Dissertations / Theses on the topic 'Outcomes'
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1
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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Holiday, Judith Miriam. "Evolving outcomes of the outcomes statement." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/2966.
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This thesis rhetorically analyzes the Outcomes Statement (OS) developed by "The Outcomes Collective" (a group of writing program administrators) for First-Year Composition. The OS was designed to create curricular consensus with regard to First-Year Composition both within and across postsecondary institutions. Though postmodern undertones permeate the OS, it can be interpreted from a purely modernist perspective. The thesis includes a chapter with suggestions on revising the OS to control this ambiguity.
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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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Rhodes, Andrew. "Outcomes from surgery." Thesis, St George's, University of London, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.604015.
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This thesis explores the utility of critical care following surgery. In particular, it assesses whether there are differences in how countries provide for critical ca re following surgery and whether these impact on outcomes. A meta-analysis of pre-emptive haemodynamic interventions in surgery was shown to reduce complications and mortality. Many of these interventions required the use of critical care which limited their utility. An analysis of a quality Austrian critical ca re database enabled an understanding of the group of patients admitted to critical care following surgery and the factors that are important in determining outcome. By utilizing these factors in a hierarchical logistic regression model, I demonstrated that outcomes are improving. Unfortunately, the provision of healthcare is not the same throughout Europe. Extrapolating data from Austria to the United Kingdom is therefore difficult. A further study was completed to identify differences in critical care provision between European countries. This study was hampered by inconsistent definitions of what an intensive care bed is, although did find a worryingly wide difference in beds per head of population. This must have implications for the case mix of patients admitted (or refused) to critical ca re and therefore surgical outcomes. A final study was performed to assess whether there were differences in outcomes at a national level. In this large observational study, critical care utilization varied following surgery and mortality rates were higher than expected with significant differences found between individual countries. In conclusion, critical care is a vital part of the surgical pathway for a select group of patients. Unless this group can be understood and quantified, then healthcare providers will be unable to develop systems that are able to cope with the likely demand. Only by matching this demand will optimal ca re be delivered.
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Packard, Anna Elise. "Parent Functioning and Child Psychotherapy Outcomes: Predicting Outcomes in Usual Care." BYU ScholarsArchive, 2009. https://scholarsarchive.byu.edu/etd/2311.
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A prominent need in the youth psychotherapy literature includes the examination of mechanisms of change within the context of "real world" clinical settings, where the practice of psychotherapy differs significantly from that in controlled clinical trials. In examining mechanisms of change in youth psychotherapy, variables related to parent functioning may be among the most important factors to consider in predicting and promoting good child outcomes. The purpose of the present study was to evaluate three important aspects of parent functioning—psychological symptom distress, interpersonal relations, and social role performance—as potential predictors of successful treatment outcomes in a traditional community outpatient treatment setting for children and adolescents. Further, this study examined whether parents indirectly benefited from their children receiving services, expanding our view on the scope and benefits inherent in youth psychotherapy. Parent Symptom Distress, Interpersonal Relations, and Social Role performance were measured using the domains of the Outcome Questionnaire 45 (OQ-45; Lambert et al., 2004), and youth treatment outcomes were measured using the parent and self-report versions of the Youth-Outcome Questionnaire (Y-OQ; Burlingame, Wells, Lambert, & Cox, 2004; Y-OQ-SR; Wells, Burlingame & Rose, 2003). Using Hierarchical Linear Modeling with this sample of 339 youth, aged 4-17 and their parents, this study examined the relationship between these parent domains and youth progress in therapy. Results revealed that parent Symptom Distress and Social Role performance improved significantly over the course of youth treatment. Further, Social Role performance at intake significantly predicted the rate of change in parent-reported youth outcome; and Interpersonal Relations at intake significantly predicted rate of change in youth-reported outcome. Finally, changes in parent Social Role performance were associated with changes in youth symptoms over the course of treatment. Examining the associations between these variables is an important step toward identifying potential mechanisms of change in youth mental health treatment. The results of this study provide valuable information on the importance of attending to parent functioning in the assessment and treatment of youth mental health issues.
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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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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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Vanhouche, Wouter. "Generalizing from purchase outcomes." [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0011362.
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Andén, Annika. "Outcomes from GPs' Consultations." Doctoral thesis, Linköpings universitet, Allmänmedicin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-18483.
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Background and aims. Patients’ consultations with GPs can deal with a wide range of conditions and problems. Generally, consultation outcomes have been considered in evaluations but outcome has a meaning for elaboration of care beyond the graduating role of quality and other evaluation instruments. Knowledge about outcomes is needed for understanding and development. The aim of this thesis was to investigate outcomes of GPs’ consultations as directly experienced by patients and GPs and to investigate connections between clinical strategies and presumed patient outcomes. Methods. First, concepts describing outcomes from patients’ and GPs’ viewpoints were developed from interviews in groups and individually. Secondly, based on this, questionnaires about the consultation outcomes were formulated. Then, patients and GPs answered questionnaires regarding the same recent consultation. The numbers of the different outcomes were counted and the experiences of outcomes from the same consultations were compared. Finally, another questionnaire including both the GP outcome questions and questions about the clinical situation and decisions made was answered by GPs. Results. Concepts describing consultation outcomes were brought forward. Cure/symptom relief, reassurance, patient understanding and satisfaction were used by both patients and GPs to describe outcome of consultations. Only patients described as outcomes a confirmation of their ideas and a change in self-perception. GPs, but not patients, described the patient outcomes in terms of check-up and coping. Besides this, GPs also described other outcomes that concerned relationship-building, a change of surgery routines and self-evaluation. Selfevaluation was related to a perceived collegial consensus about right and wrong. The concordance between GPs and patients assessing the same consultations was high for satisfaction, intermediate for patient understanding and low for belief in cure/symptom relief. Clinical strategies were linked to outcomes. Immediate problem solving was registered in about half the consultations. When immediate problem solving was registered the patients were supposed to be more reassured, satisfied and coped better than after gradual problem solving. With increasing psychosocial content of the consultation the GPs registered more dissatisfaction both for themselves and their patients. Conclusions. Change in self- perception was a prominent patient outcome. GPs’ self-evaluations ought to have the inherent possibility to serve as a basis for development of general practice. The entire map of the encountered outcome concepts can serve as a basis for further research and development. The mapping of concepts can be of help when prioritising. Knowledge about the total picture of consultation outcomes can help the GP to understand the patients’ worlds better. It can also contribute to a realistic picture of possible consultation outcomes. The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person.
