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Casteleijn, Jacoba Magdalena Francina. "Development of an outcome measure for occupational therapists in mental health care settings." Thesis, University of Pretoria, 2010. http://hdl.handle.net/2263/28019.
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It is the responsibility of professions to provide evidence of the demonstrable value and quality of service delivery. Occupational therapists in mental health care settings find it difficult to produce convincing evidence of the demonstrable value and their contribution to health care. Currently no effective outcome measure for occupational therapists in mental health practices exists for the South African context . The development of an outcomes measuring system is much needed in these crucial times of cost-cutting, rendering quality of care with the minimum resources and the quest for evidence of the effect of intervention. The purpose of this study was to fill the outcome measurement gap by developing a system that is clinically tested and user-friendly for occupational therapists in mental health care settings. Such a system had to represent the outcomes in the occupational therapy programmes, meet the needs of the therapist in terms of purpose of the tool, be easily administered and be standardised. It was also important that the outcome measure was grounded in the theoretical framework that guides intervention programmes, namely Vona du Toit’s Model of Creative Ability. This theoretical framework is widely used in South African mental health care settings and was found suitable to be transformed into a rating scale for the outcome measure. A participatory approach combined with a mixed method exploratory design, specifically the instrument development model, was selected to guide the study. The development of the outcome measure happened in three phases. Domains for the outcome measure emerged after participation from occupational therapy clinicians and mental health care users in Phase 1. The operationalisation of the domains and the development of the rating scale happened during Phase 2. The third phase was the piloting of the outcome measure to identify issues to be optimised for the final implementation of the outcome measure. Eight domains with 52 representative items emerged from Phase 1. The domains were Process skills, Communication and Interaction skills, Lifeskills, Role performance, Balanced lifestyle, Motivation, Self-esteem and Affect. Clinicians were satisfied that these domains represented the service that they deliver and compared well with the mental health care users’ need for occupational therapy. The involvement of mental health care users in confirming relevant domains for the outcome measure ensured a client-centred approach in the research process. The outcome measure, named as the Activity Participation Outcome Measure (APOM), has a unique feature of generating reports and spider graphs for every mental health care user. The APOM was piloted in three mental health care settings. In spite of good intentions from clinicians to apply the measure, it was clear that measuring outcomes is neither a priority, nor a routine task in clinical settings. The preliminary investigation into the psychometric properties yielded positive results. However, the sample sizes for the validity and reliability samples were not optimal and further data collection needs to continue for confirmation. It is recommended that investigations into the psychometric properties of the instrument continue to eventually market it as a valid and reliable outcome measure for occupational therapists in mental health care settings.Thesis (PhD)--University of Pretoria, 2011.
Occupational Therapy
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Lu, Tsui-Shan Zhou Haibo. "Statistical inferences for outcome dependent sampling design with multivariate outcomes." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2009. http://dc.lib.unc.edu/u?/etd,2447.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2009.Title from electronic title page (viewed Sep. 3, 2009). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Biostatistics, Gillings School of Global Public Health." "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Biostatistics, Gillings School of Global Public Health." Discipline: Biostatistics; Department/School: Public Health.
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Liisanantti, J. (Janne). "Acute drug poisoning: outcome and factors affecting outcome." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789514298080.
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Abstract Patients with acute drug poisonings are common in emergency departments and hospitals. Patients typically ingest medical products, most commonly psychotropic drugs that lead to intoxication. The outcome is usually good and hospital stays are short, even among patients requiring intensive care. Complications such as aspiration pneumonia can prolong hospital stays. Acute mortality is low (usually less than 5%) but repetition of self-harm is common and long-term mortality is high. The aim of this study was to evaluate the outcome of drug poisoned patients and the factors associated with unfavourable outcome, including morbidity, length of intensive care unit (ICU) and hospital stays, repetition of drug poisonings, and mortality. The study population consisted of patients treated in Oulu University Hospital due to acute drug poisoning between 1985–2006 and drug poisoned patients in the data base of the Finnish Consortium intensive Care Data. In the first part of the study 276 hospitalised self-poisoned adolescents were examined retrospectively from the patient records for acute contributing risk factors before the intake. Patients with such risk factors had higher rates of depression, non-ethanol poisonings and repetition of self-poisoning within one year. The second part of the study included 257 acute drug-poisoned adult patients requiring intensive care. The factors associated to aspiration pneumonia were evaluated retrospectively. Of these, 28.4% had aspiration pneumonia. Pre-hospital intubation of the comatose patients was associated with lower number of aspiration pneumonias. The third study evaluated 2755 drug-poisoned patients requiring intensive care for risk factors for prolonged ICU length of stay (LOS) using national intensive care database. Factors associated with prolonged stay were respiratory failure, renal dysfunction and lowered platelet count on admission. The hospital mortality in these studies ranged from 0 to 1.6%. The fourth study evaluated the long-term mortality and causes of deaths of 3709 patients admitted to Oulu University Hospital due to acute drug poisoning between 1985 and 2000. The all-cause mortality was recorded at the end 2009 and patients were compared to age- and sex-matched controls. Mortality among the study population was 30.6% compared to 13.6% for the controls. In conclusion, patients admitted to hospital due to acute drug poisoning have good short-term outcomes. Factors associated with prolonged ICU LOS were aspiration pneumonia, respiratory failure on admission, lowered platelet count on admission and renal dysfunction on admission. Impulsive self-poisonings among adolescents are associated with psychopathology and repetitions. Patients with acute drug poisonings have high long-term mortalityTiivistelmä Myrkytyspotilaat ovat yleinen potilasryhmä päivystyksissä ja sairaaloissa. Sairaalahoitoisen, akuutin lääkeainemyrkytyksen ennuste on hyvä ja jopa tehohoitoa vaativat potilaat selviävät lyhyellä sairaalahoitojaksolla. Komplikaatiot, kuten mahan sisällön hengitysteihin joutumisesta aiheutuva keuhkokuume (aspiraatiokeuhkokuume) pitkittävät hoitoa. Kuolleisuus hoitojakson aikana on yleensä alle 5 %, mutta pitkäaikaiskuolleisuus näillä potilailla on merkittävä. Tutkimuksen tarkoituksena oli selvittää akuutin lääkeainemyrkytyspotilaan ennustetta ja ennusteeseen vaikuttavia tekijöitä. Ensimmäisessä osatyössä tutkittiin 276 nuoren myrkytyspotilaan myrkytystapahtumaan vaikuttaneita akuutteja riskitekijöitä. Potilaat, joilla oli riskitekijöitä, olivat useammin masentuneita ja heillä oli enemmän uusintakäyntejä myrkytysten vuoksi vuoden sisällä. Toisessa osatyössä selvitettiin aspiraatiokeuhkokuumeen yleisyyttä 257 tehohoitoa tarvinneella lääkemyrkytyspotilaalla. Potilaista 28,4 % sai aspiraatiokeuhkokuumeen. Ennen sairaalaan tuloa suoritettu hengitysteiden varmistaminen hengitysputkella (intubaatio) pienensi aspiraatiokeuhkokuumeen riskiä merkittävästi verrattuna niihin, jotka intuboitiin vasta sairaalassa. Kolmannessa osatyössä tutkittiin 2755 myrkytyspotilaan riskitekijöitä pitkittyneeseen tehohoitoon. Hengitysvajaus, munuaisten toiminnan vajaus ja matala veren verihiutalearvo sairaalaan tullessa olivat pitkittyneen hoidon riskitekijöitä. Kuolleisuus hoitojakson aikana oli näissä kolmessa tutkimuksessa 0–1.6 %. Neljännessä osatyössä tutkittiin 1985–2000 OYS:ssa hoidettujen myrkytyspotilaiden pitkäaikaisennustetta ja kuolinsyitä. Kuolleisuus vuoden 2009 loppuun mennessä oli 3709 potilaan joukossa 30,4 %, kun vastaava kuolleisuus ikä- ja sukupuolivakioitujen verrokkien keskuudessa oli 13,6 %. Kaikki kuolinsyyt olivat yleisempiä tutkimusjoukossa verrattuna verrokkeihin. Yhteenvetona voidaan todeta että akuuttien myrkytyspotilaiden ennuste on hyvä akuutissa vaiheessa. Aspiraatiokeuhkokuume on yleinen komplikaatio myrkytyspotilailla ja se on osittain vältettävissä hengitystien varhaisella varmistamisella. Impulsiivinen käytös nuorella myrkytyspotilaalla assosioituu psykopatologiaan ja uusintamyrkytyksiin. Myrkytyspotilaan pitkäaikaisennuste on huono. Kuolleisuus ennaltaehkäistäviin syihin, kuten itsemurhiin sekä sydän- ja verisuonitauteihin, on huomattava
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Weld, Suzanne Edna. "Stress management outcome: Prediction of differential outcome by personality characteristics." Thesis, University of Ottawa (Canada), 1992. http://hdl.handle.net/10393/7740.
