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1
Welwel, Ghada. "Multi-disciplinary approach to obesity management and bariatric surgery." Electronic Thesis or Diss., Université Paris Cité, 2019. http://www.theses.fr/2019UNIP5152.
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L'étude vise les raisons, les connaissances et les attentes des personnes subissant une chirurgie bariatrique au Moyen-Orient et en Jordanie. Une étude rétrospective a été conçue et menée au Centre de la prise en charge de l'obésité Mohammad Al-Zitawi entre 2015 et 2017. 154 patients (hommes: 45; femmes: 109) - ayant une masse corporelle supérieure à 40 kg / m2 et âgés de 20 à 60 ans- ont participé à l'étude. Ils ont été choisis au hasard. Ils représentaient 10% des patients adultes au centre de l'obésité de la période de l'étude. Âgés de 20 à 60 ans, les participants a l'étude ont été orientées vers l'unité bariatrique du Centre Al-Zitawi. Le comité d'éthique du centre a approuve le protocole de l'étude. Tous les aspects éthiques ont été respectes au cours de l'enquête. La bienfaisance (bien faire), la non-malfaisance (ne justifie pas les patients), la fidélité, la confiance, le respect, le traitement impartial, le respect culturel, le droit à la justice, le respect de la confidentialité, le droit à la prise de décision et la décision volontaire ont été prises en compte. Il s'agit d'une étude rétrospective. Deux questionnaires ont été conçus: un pour les patients et l'autre pour les professionnels impliqués de la prise en charge de l'obésité. Les entretiens et le consentement des patients ont été obtenus par téléphone (chez eux, loin du centre). Les questions de l'étude a opte l'approche des méthodes mixtes pour améliorer la qualité des données collectées.Il s'agit d'une méthodologie de recherche croissante. Elle fait progresser le mélange systématique de données qualitatives et quantitatives au sein d'une même enquête ou d'un programme de recherche constant. Elle permet une utilisation complète et synergique des données. Elle donne toutefois la parole aux participants et les résultats sont basés sur l'expérience des participants. Elle laisse une place à l'équipe multidisciplinaire par la recherche en favorisant le contact des chercheurs en méthodes quantitatives, qualitatives et mixtes (Creswell et al., 2011). Les résultats montrent que les patients du Moyen-Orient n'avaient pas de connaissances et de compréhension à propos de la chirurgie bariatrique Les études de Taube-Schiff et al. (2016) et Guler et al. (2018), indiquent que les patients obèses, même dans les pays développés, ont peu de connaissance à propos des chirurgies bariatriques, Une étude récente saoudienne d'Altaf & Abbas (2019) révèle que la sensibilisation du public à l'obésité et à la chirurgie bariatrique est très limitée. Notre étude révèle une insuffisance évidente a propos de la prise de conscience et la connaissance de la chirurgie bariatrique chez les patients participants du Moyen-Orient. Différentes plates-formes sont essentielles pour mieux faire connaître la chirurgie bariatrique et ses avantages, ses facteurs de risque et ses complications associés. La revue des pratiques des chirurgiens et des éducateurs sanitaires est évidente. La plupart des patients de l'étude n'ont pas apprécié le service rendu et les bénéfices de la chirurgie. La sensibilisation du public, les services de gestion du poids, du changement de comportement et de la gestion de soi sont essentiels pour améliorer le service rendu à long terme de la chirurgie bariatrique et répondre aux attentes des patients<br>The study aimed to understand the reasons, knowledge and expectations of people undergoing bariatric surgery in Middle East and Jordan. A retrospective study is designed and was conducted in the Mohammad Al-Zitawi Obesity Management Centre between the years 2015 and 2017. A total of 154 participants (males: 45; females: 109) who had body mass greater than 40kg/m2 and aged between 20-60 years took part in the study. The study participants were randomly selected and enrolled participants were 10% of the patients who attended obesity management centre in that particular year. All study patients were above 20 years of age and had been referred to the bariatric unit at Al- Zitawi Obesity Management Centre. A total of 154 patients (males: 45; females: 109) who had body mass greater than 40kg/m2 and aged between 20-60 years took part in the study. Ethical approval for the study was taken from hospital ethical committee. At the time of filling up of questionnaire forms all ethical aspects such as beneficence (doing good), non malfeasance (not justifying patients), fidelity, trust, respect, unbiased treatment, cultural respect, right to justice, maintenance of confidentiality, right to decision making and voluntary decision were taken into consideration. The methodology involves two tier questionnaires; one for patients and the other one for the professionals involved in obesity management. Since, it is a retrospective study and participants are not in the city. Questionnaire forms and patients consent was obtained on phone from the participants. Filling up of questionnaire form was on phone. Questions were explained to participants on phone in English and Islamic language and consent was obtained. In the present study, we used mixed method approach to improve the quality of our research study. Mixed method approach refers to growing methodology of research that progress the systematic mixing of both qualitative and quantitative datum within a single investigation or constant programme of investigation. Mixed up approach allows complete and synergic use of data. Furthermore, this method gives voice to study participants and make sure that enrolled participants are part of study and results are base on participant's experience. This kind of approach provides space to multidisciplinary team by research by promoting the contact of quantitative, qualitative, and mixed methods scholars (Creswell et al., 2011). The results of our study showed that patients in the Middle East do not have much knowledge and understanding about the bariatric surgery and this finding is in consistent with the studies of Taube-Schiff et al. (2016) and Guler et al. (2018) indicating that usually obese patients have limited knowledge about bariatric surgeries even in the developed countries. Moreover, a recent research documented by Altaf & Abbas (2019) in Saudi Arab documents that the public awareness about obesity and bariatric surgery is very limited. Our study shows an obvious gap in awareness and knowledge about bariatric surgery among the studied participants from the Middle East. There is a need of using different platforms for spreading accurate awareness about Bariatric surgery and its associated benefits, risk factors and associated complications. Public awareness should be created by surgeons and health educators and they should act accordingly to develop better knowledge and awareness among general public. Most of patients in our study fail to meet their expectations from surgery as benefits of treatment. Our study also throws light on the significance of weight management services, behavioural change and self management in modifying patient's expectations of having long term benefits of bariatric surgery
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Roche, Stéphanie. "Conseil au patient en fin d'hospitalisation : une implication du pharmacien hospitalier dans la prévention de l'iatrogénie médicamenteuse." Reims, 2008. http://www.theses.fr/2008REIMP054.
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Harry, Isabelle. "Analyse des échanges écrits entre patients adultes et parents d'enfants, diabétiques de type 1, sur les forums d'Internet : implication pour l'éducation thérapeutique du patient." Phd thesis, Université Paris-Nord - Paris XIII, 2011. http://tel.archives-ouvertes.fr/tel-00695514.
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L'éducation thérapeutique permet aux patients de développer des compétences d'auto-soins et d'adaptation dans la gestion de la maladie chronique. Notre thèse a pour but de comprendre leur nature, à partir des situations de vie quotidienne dont discutent les adultes diabétiques de type 1 et les parents d'enfants diabétiques de type 1, sur les forums asynchrones d'Internet. Nous avons analysé 3756 messages écrits durant trois années, sur deux forums de discussion (314 patients diabétiques sont inclus dans l'étude) et réalisé des entretiens auprès de patients volontaires et usagers de ces forums. Nous avons utilisé les recommandations professionnelles publiées par la HAS et l'INPES (2007), pour relier nos résultats avec leur référentiel de compétences du patient chronique et pour rapporter à des objectifs pédagogiques les thématiques abordées par les discussions sur les forums. Ainsi, nos résultats mettent en évidence la capacité des patients à renforcer, via les forums d'internet, des compétences d'auto-soins liées à leur sécurité. La nature des compétences d'adaptation et d'auto-soins, indiquée par nos résultats, souligne le rapport que les patients entretiennent avec la maladie et le traitement. Les perspectives de cette thèse sont donc discutées. Dans le but d'associer les patients à la démarche en éducation thérapeutique, comme le précisent la législation actuelle et les recommandations professionnelles, la possibilité de poursuivre la recherche avec les exemples d'autres pathologies chroniques s'avère une voie pertinente. Mieux comprendre les situations de vie et la nature des compétences révélées par les échanges sur les forums d'Internet permettrait, en respectant les règles éthiques, de contribuer à l'élaboration des programmes d'éducation thérapeutique adaptés aux besoins réels des patients porteurs de maladie chronique. En outre, notre thèse permet de comprendre la nature des situations d'éducation informelle liées à la vie avec un diabète de type1 : nous en discutons l'intérêt pour l'éducation formelle proposée par les soignants éducateurs.
