Intensive Care, Infectious Disease and Gastrointestinal Medicine all had higher incidences of CDI than Medicine of the Elderly. Similarly the low risk group of Paediatrics was also starting to show a small but notable increase in potential incidence. Potential excess costs for CDI in this region rose from £3.5 million to £29 million over the study period. The second study aimed to assess the potential impact of CDI within all surgical services. In the absence of 027, a further aim of this study was to assess if the more severe and extreme forms of C. difficile disease were occurring from 2000 to 2006. Colorectal surgery had the greatest number of CDI episodes followed by Upper Gastrointestinal Surgery and Urology. Despite the total number of C. difficile toxinpositive in-patients increasing each year, a similar increase was not demonstrated in the number of patients diagnosed with more severe forms of CDI or in the number of CDI patients treated with surgical intervention. In the cases requiring surgical intervention up to 40% of patients did not present with diarrhoea and up to 50% of patients did not have a C. difficile toxin-positive faecal sample prior to surgery. Demonstrating the importance of clinical recognition of the entire spectrum of C. difficile related disease. The post-operative mortality rate for fulminant CDI was 26%. High mortality figures for fulminant CDI treated surgically have not changed significantly over the last two decades and may relate to surgical referral for CDI often occurring late when the patient is in extremis. The third and fourth studies examined the specific burden of C. difficile in the colorectal surgical patient population and the environmental surface contamination within colorectal wards. An asymptomatic carrier rate of 6.1% was identified in the out-patient colorectal surgical population. Asymptomatic carriers admitted from the community play an important role in sustaining the transmission of disease within the hospital environment with 42.8% of C. difficile strains only identified in the in-patients faecal samples but not on the surface environment of the wards. Standard enteric hospital laboratory CDI diagnosis using enzyme immuno-assay for toxin A+B detection was 52% less sensitive then toxigenic culture with a false positive rate of 2.5%. Toxigenic culture identified a further 58 colorectal surgical in-patients with CDI. Of all the C. difficile isolates identified from in-patients and the surface environment ribotype 001 was the commonest strain, consistent with other local studies where ribotype 001 has emerged as the dominant strain. A large proportion of the in-patient ribotype 001 isolates showed resistance to ceftriaxone and ciprofloxacin. The ribotype 001 isolates from the surface environment showed decreased resistance to ceftriaxone compared with the in-patient strains. Similarly 4.6% of all in-patient isolates showed intermediate resistance to vancomycin but no vancomycin resistance was demonstrated in the environmental surface isolates and may represent increased development of C. difficile resistance mechanisms in the host. The patient bed frames were the commonest contaminated environmental surface with C. difficile, followed by the patient's bedside lockers and tables. Therefore the risk of a patient ingesting a C. difficile spore from the surface environment is high. Following the introduction of a new cleaning protocol during the environmental sampling study a statistically significant reduction in environmental C. difficile surface contamination and in the number of CDI colorectal in-patients was demonstrated. Acquisition of CDI from the surface environment in hospitals is not to be under-estimated and judicious application of infection control measures remains an important factor in preventing CDI transmission.
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Joshi, Lovleen Tina. "Pathogenicity & a bedside real-time detection assay for clostridium difficile in the faeces of hospitalized patients." Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/37079/.
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Clostridium difficile, a Gram positive, anaerobic, spore-forming bacterium is the commonest cause of hospital acquired infection in the UK. The organism initiates infection through spore formation and attachment, germination in the gut and then the production of two potent cytotoxins; toxins A and B. While the contribution of toxins A and B to infection is beyond dispute the relative importance of each toxin is a subject of debate. Thus diagnostic assays capable of rapidly detecting the presence of both toxins are needed. To develop such an assay we first characterised the structure of C. difficile spores to better understand their role in pathogenicity and adherence to organic and inorganic surfaces. Following attachment the spore germinates and the resulting vegetative bacteria express toxins. To facilitate the development of an assay capable of detecting both toxins, we employed a bioinformatics based approach which identified highly conserved nucleotide sequences within regions of each toxin which we hypothesised were under strict selective pressure. The specificity of the probes identified was confirmed using a panel of 58 clinical C. difficile isolates, related Clostridium isolates, non-related species and human gut metagenomic DNA samples. Selected probes were incorporated into a metal enhanced fluorescent assay platform and their ability to detect the organism in various organic backgrounds was determined. We were able to detect as few as 10 bacteria in 500 μl of human faecal material within 40 seconds, suggesting that this approach has the potential to be developed into a commercial assay. To support the development of this assay we sought to develop an insect infection model using the worm Manduca sexta. Our inability to initiate infection, inspite of the fact that bioinformatic analysis revealed the presence of genes with homology to known insect virulence factors, suggests that C. difficile may have potential evolutionary association to invertebrates.
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Duran, Ségolène. "Symptômes et difficultés ressentis chez les patients infectés par le VIH initiant une multithérapie antirétrovirale et impact sur l'observance thérapeutique." Aix-Marseille 2, 2002. http://www.theses.fr/2002AIX20666.