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This study examined differential outcome between two stress management approaches according to subject characteristics. It was hypothesized that individuals with certain characteristics might benefit more from one form of stress management training (Rational Emotive Therapy) than another (Gendlin Focusing). The implication, were this hypothesis to be supported, would be that individuals could be streamed into one form of training versus another, according to certain personality variables, and the result would be greater effectiveness and efficiency in the delivery of services. Subjects were classed as having one of two sets of characteristics. One class of subjects (N = 34) displayed stress cognitively on the Cognitive-Somatic Anxiety Questionnaire (CSAQ) and were of the Sensing type on the Myers-Briggs Type Indicator (MBTI) while the other class of subjects (N = 31) displayed their stress somatically on the CSAQ and were of the Intuitive type on the MBTI. Based on personality theory, cognitively anxious Sensing types were predicted to have greater decreases in stress as a result of receiving a Rational Emotive Therapy approach to stress management while somatically anxious Intuitive types were predicted to have greater decreases in stress as a result of receiving a Gendlin Focusing approach to stress management. Additional measures of client characteristics were taken in order to explore the predictive potential of variables which the literature indicates might be useful in predicting differential outcome. These included Locus of Control, Verbal Reasoning, Abstract Reasoning, Experiencing Ability, Rational Beliefs. A measure of stress (Symptom Check List-90-R) was taken at three points in time: pre, post-training (or post-waiting as in the case of the waiting-list controls), and at one-month follow-up. A waiting-list control group (N = 30) was utilized to demonstrate a treatment versus no treatment comparison. Treatment group subjects received 12-15 hours of stress management training in either (Rational Emotive Therapy) RET or Focusing spread over 5 weeks. Half of each class of subjects received RET while the other half of each class of subjects received Focusing. Key results include: Both classes of treatment subjects displayed significantly greater reductions (p .05) in stress levels after training as compared to waiting-list control subjects who had not received training over the same period of time. The main hypothesis was not supported. There were no statistically significant treatment by classification interactions. However, there were relationships between client satisfaction, use of the techniques, and decrease in reported levels of stress. Further analyses showed that none of the variables were significant predictors of outcome. This Study introduced Focusing as a viable stress management technique.
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McNicoll, Tracy. "Capitalizing courage : sanctions assessment and the outcome of the outcome." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=81504.
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While sanctions proliferated after the Cold War, concerns remain about their effectiveness and humanitarian impact. In addressing these concerns, scholars have offered diverse frameworks generally emphasizing sanctions' design or application. This thesis argues that the proper focus of concern is conceptually prior to each of these. In fact, lacking political will has been characteristic of sanctions cases and the root of sanctions' failures. Significantly, the cost-benefit calculus informing policymakers' political will has been systematically incomplete. Sanctions are often judged on their lifting, in the country on which they were imposed, yet this unreasonably crops out broader sanctions' impact. Sanctions have an understudied capacity for creating vacuums filled by indigenous influences, for lastingly restructuring societies, and for affecting human capital, each in a manner obstructive of post-conflict peacebuilding and reconstruction. This has vital policy relevance given its impact on substantive international peace and security, the breech of which initially spurs sanctions. Contemporary efforts in Iraq, Haiti, Serbia, and South Africa are explored in illustration.
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Gerjy, Roger. "Outcome After Haemorrhoidopexy." Doctoral thesis, Linköpings universitet, Kirurgi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-11797.
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Background: This dissertation is composed of five individual studies of the stapled haemorrhoidopexy operation. The operation was launched to an international audience in 1998 by the Italian surgeon Antonio Longo. In conventional surgery the prolapsed piles are excised from the anodermal part of the prolapse up through the anal canal into the lower rectal mucosa where the pile is divided with diathermy or suture ligated and excised. It leaves open wounds throughout the anal canal. These wounds can be very painful, especially at defecation, and will take from three to six weeks to heal. In the stapled haemorrhoidopexy operation symptomatic haemorrhoids are seen as a disease of anodermal, haemorrhoidal and rectal mucosal prolapse of varying degree. The main component of the prolapse is the redundancy of rectal mucosa. By pushing back the prolapse into the anal canal followed by excision of the mucosal redundancy above the anal canal with a circular stapler devise a mucosal anastomosis is fashioned. This anastomosis is situated immediately above the haemorrhoids and will attach them to the rectal muscular wall to prevent further prolapse. The operation is associated with substantially less pain and a quicker recovery. Methods: For the five studies, a total of 334 patients were operated for haemorrhoidal prolapse. The first operations were performed in February 1998. All patients were assessed preoperatively and postoperatively with the same set of protocols as follows. The symptoms of haemorrhoids were scored with a questionnaire to patients to obtain their independent statements of the frequency of each of five cardinal symptoms: pain, bleeding, pruritus, soiling and prolapse in need of manual reduction. A diary was used by patients to report daily pain scores, use of pain medication and speed of recovery within the first 14 postoperative days. The surgeon rated the deranged anal anatomy before and after surgery. We also developed an algorithm based on the patients’ statement of digital reduction of prolapse (grade 3) and the surgeon’s assessment of lesser prolapse at proctoscopy (grade 2). Absence of prolapse was grade 1. The surgeon also provided statements about the conduct of the operation and rated the technical complexity. The information, for all patients, was entered into an electronic data base. Results: One registry based study and one prospective randomised controlled trial assessed the advantage of performing the operation under perianal local anaesthetic block. The postoperative pain and surgical outcome was independent of the type of anaesthesia. No operation under local block had to be converted to general anaesthesia. Anodermal prolapse is seen in 70 percent of the patients. In a registry-based study we found that excision of the anodermal folds did not increase the postoperative pain provided the excision stopped at the anal verge. In 270 patients with precise preoperative and postoperative classification we found that the symptomatic load was identical for grades 2 and 3. The symptoms were independent of the anodermal prolapse. The symptoms were greatly reduced when the operation turned out grade 1 prolapse. The long-term result was assessed in 153 patients operated 1 year to 6 years previously. The need for early re-intervention was 6.2 percent representing technical error to reduce the prolapse. At the final evaluation 12 patients (8.2 percent) complained of a mucoanal prolapse in need of digital reduction. The mean symptom burden had been reduced from 8.1 to 2.5 points but 17 percent had at least one cardinal symptom with a weekly frequency. Conclusions: Stapled haemorrhoidopexy should be performed as day surgery under local anaesthesia. Any remaining anodermal prolapse should be excised. The optimal long-term outcome is grade 1A or 1B with low symptom score. There was an 87 percent chance of cure of the prolapse with the first haemorrhoidopexy. About half the failures were insufficient primary surgery and half a relapse of the prolapse.The original title of article IV was "Prolapse grade and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients. The new title after publishing the article is "Grade of prolapse and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients".
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Jonson, Pal. "The outcome of the EDSP : an assessment of preferences and outcome." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.420088.
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Chang, Sungwon. "An integrated approach to outcome evaluation : incorporating patient reported outcomes in heart failure." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/2606.