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Harry, Isabelle. "Analyse des échanges écrits entre patients adultes et parents d’enfants, diabétiques de type 1, sur les forums d’internet : implication pour l'éducation thérapeutique du patient." Paris 13, 2011. http://www.theses.fr/2011PA132020.
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L’éducation thérapeutique permet aux patients de développer des compétences d’auto-soins et d’adaptation dans la gestion de la maladie chronique. Notre thèse a pour but de comprendre leur nature, à partir des situations de vie quotidienne dont discutent les adultes diabétiques de type 1 et les parents d’enfants diabétiques de type 1, sur les forums asynchrones d’Internet. Nous avons analysé 3756 messages écrits durant trois années, sur deux forums de discussion (314 patients diabétiques sont inclus dans l’étude) et réalisé des entretiens auprès de patients volontaires et usagers de ces forums. Nous avons utilisé les recommandations professionnelles publiées par la HAS et l’INPES (2007), pour relier nos résultats avec leur référentiel de compétences du patient chronique et pour rapporter à des objectifs pédagogiques les thématiques abordées par les discussions sur les forums. Ainsi, nos résultats mettent en évidence la capacité des patients à renforcer, via les forums d’internet, des compétences d’auto-soins liées à leur sécurité. La nature des compétences d’adaptation et d’auto-soins, indiquée par nos résultats, souligne le rapport que les patients entretiennent avec la maladie et le traitement. Les perspectives de cette thèse sont donc discutées. Dans le but d’associer les patients à la démarche en éducation thérapeutique, comme le précisent la législation actuelle et les recommandations professionnelles, la possibilité de poursuivre la recherche avec les exemples d’autres pathologies chroniques s’avère une voie pertinente. Mieux comprendre les situations de vie et la nature des compétences révélées par les échanges sur les forums d’Internet permettrait, en respectant les règles éthiques, de contribuer à l’élaboration des programmes d’éducation thérapeutique adaptés aux besoins réels des patients porteurs de maladie chronique. En outre, notre thèse permet de comprendre la nature des situations d’éducation informelle liées à la vie avec un diabète de type1 : nous en discutons l’intérêt pour l’éducation formelle proposée par les soignants éducateurs<br>Therapeutic education enables patients to develop their self-care and adaptation skills in the management of chronic illness. The aim of our thesis is to understand their nature from every day real-life situations which type 1 diabetics adults and the parents of type 1 diabetics children discuss on asynchronous Internet forums. We analysed 3756 messages written over a three-year period on two discussion forums (314 diabetic patients are included in the study) and we interviewed voluntary patients and users of these forums. We used professional recommendations published by the HAS and the INPES (2007), to link our results to their frame of reference of skills developed by patients suffering from chronic illnesses, and related to educational objectives the topics covered by discussions on forums. Thus, our results bring to light the ability of patients with diabetes to strengthen, via the internet forums, self-care skills in association with their security. The nature of the adaptation and self-care skills indicated by our results emphasizes the relationship that the patients have with the illness and the treatment. The prospects of this thesis are therefore discussed. In order to enable the patients to share in the therapeutic education procedure, as stipulated by current legislation and professional recommendations, the possibility to continue research with examples of other chronic pathologies seems a relevant path to follow. A better understanding of real-life situations and the nature of the skills revealed by exchanges on Internet forums, whilst respecting ethical rules, would permit the elaboration of therapeutic education programmes adapted to the real needs of patients with chronic illness. In addition, our thesis permits an approach to the nature of informal educational situations in relation to everyday life with a type 1 diabetes : we discuss their significance for the elaboration of structured therapeutic education programmes proposed by carers
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Alexandre, François. "Implication du système nerveux central dans la faiblesse musculaire périphérique du patient atteint de broncho-pneumopathie chronique obstructive." Thesis, Montpellier, 2015. http://www.theses.fr/2015MONT4003/document.
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La faiblesse des muscles périphériques, définie par une diminution de la force maximale volontaire en dehors de tout état de fatigue neuromusculaire, est une complication fréquente de la broncho-pneumopathie chronique obstructive (BPCO). La force maximale volontaire dépend à la fois des propriétés musculaires périphériques (i.e. volume et architecture musculaire, qualités contractiles) et de la capacité du système nerveux à activer le muscle maximalement. Dans la BPCO, plusieurs travaux ont souligné l'existence paradoxale d'une perte de force maximale volontaire sans altérations musculaires périphériques et sans qu'un déficit d'activation volontaire n'ait clairement été identifié. Pourtant, les patients atteints de BPCO présentent de nombreuses altérations du système nerveux, compatibles avec une capacité d'activation volontaire altérée.L'objectif de ce travail de thèse était donc de tester l'implication du système nerveux dans la faiblesse musculaire de la BPCO et d'en déterminer les mécanismes sous-jacents. Au cours de nos travaux, nous avons mis en évidence une activité corticale diminuée dans la BPCO lors de contractions maximales et sous-maximales volontaires. Nous avons par ailleurs rapporté une perte d'excitabilité du cortex moteur et un déficit d'activation volontaire spécifique aux patients atteints de faiblesse musculaire. Ces résultats sont en accord avec une implication des altérations cérébrales dans la faiblesse musculaire périphérique de la BPCO. Nous sommes ensuite parvenus à identifier une origine potentielle des altérations cérébrales : les désaturations en O2 au cours du sommeil avec mouvements non-rapides des yeux (NREM). Cette hypothèse a été corroborée par l'observation d'un niveau d'activation volontaire réduit chez les patients désatureurs en sommeil NREM. En revanche, aucune répercussion significative n'a pu être observée sur la force maximale volontaire de ces patients, suggérant l'existence d'un mécanisme compensatoire. In fine, nos résultats constituent une avancée importante dans la compréhension du phénomène de faiblesse musculaire, classiquement attribué à la seule perte de masse musculaire. L'implication du système nerveux central dans la faiblesse musculaire ouvre notamment la voie à de nouvelles modalités de prise en charge par des approches spécifiques, dans l'optique de lutter contre la faiblesse musculaire et ses multiples répercussions négatives dans la vie du patient atteint de BPCO<br>Peripheral muscle weakness, as defined by a reduced voluntary strength outside any state of neuromuscular fatigue, is a common complication of chronic obstructive pulmonary disease (COPD). Maximal voluntary strength is determined by both peripheral muscle properties (i.e. muscle volume and architecture, contractile quality) and the nervous system's ability to activate the muscle maximally. In COPD, many studies highlighted the paradoxical existence of maximal voluntary strength loss without any peripheral muscle impairment, and without a clearly identified voluntary activation deficit. However, patients with COPD exhibited several nervous system alterations compatible with a reduced maximal voluntary activation capacity. The aim of this thesis was to test the nervous system implication in COPD muscle weakness and to determine the involved mechanisms. As major results, we found a reduced cortical activity in COPD during maximal and sub-maximal voluntary contractions. Furthermore, we reported reduced motor cortex excitability and voluntary activation deficit, specifically in patients with muscle weakness. These results are in accordance with an involvement of cortical alterations in COPD muscle weakness. Then, we indentified a potential origin for cortical alterations: O2 desaturation during non-rapid eye movement (NREM) sleep. This hypothesis has been corroborated by the observation of a reduced voluntary activation in patients with NREM sleep desaturation. However, no significant repercussion could have been observed on maximal voluntary strength in these patients, suggesting a compensatory mechanism.Our results are an important step forward in understanding the COPD muscle weakness that was classically attributed to loss of muscle mass only. The involvement of the central nervous system in COPD muscle weakness also brings about new patient care opportunities via tailored approaches, in order to fight against muscle weakness and its deleterious consequences on a patient's life
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Isambert, Céline. "Implication et rôles du pharmacien dans un centre de substitution par la méthadone situé au sein d'un établissement hospitalier parisien." Paris 5, 1999. http://www.theses.fr/1999PA05P107.
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Linden, Caroline. "Pharmacien : acteur de santé, implication du pharmacien dans la prise en charge des usagers de drogues substituées." Paris 5, 1999. http://www.theses.fr/1999PA05P017.
