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Cordero, Maria C. "Intranasal Midazolam Procedural Sedation in the Autistic Patient for Diagnostic Dental Procedures." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1339698995.
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Nilsson, Andreas. "Patient-controlled sedation in procedural care." Doctoral thesis, Linköpings universitet, Avdelningen för läkemedelsforskning, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-112372.
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The need for procedural sedation is extensive and on the increase in numbers of patients. Minor treatments or diagnostic procedures are being performed with inadequate sedation or even without any sedatives or analgesics. Also, sedation techniques that support advanced, high-quality, in-patient care procedures representing easy performance and rapid recovery are requested for increased effectiveness. In this doctoral thesis, patient-controlled sedation (PCS) using propofol and alfentanil for surgical and diagnostic procedures was studied. The overall aim was to study aspects of safety, procedural feasibility and patients’ experiences. The main hypothesis was that PCS using only propofol is a safe and effective method for the induction and maintenance of moderate procedural sedation. The studies included were prospective, interventional, and in some cases, randomized and double-blinded. Data on cardiopulmonary changes, level of conscious sedation (bispectral index and Observer’s assessment of alertness/sedation [OAA/S]), pain, discomfort, anxiety, nausea (visual analogue scales), interventions performed by nurse anaesthetists, surgeons’ evaluation of feasibility, procedure characteristics, recovery (Aldrete score) and pharmacokinetic simulation of concentrations of drugs at the effect site supported the analysis and comparison between PCS and anaesthetist-controlled sedation and propofol PCS with or without alfentanil. PCS can be adjusted to cover a broad range of areas where sedation is needed, which, in this thesis, included burn care, gynaecological out-patient surgery and endoscopic procedures for the diagnosis and treatment of diseases in the bile ducts (endoscopic retrograde cholangiopancreatography [ERCP]). PCS for burn wound treatment demands the addition of alfentanil, but still seems to be safe. PCS was preferred by the patients instead of anaesthetist-controlled sedation. The addition of alfentanil to PCS as an adjunct to gynaecological surgical procedures also using local anaesthesia increases the surgeon’s access to the patients, but impairs safety. Apnoea and other such conditions requiring interventions to restore respiratory function were seen in patients receiving both alfentanil and propofol for PCS. Patients’ experiencing perioperative pain and anxiety did not explain the effect-site concentrations of drugs. Different gynaecological procedures and patients’ weights seemed to best explain the concentrations. For discomfort and pain during the endoscopic procedure (ERCP), propofol PCS performs almost the same as anaesthetist-performed sedation. Overall, as part of the pre-operative procedures, PCS does not seem to be time-consuming. In respect to the perioperative perspective, PCS supports rapid recovery with a low incidence of tiredness, pain, and post-operative nausea and vomiting (PONV). The data suggest that PCS further needs to be adapted to the patient, the specific procedure and the circumstances of sedation for optimal benefit and enhanced safety.
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Zobl, Christoph. "Designing for Prehospital Care Training : Aiding the development of mental models within procedural memory, through a training toolkit that improves proficiency in prehospital care procedures such as REBOA." Thesis, Umeå universitet, Designhögskolan vid Umeå universitet, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-145237.
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This is an educational design project exploring how prehospital care training can be altered to improve mental proficiency for emergency medical professionals. The London Air Ambulance performs a complex life-saving procedure known as REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) on the roadside; the only emergency medical service to do so worldwide. Teams consisting of a doctor-paramedic pairing are required to perform at their peak in extreme environments, making training for such circumstances crucial. As a result, this project strategically maps current mental processes into a framework, identifying multiple design opportunities to approach chaotic accident scenes. The framework acts as the basis for defining a curriculum, which, using Instructional Design principles, develops into a learning programme that highlights how learners experience training activities to modify communication habits and on-scene behaviour. A three-part toolkit embodies this learning programme, functioning as a sensory guide to explicitly direct attention at pre-, mid- and post-procedure interaction events between team members.
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Drover, James R. "Modification of the infant contrast sensitivity card procedure." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ55503.pdf.
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Elliott, David B. "Clinical procedures in primary eye care." Elsevier, 2020. http://hdl.handle.net/10454/18284.