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Globally individuals and health care systems are facing the burden of chronic illness. The impact of the increasing burden of non-communicable diseases is experienced by individuals and health care systems. Across the globe health care systems are struggling to meet the increasing demands for services within the confines of rising costs and needs for accountability. Beyond costs and treatment allocations, there is an increasing mandate to provide care that is patient centred and appropriate to the needs of the individual. The Innovative Care in Chronic Condition (ICCC) framework has been successful in driving health care reforms to meet the needs of individuals with chronic illness internationally. Deriving metrics that allow monitoring of conditions at the level of the patient, provider and health care system are of increasing importance. Comprising this thesis is a series of studies to investigate outcomes that includes the patient’s perspective in the evaluation of clinical interventions. To achieve this, chronic heart failure, was used as an exemplar of a chronic condition.Chronic heart failure (CHF) is the final common pathway for many cardiac conditions. As a consequence has emerged as a major public health problem and represents as an excellent exemplar of living with a chronic illness. CHF patients commonly experience high levels of ill-health, disability and mortality placing a heavy burden on health care systems. Hospitalisations are frequent and costly to both CHF patients and to society. People with CHF live with a limited quality of life and physical ability and the prognosis for CHF is poor. Given the nature of debilitating symptoms, and their potential impact on physical, social and psychological aspects of life, patient’s perspective in outcome assessment is essential in providing effective care.Specifically this study sought to: •Examine patient reported outcomes in clinical management and in clinical research •Investigate patient important outcomes, their utility, relevance and acceptability amongst patients, clinicians, researchers and administrators •Test composite outcomes model that integrate patient important outcomes in clinical trials researchPatient reported outcomes (PROs) is a strategy to capture the patient perspective and experience on their health status. The use of PROs can be incorporated in clinical assessments, monitoring of clinical progress as well as clinical research. Despite their frequent use in research, evidence suggests that to date they have had a limited influence on clinical practice and policy. As part of this thesis an integrative review was conducted to explore the potential utility of PROs at the policy level. By using the ICCC framework, PROs were indeed essential to improve the management of CHF at the micro, meso and macro levels of decision making.One of the key challenges in using PROs and outcomes important to individuals in CHF is limited methodological and reporting quality. This is cited as a reason why many clinicians are sceptical of the utility of PROs. To explore issues in reporting a review was conducted on RCTs of pharmacological therapy in CHF that reported health related quality of life (HRQoL) as a primary or secondary outcome. Using the Minimum Standard Checklist for evaluating the quality of reporting of HRQoL outcomes resulted in 26 (19.1%) studies being considered ‘very limited’ in terms of methodological and reporting rigour, and 91 (66.9%) were evaluated as ‘limited’ and only 19 (14.0%) studies were considered to be of a ‘probably robust’ quality. In fact, the quality of HRQoL reporting has not improved over time. Some of the issues identified are limited discussions, methodological shortcomings, and poor HRQoL reporting. This review has underscored the importance of standardising of the reporting of HRQoL measures.Although capturing the patient’s perspective via PROs is important, they may not be the only outcome measures important to patients. Currently, no single CHF outcome measure captures all dimensions of the quality of care from the patient’s perspective. To identify outcome measures in CHF deemed important to patients, a structured literature review was undertaken. The conceptual and methodological challenges and opportunities in each outcome measure were identified as important to patients with CHF. That is mortality, hospitalisation and PROs were identified as important to patients but also meaningful and relevant to the provider and health care system as well. These outcome measures were proposed as a core outcome set that represent the minimum set of outcomes that should be measured and reported in CHF.A number of composite outcome measures have been developed to capture the perspective of the patient, clinician as well as including objective measures of health. Three validated composite outcomes, the Packer’s Score, Cleland’s Patient Journey and the composite endpoint used in the African American Heart Failure Trial (A-HeFT) were examined in a secondary analysis of a prospective, multi-center randomized controlled trial of 280 hospitalized CHF patients in the Which Heart failure Intervention is most Cost-effective & Consumer Friendly in Reducing Hospital Care (WHICH?) Trial in order to assess the comparability and interpretability of the measures in a pragmatic clinical trial. Correlation coefficients demonstrated substantial associations amongst all three composite endpoints. Although there was a considerable agreement across the three measures when estimating deteriorating condition, these was less when estimating improvements.This thesis has described both the importance and complexity of including outcome measures that are meaningful to patients in both the assessment of individuals’ needs, testing interventions, monitoring outcomes and assessing process and outcome measures at a health systems level. This thesis has also extended the discussion and debate around PROs to discuss Patient Important Outcomes, which is outcomes that patients notice and for which they would be willing to undergo a treatment with associated risk, cost, or inconvenience for it to be the only thing that changed. Using CHF as an exemplar has provided useful insights into the dimensions and complexities of measuring outcomes in chronic and complex conditions. As the burden of chronic disease continues to increase refining the metrics of outcome measurements will be equally as important as refining novel therapies. This will be critical to develop and implement interventions to meet the growing numbers of people living with chronic illness.
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Cree, Marilyn Wanda. "Outcome following hip fracture." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0024/NQ34752.pdf.
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Brocard, Pauline. "Anaemia and pregnancy outcome." Thesis, Imperial College London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.426212.
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Dorman, Paul Jocob. "Measuring outcome after stroke." Thesis, University of Newcastle Upon Tyne, 1998. http://hdl.handle.net/10443/1611.
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Stroke is the second most common cause of death worldwide. However stroke is not invariably fatal and survivors may experience major physical, social and psychological problems. The United Kingdom government identified the improvement of the quality of life of stroke survivors as a key objective in the recent "Health of the Nation" consultative document. The concept of health related quality of life has developed over the past few years. Although there is no one universally agreed definition, there are several instruments which claim to measure at least some aspects of health related quality of life. These instruments have not been extensively tested in stroke patients, so the hypothesis which I shall test in this thesis is as follows: that a simple instrument can prove a feasible, valid, reliable, and clinically useful measure of health related quality of life in stroke survivors. I selected a simple measure of health related quality of life (the EuroQol questionnaire) and evaluated its validity in a sample of patients with stroke. A small, but important proportion of patients were unable to complete EuroQol questionnaires either by themselves or by interview, so I investigated whether a proxy (e. g. a spouse or carer) could assess the patient's health status after stroke accurately and without bias. Previous studies comparing one or more different health status instruments did not involve strictly random allocation, so could not provide reliable information on the "best" measure of quality of life to use in stroke patients. I therefore performed a study in a sample of survivors of stroke which directly compared the EuroQol and SF- 36 by using a strict random allocation of questionnaires. It was not possible to compare quantitatively the reliability and validity of the EuroQol and SF-36; however, a qualitative comparison suggested their reliability was similar and they appeared to be sampling broadly the same areas of health. I finally investigated patients' perception of their own quality of life after stroke. The data suggested that many disabled stroke survivors might not view survival in a dependent state as badly as one might expect. This somewhat surprising finding will inform decisions about whether to accept the high risks associated with certain treatments (e. g. thrombolysis) in order to reduce the chances of survival in a dependent state. Assessments of health related quality of life may therefore provide a more comprehensive and relevant view of the patients' outcome than simple measures of disability or impairment.
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Magenheim, Nina. "Entlastungskraniektomie - Komplikationen und Outcome." [S.l. : s.n.], 2008. http://nbn-resolving.de/urn:nbn:de:bsz:289-vts-64106.
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Fratila, Liana M. "Renal transplant outcome assessment /." free to MU campus, to others for purchase, 2004. http://wwwlib.umi.com/cr/mo/fullcit?p1421135.
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Tramacere, I. "MULTIPLE OUTCOME META-ANALYSES." Doctoral thesis, Università degli Studi di Milano, 2013. http://hdl.handle.net/2434/215070.
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Introduction Commonly, the main aim of a meta-analysis is to provide, when possible, a clear and definite evidence on, for example, the best treatment available for a disease. However, when multiple potentially correlated outcomes are of interest in evidence synthesis, they should be jointly analyzed, taking into account their correlation. Standard meta-analysis combines estimates of one parameter over several studies, but it is not appropriate when there is the necessity to consider multiple potentially correlated outcomes. Thus, the Multiple Outcome Meta-Analysis (MOMA) was thought as an extension of the standard meta-analysis in order to combine estimates of several related parameters.
Methods In order to evaluate the feasibility, advantages and limitations of the MOMA compared to the standard meta-analysis, data on azathioprine use in multiple sclerosis treatment, in terms of number of patients with relapses, number of dropouts and number of patients with a disease progression over two years, were analyzed through the use of these two methods.
Results Using a method proposed by Riley at al. in 2008 in the context of the MOMA, which showed to be a good method especially when the within-study correlations are not known, compared to the standard meta-analysis, different results were observed in terms of Odds Ratios (ORs), corresponding 95% Confidence Intervals (95% CIs), explained and residual variances, and between-studies correlations. In particular, considering the two outcomes of efficacy, in terms of number of patients with relapses, and of safety, in terms of number of dropouts, over two years, and comparing results obtained through the use of the MOMA with those derived from the standard meta-analysis, the ORs and the corresponding 95% CIs were similar, but the corresponding standard errors (SE) appeared to be very different. Accordingly, using the MOMA methods, SE reductions of 18% and 5% for the two outcomes were observed, respectively. Moreover, when the two outcomes representing two different efficacy measures in terms of number of patients with relapses and number of patients with a disease progression over two years were considered, a relapse risk reduction of over 20% (i.e., an OR of 0.50 from the MOMA vs 0.64 from the standard meta-analysis), and a progression risk reduction of almost 15% (i.e., a significant OR of 0.66 vs a non-significant OR of 0.77) were observed. In this second application, however, the small number of studies could have led to a very high between-studies correlation estimate, which is associated with unstable pooled estimates and SE. Thus, in this case the MOMA could not represent the better choice.