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Musumari, Patou Masika. "A mixed method study on the correlates of patient adherence to antiretroviral therapy in the Democratic Republic of Congo: implication of food insecurity." Kyoto University, 2014. http://hdl.handle.net/2433/188677.
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Goetz, Laurent. "La formation réticulée mésencéphalique : implication dans le contrôle de la locomotion et les troubles de la marche. Approche électrophysiologique chez le primate et le patient parkinsonien." Phd thesis, Université de Grenoble, 2013. http://tel.archives-ouvertes.fr/tel-00872694.
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La compréhension des mécanismes physiologiques et physiopathologiques du contrôle la locomotion et de ses troubles, constitue un enjeu majeur de la recherche biomédicale, pour améliorer la qualité et l'espérance de vie des patients atteints de la maladie de Parkinson. A partir de données expérimentales, la stimulation cérébrale profonde de la formation réticulée mésencéphalique (FRM), incluant les noyaux pédonculopontins et cunéiformes, a été proposée en 2005 comme nouvelle stratégie thérapeutique pour traiter le freezing de la marche. Cependant, au regard de résultats cliniques très hétérogènes, de nombreuses interrogations se posent concernant les connaissances anatomiques et fonctionnelles de la FRM, marquées notamment par un nombre limité de données expérimentales chez le primate non-humain. Cette étude s'inscrit dans une approche translationnelle associant des données cliniques et pré-cliniques. Dans un premier temps, un modèle de locomotion bipède chez le primate non-humain a été développé puis validé à partir de données cinématiques. Une approche IRM multi-séquences a été développée pour permettre un suivi longitudinal du protocole et la construction d'un atlas du tronc cérébral de Macaca fascicularis. Un mapping électrophysiologique de la FRM a ensuite été réalisé chez deux primates éveillés, qui a permis de mettre en évidence pour la première fois, des activités neuronales qui répondaient à la locomotion, confirmant ainsi l'existence d'une région locomotrice mésencéphalique chez le primate. Après intoxication au MPTP, seule une modification du pattern de décharge des neurones de la FRM a été observée, ainsi que des arguments en faveur d'un dysfonctionnement de l'activité de certains neurones de la FRM durant le blocage du pas. Enfin, des enregistrements électrophysiologiques durant des phases de locomotion puis d'endormissement naturel, suggèrent une double implication de populations neuronales dans le contrôle de la locomotion et du niveau de vigilance. La réalisation d'un nouveau système de coordonnées adapté au tronc cérébral humain a permis de réaliser une étude de corrélations anatomo-cliniques des effets de la stimulation cérébrale profonde du noyau pédonculopontin et de proposer une cible probabiliste pour l'implantation d'électrodes dans la FRM pour traiter le freezing de la marche dans le contexte parkinsonien.
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Lanciotti, Marco. "Information Usefulness To Support Dialogue Management in Healthcare." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2021. http://amslaurea.unibo.it/24648/.
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The main objective of the framework we are proposing
is to help the physician obtain information about the patient's condition in order to reach the \emph{correct} diagnosis as soon as possible.
In our proposal, the number of interactions between the physician and the patient is reduced to a strict minimum on the one hand and, on the other hand, it is made possible to increase the number of questions to be asked if the uncertainty about the diagnosis persists.
These advantages are due to the fact that (i) we implement a reasoning component that allows us to predict a symptom from another symptom without explicitly asking the patient, (ii) we consider non-binary values for the weights associated with the symptoms, we introduce a dataset filtering process in order to choose which partition should be used with respect to some particular characteristics of the patient, and, in addition, (iv) it was added new functionality to the framework: the ability to detect further future risks of a patient already knowing his pathology.
The experimental results we obtained are very encouraging
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Willigsecker, Annick Ziegler Olivier. "Implication et rôle du médecin traitant dans le traitement chirurgical de l'obésité Enquête téléphonique auprès de 100 médecins généralistes ayant au moins un patient opéré d'un court-circuit gastrique /." [S.l.] : [s.n.], 2009. http://www.scd.uhp-nancy.fr/docnum/SCDMED_T_2009_WILLIGSECKER_ANNICK.pdf.
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DeAdder, Dawna Nadine. "The illness experience of patients following a myocardial infarction : implications for patient education." Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/29706.
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This study used the research method of phenomenology to elicit the patient's perspective of the illness experience following a myocardial infarction (MI). The purpose of studying this experience was to gain an understanding of what it meant to men and women to have a MI, what the learning needs were following a MI, and how these learning needs were met. It was proposed that patients would view the illness experience differently from health professionals, thus the patients would identify different learning needs. Anderson's (1985) adaptation of Kleinman's health care system framework was used to conceptualize this problem.
Three males and two females, ranging in age from 42 to 77 years, participated in the study. Data were collected through 11 in-depth interviews. From analysis of this data significant statements were extracted to provide a description of the phenomenon under study.
The findings of this study suggest that health professionals and patients do view the MI experience from different perspectives. The emphasis of the patients on understanding the MI experience from the reality of their world is reflected in their attempts to rationalize the occurrence of the MI and their desires to know more about
their own MI, prognosis, and treatment. In order to plan patient education that will assist post-MI patients in their recovery health professionals must assess patients individually for their: (1) beliefs regarding risk factors and causes of MI; (2) desire for Information; (3) preference for method of instruction; and, (4) preference for timing of education.<br>Applied Science, Faculty of<br>Nursing, School of<br>Graduate
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Fram, Fawaz. "Patient information provision and involvement of patients by stroke professionals : implications for the patient-provider relationship." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/31381.
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Despite significant moves to inform and involve patients in their care, implementation of this vision has only been achieved with limited success. Part of the problem appears to stem from an insufficient consideration of the processes underpinning patient participation in the first instance. To help resolve this, we ask what factors drive the patient information provision and participation processes and how these factors have their impact. A significant barrier to the improvement of patient information and empowerment is the incomplete understanding of the interaction between patients and health professionals - commonly termed the patient-provider relationship (PPR). We argue that the PPR has not been fully developed in the context of stroke care specifically and we therefore propose a revised framework for understanding the nature of the patient-provider interaction, specific to stroke care. The new framework more realistically conveys the context for stroke care services in the UK today. The work first evaluates the research literature on the PPR in general, before focusing on the PPR in the acute phase of stroke care. We therefore place stroke care in the context of what is already theorised about the PPR. Based on the results from 50 semi-structured telephone interviews with stroke professionals, we then propose that a revision of our understanding of stroke PPR is needed to more fully take into account the dynamic external influences acting upon it. The general analytical approach is an inductively driven constant comparative method of qualitative analysis, conducted in line with grounded theory. Significant findings include: (i) the provider may no longer be the most important source of information for the patient within a revised stroke PPR model; (ii) stroke physicians reported cases involving lucid patients refusing thrombolytic treatment. Studies reporting stroke patients playing active, participatory roles in acute decision making do not appear in the literature and policymakers have tended to assume that the involvement of patients should only begin after the hyper-acute stages of care have passed. The findings here challenge this position and suggest that participation in decision-making during the hyper-acute phase is feasible and should be considered in clinical practice and policy making. Further, stroke care policy and practice recommendations arising from the study include: (i) greater consideration needs to be given to the allocation of resources designed to psychologically support stroke patients, (ii) audits must be designed to assess better the quality of stroke patient information provision, (iii) more information should be provided to patients and their families about what they can reasonably expect from the service they are using, (iv) priority should be given to the production of high-quality online material to complement the existing offline offering, (v) longer-term strategies should be developed for sustaining the sense of empowerment stroke patients have outside the hospital, when they generally ask more questions and demand more say in their care.
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Haigler, Susan Lynne. "The persuasive implications of therapeutic touch in doctor-patient relationships /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/8230.
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Barrier, Philippe. "L'auto-normativité du patient chronique : approche méthodologique : implications pour l'éducation thérapeutique du patient." Paris 5, 2007. http://www.theses.fr/2007PA05H069.