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Condon, Marie. "Improving outcomes in glomerulonephritis." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/41079.
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INTRODUCTION: Lupus Nephritis (LN) and Idiopathic Membranous Nephropathy (IMN) are immune mediated kidney diseases. The gold standard test for diagnosis and monitoring is kidney biopsy. Current treatment regimens for both diseases can be toxic with long-term effects. AIMS: Assess the outcomes of less toxic steroid sparing regimens in both diseases. To validate urinary biomarkers in LN. Assess the indirect immunofluorescence test (IIFT) for identification of anti-PLA2R antibodies in IMN. METHODS: Prospectively data was collected on 50 consecutive patients with Lupus Nephritis (LN) were treated with the steroid sparing RITUXILUP regimen. Retrospectively data was collected on 43 patients with Idiopathic Membranous Nephropathy (IMN) who received >12 months of treatment with Tacrolimus Monotherapy (Tac). Enrolment and data monitoring of the IMN induction trial 'MTac' is described. The urine biomarker MIF was measured in 586 urine samples from 59 patients; results were correlated with disease activity. A Multiplex cytokine array identified Angiogenin (ANG) as a novel cytokine. ANG was measured in 342 urine samples from 34 patients treated with RITUXILUP regimen. IIFT was used to identify anti-PLA2R antibodies in 59 plasma samples from 24 patients in the MTac trial. RESULTS: RITUXILUP and Tac regimens were safe and effective with 86% response rate at 1 year (52% CR and 34% PR) and 98% response rate respectively. Tac can be valuable in relapsing or resistant disease to maintain remission. uMIF reflected the change in disease activity, baseline uMIF did not predict time to CR. ANG was identified in urine from patients with active LN. Levels were significantly lower when in remission. An association between uANG and the degree of renal impairment but not with proteinuria was shown. IIFT is effective and reproducible for the qualitative assessment of anti-PLA2R antibodies, however it is laborious and can have subjective variability when used in a quantitative manner. CONCLUSIONS: Steroid sparing treatment may be possible in both LN and IMN; but this needs to be validated in RCTs. uMIF and uANG both reflect disease activity in LN, more work is needed to assess if they have a unique role as a biomarker in LN or as a therapeutic target. The clinical application of anti-PLA2R antibodies is being investigated widely. The IIFT is sufficient for current research use, however probably not for a high throughput use.
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Calder, Nicole. "Factors Affecting Caregiver Outcomes." The University of Waikato, 2008. http://hdl.handle.net/10289/2281.
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Research in the area of caregiving has tended to focus on the impact of the caregiving experience itself without consideration of continued psychological distress for caregivers after institutionalisation or death. Seven caregivers of loved ones with Alzheimer's Dementia (mostly spousal) were interviewed about their experiences of caregiving and their emotional well-being after placement of their loved one into a residential care facility or death. The nature of the carers relationship with their loved one (e.g. highly dependent), lack of social supports, inactivity and a poor experience of transition into care seemed to be factors relating to poorer outcomes for these caregivers. Utilisation of social supports, involvement in pleasant events, adequate preparation and information relating to the disease and collaboratively planned transition into care played protective roles for the remaining carers who reported decreased levels of anxiety, guilt, depression and stress post-institutionalisation/death. The implications of the current research for practise, policy change and prevention are extensive and suggest that risk factors may be identifiable and thus poorer mental health outcomes in caregivers preventable. A need for greater support to be made available to caregivers is necessary.
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Yoon, Jeong Ho Optometry & Vision Science Faculty of Science UNSW. "Modelling outcomes from orthokeratology." Awarded By:University of New South Wales. Optometry & Vision Science, 2009. http://handle.unsw.edu.au/1959.4/40944.
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This research aimed to develop and validate a new method for calculating anterior and posterior corneal topography. The novel calculation method was then used to evaluate the influence of orthokeratology (OK) lens wear and overnight edema on posterior corneal shape, and to develop a physical model for anterior and posterior corneal shape changes during myopic overnight OK. The new method uses anterior corneal topographic data derived from the Medmont E300 corneal topographer, and total corneal thickness data measured along the horizontal corneal meridian using the Holden-Payor optical pachometer. The data are then entered into an Interactive Data Language computer program, which calculates the anterior and posterior corneal apical radii of curvature and Q (asphericity) based on the calculated anterior ellipsoid curve, the locations of corneal pachometry measurements, direction of thickness measurements, and the local radius of curvature. Pachometry data were optimised based on the local radius of anterior corneal curvature and an exact solution for the relationship between real and apparent thickness. The newly developed method was validated using a range of test surfaces and repeatability was also investigated with five adult subjects. Eighteen young adult subjects wore BE OK lenses overnight only in both eyes for 14 days. Ten young adult subjects participated as a control group, wearing J-Contour RGP lenses in one eye only for one night. OK subjects were assessed on days 1, 4, 7, and 14, and control group subjects on day 1, in the morning and evening. Subjective refraction, visual acuity, corneal topography and corneal thickness were measured. Most change in refractive error occurred within the first 7 nights of overnight OK. This rapid reduction in myopia was associated with improvement in unaided VA, and flattening of anterior corneal curvature. There were no changes in posterior corneal apical radius but an increase towards an oblate posterior corneal Q was found during 14 days of overnight OK, at both morning and evening measurements. Fixed anterior corneal points were determined at 8.13mm and 5.30mm chords at morning and evening measurements in the OK group. The points of maximum increase in anterior corneal elevation at evening and morning measurements were at 6.90mm and 7.00mm chords respectively. In the OK group, significant backwards movement of anterior and posterior corneal apices was found relative to the fixed anterior corneal points at the morning measurement. Backwards movement of the anterior corneal apex remained during the day whereas the posterior corneal apex recovered to baseline. In conclusion, our results support the theory that the OK refractive effect is achieved through remodelling of anterior corneal layers, without overall corneal bending. Central corneal thinning in the evening after overnight OK lens wear is primarily due to to posterior movement in space of the anterior corneal apex. The posterior direction of overnight corneal edema across the cornea in OK lens wear is consistent with previous models that predict that the cornea swells in a posterior direction during edema.
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Hillan, Edith M. "Outcomes of Caesarean section." Thesis, University of Glasgow, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.257964.
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Cunningham, Susan Jane. "Outcomes of orthognathic treatment." Thesis, University College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325911.
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Flanagan, Sarah Marie. "Adverse outcomes after colposcopy." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4124/.