Discussion Unless the variation observed was very large, or the number of studies in the meta-analysis was small, and when there is the necessity to combine estimates of several potentially correlated outcomes, the MOMA methods appear to produce appropriate pooled estimates, which show better statistical properties than those from the standard meta-analysis. Finally, how to combine the methods of the MOMA with those of the Multiple Treatment Meta-Analysis (MTMA), in order to jointly analyzed multiple outcomes and including both direct and indirect comparisons, was presented.
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Stephens, Jennifer Anne. "Development of a comprehensive reporting system for a school reform organization: The Accelerated Schools Project." Texas A&M University, 2004. http://hdl.handle.net/1969.1/3100.
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Given the conflicting research results on the effectiveness of whole-school
reform models (Nunnery, 1998; Stringfield & Herman, 1997; American Institutes for
Research, 1999; U.S. Department of Education, 2004), there is a need to focus on the
evaluation procedures of whole-school reform organizations. Because the ultimate goal
is to improve school performance, it should also be a goal of each whole-school reform
organization to design a comprehensive data collection system to evaluate each schoolÂs
performance.
A comprehensive reporting system was developed for a school reform
organization, the Accelerated Schools Project (ASP). Using the steps of the research and
development process recommended by Borg and Gall (1989), this study: (a) developed a
theoretical framework for the reporting system, (b) identified data that should be
collected in the reporting system, (c) performed a field test with an expert panel of
educational professionals, (d) developed a preliminary form of the reporting system, (e)
performed a main field test with principals and coaches in the ASP network, (f) reported
field test results, (g) revised the preliminary reporting system, (h) developed a website
for the reporting system, and (i) provided recommendations for the completion,
dissemination and implementation of the system in accelerated schools across the nation.
This study has important implications for both the ASP community and for the
entire whole-school reform community. For the ASP community, the reporting system
could be used: (a) to collect data in all accelerated schools across the nation (b) as a
longitudinal database of information to monitor data on each ASP school, and (c) to
generate school summary reports on ASP schools. These data will assist researchers in
measuring the effectiveness of the ASP model on student achievement and other
important variables. For the whole-school reform community, the method used in this
study could be replicated in other school reform organizations to develop a
comprehensive reporting system. By providing consistent data for school reform
organizations to evaluate the impact of their models on students and schools, educational
researchers will be better equipped to understand each modelÂs impact, and thus will
better understand the diverse research results on school reform effectiveness.
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Busca, Erica. "Nursing care models in primary care and hospital settings: implementation and evaluation." Doctoral thesis, Università del Piemonte Orientale, 2021. http://hdl.handle.net/11579/128002.
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In the last year, the COVID‑19 pandemic has made clear how vulnerabilities in health systems can have profound implications for the health of people. Thus, organizations are taking in place significant changes which are also influencing nursing staff and the nursing care model.
This dissertation aims to: 1) explore the effects of primary nursing on patient, -staff,-organizational-related outcomes in hospital settings; 2) identify barriers and facilitators of nursing role implementation in primary care; and 3) assess the effects of the family and community nursing (FCN) practice model on patient-, organizational-related outcomes.
Method. To reach aim 1 a multi-centre, prospective before-after study is performed. Primary outcome are healthcare-associated infections. Also, staff-related outcomes are included. To reach aim 2 an integrative literature review was conducted. It combines data from quantitative and qualitative studies from two databases searches (Medline and CINAHL) up to 09 June 2020. Data extraction and identification of emerging themes are performed using the Consolidating Framework for Research Implementation (CFIR).
To reach aim 3 a prospective controlled study was designed. The study will recruit older and frail residents in municipalities belonging to Community Health Centres (CHC) of Santhià and Gattinara (Local Health Authority of Vercelli). The Intervention is the FCN and it is allocating in one of the CHC. Primary outcome is hospitalization.
Results. In this dissertation, the results of the integrative literature review are listed. 56 papers met the inclusion criteria. The major barriers identified are related to: i) the limited availability of nursing special education, ii) legislations and regulations, iii) organizational setting in which nurse’s role implementation is embedded; and iv) lack of nurse’s role clarity among stakeholders.
Major facilitators include: i) prior planning for role introduction and nurses’ involvement in the early stage of role implementation, ii) job satisfaction and nurses’ access to high-quality education, iii) successful doctor-nurse collaboration.
Finally, the two study protocols were submitted to the Local Ethics Committee. The before-after study has begun in 2019 with 10 Centres enrolled. Actually, the study has recruited 422 patients and 94 nurses.
Discussion. Implementation and evaluation of the nurse’s role in primary care and hospital settings are complex interventions due to several components which interact with each other. In this regard, the Medical Research Council framework has been used to guide the development and evaluation of complex interventions, related to nursing research and practice. Despite using this framework, two different studies have been designed to explore how the nursing care model works and its effects. The studies are still suspended due to restrictions imposed by the ongoing COVID-19 pandemic.
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Gleason, James P. "THE IMPACT OF INTERACTIVE FUNCTIONALITY ON LEARNING OUTCOMES: AN APPLICATION OF OUTCOME INTERACTIVITY THEORY." Lexington, Ky. : [University of Kentucky Libraries], 2009. http://hdl.handle.net/10225/1165.
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Thesis (Ph. D.)--University of Kentucky, 2009.Title from document title page (viewed on May 24, 2010). Document formatted into pages; contains: xix, 225 p. : ill. (some col.). Includes abstract and vita. Includes bibliographical references (p. 217-222).
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Casey, Petrina Pauline. "Outcomes following Whiplash Associated Disorder (WAD) in a Compensation setting: The Whiplash Outcome Study." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/14122.
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Whiplash Associated Disorders (WAD) following a road traffic crash results in many people seeking treatment through a compensation scheme. This process has been reported as having a negative impact on health and recovery. This thesis investigates health, recovery and claim outcomes in people with WAD in a compensation context. The Whiplash Outcome Study prospectively recruited and enrolled 246 people. Health outcomes were assessed within three months, 12 and 24 months post injury. The findings suggest one in four claimants remained in the compensation system longer than 24 months. Improvement in health occurred up to 12 months. More than 50% of the cohort continued to have moderate to severe disability and psychological symptoms 24 months post injury. Claimants with WAD can be predicted to follow three distinct recovery trajectories. The profile of those in the trajectories suggest physical and psychological factors are important and should be addressed in claim and clinical interventions. A vulnerable group of claimants emerged who presented with poorer baseline disability and psychological factors that might make them susceptible to the unintended negative consequences of compensation processes. It is recommended that these claimants are identified, and appropriate interventions instigated aimed at minimising their exposure to compensation system stressors.
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Khachatryan, Naira. "Study of post cataract surgery outcomes and predictors of poor outcome in Yerevan, Armenia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536931.
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Galvinhill, Paul Robert. "THE EFFECTS OF PROVIDING FEEDBACK REGARDING CLIENT SYMPTOMATOLOGY ON PSYCHOTHERAPY OUTCOME." University of Cincinnati / OhioLINK, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=ucin992361796.
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Glasper, Erica Renee. "Psychobiological factors alter health outcome." Columbus, Ohio : Ohio State University, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1148415999.
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Goddard, Kalanithi Lucy Emily. "Placental Localization and Perinatal Outcome." Yale University, 2008. http://ymtdl.med.yale.edu/theses/available/etd-08132007-124118/.
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This retrospective case-control study was designed to investigate the relationship between placental localization and intrauterine growth restriction (IUGR). Pregnant women with an anatomic survey from January 1, 2000, to December 31, 2005, and delivery of the pregnancy at Yale-New Haven Hospital (YNHH) were identified using clinical and billing records. Multiple gestation, fetal anomaly, and incomplete medical information were reasons for exclusion. Cases (N=69) were consecutive pregnancies with evidence of IUGR (estimated fetal weight <10th percentile for gestational age) at last follow-up ultrasound. Randomly selected controls (N=258) from the same time period had no evidence of IUGR. Maternal, ultrasound, delivery, and perinatal data were collected by retrospective medical record review, and IUGR cases and non-IUGR controls were compared using the Students t-test, Wilcoxon test, Chi-square analysis, Fishers exact test, and ANOVA. Placental location was determined from the anatomic survey record (obtained at 18.4 ± 1.2 weeks gestation in the IUGR group and 18.2 ± 1.0 weeks gestation in the control group; P=0.18). Multivariate logistic regression with adjustment for confounders was used to investigate the association between IUGR and placental localization. Consistent with known predictors of IUGR, the IUGR group had a higher proportion of black women (36.4% vs. 19.8%, P=0.03), chronic hypertension (26.0% vs. 3.5%, P<0.001), and hypertensive disorders of pregnancy (36.2% vs. 5.0%, P<0.001). Mean birth weights of IUGR and non-IUGR pregnancies differed by 2 kilograms (3244 ± 625 grams vs. 1277 ± 637 grams, P<0.001). IUGR infants were more likely to receive antenatal steroids, deliver preterm, deliver by cesarean section, and be admitted to neonatal intensive care. In both IUGR and non-IUGR pregnancies, the placenta was most commonly anterior or posterior. Unilateral placentas were three times more common in the IUGR group than in the non-IUGR group (17.4% vs. 5.0%, P=0.01). IUGR pregnancies were over four times as likely as control subjects to have unilaterally-located placentas compared to anterior placentas (OR 4.8, 95% confidence interval, 1.9-11.7). Adjusting for ethnicity, chronic hypertension, and hypertensive disorders of pregnancy did not affect this finding (OR 4.6, 95% confidence interval 1.6-13.5). In conclusion, we compared a group of 69 IUGR pregnancies to 258 non-IUGR controls and found intrauterine growth restriction to be associated with unilateral placentation.