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Cette recherche en sciences de l'éducation part de l'expérience propre de la maladie chronique par le chercheur lui-même. Elle tente d'établir un concept capable de rendre compte du phénomène d'abord observé chez lui, de transformation du traumatisme de la chronicité en expérience à valence positive. La réflexion entamée sur le parcours personnel trouve un écho théorique dans la conception de Georges Canguilhem de la norme et de la pathologie. Elle s'appuie aussi sur la méthode phénoménologique pour faire « passer à l'expression » l' « éprouvé » de la maladie, c'est-à-dire de cette expérience réflexive d'un rapport singulier à la norme de santé. En s'appuyant sur l'ethnométhodologie, une enquête qualitative auprès de trente patients, observe, à des degrés divers, l'existence de cette même tendance : « l'auto-normativité », qui permet au patient, par un processus d'appropriation de la maladie, de déterminer lui-même une « norme de santé globale », qui établit un rapport harmonieux entre le sujet, sa maladie, son traitement, et sa vie en général, dans toutes ses implications. Nous envisageons, pour terminer, les implications sur la relation patient-soignant de ce concept d'auto-normativité, qui renverse la problématique traditionnelle de ce rapport. Et enfin ses implications sur les programmes d'éducation thérapeutique, orientés vers cette visée « autonomisante » induite ou renforcée par ce concept<br>This research in educational science comes from the researcher's own personnal experience of chronic disease. It tries to establish a concept capable of rending the phenomen first o bserved in himself: the transformation of chronicity traumatism into a positive experience. This reflection based on personnal experience, finds a theoritical echo in George Canguilhem's concept of norm and pathology. To express the factual experience of chronic disease, that is to say the introspective experience of a remarkable link with health norm, it is also supported by the phenomenological method. Relying on ethnomethodology, a qualitative survey addressed to thirty patients point out, at diverse degrees, the existence of the same tendeny of « self-normativity ». This self-normativity allows the patient, by a process of appropriation of illness, to determine for himself a « global health norm ». It also permits a harmonious connection between the subject, his illness, his treatment, and his life in general with all its implications. Finally, we have also contemplated the implications of this self-normativity concept on the doctor-patient relationship wich reverses the traditional problematic of this link. And also, its implications on therapeutic educational programmes orientid towards the « autonomising » aim induced or renforced by this concept
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Yee, Mean-Fong. "Dental Implications For The Patient With Mental Illness." Thesis, The University of Sydney, 1991. http://hdl.handle.net/2123/4960.
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O'Dea, Patricia Ann Margaret. "Treatment of the chronic mental patient: issues and implications." Master's thesis, University of Cape Town, 1986. http://hdl.handle.net/11427/17620.
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The aim of this study is to clarify the unique needs of the chronic mental patient, and draw implications therefrom for the design of comprehensive and effective systems of continuous care. The history of treatment for mental patients in the western industrialized world is reviewed, with special emphasis on the ethical, legal and socio-cultural background to the deinstitutionalization movement, and the development of new models of caring for the chronic mental patient. Recent attempts to humanize mental health care are examined for guidelines to more successful planning in the future.
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Lenz, Lynn. "Disruptive behaviors in healthcare : implications for patients /." Connect to online version, 2009. http://minds.wisconsin.edu/handle/1793/45112.
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Lo, Yen Andrea. "Doctor-Shopping : implications for continuity of care in Hong Kong /." Hong Kong : University of Hong Kong, 1995. http://sunzi.lib.hku.hk/hkuto/record.jsp?B14017726.
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Merriman, Olivia. "Clinical implications of counselling psychologists' responses to client trauma : an interpretative phenomenological analysis." Thesis, University of Roehampton, 2012. https://pure.roehampton.ac.uk/portal/en/studentthesis/clinical-implications-of-counselling-psychologists’-responses-to-client-trauma(15c5281c-b0f5-4032-96d7-f63264a7c48e).html.
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Background and aims: The past two decades have seen a surge of interest in the impact of working with trauma on psychological therapists’ well-being. However, the implications of therapists’ responses to trauma for the process of therapy are unknown. The existing literature carries the assumption that therapists’ strong subjective responses to traumatic material have a negative impact on the therapeutic process, but this has not been directly researched. Therefore, this thesis investigates the experiences of therapists working with clients who describe traumatic events, and how therapists consider their responses to the disclosure of traumatic material to have impacted upon the therapeutic process. Method: Semi-structured interviews were carried out with nine qualified chartered counselling psychologists with experience of working with trauma. Interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four superordinate themes. These were: (1) Demands and challenges in the use of self in response to trauma; (2) Dimensions of complexity in working with trauma: Conceptual, contextual, ethical, political; (3) Developing the therapeutic self in response to trauma; and (4) Valuing the therapeutic self in work with trauma. Conclusion: The research indicated that significant challenges were experienced in terms of the complex interpersonal dynamics, troubling somatic processes and ethical dilemmas in therapy with trauma. Furthermore, existing theoretical models were not sufficient to illuminate practice in these areas. Thus, this research indicates that specific 8 training and development in these areas is warranted, and a possible theoretical framework to help facilitate this is proposed. In addition, the current research supports the development of more explicitly socially contextualised approaches to trauma. Future research could usefully build on the current study by further investigating embodied processes and interpersonal dynamics, as well as the impact of therapists’ disclosure of their subjective responses in therapy with trauma.
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Griffiths, Catherine. "Terminal cancer patients' concerns : implications for psychological distress." Thesis, University of Liverpool, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368634.
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Reinhart, Jennifer M. "Derangements of tonicity and implications for veterinary patients." Thesis, Kansas State University, 2014. http://hdl.handle.net/2097/19761.
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Master of Science<br>Department of Clinical Sciences<br>Thomas Schermerhorn<br>Tonicity is property of a solution that is defined as the total effective (impermeable)
osmole concentration that drives fluid movement across a semipermeable membrane via
osmosis. Tonicity is related to but distinct from solution osmolality, which is a summation of all
solute concentrations, regardless of the solute membrane permeability. In the mammalian body,
tonicity is tightly regulated at both a cellular and systemic level; tonic derangements cause rapid
change in cell and tissue volume leading to significant dysfunction. Input from the central
nervous, circulatory, endocrine, gastrointestinal, and urinary systems are integral to
osmoregulation, so many diseases in veterinary medicine are associated with tonicity disorders.
However, because the homeostatic mechanisms that control tonicity overlap with those
regulating electrolyte and acid-base balance as well as hydration and vascular volume, tonic
consequences of disease can be difficult to isolate. Understanding of disease-associated changes
in tonicity is further complicated by the fact that the tonic contributions of many solutes that
accumulate in disease are unknown. Additionally, direct assessment of tonicity is difficult
because tonicity is not just a physiochemical property, but it implies a physiologic effect. Thus,
simple summation of osmole concentrations is an inadequate measurement of tonicity.
The following report includes three studies investigating various aspects of tonicity as it
applies to veterinary patients. Chapter 2 reports a study that examines the tonic effects of
ketoacids and lactate using two different in vitro red blood cell assays. Results demonstrated that
the ketoacids, beta-hydroxybutyrate and acetoacetate, behave as ineffective osmoles while the
tonic behavior of lactate is variable, implying a more complex cellular handling of this anion.
Two additional studies examine whether the mean corpuscular volume difference (dMCV) is a
novel clinical marker for hypertonicity in dogs. Results of separate retrospective (Chapter 3) and
prospective (Chapter 4) studies provide evidence that dMCV is a useful clinical marker for
hypertonicity in dogs.
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Jones, Christian. "Understanding procedural violations and their implications for patient safety in community pharmacies." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/understanding-procedural-violations-and-their-implications-for-patient-safety-in-community-pharmacies(a61be045-6aea-4b24-9535-f7c77e270c53).html.