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Little is known about the long term adverse outcomes following colposcopy. This thesis employs a mixed method approach to investigate the long term adverse impacts of undergoing this procedure. Following a systematic review undertaken to explore the evidence base in terms of the potential impacts of colposcopy upon psycho-sexual functioning a two stage cohort study using questionnaires was undertaken employing quantitative and qualitative data collection tools. Of particular interest was whether the level of colposcopic intervention (colposcopy, biopsy or loop excision)was associated with more pronounced levels of sexual dysfunction, higher levels ofanxiety and depression and impaired quality of life. There were no significant differences observed between women undergoing colposcopy, biopsy or loop excision for any ofthe outcome measures across both stages ofthe study. Age was the only predictor found to be associated with some of the outcomes measured. The study concludes that the level of colposcopic intervention has no impact upon outcomes measured. Factors other than undergoing colposcopy are likely to explain any problems observed in this cohort.
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Khan, Mansoor Ali. "Outcomes of laparoscopic fundoplication." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/88019/.
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Gastro-esophageal reflux disease (GORD) is common and a variety of surgical repair techniques have been shown to be effective. This thesis contains two randomised controlled trials and a combined data analysis of both studies to establish which techniques appear the most effective in controlling reflux. It also contains a pilot study to determine whether intraoperative manometry can predict which patients are likely to suffer from postoperative dysphagia. One hundred and three underwent partial fundoplication (Anterior or Posterior) and one hundred and twenty one patients underwent total/subtotal (Nissen or Lind) in the randomised controlled trials and 40 patients were recruited into the intraoperative manometry study. Patients were followed up for 12 months and their change in symptoms recorded. In the partial fundoplication trial, patients who underwent posterior fundoplication had better control of symptoms compared to those who underwent anterior fundoplication at the 12 month follow up point. There was no difference between the groups who underwent Nissen and Lind fundoplication. When the studies were collated, the laparoscopic total/subtotal fundoplication appears to be superior in the control of reflux when compared to the laparoscopic partial fundoplication. Intraoperative manometry may be advantageous as the study does suggest that this investigation may be useful in predicting post-operative dysphagia.
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Johnson, Kiana. "Better Communication, Better Outcomes." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7020.
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Ali, Omair. "Outcomes of refractive surgery." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12262.
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Thesis (M.A.)--Boston UniversityProcedures to reshape the cornea to correct refractive errors have been a longstanding and fast-evolving area of interest for centuries. As recent advances in excimer laser technology allow keratorefractive treatments to deliver precise treatments with fewer associated risks and complications, the popularity of modern refractive procedures continues to grow at unprecedented rates. For this reason, it is imperative to continue correlating patient characteristics to outcomes so that refractive surgeons can more accurately foresee the results of the selected procedure. This study examined the outcomes of refractive surgeries at a full-scope ophthalmology clinic from January 2011 to November 2011. The main objectives of th is study were to determine the differences between the outcomes of LASIK vs. LASEK, Custom vs. Traditional treatment plans, myopic vs. hyperopic patients and MMC exposure vs. no MMC exposure (LASEK only). More importantly, the data was scrutinized to determine whether or not any of these treatments and/or patient characteristics correlated with poor visual outcomes or the need for an enhancement. Of the 590 myopic eyes treated with Custom LASIK, 90.85% (n=536 eyes) had UDVA of 20/20 or better, 96.10% (n=567 eyes) had UDVA of 20/25 or better and 99.32% (n=586 eyes) had UDVA of 20/40 or better. Of the 170 myopic eyes treated with Custom LASEK, 70.59% (n=120 eyes) had a UDVA of 20/20 or better, 82.94% (n=141 eyes) had a UDVA of 20/25 or better and 96.47% (n=164 eyes) had a UDVA of 20/40 or better. Of the 45 hyperopic eyes that were treated with Traditional LASIK, 44.44% (n=20 eyes) had postoperative UDVA of 20/20 or better, 62.22% (n=28 eyes) had postoperative UDVA of 20/25 or better and 82.22% (n=37 eyes) had postoperative UDVA of 20/40 or better. Of the 536 eyes receiving LASIK, 91.42% (n=490 eyes) had an UDVA of 20/20 or better, 96.46% (n=517 eyes) had an UDVA of 20/25 or better and 99.44% (n=533 eyes) had an UDVA of 20/40 or better. Of the 146 low or moderately myopic eyes receiving Custom LASEK, 74.65% (n=106 eyes) had an UDVA of 20/20 or better, 86.62% (n=123 eyes) had an UDVA of 20/25 or better and 96.48% (n=137 eyes) had an UDVA of 20/40 or better. Of the 54 highly myopic eyes treated with Custom LASIK, 85.19% (n=46 eyes) had an UDVA of 20/20 or better, 92.59% (n=50 eyes) had an UDVA of 20/25 or better, and 98.15% (n=53 eyes) had an UDVA of 20/40 or better. Of the 28 highly myopic eyes treated with Custom LASEK, 53.57% (n=15 eyes) had an UDVA of 20/20 or better, 64.29% (n=18 eyes) had an UDVA of 20/25 or better, and 96.43% (n=27 eyes) had an UDVA of 20/40 or better. An analysis of these data yields significantly greater percentages of myopic (low, moderate and high) eyes achieving 20/20 or better after treatment by Custom LASIK versus Custom LASEK. The data suggested no correlations between poor visual outcomes and/or the need for an enhancement treatment and intraoperative complications, magnitude of ametropia, pupil size, age, treatment type, and treatment plan. All of the LASEK patients who underwent an enhancement treatment were exposed to MMC during their original procedure. Hyperopic patients displayed significantly reduced visual outcomes than comparable myopic treatments. Future studies should investigate similar preoperative characteristics and attempt to correlate them to results to improve predictability and, thus, visual outcomes.
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Honn, Vanessa Janel. "Psychological outcomes and moderators /." The Ohio State University, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=osu148646206784129.
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CLAYTON, Philip. "Outcomes of Kidney Transplantation." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/10553.
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Kidney transplantation is the preferred treatment for the majority of patients with end-stage kidney disease, offering improved survival and quality of life compared with dialysis at reduced cost. However, kidney transplantation remains a treatment rather than a cure. A good outcome requires appropriate donor and recipient selection, careful management of immunosuppression, and avoidance of long-term complications including death from cardiovascular disease or malignancy, and graft loss from chronic allograft nephropathy or recurrence of the primary kidney disease. Making use of data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, supplemented where necessary by other sources, this thesis contains a number of linked epidemiologic investigations: (1) a report of the risk profile of Australian and New Zealand living kidney donors over 2004-11; (2) simulations of the allocation of deceased donor kidneys in Australia over 2006-2010, and development of novel metrics for the utility and equity of each allocation system; (3) external validation of the US estimated post-transplant survival (EPTS) score; (4) study of the long-term consequences of early acute rejection; (5) 15 year follow-up of a randomised trial of mycophenolate vs azathioprine; and (6) analysis of the association between steroid use and graft loss from recurrent IgA nephropathy.