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Schwab, Bettina. "Fetale Echokardiographie und postnatales Outcome." Diss., lmu, 2006. http://nbn-resolving.de/urn:nbn:de:bvb:19-63435.
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Gallmeier, Ludwig. "Trends im Outcome des Larynxkarzinoms." Diss., lmu, 2007. http://nbn-resolving.de/urn:nbn:de:bvb:19-68792.
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Abdallah, Yazan. "Prediction of early pregnancy outcome." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/34503.
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Introduction: Conventional ultrasound has been used in the management of early pregnancy complications. Common clinical situations that are encountered include pregnancies of unknown location (PUL) defined as a woman with a positive pregnancy test, but when no intra or extra-uterine pregnancy is visualised on transvaginal sonography (TVS); intra-uterine pregnancies of uncertain viability (IPUV) defines as when an intrauterine gestational sac (<20mm mean diameter) is seen on ultrasonography with no visible yolk sac or embryo, or an embryo of <7mm crown- rump length with no visible heart activity; and recurrent pregnancy losses (RPL). Emerging evidence suggests that novel strategies may be developed to predict early pregnancy complications such as miscarriage using B mode ultrasound imaging and advanced three-dimensional 3D technology, alongside early pregnancy biochemical parameters. These strategies can be assessed prior to conception, at implantation and subsequently in the early stages of pregnancy. In this thesis we describe a series of studies to evaluate the role of ultrasound and biochemical markers for the prediction of early pregnancy complications in relation to these three time periods. Methods: Pre-conception, we used 3D ultrasound to study longitudinal changes in endometrial morphology and vascularity, the influence of physical injury to the endometrium on these parameters and their relationship with implantation success. We investigated the relationship between the ovulation-implantation (OI) time interval and subsequent implantation or early pregnancy failure. Post-conception, we studied PUL and IPUV. In the PUL group, ultrasonography in combination with serum biochemical markers were used to validate the role of mathematical logistic regression models for predicting pregnancy location and viability. We investigated the performance of biochemical markers in urine to assess whether measurements of urine markers can replace serum markers for the management of PUL. In the IPUV group, we established ultrasound criteria that can be used to definitively diagnose miscarriage. In addition, we studied the growth of these pregnancies and its relationship with pregnancy viability and the appearance of early embryonic structures in the gestational sac. Results: We have provided evidence to support the view that endometrial biopsy enhances endometrial vascularity in women with a history of RPL. We have suggested a safe approach to characterise PUL and have shown that logistic regression-based prediction models can reliably be used and further developed to predict the outcome in PUL, independent of the timing of serum biochemistry. In addition, we have shown a potential role for urine pregnancy biochemistry in the management of PUL. We have developed new reliable definitions to diagnose miscarriage, which have now been adopted both in the UK and internationally. Furthermore, we found that, gestation sac growth is not a safe indicator of pregnancy viability, although cutoff values for embryo growth can be suggested below which a miscarriage can be predicted. Conclusion: The studies described in this thesis have introduced a number of novel findings in relation to the use of ultrasound and biochemistry for predicting, and optimising the management of, early pregnancy complications from the preconception phase, through early implantation, to the post conception phase.
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Connelly, James Bernard. "Outcome of major traumatic injury." Thesis, University of Leeds, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.413207.
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Appelboom, Geoffrey. "Outcome prediction in intracerebral hemorrhage." Doctoral thesis, Universite Libre de Bruxelles, 2012. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209154.
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L'hémorragie intra-cérébrale (HIC) est responsable d’environ 15 % des accidents vasculaires cérébraux. Son incidence augmente avec l’âge et sa mortalité à 3 mois est de 30 % pour atteindre 60% à 1 an .1 La prise en charge de l’HIC représente un défi majeur pour la Santé Publique. Plusieurs attitudes thérapeutiques ont été proposées récemment ;parmi elles l’administration, lors de la phase aigue, de substances neuroprotectrices 1,2 ou de facteurs de coagulation 1,2,3 .
En effet, c’est durant cette phase, que surviennent l’inondation ventriculaire, la constitution et la croissance de l’hématome et l’engagement cérébral avec le décès comme conséquence.
Le contrôle de l'hypertension intra-crânienne représente la première ligne de traitement ;malheureusement son efficacité s’avère très limitée à l’heure actuelle et aucune nouvelle modalité thérapeutique n’a porté ses fruits. 1
Dans ce travail nous avons tenté de définir les éléments cliniques intervenant au cours de la phase aigue de l’hémorragie intracérébrale sur lesquels pourraient agir une prise en charge mieux ciblée plus spécifique.
(1) Nous avons comparé la dizaine d’échelles pronostiques proposées depuis celle d’Hemphill en 2001, comprenant des éléments cliniques et radiologiques et utilisées pour la stratification du risque dans l’HIC afin de déterminer la ou les plus adaptée(s).3,4,5,6
Nous avons conclu que ces échelles ne permettent pas une discrimination optimale et qu’elles restent équivalentes dans leur sensibilité et spécificité pronostiques.5
(2) Nous nous sommes ensuite concentrés sur les éléments cliniques et biologiques liés à la phase aigue de l’HIC pouvant influencer les décisions thérapeutiques (température, glycémie, dysfonction ionique, état critique,…).
Il ressort de l’étude de ces facteurs que seule l'hyperglycémie est associée à un mauvais pronostic.7,8
(3) Nous avons également essayé de voir si les caractèristiques de la lésion hémorragique jouent un rôle important ;nous avons noté (a) que la taille de l’hématome proprement dit reste l’élément prédicteur le plus important de mortalité, (b) 9 que la taille de l’ œdème cérébral y est lié (c) 9 qu’il existe une synergie d’effets délétères (surtout pour les petits hématomes) entre la taille de l’hématome et celle de l’œdème (d) 9, que la localisation de l’hématome influence également son extension ventriculaire (d) que la quantité de sang libéré dans les ventricules cérébraux a pour conséquence un pronostic péjoratif (associé à l’élévation de la glycémie à la phase aigue). 6,7
(4)Nous nous sommes intéressés à l’existence d’une éventuelle susceptibilité génétique pouvant intervenir dans la cinétique du saignement; nous avons relevé que la simple variation d’une paire de base du génome (SNP single nucleotide polymorphism) au niveau des gènes impliqués dans l’hémostase (gène du facteur de von Willebrand; rs216321) et l’agrégation plaquettaire (rs342286) pourrait influencer la taille de l’hématome lors de la phase aigue et sa croissance au cours des premières heures.10,11,12
(5) Enfin, nous avons voulu caractériser l’invalidité liée à l’HIC chez les survivants. Il existe une hétérogénéité des échelles d’évolution clinique mais en les comparant, l’Index de Bartel (qui intègre un large éventail d’activités de la vie de tous les jours) se montre supérieur aux scores de Rankin et de Glasgow. 13 Néanmoins, l’index de Barthel n’intègre pas la mortalité au sein des paramètres d’évolution clinique, risquant ainsi de biaiser l'interprétation en présence d’un nombre élevé de décès dans l’étude.
En conclusion, au cours de l’HIC, les caractéristiques s évolutifs de l’hématome au cours de la phase aigue, notamment sa taille, sa croissance et son extension dans les ventricules cérébraux sont responsables d’une série d’événements interactifs conduisant à un effet de masse mais également une cascade d’événements biologiques aggravant le pronostic, surtout chez des patients présentant une susceptibilité génétique La prise en compte de ces facteurs de risque devrait permettre une amélioration de la qualité de prise en charge et donc des résultats cliniques.
Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished
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Barhamein, Majdah Yaseen Ahmed Flemben /. "Outcome predictors in lupus nephritis." Thesis, Imperial College London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.413714.
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Gribbin, Guy M. "Pacemaker mode and patient outcome." Thesis, University of Oxford, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.409718.
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Hancock, Alexander J. "The consistency of outcome effect." Thesis, University of York, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.489195.
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The aim of the experiments reported in this thesis was to establish if the US is susceptible to learned changes in stimulus effectiveness (a notion well established for the CS). In Chapter Two a shock was preexposed followed by either consistent or inconsistent post-US events (or outcomes). It was found that a shock was less effective as a US hi a subsequent conditioning procedure when it was followed by an inconsistent, rather than a consistent, outcome m preexposure. This effect was observed whether the outcome was varying (that is, sometimes a clicker sometimes a noise stunulus) or partial (a clicker or noise stimulus occurring on only half of the trials).
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Blood, Rachel. "Outcome in autistic spectrum disorders." Thesis, University of Oxford, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.510414.
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Houssien, Dhiya Taj Alhaj. "Outcome studies in rheumatoid arthritis." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298543.
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Lawson, Clare Helena. "Outcome from minor brain injury." Thesis, University of Southampton, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243071.
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Whittle, J. "Autonomic dysfunction and perioperative outcome." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1557406/.
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OBJECTIVE: To examine the relationship between established autonomic dysfunction, measures of cardiopulmonary physiology and perioperative outcome in high-risk patients presenting for major surgery. SUMMARY BACKGROUND DATA: Experimental data demonstrate that autonomic activity is a key modulator of both cardiovascular and immune function following tissue injury and inflammation. Autonomic dysfunction is associated with adverse outcomes across several medical populations. Whether pre-existing autonomic dysfunction is detrimental following controlled tissue injury (surgery) in humans is unknown. SUMMARY OF STUDIES: Parasympathetic autonomic dysfunction (PAD), defined by impaired heart rate recovery after exercise, was associated with a distinct physiological profile in patients presenting for preoperative Cardiopulmonary Exercise Testing (CPET). This comprised impaired cardiac performance at peak exercise, reduced peak oxygen uptake and anaerobic threshold as well as chronotropic incompetence. Levels of GRK2, a regulator of beta adrenoreceptor and immune/inflammatory activity, in circulating lymphocytes were raised in cells derived from individuals with PAD. Retrospective analysis of outcomes from two prospectively collected colorectal surgical cohorts (n=1047) revealed PAD to be common (>30%) and associated with an increased length of hospital stay (12 days (95% CI: 9-16) vs. 8 days (95% CI: 6-8.5), p=0.01), as well as increased risk of significant Clavien-Dindo defined morbidity, postoperative gastrointestinal function, sepsis and increased 90-day mortality (RR 1.1 (1.007-1.41), p=0.008). Intraoperative haemodynamic data indicated impaired cardiac contractility and increased risk of intraoperative hypotension, possibly contributing to detriments in postoperative outcome. Sympathetic autonomic hyperactivity, defined by excessive anticipatory heart rate rise prior to starting loaded exercise was associated with a different CPET profile to that seen in PAD, defined by evidence of cardiac ischaemia during exercise, resulting in impaired cardiac contractile function at peak effort, but also associated with increased hospital length of stay. Patients with PAD did not necessarily demonstrate sympathetic hyperactivity, but when both were present, physiological performance and postoperative outcomes were further impaired. Conclusions: Both preoperative parasympathetic and sympathetic autonomic dysfunction are associated with impaired perioperative outcomes. These data demonstrate in high risk surgical patients that established autonomic dysregulation is associated with the development of sepsis, myocardial ischaemia, critical illness and mortality following major elective surgery. The autonomic nervous system represents an underexplored target for therapies aimed at reducing the morbidity burden of major surgery.
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Roy, Brian Michael. "Lip Repositioning: Patient Outcome Assessments." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1466520904.
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Hernandez, Leslie, and Leslie Hernandez. "Renal Perfusion Model: Outcome Predictions." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/624104.
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The Banner University Medical Center's (BUMC) renal transplant program relies on the LifePort Kidney Transporter to optimize marginal kidney organs via hypothermic machine perfusion (HMP) prior to transplantation. Hemodynamic parameters produced by the device followed over the duration of support, combined with clinical experience, guide decisions in determining the acceptability of a donor kidney for implantation. Thus far, statistical evidence supporting ideal parameters remain undefined. The purpose of this study is to create a logistic model that will ascertain the post-implant sustainability of LifePort® supported kidneys and predict clinical outcomes. My hypothesis is that the statistical models constructed based on retrospective LifePort® parameters and clinical outcome data will successfully predict donor organ vascular health for transplantation and the optimal support duration. A successful model will contribute to increased efficiencies in the kidney transplant process as well as improved patient outcomes.
An overview of the institution’s success was weighed using a survival analysis, with delayed graft function (DGF) as the endpoint. A logistic regression model and forecast model were built to predict the outcome for rejecting or accepting the organ for transplant, as well as to predict the hemodynamic parameters hours after the start of infusion.
Results concluded a flow greater than 80 mL/min had a 90% probability of transplantation. The forecast model was capable of predicting flow for up to five hours. The calculated flow was in a 10 mL/min range of the actual flow, when up to one hour parameters were entered into the model. The study concluded practicality in the clinical setting, in kidney transplantation.
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Sorohan, Helen Henrietta. "Psychosocial factors and pregnancy outcome." Thesis, University of Birmingham, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273937.
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Reist, Ursula. "Ansteigende Sectiofrequenz und perinataler outcome /." [S.l : s.n.], 1986. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Dowdall-Thomae, Cynthia Lea. "Outcome Coping Efficacy of Firefighters." Diss., The University of Arizona, 2009. http://hdl.handle.net/10150/195685.
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Firefighter coping strategies of Problem Focused Coping and Seeking Social Support were found to have positive significant relationships to Strategic Efficacy resulting in Outcome Coping Efficacy, after transitioning from one critical incident to a second. The coping strategies of Blamed Self, Wishful Thinking, and Avoidance appeared to have a negative significant relationship to Mobilization Efficacy in overall Outcome Coping Efficacy. Additionally, the Appraisals of Challenge and Positive Reappraisal to meet the Challenge appeared to have a positive significant relationship to Problem Focused Coping and Seeking Social Support. These findings of Outcome Coping Efficacy may be of help to firefighters for rehabilitative efforts after traumatic incidents.
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DeBerard, M. Scott. "Predicting Lumbar Fusion Surgery Outcomes From Presurgical Patient Variables: The Utah Lumbar Fusion Outcome Study." DigitalCommons@USU, 1998. https://digitalcommons.usu.edu/etd/6142.
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Lumbar fusion surgery is a commonly used procedure to treat severe spinal pathology and associated chronic disabling low back and leg pain. Despite the common incidence of spinal fusion surgery, few studies have examined patient outcomes or predictive correlates of this procedure. The objectives of this study were to characterize Utah workers who received lumbar fusion surgery in terms of relevant presurgical and outcome variables and to identify presurgical correlates of patient outcomes. An archival prospective research design was utilized consisting of a retrospective medical chart review and a postsurgical telephone outcome survey.
Subjects were 203 workers' compensation patients from the state of Utah who have undergone spinal fusion surgery and who were at least 2 years postsurgery at time of follow-up. Outcomes were assessed for 144 of the 203 patients (71%). Presurgical measures _included demographic, work, compensation, disability, health, surgical, and physiological variables. Outcome measures included solid arthrosis, patient satisfaction, work disability status, functional disability due to back pain, and multidimensional health.
Analysis of patient outcome data revealed that solid arthrosis was achieved in 71.9% of patients. Forty-six percent of subjects felt their back/leg pain problems were worse than what they had expected following the surgery, and 42 % felt that their quality of life had not changed or worsened as a result of lumbar fusion. Twenty-eight percent of fusion patients were work disabled at follow-up. Fusion patient mean outcome scores on multidimensional health measures reflected poorer health than comparative medical patient and nonpatient norms. The most consistent presurgical correlates across outcomes were lawyer involvement, number of prior low back operations, age at injury, and household income at time of injury.
Results are compared to data from previous lumbar fusion research studies and reasons for varying findings are offered. Implications of the findings are discussed in terms of inadequate patient selection and insufficient assessment of patient outcomes in low back research studies. Limitations of the present research are discussed, including how placebo, natural history, and regression to the mean can lead to erroneous conclusions about the efficacy of lumber fusion surgery. Suggestions for improvements in low back surgery outcome research are offered.