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Background: Violations occur when individuals choose to bypass or deviate from procedures. Although violations are often not intended to cause harm, they are nevertheless breaches of the preferred way of working. Violations have been suggested to introduce risk into the environment by eroding the margin of safety. Therefore, violations are of potential concern to healthcare professionals that are responsible for patient safety. This thesis examines how and why violations occur in community pharmacies. Method: The research adopted a mixed methods approach to explore violations in community pharmacies and three studies were undertaken. The first study was a qualitative study that explored the views of management and frontline staff with regards to the prevailing safety culture in community pharmacies. The aim was to understand the context in which violations occur and to explore the goals that staff manage in practice. The second interview study explored how procedures are perceived in practice and the types of violations that occur in this setting. The third study utilised a survey based on the COM-B model that further explored the influence of capability, opportunity and motivation on violating behaviours. Results: Overall, findings demonstrated that numerous types of violations occur in community pharmacies. Mainly they occur either to ensure that timely patient care is provided or to ensure that productivity is maintained in practice. The safety culture study suggested that frontline staff and management have a different safety culture, with frontline staff reacting to risk in the moment and head office staff managing risk through the provision of multiple detailed procedures. The interviews suggested that procedures are useful for outlining what is expected of staff in practice; however they are not always possible to follow to the letter due to the complex working environment. The social norm within each pharmacy was suggested to influence violating behaviours, as was the professional judgement of the pharmacist. Violations were shown to be necessary for maintaining care at times, especially in exceptional circumstances. However, at times violations to maintain productivity did result in an increased risk to patient safety. The questionnaire study highlighted motivation, opportunity, length of experience, staff role and gender as influences on certain types of violations. Conclusions: The mixed methods utilised as part of this thesis revealed the types of violations that occur in community pharmacies and the reasons why pharmacists and support staff choose to violate. The findings led to recommendations for policymakers to evaluate how procedures are implemented in practice, to provide additional support for staff in practice through improved workflow, to provide patient safety specific training in pharmacies, to improve communication between frontline and head office staff and to educate pharmacy students regarding the possibility that they will need to violate procedures at times to manage the complex reality of working within community pharmacies.
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Abu-El-Noor, Mysoon K. "Spiritual Care of the Hospitalized Patients Following Admission to the Cardiac Care Units: Policy Implications." University of Akron / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=akron1334636792.
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Butson, Melissa B. "Implications of Pleiotropy for Clinical Genetic Testing: Assessing the Patient Perspective." Case Western Reserve University School of Graduate Studies / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=case1333112935.
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Söderberg, Johan. "Sources of preanalytical error in primary health care : implications for patient safety." Doctoral thesis, Umeå universitet, Klinisk kemi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-21256.
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Background Venous blood tests constitute an important part in the diagnosis and treatment of patients. However, test results are often viewed as objective values rather than the end result of a complex process. This has clinical importance since most errors arise before the sample reaches the laboratory. Such preanalytical errors affect patient safety and are often due to human mistakes in the collection and handling of the sample. The preanalytical performance of venous blood testing in primary health care, where the majority of the patients contact with care occurs, has not previously been reported. Aims To investigate venous blood sampling practices and the prevalence of haemolysed blood samples in primary health care. Methods A questionnaire investigated the collection and handling of venous blood samples in primary health care centres in two county councils and in two hospital clinical laboratories. Haemolysis index was used to evaluate the prevalence of haemolysed blood samples sent from primary health care centres, nursing homes and a hospital emergency department. Results and discussion The results indicate that recommended preanalytical procedures were not always followed in the surveyed primary health care centres. For example, only 54% reported to always use name and Swedish identification number, and 5% to use photo-ID, the two recommended means for patient identification. Only 12% reported to always label the test tubes prior to blood collection. This increases the possibility of sample mix-up. As few as 6% reported to always allow the patient to rest at least 15 minutes before blood collection, desirable for a correct test result. Only 31% reported to have filed an incident report regarding venous blood sampling, indicating underreporting of incidents in the preanalytical phase. Major differences in the prevalence of haemolysed blood samples were found. For example, samples collected in the primary health care centre with the highest prevalence of haemolysed samples were six times (95% CI 4.0 to 9.2) more often haemolysed compared to the centre with the lowest prevalence. The significant variation in haemolysed samples is likely to reflect varying preanalytical conditions. Conclusions This thesis indicates that the preanalytical procedure in primary health care is associated with an increased risk of errors with consequences for patient safety and care. Monitoring of haemolysis index could be a valuable tool for estimating preanalytical sample quality. Further studies and interventions aimed at the preanalytical phase in primary health care are clearly needed.
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Holland, L., Amy Poole, S. Subedi, and Nicholas E. Hagemeier. "Pharmacy Deserts, Swamps, and Oases: Definition Development and Implications for Patient Care." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1440.
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Lo, Yen Andrea, and 盧茵. "Doctor-Shopping: implications for continuity of care in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1995. http://hub.hku.hk/bib/B31234343.
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Wallace, Cynthia A. "Unawareness of deficits : emotional implications for patients and significant others /." The Ohio State University, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=osu1488192119266368.
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Lee, Chu-kee Angel, and 李珠璣. "Incidence, predictors and implications of depression after stroke." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B39634358.
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Giese-Sweat, Andrea. "The intersection of religion, spirituality and social work : implications for clinical practice : a project based upon an independent investigation /." View online, 2008. http://hdl.handle.net/10090/5885.
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Zimmerman, Elizabeth M. "Focal Sharp Waves in Psychiatric Patients| Implications for Complex Clinical Presentation." Thesis, The Chicago School of Professional Psychology, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3560217.
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<p> Sharp waves are areas of transient electrophysiological activity on conventional electroencephalogram (EEG) and are controversial as to their role in psychopathology. While some previous research has approached sub-seizure sharp waves as benign phenomena, the position taken in this study is that such activity indicates focal brain abnormalities with demonstrable behavioral correlations. This study explored the hypotheses that prevalence, location, and pattern of distribution of sharp wave activities in psychiatric patients would be associated with significant pathology and would predict specific clinical features. In a sample of 250 outpatient psychiatric patients, seventy-one non-epileptic patients demonstrated focal epileptiform predominantly distributed to frontotemporal regions. Location and distribution patterns of sharp wave activity had significant implications for clinical presentation, including relationship between homologous pairs of electrodes and affective symptom endorsement. Results of this study provide support of the pathological nature of epileptiform activity and suggest location and distribution have significant impact on clinical features. </p>
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Hanson, P. J. V. "The decontamination of endoscopes in AIDS patients : implications for infection control." Thesis, University of Cambridge, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.603667.
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Kobayashi, Masatake. "Evaluation Tools to Quantify Congestion and Prognostic Implication in Patients with Heart Failure." Thesis, Université de Lorraine, 2020. http://www.theses.fr/2020LORR0165.
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La congestion réfère aux œdèmes pulmonaires et systémiques habituellement observés dans un contexte d’augmentation des pressions intracardiaques. C’est un prédicteur majeur de mauvais pronostic en insuffisance cardiaque (IC). Une meilleure évaluation et quantification de la congestion au cours du parcours de soins (en amont d’une décompensation, aux urgences, en cours d’hospitalisation et en contexte ambulatoire) est souhaitable pour améliorer la stratification du risque et le management de ces patients. Des outils d’évaluation de la congestion facilement accessibles et d’utilisation simple seraient utiles dans ce contexte. Nous avons évalué 1) la capacité diagnostique et pronostique du score de congestion pulmonaire radiologique dans le contexte de la dyspnée aigue, 2) les implications cliniques et pronostiques de la quantification du volume plasmatique estimé à partir de l’hémoglobine et de l’hématocrite sanguine en IC et 3) l’utilité de la combinaison de ces 2 variables en IC décompensée. Nous avons dans un premier temps étudié la valeur diagnostique et pronostique d’un score radiologique de congestion pulmonaire. Nos résultats montrent que ce score améliore la performance diagnostique en plus de l’utilisation de variables cliniques et la valeur pronostique en IC. Concernant notre deuxième marqueur d’intérêt de congestion, le volume plasmatique estimé, nous avons évaluer son association avec des variables biologiques, échographiques et hémodynamiques de congestion ainsi qu’avec le risque d’évènements cliniques dans différents contextes (en IC décompensée et en IC avec fraction d’éjection préservée). Nos résultats suggèrent que le volume plasmatique estimé est un marqueur de congestion préférentiellement gauche et est associé au pronostic des patients IC. Par ailleurs, nous avons exploré la valeur pronostique combinée du score radiologique de congestion pulmonaire et du volume plasmatique estimé chez des patients hospitalisés pour aggravation d’IC et, avons trouvé qu’une approche bivariable avait une valeur importante pour la stratification du risque dans les suites de l’hospitalisation. Notre travail souligne l’utilité clinique du score radiologique de congestion pulmonaire, du volume plasmatique estimé et de leur évaluation conjointe dans le champ de l’IC. Par ailleurs, nous montrons la bonne performance d’une approche mêlant marqueurs d’imagerie et marqueurs biologiques évaluant différentes composantes de la congestion. Dans la lignée de ces travaux, une intégration des marqueurs de congestion au sein d’une démarche multiparamétrique pourrait apporter une meilleure caractérisation du profil congestif individuel. Des travaux futurs utilisant de grandes bases de données comportant des informations relatives à des variables variées de congestion pourrait aider à l’intégration de ces variables à des modèles diagnostiques et pronostiques en IC<br>Congestion expresses systemic and pulmonary edema associated with elevated intracardiac pressure, and is a major predictor of poor prognosis in heart failure (HF). Therefore, it is of paramount importance to better assess congestion at each point of patient management (i.e., before progression to decompensation, prior discharge assessment, outpatient clinic). Accumulated data highlighted that several evaluation tools of congestion can help clinicians diagnose acute HF and manage optimally patients with chronic HF or acutely decompensated HF. However, the availability of these congestion markers may limit their clinical utility. Readily and widely available evaluation tool is warranted to quantify and/or monitor congestion and eventually improve risk-stratification. Congestion score evaluated from chest radiography and plasma volume estimated from hemoglobin and hematocrit may provide relevant information in patients with HF. Our aims were; 1) to evaluate the diagnostic and prognostic performance of radiographic pulmonary congestion quantification in acute HF; 2) to evaluate the clinical and prognostic implications of estimated plasma volume (ePV) in HF; and 3) to assess the prognostic value of a combination of these congestion markers. We studied the diagnostic value of a radiographic congestion score for acute HF, and its prognostic value in acute HF. Our results showed that this score improved clinical-based diagnostic performance, and expressed residual congestion with poor prognostic value in acute HF. Regarding our second congestion marker of interest, ePV, we investigated its associations with biological, echocardiographic and hemodynamic markers of congestion and outcomes in different settings of HF (HF with preserved ejection fraction, and acute HF). Our results suggested that ePV appears as a left-sided congestion marker (i.e., natriuretic peptide) and an independent prognostic marker. Furthermore, we explored the prognostic value of the combination of radiographic congestion score and ePV on admission in patients hospitalized for worsening HF in different patient populations/managements (emergency department and cardiology department), and found that this bivariable approach had promising prognostic utility for in-hospital outcomes and post-discharge short-term outcomes. Our work provided the clinical relevance of radiographic pulmonary congestion scoring, ePV and their combination in patients with HF. Throughout our research, better performance of a combination of different type congestion markers was observed; thus, integration of multiple congestion markers might provide more pragmatic and clinically useful information about diagnosis for HF and prognosis in HF. Further research would be warranted
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Hui, Yung-lam, and 許用藍. "Psychosocial and functional implications of strabismus in adult patients using the AS-20 score." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46937390.