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Bruce, Vanessa Leigh. "Couple Outcomes in Stepfamilies." Thesis, Griffith University, 2012. http://hdl.handle.net/10072/367677.
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Stepfamilies are an increasingly common family structure which has been associated with unique challenges for couples early in their relationships. Previous research has shown that both children and couples within stepfamilies have poorer outcomes than those in first marriage (intact) families and that couples within stepfamilies break-up at much higher rates than couples in first marriage families.
The present research consists of two studies that aimed to investigate these differential outcomes for stepfamily couples by examining the longitudinal relationship between a range of both couple and stepfamily specific variables and relationship satisfaction and stability. The broad aims of the research were to compare the relative contribution of general couple factors that have been found to be associated with relationship outcomes for first married couples as opposed to factors that are specific to stepfamilies.Thesis (PhD Doctorate)
Doctor of Philosophy in Clinical Psychology (PhD ClinPsych)
School of Psychology
Griffith Health
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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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Jadambaa, Amarzaya. "Bullying in Australia: Prevalence, health outcomes, cost outcomes, and economic evaluation of bullying prevention." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/206147/1/Amarzaya_Jadambaa_Thesis.pdf.
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Bullying among children and adolescents is a major public health problem. The negative consequences of bullying are not limited to health problems, nor to experiences in childhood and adolescence, and can persist into adulthood. This research found that one in seven Australian children experienced bullying victimisation; bullying victimisation contributes a significant proportion of the burden of disease; a substantial annual cost to Australian society results from bullying; and further investment in bullying prevention is an efficient use of scarce healthcare resources. This thesis makes an important contribution to the field of bullying and the vital role of bullying intervention programmes.
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Mitchell, Mary. "Re-imagining family group conferencing 'outcomes'." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/31278.
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Family Group Conferencing (FGC) is a family led decision-making approach where practical plans are made by the family to keep children safe and improve their quality of life. FGC has attracted worldwide interest from policymakers, researchers and practitioners for its potential to: involve families in the decision-making process in child and families social work; keeping children safe within a culture of co-operation between the state and families. There is significant empirical research about the impact of the FGC process on families, and its immediate outcomes but less is known about outcomes in the longer-term. This thesis reports on the findings of a retrospective qualitative study, which sought to understand the contribution FGC makes to longer-term outcomes for looked after children at risk of being accommodated, and their families. Eleven FGC examples were studied across five local government areas in Scotland. Each example includes the perspective of different stakeholders in the process including: looked after children, their parents and extended family (n=32), and professionals (n=28) involved with them. Criteria for case selection included: the child and family had originally been referred to FGC service because the family social worker considered the child was at risk of being accommodated; the stages of FGC had been achieved and a family meeting had taken place at least one year prior to the data being collected; the age of the child who was the focus of the meeting was over eight years old wherever possible; and the core family members were prepared to be involved in the study. Individual, joint or group interviews were conducted to provide multi-dimensional perspectives of the FGC phenomena. FGC service documents (n=94) were also analysed, providing data of social activity that occurred prior to the study. This study challenges current outcome focused paradigms, arguing for a more complex and nuanced understanding of outcomes in child welfare, where the child and family,alongside professionals,are valued in the identification and measurement of outcomes. Evidence from this study highlights the need to accept two sets of outcomes when considering FGC contribution: personal and professional. The identification of outcomes in this manner supports three interconnected issues argued throughout the thesis in relation to contribution. Firstly, process matters to the service user and his/her experience of the service and opinion of outcomes. Secondly, what professionals do and how they do it is important to the outcomes of families requiring support -relationships and practice are therefore central concerns in understanding how and why families achieve (or not) longer-term outcomes. Finally, who defines outcomes and to what purpose is significant when conceptualising outcomes. The study draws on empowerment, recognition and partnership theories to better understand FGCs contribution to longer-term outcomes for children and families. The study found the FGC process contributed towards building service users' capacities to reflect on their own and acknowledge others' experiences and situations. Feelings of increased confidence, self-respect and self-esteem, derived from the FGC process, contributed towards improved social relations and a sense of control over their own lives. This increased capacity can support family members to manage future crises and conflict if they arise. FGC offers professional and service users an opportunity to reframe unhelpful attitudes towards each other. In the longer term this can contribute towards families reduced need for social work services and/or improved working relationships between social work and families. This study has significance for all professionals working with looked after children and their families; contributes to the theoretical knowledge applied in social work practice; and is applicable when considering the implementation and impact of child welfare policy in Scotland and internationally.
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Schembari, Anna 1982. "Ambient air pollution and birth outcomes : Insights on exposure determinants and new outcomes." Doctoral thesis, Universitat Pompeu Fabra, 2014. http://hdl.handle.net/10803/382485.
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Recent epidemiological evidence on effect of air pollution and pregnancy outcomes is inconsistent. Differences in study design, sample size, population characteristics, control for confounders, air pollution measurements and exposure assessment techniques as well as the lack of knowledge on the exact biological mechanism are likely to contribute to the observed heterogeneity. The aim of this project was to better understand the personal exposure determinants and to use refined exposure assessment techniques such as Land Use Regression (LUR) models to assess the impact of air pollution on birth outcomes. Moreover to encompass outcomes that might help in the identification of possible biological mechanisms of the effect of air pollution on fetus development. Ventilation of the house by opening the windows, the time spent cooking and indicators for traffic intensity were re-occurring statistically significant determinants of the personal and indoor pollutants levels. In our studies of air pollution and birth outcomes we were able to identify congenital anomalies groups not systematically studied before and we were the first to include indicators of fat mass at birth. Air pollutants, estimates using LUR, were associated to increased risk of some congenital anomalies of the hearth and with impaired fetal growth.Les últimes evidències epidemiològiques sobre l’efecte de la contaminació atmosfèrica i els efectes durant l'embaràs són inconsistents. Les diferències en el disseny de l'estudi, la grandària de la mostra, les característiques de la població, el control dels factors de confusió, les mesures de contaminació de l'aire i les tècniques d'avaluació de l'exposició, així com la manca de coneixement sobre el mecanisme biològic exacte, poden contribuir a l'heterogeneïtat dels resultats observats. L'objectiu d'aquest projecte era comprendre millor els determinants de l'exposició personal i utilitzar tècniques millorades d'avaluació d'exposició, com als models de models d’ús del territori (Land Use Regression, LUR) per avaluar els efectes de la contaminació atmosfèrica a la salut del neonat. Alhora incloure els resultats que podrien ajudar en la identificació de possibles mecanismes biològics dels efectes de la contaminació atmosfèrica en el desenvolupament del fetus. Els factors determinants dels nivells de contaminants personals i d'interior, com ventilació de la casa obrint les finestres, el temps dedicat a la cuina i els indicadors de la intensitat del trànsit es tornen a mostrar estadísticament significatius., En els nostres estudis de la contaminació de l'aire i els efectes en la salut en neonats hem estat capaços d'identificar uns grups d'anomalies congènites no estudiades abans de forma sistemàtica i hem estat els primers a incloure indicadors de massa de greix al néixer. Els contaminants de l'aire i les estimacions utilitzant LUR es van associar a un major risc d'algunes anomalies congènites del cor i amb el retard del creixement fetal.