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Dennis, Diane. "Exploring different models of stroke unit care and outcome : the Stroke Rehabilitation Outcome (SRO) study." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/2093.
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Introduction: Stroke is a significant cardiovascular event requiring sub-acute rehabilitation, best provided in a stroke unit (SU). These units include dedicated neurological SUs usually catering only for patients with stroke and more generic SUs existing within geriatric rehabilitation units (GRUs). There exists a "grey" group of survivors of stroke whose allocation to one type of rehabilitation facility over another is arbitrary, in that the referring physician had no evidence to suggest advantages of SU versus GRU rehabilitation.Objectives: The aim of this inception cohort study was to provide a direct comparison of quality of life and functional outcome between two commonly applied models of organised multidisciplinary SU rehabilitation for the "grey" group of stroke survivors. Further, it evaluated differences in the intensity of treatment and the environment in which rehabilitation was implemented.Method:All patients presenting to Royal Perth Hospital-Wellington Street Campus acute stroke unit (RPH-WSC ASU) with a diagnosis of recent stroke requiring hospitalisation and subacute rehabilitation were considered for inclusion into the study. Patients were selected based on their age, absence of dementia and their acceptance by incumbent medical staff for rehabilitation transfer at either Royal Perth Hospital-Shenton Park Campus stroke unit (SPC SU) or at a GRU geographically closest to their home (located at either Mercy hospital, Bentley hospital or Swan health campus).Baseline data was collected in order to establish the underlying level of disability and compare groups for comparability, and also to be used as covariates in data analysis.All treatments received were those considered standard for the individual facility, administered as usual by registered health professionals. During the study, periodic behaviour mapping at each of the study facilities was undertaken by a research assistant in order to quantify differences in the rehabilitation environment. In addition, attending therapists at each facility recorded the frequency and duration of their intervention with individual patients involved in the study in a patient diary designed for that purpose. Six and twelve months following their transfer from RPH-WSC ASU, patients attended follow-up outpatient appointments at neutral rooms where objective and subjective assessments were undertaken by an independent assessor (a physiotherapist) who was blinded as to which rehabilitation facility the patient had attended. The primary outcome measure was the MOS 36-Item Short Form Health Survey (SF-36) and secondary outcome measures included the Functional Independence Measure (FIM) and other functional measures.Results: Between July 2004 and June 2007, 354 patients with stroke were age appropriate (60 years of age or older) for recruitment into the study and of these, 94 consented to participate (SPC SU n=22; GRUs n=72). Patients referred to SPC SU were younger, more likely to be male, and have speech abnormality, peripheral vascular disease and diabetes than those referred to GRUs. Otherwise there were no significant differences between groups in any of the characteristics measured at baseline. Rehabilitation data demonstrated a significant difference in both the total allied health professional (AHP) therapy time (p<0.001) and the indirect support time such as telephone calls and meetings with family (p=0.022), with SPC SU therapists utilising more time compared with GRU therapists. There was no significant difference in time spent undertaking administration including writing notes and reports (p=0.957). Data showed significant difference in length of stay (LOS), whereby patients spent a longer time at SPC SU (p=0.036), however there was no significant difference in discharge destination between facilities (p=0.312). Of the 10 unadjusted patient measures in this study, there were significant differences between groups in only two, the Berg balance score and the Chedoke McMaster posture inventory. The differences in both of these secondary outcomes favoured the SPC SU group. In addition there were differences in the SF36 Mental component summary (MCS) and Physical component summary (PCS) scores that approached significance. The difference in the PCS scores also favoured the SPC SU group but for the MCS score it was the GRU group that had more favourable scores.As the study was not randomized, age and gender, which differed between groups at baseline, and Barthel Index score, known to be associated with length of stay in stroke patients, were added to the models as covariates. As data from 6 and 12 month follow-ups was included in the dependent variable, "visit" was added to the models. After these adjustments there were no significant differences between facilities in any quality of life or functional outcomes.Discussion:Overall there was relatively high quality of life, and low anxiety and depression reported and results were not influenced by where rehabilitation took place. Selection criteria excluding dementia and young age may in part explain this, as both have been found to predict worse quality of life outcome in stroke. Significant differences in both where patients were, and what they were doing throughout the day reflected different ethos between facilities in the way rehabilitation was delivered. However, there was no difference in functional outcome despite these environmental differences and the fact that patients experienced more intensive treatment over a more prolonged hospital stay at SPC SU.Conclusion:In most cases, rehabilitation of this "grey" subgroup of the wider population of stroke may be more cost-effective if carried out at GRUs (with higher patient/ staff ratios, less intensive treatment and shorter LOS) rather than the neurological SUs.
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Manera, Karine. "Standardised Outcomes in Nephrology – Peritoneal Dialysis (SONG-PD): establishing a core outcome set in peritoneal dialysis." Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/23662.
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Worldwide, approximately 11% of patients on dialysis receive peritoneal dialysis (PD). Whilst PD may offer more autonomy to patients compared with hemodialysis, patient and caregiver burnout, technique failure, and peritonitis remain major challenges to the success of PD. Improvements in care and outcomes are likely to be mediated by randomised trials of innovative therapies, but will be limited if the outcomes measured and reported are not important for patients and clinicians. The aim of the Standardised Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) study is to establish a set of core outcomes for trials in patients receiving PD based on the shared priorities of all stakeholders, so that outcomes of most relevance for decision-making can be evaluated, and that interventions can be compared reliably. The phases of the SONG-PD project included in this thesis are: a systematic review to identify outcomes and outcome measures that have been reported in randomised trials involving patients receiving PD; focus groups using nominal group technique with patients and caregivers to identify, rank and describe reasons for their choice of outcomes; a 3-round international Delphi survey involving a multi-stakeholder panel; and a consensus workshop to review and endorse the proposed set of core outcome domains for PD trials. The establishment of 3 to 5 high-priority core outcomes, to be measured and reported consistently in all trials in PD, will enable patients and clinicians to make informed decisions about treatment based on outcomes of common importance.
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Carter, Simon. "Standardised Outcomes in Nephrology – Glomerular Disease (SONG-GD): developing a core outcome set for trials in glomerular disease." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/28641.
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Glomerular diseases are a major cause of kidney failure worldwide and are responsible for a large burden on patients and health systems. Patients may experience fatigue, reduced mobility, cognitive dysfunction, infertility, bone disease, cancer and impaired psychosocial wellbeing. Trials are the primary means of assessing interventions that may improve health outcomes, however outcomes reported in trials may lack relevance during treatment decision-making or be inconsistently reported which limits the effective comparison of treatments. The aim of the Standardised Outcomes in Nephrology – Glomerular Disease initiative (SONG-GD) was to establish a core outcome set for trials in adults with glomerular disease. The methods included this thesis are: a systematic review to analyse the scope and heterogeneity of reported outcomes for glomerular disease activity; focus groups with nominal group technique to identify and rank patient-important outcomes; an international two-round Delphi survey to develop consensus among diverse stakeholder groups; and two stakeholder workshops to discuss and endorse the proposed core outcomes. SONG-GD established the core outcomes of kidney function, disease activity, death, life participation and cardiovascular disease to be reported in all trials in adults with glomerular disease. Ultimately, this core outcome set will ensure the shared priorities of patients, care partners and health professionals are addressed by trial outcomes and improve the evidence base for shared treatment decision-making.
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Martin, Kathryn S. "Measurement and prediction of mobility outcome pre and post stroke rehabilitation using Clinical Outcome Variables (COVS)." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0006/MQ42660.pdf.
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Wheeler, Louise Fidalgo. "Stress and Psychotherapy Outcome: Implementation of a Heart Rate Variability Biofeedback Intervention to Improve Psychotherapy Outcome." BYU ScholarsArchive, 2017. https://scholarsarchive.byu.edu/etd/6474.
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Research has shown that psychotherapy patients experience increased physiological responsivity to stress which might negatively impact their experience in psychotherapy and their overall progress and outcome. The purpose of the present study was to investigate the effect of a heart rate variability biofeedback intervention on the physiological stress responsiveness and the psychotherapy outcomes of participants in psychotherapy. Forty college students attending psychotherapy at their university counseling center were divided into an experimental group and a control group. The experimental group participated in a 6-week biofeedback intervention and we assessed their physiological stress reactivity before and after implementation of the intervention, compared to a matched control group. The Trier Social Stress Test (TSST) was administered pre- and post-intervention to induce a stress reaction. It was hypothesized that psychotherapy patients involved in the biofeedback intervention would show decreased physiological stress reactivity to and faster physiological recovery from a laboratory induced stressor post-intervention compared to psychotherapy patients in the matched control group. It was also hypothesized that these participants would demonstrate larger distress reduction after implementation of the intervention. Results of the study found no significant main effect of the TSST on systolic blood pressure, heart rate, and HRV. There however was a main effect on diastolic blood pressure. The only variable that significantly differed between groups was the LF/HF ration. The results also revealed no significant change from pre-intervention baseline to post-intervention heart rate, blood pressure, and HRV, suggesting that the HRV biofeedback intervention was not effective in changing the stress response over time. Regarding levels of distress, results also revealed no statistical between group differences post-intervention, although the biofeedback group appeared to report significantly lower levels of distress post-intervention.