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Hittle, Beverly M. "Elusive Sleep: Healthcare Workers, Shift Work, and Implications for Worker Health and Patient Safety." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1562059911010694.
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Gao, Hao. "Carotid plaque stress analysis by fluid structure interaction based on in-vivo MRI : implications to plaque vulnerability assessment." Thesis, Brunel University, 2010. http://bura.brunel.ac.uk/handle/2438/4731.
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Stroke is one of the leading causes of death in the world, resulting mostly from the sudden rupture of atherosclerotic plaques. From a biomechanical view, plaque rupture can be considered as a mechanical failure caused by extremely high plaque stress. In this PhD project, we are aiming to predict 3D plaque stress based on in-vivo MRI by using fluid structure interaction (FSI) method, and provide information for plaque rupture risk assessment. Fluid structure interaction was implemented with ANSYS 11.0, followed by a parameter study on fibrous cap thickness and lipid core size with realistic carotid plaque geometry. Twenty patients with carotid plaques imaged by in-vivo MRI were provided in the project. A framework of reconstructing 3D plaque geometry from in-vivo multispectral MRI was designed. The followed reproducibility study on plaque geometry reconstruction procedure and its effect on plaque stress analysis filled the gap in the literature on imaging based plaque stress modeling. The results demonstrated that current MRI technology can provide sufficient information for plaque structure characterization; however stress analysis result is highly affected by MRI resolution and quality. The application of FSI stress analysis to 4 patients with different plaque burdens has showed that the whole procedure from plaque geometry reconstruction to FSI stress analysis was applicable. In the study, plaque geometries from three patients with recent transient ischemic attack were reconstructed by repairing ruptured fibrous cap. The well correlated relationship between local stress concentrations and plaque rupture sites indicated that extremely high plaque stress could be a factor responsible for plaque rupture. Based on the 20 reconstructed carotid plaques from two groups (symptomatic and asymptomatic), fully coupled fluid structure interaction was performed. It was found that there is a significant difference between symptomatic and asymptomatic patients in plaque stress levels, indicating plaque stress could be used as one of the factors for plaque vulnerability assessment. A corresponding plaque morphological feature study showed that plaque stress is significantly affected by fibrous cap thickness, lipid core size and fibrous cap surface irregularities (curvedness). A procedure was proposed for predicting plaque stress by using fibrous cap thickness and curvedness, which requires much less computational time, and has the potential for clinical routine application. The effects of residual stress on plaque stress analysis and arterial wall material property characterization by using in-vivo MRI data were also discussed for patient specific modeling. As the further development, histological study of plaque sample has been combined with conventional plaque stress analysis by assigning material properties to each computational element, based on the data from histological analysis. This method could bridge the gap between biochemistry and biomechanical study of atherosclerosis plaques. In conclusion, extreme stress distributions in the plaque region can be predicted by modern numerical methods, and used for plaque rupture risk assessment, which will be helpful in clinical practice. The combination of plaque MR imaging analysis, computational modelling, and clinical study/ validation would advance our understandings of plaque rupture, prediction of future rupture, and establish new procedures for patient diagnose, management, and treatment.
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Jermihov, Paul Nicholas. "Biomechanical implications of congenitally bicuspid aortic valves: a finite element analysis of patient-specific geometry." Diss., University of Iowa, 2013. https://ir.uiowa.edu/etd/2531.
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This thesis introduces a framework aimed at developing an aid for physicians to diagnose and manage failing aortic valves using finite element (FE) simulations. The bicuspid aortic valve (BAV) is the most commonly observed valvular defect (Sievers et al. 2007) and therefore used to investigate the clinical utility of FE-based mechanical simulations. For the analysis, patient data was collected using real-time 3D echocardiography (rt3DE) of five normal valves and three pathological. The valve geometries were reconstructed into 3D models including the sinus and leaflet structures. An FE analysis was completed on the models, and the results were critically analyzed and validated with experimental data. Results indicate that human patient aortic valves can be successfully reconstructed and when simulated, realistic deformation is observed. This thesis focused on severity assessment of BAV morphologies through comparison to that of normal aortic valves.
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García, Pascua Luis M. "Predictive biomarkers of hypercalciuria in patients with permanent postsurgical hypoparathyroidism. Clinical implications." Doctoral thesis, Universitat Autònoma de Barcelona, 2019. http://hdl.handle.net/10803/666870.
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La hipercalciuria es un efecto adverso del tratamiento de los pacientes con hipoparatiroidismo postquirúrgico que puede provocar litiasis renal, nefrocalcinosis e insuficiencia renal. La recogida de orina de 24 horas para detectar hipercalciuria suele considerarse un método poco fiable.
El objetivo del estudio fue buscar biomarcadores predictores de hipercalciuria en pacientes con hipoparatiroidismo postquirúrgico que recibían tratamiento con suplementos de calcio y calcitriol.
Realizamos un estudio prospectivo transversal en un entorno clínico hospitalario ambulatorio. Se incluyeron 42 pacientes consecutivos estables afectos de hipoparatiroidismo postquirúrgico que eran tratados con suplementos orales de calcio y calcitriol y 17 controles adultos sin hipoparatiroidismo. La variable principal fue la hipercalciuria, definida como una excreción urinaria de calcio superior a 300 mg/24 horas.