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Mo, Ho-kwan, and 毛皓羣. "A systematic review of incident reporting systems improving patient outcomes and organizational outcomes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48424936.
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BACKGROUND
Patient safety, reducing medical errors and risk management have become a global public health and administrative issue. Population-based studies around the world have alerted high rates of preventable medical errors and deaths. In response, a global effort agreed on a World Health Assembly resolution on patient safety. The World Alliance for Patient Safety guideline and the Conceptual Framework for the International Classification for Patient Safety have been launched by the World Health Organization (WHO) to galvanize and facilitate efforts by all Member States to make health care safer. The guidelines introduced adverse event reporting and focus on reporting and learning to improve the safety of patient care. The WHO suggested a conceptual framework for patient safety providing comprehensive understanding of the domains of patient safety. It represents a continuous learning and improvement cycle emphasizing on proactive (identification of risk, prevention, detection, reduction of risk) and reactive (incident recovery, system resilience) risk management. The ultimate measure of a successful incident reporting system is whether the information it yields is used appropriately to improve patient and organization safety.
OBJECTIVES
To systematic review literature to determine incident reporting systems improve patient outcomes and organization outcomes, and to identify successful characteristics of incident reporting system which information it yields is used appropriately to improve patient and organization safety, and to investigate if the incident reporting system can serve as an interface to support the (inform and influence) information flows in the WHO’s Conceptual Framework for the International Classification for Patient Safety.
METHODS
Two bibliography databases, Medline and Embase via OvidSP, were systematically searched using search keywords of ‘incident reporting’, ‘patient / organization outcomes’. Quality appraisal, data extraction were conducted on literature which met the inclusion criteria. Narrative synthesis was conducted.
RESULTS
A total of 584 citations were initially identified and 6 studies were finally included in this systematic review. The methodological quality of the 6 included studies was generally average to poor. The 6 included studies could be classified into 3 groups by research question and intervention strategies examined 1) case series on incident reporting system; 2) comparison study on two main streams of incident reporting systems: routine incident reporting system versus structured case note / chart review; and 3) review of incident reporting systems. Successful characteristics of incident reporting system identified including confidential, non-punitive, expert analysis, system-oriented, responsive, standardized taxonomy coding, clarified and unified concepts of incident reporting system, voluntary reporting, facilitation reporting, proper training and health informatics infrastructure support. Quantitative and qualitative evidences were identified that incident reporting system could serve as an interface to support inform and influence types of information flows in the WHO’s Conceptual Framework for the ICPS. However, no evidence could be found that incident reporting systems could directly improve patient outcomes and organization outcomes.
CONCLUSION
This systematic review found no evidence that incident reporting systems could directly improve patient outcomes and organization outcomes, but the systems could serve as an interface to support information flows in the WHO’s Conceptual Framework for the ICPS. Successful characteristics of an incident reporting system were identified coherent to the WHO’s recommendations. Future studies can further examine the causation relationship between incident reporting systems and the process components by applying the Donabedian’s structure-process-outcome model.published_or_final_version
Public Health
Master
Master of Public Health
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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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Beveridge, Scott Francis. "Vocational rehabilitation outcomes a study on the relationship between rehabilitation goals and employment outcomes /." College Park, Md. : University of Maryland, 2003. http://hdl.handle.net/1903/134.
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Thesis (Ph. D.) -- University of Maryland, College Park, 2003.Thesis research directed by: Counseling and Personnel Services. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.
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Williams, Peter Alan. "Exploratory study of mapping outcomes of executive coaching with specific focus on unplanned outcomes." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/97433.
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Thesis (MPhil)--Stellenbosch University, 2014.ENGLISH ABSTRACT:This research assignment is an exploratory qualitative study into mapping unplanned outcomes of executive coaching. The research purpose was twofold: to address the lack of a common and comprehensive framework for the mapping of outcomes of executive coaching, and to add to the body of knowledge regarding unplanned outcomes of executive coaching. In developing the mapping framework, the available literature was reviewed and, through an inductive process, a framework, model, taxonomy and mapping tool were developed. Based on core concepts attributable to Kirkpatrick, Wilber and Jaques, the mapping tool developed was then tested, using data obtained from a purposive sample of seven semi-structured interviews with Gauteng based coachees. The sample excluded any individuals who had been coached by the researcher. During the data analysis, the planned outcomes were mapped using the mapping tool and related processes. Thereafter the actual outcomes were mapped, identifying those outcomes that matched planned outcomes and those that supported the planned outcomes. A technique named ‘outcome chains’ was developed and used for this process. The unplanned outcomes were identified by a process of elimination, being those that remained unallocated in the planned chain process. It was found that outcomes of executive coaching can be mapped using a framework based on the principles of Kirkpatrick, Wilber and Jaques, with all identified outcomes being mapped successfully. Four categories of unplanned outcomes were identified, namely those that hinder the attainment of planned outcomes, insufficient evidence of achieving planned outcomes, actual outcomes related to planned outcomes but with scope different to planned and, fourthly, actual outcomes unrelated to planned outcomes. Additionally, three themes of unplanned outcomes, each with two sub-themes, were identified, namely personal (sub-themes: physical and spiritual), family (sub-themes: immediate and extended) and work (sub-themes: positive and negative). The most surprising finding was that all seven coachees experienced unplanned outcomes, which is markedly different to previous research findings and may be due to the inclusion of non-work related outcomes. The key recommendations arising from this research assignment embrace the research into, and practice of, executive coaching. Regarding the research elements, it is recommended that the mapping framework developed in this research be further refined and tested as a holistic standard for evaluating the outcomes of executive coaching, including those outcomes that impact the coachee as an individual. For the executive coaching fraternity, it is recommended that coaches challenge themselves and their practices regarding the probability, categories and impact of unplanned outcomes, and introduce measures to maximise the upside and minimise the risks of unplanned outcomes. Finally, the regular testing and recording of the coachee’s reaction to executive coaching is recommended as a predictor of coaching efficacy.