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Leone, Ludovica <1983>. "Does improvisation lead to outcome deviation? A conceptual framework of improvisation, its antecedents and outcome deviation." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amsdottorato.unibo.it/3687/1/Leone_Ludovica_tesi.pdf.
Full textAbstract:
Management and organization literature has extensively noticed the crucial role that improvisation assumes in organizations, both as a learning process (Miner, Bassoff & Moorman, 2001), a creative process (Fisher & Amabile, 2008), a capability (Vera & Crossan, 2005), and a personal disposition (Hmielesky & Corbett, 2006; 2008). My dissertation aims to contribute to the existing literature on improvisation, addressing two general research questions: 1) How does improvisation unfold at an individual level? 2) What are the potential antecedents and consequences of individual proclivity to improvise? This dissertation is based on a mixed methodology that allowed me to deal with these two general research questions and enabled a constant interaction between the theoretical framework and the empirical results. The selected empirical field is haute cuisine and the respondents are the executive chefs of the restaurants awarded by Michelin Guide in 2010 in Italy.
The qualitative section of the dissertation is based on the analysis of 26 inductive case studies and offers a multifaceted contribution. First, I describe how improvisation works both as a learning and creative process. Second, I introduce a new categorization of individual improvisational scenarios (demanded creative improvisation, problem solving improvisation, and pure creative improvisation). Third, I describe the differences between improvisation and other creative processes detected in the field (experimentation, brainstorming, trial and error through analytical procedure, trial and error, and imagination).
The quantitative inquiry is founded on a Structural Equation Model, which allowed me to test simultaneously the relationships between proclivity to improvise and its antecedents and consequences. In particular, using a newly developed scale to measure individual proclivity to improvise, I test the positive influence of industry experience, self-efficacy, and age on proclivity to improvise and the negative impact of proclivity to improvise on outcome deviation. Theoretical contributions and practical implications of the results are discussed.
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Leone, Ludovica <1983>. "Does improvisation lead to outcome deviation? A conceptual framework of improvisation, its antecedents and outcome deviation." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amsdottorato.unibo.it/3687/.
Full textAbstract:
Management and organization literature has extensively noticed the crucial role that improvisation assumes in organizations, both as a learning process (Miner, Bassoff & Moorman, 2001), a creative process (Fisher & Amabile, 2008), a capability (Vera & Crossan, 2005), and a personal disposition (Hmielesky & Corbett, 2006; 2008). My dissertation aims to contribute to the existing literature on improvisation, addressing two general research questions: 1) How does improvisation unfold at an individual level? 2) What are the potential antecedents and consequences of individual proclivity to improvise? This dissertation is based on a mixed methodology that allowed me to deal with these two general research questions and enabled a constant interaction between the theoretical framework and the empirical results. The selected empirical field is haute cuisine and the respondents are the executive chefs of the restaurants awarded by Michelin Guide in 2010 in Italy.
The qualitative section of the dissertation is based on the analysis of 26 inductive case studies and offers a multifaceted contribution. First, I describe how improvisation works both as a learning and creative process. Second, I introduce a new categorization of individual improvisational scenarios (demanded creative improvisation, problem solving improvisation, and pure creative improvisation). Third, I describe the differences between improvisation and other creative processes detected in the field (experimentation, brainstorming, trial and error through analytical procedure, trial and error, and imagination).
The quantitative inquiry is founded on a Structural Equation Model, which allowed me to test simultaneously the relationships between proclivity to improvise and its antecedents and consequences. In particular, using a newly developed scale to measure individual proclivity to improvise, I test the positive influence of industry experience, self-efficacy, and age on proclivity to improvise and the negative impact of proclivity to improvise on outcome deviation. Theoretical contributions and practical implications of the results are discussed.
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Wong, Sze Ying. "Neurodevelopmental outcomes of children born preterm : analyses into the validity of data collection and outcome reports." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/45429.
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Background and aims: Information on the neurodevelopmental outcomes of children born very preterm is required for multiple purposes. Reliable and up-to-date data sources are lacking. The overall aim of this thesis is to evaluate the validity and usability of the neurodevelopmental outcome data of very preterm children available from current data sources. The specific objectives were: 1) to examine the validity of outcome data recorded during routine follow-up assessment 2) to explore early childhood social-communication difficulties exhibited by very preterm children 3) to assess the stability over time of neurodevelopmental diagnoses made in early childhood. Methods: Three studies were conducted to meet the objectives. For studies 1 and 2, I recruited children born at < 30 weeks’ gestation at 2 years corrected age (age corrected for prematurity) from 13 participating study sites. In study 1, I compared the agreement between the neurodevelopmental outcomes of 190 children recorded at their routine NHS assessments and data obtained by a research assessment using the Bayley Scales of Infant Development, 3rd edition. In study 2, the social-communication skills of 141 children were determined using the parent-completed Quantitative Checklist of Autism in Toddlers (Q-CHAT) questionnaire and compared to published results from the general population. In study 3, I conducted a systematic review and using meta-analytic methods, I calculated the pooled sensitivity and specificity of early developmental assessment in identifying school-age cognitive deficit from 24 studies. Conclusions: 1) Compared with research assessment, routine NHS follow-up assessment had a low sensitivity but high specificity for identifying children with neurodevelopmental impairment. 2) Very preterm children display greater early childhood social-communication difficulties and autistic behaviour than the general population as measured by their parents on the Q-CHAT. 3) Early neurodevelopmental assessment has high specificity but low sensitivity for identifying later school-age cognitive deficits.
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Estelle, Dawn N. "Central auditory processing disorders Outcome Measures /." Cincinnati, Ohio : University of Cincinnati, 2005. http://www.ohiolink.edu/etd/view.cgi?acc%5Fnum=ucin1121349085.
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Thesis (M.A.)--University of Cincinnati, 2005.Title from electronic thesis title page (viewed Mar. 3, 2006). Includes abstract. Keywords: Central Auditory Processing Disorders. Includes bibliographical references.
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Zabihi, Sheller. "Fetal Outcome in Experimental Diabetic Pregnancy." Doctoral thesis, Uppsala University, Department of Medical Cell Biology, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8739.
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Women with pregestational diabetes have a 2-5 fold increased risk of giving birth to malformed babies compared with non-diabetic women. Diabetes-induced oxidative stress in maternal and embryonic tissues has been implicated in the teratogenic process. The malformations are likely to be induced before the seventh week of pregnancy, when the yolk sac is partly responsible for the transfer of metabolites to the embryo, and the uterine blood flow to the implantation site determines the net amount of nutrients available to the conceptus. We aimed to evaluate the effect on embryogenesis caused by a diabetes-induced disturbance in yolk sac morphology, uterine blood flow or altered maternal antioxidative status in conjunction with a varied severity of the maternal diabetic state.
We investigated to which extent maternal diabetes with or without folic acid (FA) supplementation affects mRNA levels and protein distribution of ROS scavenging enzymes (SOD, CAT, GPX), vascular endothelial growth factor-A (Vegf-A), folate binding protein-1 (Folbp-1), and apoptosis associated proteins (Bax, Bcl-2, Caspase-3) in the yolk sacs of rat embryos on gestational days 10 and 11. We found that maternal diabetes impairs, and that FA supplementation restores, yolk sac vessel morphology, and that maternal diabetes is associated with increased apoptotic rate in embryos and yolk sacs, as well as impaired SOD gene expression. We assessed uterine blood flow with a laser-Doppler-flow-meter and found increased blood flow to implantation sites of diabetic rats compared with controls. Furthermore, resorbed and malformed offspring showed increased and decreased blood flow to their implantation sites, respectively. In mice with genetically altered CuZnSOD levels, maternal diabetes increased embryonic dysmorphogenesis irrespective of CuZnSOD expression. We thus found the maternal diabetic state to be a major determinant of diabetic embryopathy and that the CuZnSOD status exerts a partial protection for the embryo in diabetic pregnancy.