Resultados: como era de esperar, de las variables comparadas entre los controles y los pacientes, sólo aquellas relacionadas con el estado de hipoparatiroidismo mostraron diferencias estadísticamente significativas (suplementos de calcio, dosis de calcitriol, hormona paratiroidea sérica y excreción urinaria de calcio). Los pacientes sin hipercalciuria (n=26) vs. aquéllos con hipercalciuria (n=16) tuvieron niveles menores de 1,25-dihidroxivitamina D sérica (32,4+11,7 pg/ml vs. 45,8+9,3 pg/ml; p<0,001), así como de calcio sérico corregido por la albúmina (8,42+0,46 mg/dl vs. 8,73+0,48 mg/dl; p:0,047), y una concentración similar de hormona paratiroidea sérica (12,5+5,4 pg/ml vs. 11,2+7,4 pg/ml; p:ns). En el análisis de regresión lineal múltiple se apreció una relación independiente y estadísticamente significativa entre la 1,25-dihidroxivitamina D y la excreción urinaria de calcio (B= 7,566+1,679; p<0,001). Un valor de punto de corte en 33,5 pg/ml de la 1,25-dihidroxivitamina D sérica para predecir la ausencia de hipercalciuria tuvo un 100% de sensibilidad y un 65,4% de especificidad, con un área bajo la curva ROC de 0,829. Ningún paciente con un nivel sérico de 1,25-dihidroxivitamina D inferior a 33,5 pg/ml tuvo hipercalciuria, cualquiera que fuese el nivel de calcio sérico corregido por la albúmina.
Cinco pacientes con hipercalciuria, un calcio sérico corregido por la albúmina superior a 8,5 mg/dl y un nivel de 1,25-dihidroxivitamina D superior a 33,5 pg/ml fueron tratados mediante reducción en las dosis de los suplementos de vitamina D3 y calcitriol, sin añadirles diuréticos tiazídicos. En todos ellos se normalizó la excreción urinaria de calcio al tiempo en que los niveles séricos de 1,25-dihidroxivitamina D descendieron por debajo de 33,5 pg/ml.
Conclusiones: la concentración sérica de 1,25-dihidroxivitamina D es un biomarcador útil para predecir la ausencia de hipercalciuria en los pacientes con hipoparatiroidismo postquirúrgico permanente que reciben tratamiento con suplementos orales de calcio y calcitriol. La determinación del 1,25-dihidroxivitamina D permite restringir la medición de la excreción urinaria de calcio en 24 horas a los pacientes con valores séricos de 1,25-dihidroxivitamina D sérico por encima de 33,5 pg/ml.
Proponemos un algoritmo basado en la monitorización de los niveles séricos de 1,25-dihidroxivitamina D que puede mejorar el manejo clínico de los pacientes con hipoparatiroidismo postquirúrgico en tratamiento con suplementos orales de calcio y calcitriol.<br>Hypercalciuria is an adverse event of postsurgical hypoparathyroidism treatment which can lead to nephrolithiasis, nephrocalcinosis and renal insufficiency. The collection of 24-hour urine is often considered an unreliable method to detect hypercalciuria.
The objective of the study was to find useful predictive biomarkers of hypercalciuria in patients with permanent postsurgical hypoparathyroidism receiving treatment with oral calcium and calcitriol supplements.
We performed a prospective cross-sectional study in an outpatient hospital clinical setting. A total of 42 consecutive stable patients with postsurgical hypoparathyroidism taking oral calcium and calcitriol supplements, and 17 adult controls without hypoparathyroidism, were included. The main outcome measure was hypercalciuria, defined as 24-hour urine calcium above 300 mg.
Results: As expected, of the variables compared between controls and patients, only those that were related to the hypoparathyroid condition showed significant differences (calcium supplements, calcitriol dosage, serum parathyroid hormone, and urinary calcium excretion). Patients without hypercalciuria (n=26) vs. those with hypercalciuria (n=16) had lower levels of serum 1,25-dihydroxyvitamin D (32.4+11.7 pg/ml vs. 45.8+9.3 pg/ml; p<0.001), lower albumin-corrected serum calcium (8.42+0.46 mg/dl vs. 8.73+0.48 mg/dl; p=0.047), and similar serum parathyroid hormone levels (12.7+5.4 pg/ml vs. 11.2+7.4 pg/ml; p:ns). Multiple linear regression analysis showed a significant independent relationship between 1,25-dihydroxyvitamin D and urinary calcium excretion (B= 7.566+1.679; p<0.001). A cut-off value of 33.5 pg/ml for serum 1,25-dihydroxyvitamin D to predict the absence of hypercalciuria had 100% sensitivity and 65.4% specificity, and the area under the ROC curve was 0.829. No patients with serum 1,25-dihydroxyvitamin D under 33.5 pg/ml presented hypercalciuria, regardless of the level of albumin-corrected serum calcium.
Five patients with hypercalciuria, albumin-corrected serum calcium level above 8.5 mg/dl, and serum levels of 1,25-dihydroxyvitamin D above 33.5 pg/ml, were treated by having their vitamin D3 supplements and calcitriol doses reduced, without thiazide diuretics being added. They normalized their urinary calcium excretion, and their serum 1,25-dihydroxyvitamin D levels were simultaneously lowered to less than 33.5 pg/ml.
Conclusions: Serum 1,25-dihydroxyvitamin D is a useful biomarker to predict the absence of hypercalciuria in patients with permanent postsurgical hypoparathyroidism who are receiving treatment with oral calcium and calcitriol supplements. The measurement of serum 1,25-dihydroxyvitamin D will permit us to limit the measurement of 24-hour urine calcium to those patients with serum levels of 1,25-dihydroxyvitamin D above 33.5 pg/ml.
We propose an algorithm based on the monitorization of serum 1,25-dihydroxyvitamin D that will improve the clinical management of patients with postsurgical hypoparathyrodism that are receiving supplementary treatment.
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Li, Yiran. "Evaluation of Food Assistance Programs and Implications of Patients' Health Information Seeking." Diss., Virginia Tech, 2013. http://hdl.handle.net/10919/52927.
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The first part of this dissertation evaluates the effectiveness of food assistance by gathering evidence from developing countries and the United States. The first essay applies a multi-market model to three developing countries and simulate recent spikes in staple prices and food aid impacts. Results indicate that higher food prices would result in reduction in household real income and deterioration of household welfare. Food aid in the form of cash transfers targeted at low-income groups could improve household real income of the target group after world price shocks and, partially or completely, offset the negative impacts of higher food prices. The impact of cash transfer on untargeted groups is ambiguous. It is likely to be positive for households that are net producers of the commodities that have increased production and prices under cash transfer and the production surplus is sufficiently large. The second essay focuses on the Food Stamp Program (FSP), a cornerstone of food assistance safety net efforts in the U.S. to reduce household food insecurity, particularly among children. The essay examines the dynamic relationship between FSP participation and child food security using monthly measures. Empirical estimates using the Panel Study of Income Dynamics demonstrate that child food security declines in the months immediately prior to FSP entrance, but then partially recovers following program entrance. These dynamic FSP effects are masked when annual measures are employed.
The third paper of this dissertation studies the potential impacts of patient's widespread use of online health information. In particular, the essay employs a principal agent model and focuses on the quality of online health information. The model shows that when the quality of health information improves, since medical consultations become more efficient and less costly, a higher effort will be induced or contracted from the physician. Diagnosis becomes more accurate, because physicians will try exert more effort in diagnosing patients and patients will suffer less loss from their illnesses.<br>Ph. D.
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Maparzadeh, Milad. "Patients’ perspective of digital healthcare : Social implications during a digital healthcare meeting." Thesis, Högskolan Väst, Avd för informatik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-16811.
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The purpose of this study was to gain a deeper understanding of the patient’s perspective regarding social interactions in video healthcare meetings. Social presence theory was used in the context of how video calls can result in vital aspects of social interactions disappearing and how that can affect the outcome of a doctor consultation in contrast to physical meetings. A qualitative method with semi-structured interviews was applied to this study. This study included 7 participants with similar age range from 26-36 years old including both genders. This study resulted in many different views and perspectives whereas some participants found it harder to communicate virtually whereas others did not think that social interactions was not even an important factor. The conclusion that could be made from this study is that virtual healthcare meetings are good depending on which context they are used for. Furthermore, the doctor cannot always get the full picture because the camera creates a psychological distance which makes it harder for the doctor to observe as much as he/she can in a physical setting which can lead to many signals and cues missing out.
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Rosada, Eva. "Dual disorders and implications for assessment and treatment." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2000. https://ro.ecu.edu.au/theses/1387.