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Allspaw, Kathleen M. "Secondary science classroom dissections forming policy by evaluating cognitive outcomes and exploring affective outcomes /." [Bloomington, Ind.] : Indiana University, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3344557.
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Thesis (Ph.D.)--Indiana University, School of Education, 2008.Title from home page (viewed on Oct. 5, 2009). Source: Dissertation Abstracts International, Volume: 70-02, Section: A, page: 0517. Adviser: Charles Barman.
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Lam, Oi-yeung. "Family dynamics and educational outcomes." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/B31472370.
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Wallace, Sandra K. (Sandra Kay). "Outcomes of Supervisory Communication Competence." Thesis, University of North Texas, 1988. https://digital.library.unt.edu/ark:/67531/metadc500246/.
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The purpose of this study was to investigate the impact of the communication competence of supervisors upon an employee's job satisfaction. Results obtained supported the 5 hypotheses proposed. Findings indicated the importance of supervisory communication responsiveness in areas of listening, sensitivity, and expression of interest in subordinate's ideas and concerns in ensuring satisfaction with supervision received. Support was also generated for the value of an "open" communication climate where continual feedback and idea exchange interact to produce organizational identification. Significant relationships were found to exist between communication climate and dimensions of the JDI: satisfaction with supervisor, work satisfaction, pay satisfaction, satisfaction with promotion opportunities, satisfaction with coworkers. Finally, communication skills training for supervisors was recommended to animate organizational growth and development.
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Kurz, Xavier. "Varicose veins : epidemiology and outcomes." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0034/NQ64594.pdf.
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Almgren, Torbjörn. "Outcomes in treated hypertensive men /." Göteborg : Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/4437.
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Schmidtke, Kelly Ann Katz Jeffrey S. "Differential outcomes facilitate relational associations." Auburn, Ala, 2008. http://repo.lib.auburn.edu/EtdRoot/2008/SPRING/Psychology/Thesis/Schmidtke_Kelly_16.pdf.
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Panudulkitti, Panupong. "Urbanization and Poverty Reduction Outcomes." Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/econ_diss/45.
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This dissertation attempts to examine the effect of urbanization on poverty reduction outcomes by considering various dimensions of poverty and channels of reducing poverty. First, we develop a theoretical model in order to infer a relationship between urbanization and poverty reduction outcomes. Specifically, it shows an optimal level of urbanization to properly allocate basic public infrastructure and promote pro-poor growth. Second, we conduct empirical analysis on international data to examine the testable hypotheses that are derived from the theoretical model. Further, we explore the “channeled effects” of urbanization on basic education and health by the IV estimation and on productivity by the dynamic panel GMM estimation. As the theoretical model suggests, our results exhibit the statistically significant relationship in a non-linear form between urbanization and poverty. In addition, we explore the impact of urbanization on poverty reduction outcomes in different regions in order to see the various magnitudes of urbanization effects among regions.
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Lu, Ellen Meng-I. "Perinatal outcomes in multiple sclerosis." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44199.
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Gyles, Petra. "Student outcomes in inquiry instruction." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=96867.
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A literature review of student outcomes from inquiry instruction generated a list of 23 criterion-referenced student outcomes. These included more commonly addressed outcomes such as content knowledge and process skills, and less commonly addressed outcomes such as creativity, motivation, collaborative ability, and autonomy. This list was adapted into a questionnaire probing to what extent the various outcomes were perceived in classrooms by teachers working at varying self-rated levels of inquiry use (low, middle, high). Analyses were performed on a sample of 74. Teachers' self-ratings of inquiry use were significantly and positively related to the inquiry outcomes categorized as learning competencies and personal motivation. At moderate levels of inquiry use, teachers recognized that students adopted new learning roles. Teachers appeared to perceive changes in students' roles before their own but this result could be explained by recognition of the positive value of collaboration and, unexpectedly, memorization within high levels of inquiry.Un survol de la littérature des résultats d'élèves ayant suivi une démarche par investigation raisonnée nous a permis d'établir une liste de résultats d'étudiants avec 23 critères référentiels. Ceux-ci incluaient des résultats plus usuels, tels que la connaissance du contenu ou les habiletés procédurales, mais aussi des résultats moins souvent abordés, comme la créativité, la motivation, les habiletés à collaborer, et l'autonomie. Cette liste a été adaptée sous forme de questionnaire visant à déterminer jusqu'à quel point les divers résultats étaient perçus en classe par les enseignants dans leur auto-évaluation des divers niveaux d'utilisation (faible/moyen/élevé) de leur approche par investigation raisonnée. Des analyses ont été faites avec un échantillon de 74 individus. L'auto-analyse des enseignants de l'approche par investigation raisonnée était définitivement reliée de façon significative à la démarche par investigation de la catégorie des compétences d'apprentissage et de la motivation personnelle. Selon les enseignants, l'utilisation modérée de l'approche par investigation a permis aux élèves d'adopter de nouveaux rôles d'apprenants. Les enseignants ont semblé percevoir des changements dans le rôle des élèves avant de les constater dans leurs rangs, mais ce résultat pourrait s'expliquer par la reconnaissance de la valeur positive de la collaboration, et, de façon inattendue, de la mémorisation aux niveaux supérieurs de l'approche par investigation raisonnée.
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West, Nicholas Paul. "Improving outcomes in colorectal cancer." Thesis, University of Leeds, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.549772.