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Kim, Hwasoon. "The effect of concrete objective information on emotional distress and communication difficulty of Korean patients on ventilator therapy after cardiac surgery /." The Ohio State University, 1998. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487949150071447.
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Ait, Si M'Hamed Mohamed. "Évaluation du mode d’assistance ventilatoire NAVA dans le processus de sevrage ventilatoire chez les patients sous ventilation mécanique – Projet pilote." Mémoire, Université de Sherbrooke, 2014. http://savoirs.usherbrooke.ca/handle/11143/169.
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La procédure de sevrage ventilatoire vise à réduire la durée de la ventilation mécanique (VM) et de minimiser les risques de complications. Il est donc important d’identifier les stratégies de sevrage ventilatoire (SV) qui aident le patient à récupérer, dans les plus brefs délais possibles, son autonomie respiratoire et se séparer de la VM. Le mode NAVA présente des avantages potentiels pouvant aider à améliorer la qualité et la vitesse du sevrage. Ce projet est une étude clinique randomisée menée en parallèle de phase pilote qui vérifie si le NAVA pourrait permettre au patient une bonne tolérance au sevrage ventilatoire (TSV) et réduire la durée de sevrage (DSV) en le comparant avec la stratégie classique qui se base sur le mode de ventilation spontanée avec aide inspiratoire (VSAI). Un nombre de 8 patients classés dans la catégorie de «sevrage difficile» sont inclus dans cette étude. Ils sont répartis en deux groupes. Le groupe A est sevré en mode conventionnel VSAI tandis que le groupe B est sevré avec le mode NAVA. Un sevrage ventilatoire réussi et bien toléré fini par séparer le patient de son ventilateur dans les plus brefs délais et avec une récupération soutenue de la respiration spontanée. Les principaux résultats de cette étude affichent une DSV de 2,48 jours chez le groupe sevré en NAVA versus 4,96 jours chez le groupe sevré en VSAI. Cette différence, est statistiquement non significative à cause du petit nombre de sujets inclus. Pour mesurer la TSV, les tendances des paramètres hémodynamiques et oxygénatoires ont été enregistrées. La charge du travail respiratoire a été évaluée en observant les tendances de P0.1 qui est inférieur à 4 cmH[indice inférieur 2]O chez les patients NAVA, l'indice f/Vt qui a la tendance d’augmenter à la fin de sevrage chez les patients VSAI et l'Eadi qui reste normale chez les patients NAVA. Nous avons conclu que les patients en sevrage difficile pourraient être sevrés avec le mode NAVA. Toutefois, aucune différence statistiquement significative notée lorsque le mode NAVA est comparé avec le mode conventionnel VSAI quant à la durée de sevrage et au degré de la tolérance.
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Smith, Amelia, Kathyrn Matthias, and Hanna Phan. "Evaluating Treatment Options for NAP1 Versus Non-NAP1 Strains of Clostridium Difficile Infection Among Pediatric Patients at an Academic Hospital." The University of Arizona, 2014. http://hdl.handle.net/10150/614169.
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Class of 2014 AbstractSpecific Aims: The incidence of Clostridium difficile (C. Diff) infections in pediatric patients has continually risen, which could be caused by the emergence of a hyper virulent strain, specifically NAP1/B1/027. The objectives of the study were to evaluate the incidence of strain type, compare treatment(s) prescribed, treatment duration, rate of infection recurrence based on strain and severity, rates of re-infection or recurrence, and treatment failures for patients less than 6 months and up to 18 years of age. Methods: A retrospective study of patients admitted to an academic medical center with detection of C. diff toxin was performed. Data analyses included descriptive and inferential statistics to examine demographics, strain type, infection severity, and treatment failure. Main Results: Fourty-five patients with C. Diff toxin detection were included in study analyses and the median age was 6.2 [0.31- 17.9 years]. Oral or intravenous metronidazole was prescribed as initial therapy in 89% of the patients. Strain type was available in 77% of patients, with NAP1/B1/027 detected in 31% of stool samples tested. Within 21 days after initial toxin detection, there was a 13% rate of clinical failure or death, although none directly associated with C. Diff. Within days 22 - 65 after initial toxin detection, there was a 16% rate of recurrence or reinfection. Initial therapy selection, therapy duration, and rate of recurrence or reinfection were not significantly associated with NAP1/B1/027 strain type. Conclusion: Despite variability in severity of infection, the majority of pediatric patients with C. Diff were treated with metronidazole and were infected with a non-B1/NAP1/027 strain.
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Kleine-Brüggeney, Maren. "A cross-over comparison of the laryngeal mask airway Supreme and the laryngeal mask airway I-gel in a simulated difficult airway scenario in anasthetized patients /." [S.l.] : [s.n.], 2009. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Phillips, Janet Moira. "The lived experiences and support needs of a mainstream high school learner with a speech-flow difficulty." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86205.