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Part 1: Literature review. This review of the published literature examines the consequences for individuals with co-occurring substance use disorder and chronic mental illness in traditional treatment systems that provide separate mental health and substance use treatment and identifies barriers to effective service delivery. Barriers to effective assessment and treatment are related to a lack of integration of treatments, a Jack of networking among services, and a failure to identify and assess adequately for the presence of a dual disorder. The attitude of professionals towards DD individuals is indicated as a potential barrier. Professional education in dual disorders is emphasized and recommendations from the literature are discussed. Part 2: Research report. This study was undertaken to examine the attitudes and practice of psychologists towards patients with dual disorders, and to establish whether the acquisition of additional education in dual diagnosis made a difference regarding assessment and treatment. An 18-item questionnaire was developed and mailed to 200 registered psychologists throughout Australia. A total of 98 responded after receiving two reminder letters. Results of univariate tests and discriminant function analysis indicated that education in dual diagnosis was significantly related to better knowledge of, and practice by psychologists towards, dually disordered patients. These findings were significantly related to the successful identification of individuals with a dual disorder as well as effective assessment and treatment.
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Kearney-Schwartz, Anna. "Perturbations hémorhéologiques chez les patients hypertendus diabétiques de type 2 : implication du traitement antihypertenseur." Vandoeuvre-les-Nancy, INPL, 2003. http://www.theses.fr/2003INPL003N.
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L'objectif de ce travail est de décrire le profil hémorhéologique, son influence sur les forces de cisaillement et d'étudier l'efficacité du traitement antihypertenseur par l'antagoniste calcique (amlodipine) et par l'Inhibiteur d'Enzyme de Conversion (énalapril) sur la rhéologie sanguine chez les patients présentant simultanément une hypertension artérielle modérée et un diabète de type 2 comparés à des sujets sains. Les résultats de cette étude ont démontré que chez des patients hypertendus diabétiques de type 2 l'hyperviscosité sanguine contribue à l'augmentation des forces de cisaillement. La rhéologie des patients hypertendus diabétiques de type 2 n'est pas significativement influencée lorsque la pression artérielle est diminuée par un traitement antihypertenseur. L'implication éventuelle d'autres facteurs (neurohormonaux ou métaboliques), influençant potentiellement la rhéologie, en dehors de la pression artérielle devrait être discutée et nécessite par conséquent des recherches plus approfondies.
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Gabin, Karine. "Traitement de l'hémophilie : implication du pharmacien hospitalier." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2P104.
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Griffioen, T. Robert. "Patience and urgency in biblical conversion implications for small groups /." Theological Research Exchange Network (TREN), 1998. http://www.tren.com.
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Laviolette, Louis. "Tolérance à l'effort dans la maladie pulmonaire obstructive chronique : mécanismes, méthodologies & implications cliniques." Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/27247/27247.pdf.
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Poon, Hung-wai Philip, and 潘雄威. "Hepatitis B carrier state and its implications in the dental treatmentof handicapped patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B31954042.
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Ouedraogo, David Eric. "Exploration du réservoir EBV chez les patients infectés par le VIH : implications pathologiques." Thesis, Montpellier 1, 2013. http://www.theses.fr/2013MON1T001.
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Les lymphocytes B mémoires circulants incluant ceux infectés par EBV de façon latente retournent périodiquement vers les territoires lymphoïdes secondaires où ils subissent une différenciation en cellules productrices d'immunoglobulines permettant au virus d'initier la réplication virale. Cependant, le suivi et la gestion de la réactivation de EBV et son association avec des néoplasies lymphoïdes chez les sujets infectés par le VIH restent un sujet de controverse et nécessite une meilleure compréhension des mécanismes impliqués. Dans cette étude, nous avons proposé de nouveaux outils biologiques pour la quantification de l'ADN EBV permettant la discrimination entre le réservoir latent et le cycle lytique du virus. Nous avons montré que la taille de ces réservoirs est étroitement associée à une activation polyclonale plus ou moins importante des cellules B. Nous avons également observé une association entre les marqueurs d'activation immunitaire et de réactivation de EBV avec la survenue de lymphome B. En outre, nous avons décrit l'évolution de gammapathies monoclonales chez des sujets infectés par le VIH sous traitement antirétroviral, et la persistante du pic monoclonal d'immunoglobulines était associée à des charges virales EBV plus élevés. Par conséquent, l'activation des lymphocytes B et subséquemment la réactivation EBV joueraient vraisemblablement les rôles principaux dans la survenue de tumeurs bénignes ou malignes des lymphocytes B au cours de l'infection VIH<br>It is assumed that circulating memory B cells including those latently infected by EBV return periodically to lymphoid nodes where they are stimulates and undergo differentiation into immunoglobulin-producing cells allowing the virus to initiate viral replication. However, the monitoring and the management of EBV reactivation and it association with lymphoid malignancies in HIV-infected patients are still being controversies and need a better understanding of the probable mechanisms involved. In this study, we proposed novel biological tools for EBV DNA quantification allowing discriminating latent and lytic reservoir. We showed that the EBV reservoir levels are closely associated with the polyclonal B-cell activation. We also observed an association between immune activation and EBV reactivation markers with the occurrence of B-cell lymphoma. Moreover, we described a long term evolution of monoclonal gammapathies in HIV-infected subjects and the persistence of the immunoglobulis monoclonal pike was found to be associated with higher EBV reservoir levels. Therefore, the B-cell activation and subsequently EBV reactivation likely play the main roles on the occurrence of B lymphocytes malignancies during HIV infection
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Simoens, Kevin James. "Anthropometric shape parameters in obese subjects: implications for obese total joint arthroplasty patients." Thesis, University of Iowa, 2017. https://ir.uiowa.edu/etd/5634.
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Obesity is a severe concern worldwide and its prevalence is expected to continue to increase. Linked to diabetes, kidney disease, heart disease, and high blood pressure among other things, obesity has been identified as the forthcoming, largest preventable cause of mortality. Osteoarthritis, surgical consequences, distribution of subcutaneous adipose tissue, and alteration of joint biomechanics have vast implications in total joint repair (TJR). Previous studies have linked obesity to increased forces through weight-bearing lower extremities, alterations in gait, and risk of implant failure. The objectives of this study were to (1) provide a tool to predict lower extremity dimensions and shape variations of subcutaneous adipose tissue, (2) identify the degree to which obesity influences shape variation of the osseous anatomy of the knee joint, and (3) lay a foundation to compare the knee contact force of obese patients in activities of daily living.
Long-leg EOS films were obtained, retrospectively over 5 years, from 232 patients that were being seen at the Adult Reconstruction Clinic at the University of Iowa. Using custom Matlab algorithms, measurements of soft tissue distribution and lower extremity osseous anatomy were obtained and analyzed. Additionally knee contact force measurements were obtained through motion capture analysis and modeling in Anybody Technology.
Males and females had similar lower extremity shapes, with females having greater knee circumferences than males. The variability of PPT and PTT tended to be greater in females and increased with increasing BMI. Although similar in the anteroposterior direction, males tended to have on average 12mm wider proximal tibias in the mediolateral direction. Clinical observations of increased post-operative complications trend with these findings. The future of research into biomechanics of obesity will rely heavily on anatomic models of the obese lower extremities, which until this work did not exist.
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Combrinck, Celeste-Marie. "The psychological implications of creative activities : an investigation into how painting affects stress levels." Diss., University of Pretoria, 2008. http://hdl.handle.net/2263/23850.
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The research aimed to investigate the effects of creative activity on stress and anxiety levels. The reasons for this proposed direction of study was to investigate the reasons for reported success in art therapy (thus strengthening its standing in the scientific psychological community), to examine whether creative activities could be used to benefit the mental well-being of people in general and to study the link between creativity and mental well-being. This was accomplished through the following means: Patients from MuelMed hospital’s rehabilitation centre took part in a creative intervention. Patients took the SCL-90-R before painting for about an hour and then filled in the SCL-90-R again. A control group was also selected who also filled in the SCL-90-R to ascertain their stress levels. The mean score’s of the two groups was compared as well as the before and after scores of the experimental group. The MMSE (Mini Mental Status Exam) was used to screen patients, so that only those patients cognitively capable of participating in the study took part in the experiment. For the most part the MMSE was a useful tool to screen patients. In the experimental group, there was no statistically significant difference between the before and after scores on the SCL-90-R. Because the experimental group showed no difference, only one measure of the control group was taken, which also did not differ significantly from the scores of the experimental group. Reasons for the lack of statistical significance is discussed, and may be due to a lack of reported initial stress levels. Despite the lack of a statistically significant findings, it is suggested that further studies be conducted to establish the role creativity plays in mental well-being. Copyright<br>Dissertation (MA)--University of Pretoria, 2010.<br>Psychology<br>unrestricted