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Colorectal cancer is common with a high mortality rate despite significant advances in its management. While outcomes for rectal cancer have improved over recent years, outcomes for low rectal cancer. and colon cancer have not improved to the same degree. Studies were designed to investigate the optimal operations for both low rectal cancer and colon cancer using tissue morphometry and assessment of the surgical planes. Additionally, the utility of tumour cell density as a prognostic marker and a method of assessing the response to pre-operative treatment was investigated. Extralevator 'abdominoperineal excision for low rectal cancer was shown to be associated with better pathological outcomes and planes of surgery when compared to standard abdominoperineal excision. Careful mesocolic plane surgery for colon cancer was associated with better survival when compared to disrupted specimens. Complete mesocolic excision with central vascular ligation and Japanese D3 resection resulted in an oncologically superior specimen when compared to standard surgery. They could both be performed laparoscopically and were easily adopted by a group of highly motivated surgeons. Tumours with a low tumour cell density appeared to have an independently worse prognosis, and the same technique generated a useful measure of response to pre-operative therapy in both colon and rectal cancer. Outcomes for low rectal cancer and colon cancer could be improved by surgical education programmes backed up by pathological audit. Tumour cell density could be introduced as a new prognostic marker and could be used to define the degree of response to pre-operative treatment in colorectal cancer.
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Briggs, Timothy William Roy. "Clinical outcomes of autologous implantation." Thesis, University College London (University of London), 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.505121.
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Caamal-Olvera, Cinthya G. "Labour market outcomes in mexico." Thesis, University of Essex, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.494194.
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Poulette, Joshua J. "INTERGENERATIONAL DYNAMICS AND POLITICAL OUTCOMES." UKnowledge, 2013. http://uknowledge.uky.edu/msppa_etds/10.
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This dissertation explores the relationship between intergenerational dynamics and politics outcomes in several distinct contexts. It is motivated by the remarkable demographic shifts exhibited by people in advanced countries over the past several decades. Individuals on average have longer lives and fewer children than ever before. Combining these shifts with the large intergenerational public policies that exist in many such states (education, old-age social welfare, healthcare) provokes several distinct yet related research questions addressed in the chapters below. First, do political traits matter for fertility behavior? If so, could the presence of differential fertility behavior across political groups lead to a shift in the position of the future median voter? Second, what are other significant determinants of fertility in contemporary Europe and the United States? Does more recent data support the findings of established “determinants of fertility” models? Finally, does the relationship between age and Social Security benefit preferences (and confidence in the Social Security system) seem to suggest the potential for intergenerational conflict over Social Security? The chapters below tie together disparate bodies of literature from multiple academic disciplines and use empirical evidence to answer these research questions. The results suggest political traits are significant determinants of fertility in some cases. The results also demonstrate that the relationship between wealth/education and fertility in many European states is positive – in contrast to much of the literature on this relationship and the common wisdom. Finally, the last empirical chapter illustrates the existence of potential age-based political conflict over Social Security in the United States.
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Lam, Oi-yeung, and 林藹陽. "Family dynamics and educational outcomes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B31472370.
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Iyer, R. "Surgical outcomes in gynaecological oncology." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1482204/.
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Presently there are no reliable statistics available on complication rates associated with surgery in gynaecological cancer in the UK, apart from data from small studies involving individual centres and clinical trials. This thesis describes the United Kingdom Gynaecological Oncology Surgical Outcomes and Complications study (UKGOSOC) that was set up to prospectively capture data from ten UK gynaecological cancer centres on surgical procedures and complications in a uniform manner using agreed definitions so that data could be analysed and compared. A web-based database was set up to capture surgery and complications contemporaneously from the hospitals, and, consented women were sent a follow-up letter eight weeks postoperatively. Intraoperative and postoperative complications were recorded using a pre-determined list. Postoperative complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from analysis. Univariable and multivariable regression analyses were performed to determine the predictors for intraoperative and postoperative complications. The Lasso method of penalised regression was used to create a risk-prediction model for comparing outcomes between the centres. Data on 2948 eligible major surgical procedures were analysed and 1462 follow-up letters were received. The overall intraoperative complication rate was 4.7% (95% CI 4.0-5.6). The hospital-reported postoperative complication rate was 14.4% (95% CI 13.2-15.7) which increased to 25.9% (95% CI 23.7-28.2) when both hospital and patient- reported postoperative complications were included. The predictors for intraoperative and postoperative complications were different apart from diabetes which was common to both. Risk-adjustment had a modest effect on the complication rates for individual centres but allowed for a fairer comparison. There was no concordance between the ranking order of the centres for intraoperative and postoperative complication rates. The overall intraoperative (≈5%) and postoperative (≈26%) complication rates and funnel graphs derived from this study could be used to benchmark performance of gynaecological oncology centres and even individual surgeons if a larger dataset becomes available nationally.
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Krishnan, Kailash. "Outcomes after acute intracerebral haemorrhage." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/43228/.
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Primary Intracerebral haemorrhage is a severe form of stroke with poor prognosis attributed to haematoma characteristics. High blood pressure is present during the acute phase of intracerebral haemorrhage and associated with poor outcome in part through expansion of haematoma. Data from the ‘Efficacy of Nitric Oxide in Stroke trial’ (ENOS) was used to analyse the performance characteristics of qualitative and quantitative descriptors of intracerebral haematoma. The results showed that formal measurement of haemorrhage characteristics and visual estimates are reproducible. Intracerebral haemorrhage volumes measured using the modified ABC/2 formula were significantly lower compared to standard ABC/2 and computer assisted semi-automatic segmentation. In 629 patients with intracerebral haemorrhage presenting within 48 hours, the effect of blood pressure lowering with transdermal glyceryl trinitrate was assessed. Glyceryl trinitrate lowered blood pressure, was safe but did not improve functional outcome. In a small group of patients treated within 6 hours, glyceryl trinitrate improved functional outcome. Analysis of 246 patients with acute intracerebral haemorrhage from ENOS was undertaken to assess whether there were any differences in functional outcome among those who continued prior antihypertensive drugs during the immediate stroke period compared to those assigned to stop temporarily for 7 days. The results were neutral indicating that there was no benefit in those who continued treatment. Data of 1,011 patients with intracerebral haemorrhage in hyperacute trials from the VISTA collaboration showed differences in baseline characteristics and functional outcomes among patients from various ethnic backgrounds. A systematic review was updated to assess the effect of 26 randomised controlled trials that aimed to alter blood pressure within one week of acute stroke. The results showed that blood pressure reduction did not improve functional outcome irrespective of stroke type. When examined by time, treatment within 6 hours appeared to benefit but the number of patients were small and more studies are needed. The analysis also showed that continuing prestroke antihypertensive drugs in the immediate period after stroke did not benefit and might be harmful. In summary, this thesis provides new information on parameters used to estimate intracerebral haematoma, relationship between management of blood pressure and outcomes after haemorrhagic stroke. The work supports testing of whether very early blood pressure lowering after ictus is beneficial as is being undertaken in ongoing randomised controlled trials. Adjusting for ethnic differences may further identify patients in whom treatment may confer measurable advantage.