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Thesis (MEd)--Stellenbosch University, 2014.ENGLISH ABSTRACT: The aim of this study was to better understand the lived experiences of a learner in a mainstream high school, who is experiencing a speech-flow difficulty, in order to gain insight into how best to support such a learner within an inclusive classroom. The theoretical framework on which this study was based is the bio-ecological model, inclusive education, positive psychology, resilience as well as developmental psychology, specifically the developmental phase of adolescence. The purpose of this was to view the learner holistically, taking into account all of the positive support structures in her life, especially, her levels of resilience, whilst taking cognisance of the fact that she is in the adolescent developmental phase, within a mainstream high school. Inclusive classrooms should ideally be structured in such a way that they accommodate a learner’s specific individual learning needs. The methodology employed in this study was based on a basic qualitative research approach, and viewed through an interpretive paradigmatic lens. Purposive sampling was used to select a learner who was experiencing a speech-flow difficulty. Various methods of data collection were employed, such as: a semi-structured interview with the learner and her mother, diary entries from the learner, a timeline of the learner’s life drawn by the learner herself, the researcher’s observations (both in the classroom and during a break time), as well as the researcher’s own reflective notes. Documents were also made available to the researcher, and these were the learner’s school reports, the learner’s speech therapy workbook, as well as a report on the learner from her speech therapist. This data was analysed through a qualitative coding process. The research findings indicated that the learner had various experiences, both positive and negative, within all spheres of her life. The majority of her experiences were positive, as the learner had strong support structures in her life, in the form of her mother, her friends, her sound academic capabilities, as well as her level of resilience. The learner is also currently receiving positive intervention in the form of speech therapy, where she is learning various strategies in order to assist her with her speech-flow difficulty. However, there are few factors that make the learner feel uncomfortable, especially in the classroom. The researcher has thus recommended ways in which educators can better support learners who are experiencing speech-flow difficulties within their classroom.
AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die geleefde ervaringe van ʼn leerder in ʼn hoofstroomskool, en wat ʼn spraakvloeiversteuring ervaar, te probeer verstaan. Die doel hiermee was om insig te verkry in hoe so ʼn leerder ondersteun kan word binne ʼn inklusiewe klaskamer. Die teoretiese raamwerk waarop hierdie studie berus is die bio-ekologiese model, inklusiewe onderwys, positiewe sielkunde, veerkragtigheid, sowel as ontwikkelingsielkunde, spesifiek die adolessente ontwikkelingsfase. Die mikpunt was om die leerder holisties te beskou, deur al die positiewe ondersteuningstrukture in haar lewe in ag te neem veral haar vlakke van veerkragtigheid, terwyl die feit dat sy haar in die adolessente ontwikkelingsfase bevind, en in ʼn hoofstroomskool is, verder lig op haar ervaringe kan werp. Inklusiewe klaskamers behoort dus in so ʼn mate gestruktureer te wees dat individuele behoeftes van leerders in ag geneem word. Die navorsingsmetodologie in hierdie studie het berus op ʼn basiese kwalitatiewe benadering, en beskou deur ʼn interpretatiewe paradigmatiese lens. ʼn Doelgerigte steekproef is gebruik om ʼn leerder te identifiseer wat ʼn spraakvloeiversteuring ervaar. Verskeie metodes van data-insameling is gebruik, byvoorbeeld semi-gestruktureerde onderhoude met die leerder en haar moeder, dagboekinskrywings van die leerder, ʼn tydlynoefening wat die leerder van haarself geteken het, die navorser se waarnemings (binne die klaskamer sowel as op die speelgrond), asook die navorser se reflektiewe notas gedurende die proses afgeneem. Dokumente is beskikbaar gestel aan die navorser, naamlik die leerder se skoolrapporte, haar werkboek wat sy gedurende spraakterapie sessies gebruik, sowel as ʼn verslag deur die spraakterapeut wat die deelnemer tans konsulteer. Die data is geanaliseer met behulp van ʼn kwalitatiewe koderingsproses. Die navorsingsbevindinge dui ʼn verskeidenheid van ervarings (positief sowel as negatief) aan wat die leerder binne al die areas van haar lewe ondervind. Die meerderheid van haar ervaringe is positief, aangesien sy sterk ondersteuningsstrukture in haar lewe het, veral haar moeder, haar vriende, haar sterk akademiese vermoeëns sowel as haar veerkragtigheid. Die leerder ontvang ook tans ʼn baie positiewe intervensie van ʼn spraakterapeut, waar sy ʼn verskeidenheid strategieë aanleer, wat haar help om die spraakvloeiversteuring mee te hanteer. Daar is egter ʼn paar faktore wat haar ongemaklik maak, veral in die klaskamer. Die navorser kan dus ‘n verskeidenheid van riglyne aanbeveel waardeur leerders met spraakvloeiversteurings ondersteun kan word binne die klaskamer.
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Faure, Julia Goutaudier Fanny Quentel Jean-Claude. "Quelle place pour l'estime de soi chez l'enfant suivi en orthophonie ?" [S.l.] : [s.n.], 2009. http://castore.univ-nantes.fr/castore/GetOAIRef?idDoc=58581.
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Günther, Claudia [Verfasser]. "Anstieg der Clostridium difficile-assoziierten Diarrhoe nach Einsatz von Moxifloxacin : eine klinische Beobachtungsstudie mit stationären Patienten / Claudia Günther." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2010. http://d-nb.info/1024502406/34.
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