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McQueen, Carl. "Improving outcomes from major trauma." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/91534/.
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This thesis presents work from six papers written by the late Dr Carl McQueen during his time as a National Institute for Health Research Doctoral Research Fellow working at the University of Warwick. It explores how best to improve the outcomes of patients who sustain major trauma in the UK – something McQueen was passionate about. Mobile enhanced care teams can bring the specialist skills usually limited to a hospital to the patient’s side at the point of injury. One of the key specialist interventions such teams can provide is prehospital anaesthesia. In a retrospective observational study from a regional enhanced care team, McQueen showed that prehospital anaesthesia was delivered with a high success rate to patient who sustained major trauma and were unconscious, with or without airway compromise. The decision about when to send an enhanced care team to the scene of an emergency is challenging. Often insufficient information is available about the nature of the victim’s injury or illness to make an informed decision. McQueen showed that it was relatively rare for patients with medical problems or those linked to equestrian incidents to require specialist intervention. McQueen also showed the location of patients requiring enhanced care skills varies by time of day with most incidents at night occurring around cities / large towns. A systematic review of the literature found little evidence to guide decision making for primary dispatch of the enhanced care teams. Despite the paucity of evidence for triage systems to inform dispatch of enhanced care teams, reorganisation of regional trauma services in the West Midlands appears to have improved targeted dispatch of enhanced care teams. Together these papers show the potential for benefit from better co-ordination of enhanced care teams.
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Rockwood, Neesha. "Determinants of tuberculosis treatment outcomes." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/54384.
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Background: Despite 6 months of standardised tuberculosis treatment, unsuccessful treatment outcomes (acquired drug resistance, failure, relapse) may occur in a subset of patients with drug-susceptible tuberculosis. The aim of this thesis was to study determinants of treatment outcomes in rifampicin susceptible pulmonary tuberculosis in a setting with a high prevalence of HIV-1 co-infection. Methods: A prospective cohort study was carried out to determine the frequency and determinants of acquired drug resistance. The minimum inhibitory concentration (MIC) of sputum TB isolates was determined in a sub-set (BACTEC 960 system). The clinical utility of MTBDRplus performed directly on 2-month sputum for treatment monitoring was assessed. Expression of 12 MTB-specific messenger (m) and small (s) RNAs was quantified in RNA extracted from sputum before tuberculosis treatment and compared to expression in exponential and stationary phase H37Rv cultures. Intensive pharmacokinetic studies were carried out for rifampicin, isoniazid and pyrazinamide and non-linear mixed effects modeling was used to derive individual pharmacokinetic parameters. Multivariate logistic regression and multivariate adaptive regression splines (MARS) analyses were used to evaluate utility of pharmacokinetic/pharmacodynamics measures (AUC0-24:MIC, Cmax,:MIC, % time above MIC) to predict 2-month culture conversion. A panel of analytes measured by ELISA and Luminex in plasma/serum taken pre-trearment and at 2 and 5-6 months on treatment was evaluated to determine correlates of HIV-1 co-infection, disease severity and unsuccessful outcomes. Results: 0.3- 1% of patients treated for rifampicin susceptible-tuberculosis (n=306) acquired drug resistance during or subsequent to treatment. None of the 17 cases of isoniazid monoresistance had unsuccessful outcomes. There were no differences in baseline MIC profiles (n=109) when analysed by retreatment, 2-month culture conversion or HIV-1 status and there was no evidence of increase in MIC during treatment comparing baseline and 2-month isolates (n=20). Direct MTBDRplus (n=289) on 2-month sputa had a sensitivity of 78%(95%CI 65-87) and specificity of 80%(95%CI 74-84) for predicting culture conversion with a negative predictive value of 93%(95%CI 89-96). This was in comparison to a gold standard of MTBDRplus on positive 2-month cultures. The transcriptomic signature (here limited to 11 selected mRNAs/sRNAs) of sputum (n=19) more closely resembled H37Rv in exponential phase culture than stationary phase culture. There was evidence of biological variation and a trend towards an increased hspXhi atpAlo nuoGlo signal in the sub-group who were culture positive at 2 months. Ambulant HIV-1-tuberculosis co-infected patients (n=100), the majority of whom were co-prescribed ART, did not have reduced anti-tuberculosis drug concentrations compared with HIV-1 uninfected tuberculosis patients. No relationship was found between pharmacokinetic exposures and 2-month culture conversion using logistic regression, after adjusting for MIC and clinical factors. However, MARS identified negative interactions between isoniazid Cmax and rifampicin Cmax/MIC ratio on 2-month culture conversion. If isoniazid Cmax was below 4.6 mg/L and rifampicin Cmax /MIC below 28, the isoniazid concentration had an antagonistic effect on culture conversion. For patients with isoniazid Cmax > 4.6 mg/L, higher isoniazid exposures were associated with improved rates of culture conversion. We found significant differences in the majority of blood analytes over the course of treatment (n=133). Within the HIV-1 co-infected sub-group, there were marked differences comparing subjects with and without advanced immunosuppression and with and without virological suppression. We found an association between Type 1 interferon response, neutrophil-associated cytokines (IL-17 and IL-8), neutrophil-associated MMPs (MMP-8 and MMP-9) and the presence of cavitatory disease. On multivariate analyses, receiver operator curve-derived thresholds at baseline for IL-8, IL-6, IL-1RA, MMP-3 and ferritin and thresholds for IL-8. IL-6, IL-1RA, MMP-3, MMP-8, TIMP-1, TIMP-3, GM-CSF and VEGF at 2 months were able to predict unfavourable outcomes with reasonable performance characteristics. Conclusion: Although rare, in this high burden setting, acquired drug resistance does contribute to the growing drug-resistant tuberculosis epidemic. Emphasis should be on prevention of transmission to others. Ambulant HIV-1 co-infected patients, the majority of whom were co-prescribed antiretroviral therapy, did not have reduced anti-tuberculosis drug concentrations compared with HIV-1 uninfected patients. The majority of patients had plasma drug exposures well below accepted thresholds, but nevertheless had good treatment outcomes. Further clinical studies are required to investigate the potential role of nonlinear pharmacokinetic/pharmacodynamic relationships such as concentration-dependent antagonism. A deeper understanding of host and mycobacterial factors influencing treatment outcomes is required in the search for biomarkers and surrogate endpoints predicting long-term outcomes.