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NoFrom the publisher - Well organized and easy to read, Clinical Procedures in Primary Eye Care, 5th Edition, takes an accessible, step-by-step approach to describing the commonly used primary care procedures that facilitate accurate diagnosis and effective patient management. This practical, clinically-focused text offers succinct descriptions of today's most frequently encountered optometric techniques supported by research-based evidence. You’ll find essential instructions for mastering the procedures you need to know, including recent technical advances in the field.
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Bhandari, Nishchal. "Procedural synthetic data for self-driving cars using 3D graphics." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/119745.
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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2018.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 43-44).
In this thesis we present CoSy, a configurable system for procedurally generating synthetic data for self-driving vehicles. To address the problem of data hungry vision-based learning algorithms used in self-driving vehicles, we develop a system that generates synthetic images, including class level annotations, of street scenes. To give researchers control over how data is generated, our system is designed to be configurable and extendable. We provide two example datasets generated by our system, and provide extensive documentation on how the system is architected, and how it can be extended.
by Nishchal Bhandari.
M. Eng.
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Callaghan, Liam. "Investigating the clinical impact of procedural packs in secondary care." Thesis, Ulster University, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.697544.
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Background: Clinical procedural packs were identified as an area of healthcare where an enhancement in design and implementation could improve practitioner performance and associated service user outcomes. Objectives: This study assessed the clinical impact of two interventions, (1) procedural packs with an enhanced training programme and (2) feedback system, on both blood culture sampling and PVC insertion procedures within Antrim Area Hospital. Study Design: A time series design study, using retrospective and prospective data, was used to evaluate impact of two interventions on complication rates associated with both procedures. Impact of the interventions was evaluated by comparing pre- and post- mean complication rates calculated through statistical process control p-chart analysis. Qualitative data gathered from practitioner focus group discussion and quantitative data from patient questionnaires further facilitated exploration of underlying issues. Results: A non-significant reduction in mean blood culture contamination rate was recorded from a Phase A baseline rate of 2.5%, with a reduction to 1.89% from Phase B intervention and to 1.47% from Phase C intervention, over a 30 month study, p = 0.066. However, regression analysis did show a significant downward trend of mean blood culture contamination rate over the 30 month study period, p = 0.015. A significant decrease in mean PVC clinical adverse event rates were recorded from a Phase A baseline rate of 12.84%, with a reduction to 9.48% from Phase B intervention (p = 0.008) and a further drop to 5.96% from Phase C intervention, over a 72 week study (p < 0.001). However, a high rate of PVC failures due to non-clinical adverse events was recorded through Phase A (22.30%), Phase B (31.80%) and Phase C (25.66%) of the study. Conclusions: The combination of best practice guidelines, procedural pack with an enhanced training programme and feedback system achieved and maintained optimal procedural practice.
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Williams, Hannah Washington. "Policies and Procedures to Address Respite Care." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3644.
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Hospice services are utilized by more than 1.6 million people yearly, and there are a great number of caregivers who are tasked with caring for these individuals at home. Caregivers are at risk for fatigue, burnout, and decline in their own physical and mental health. While the Centers for Medicare and Medicaid Services (CMS) cover costs of temporary respite care for hospice patients, the caregivers' needs for respite care are often unrecognized and unaddressed. The purpose of this project was to plan a respite program within the hospice agency consisting of revised respite policy and procedures, the Caregiver Reaction Assessment (CRA) tool to routinely assess the caregiver for burnout and/or fatigue, and a detailed outline for the implementation of respite care. Anderson's behavioral model of service was used to guide the project's understanding of the underutilization of respite services. This project was guided by the practice-focused question examining the development of an evidence based caregiver respite program within the hospice agency. The program was developed based on a review of peer reviewed research studies and the input of a project team of local experts. The project team participated in the project that created a respite policy which includes a biweekly caregiver assessment and step-by-step directions on how to implement respite care. A final report was developed and submitted to the Hospice agency. This revised policy and procedure includes a blueprint for implementation and a full set of recommendations on the process, use of the CRA, educational in-services, and evaluative methods. These recommendations have the potential for positive social change by increasing patient and caregiver outcomes, serving as an example for other hospice agencies to follow, and improving care at the end of life.
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Cruz, M. D., A. M. Fernandes, and CR Oliveira. "CO75 - Epidemiology of procedural pain in neonatal intensive care units of Portugal." Bachelor's thesis, Secção de Neonatologia da Sociedade Portuguesa de Pediatria, 2015. http://hdl.handle.net/10174/17193.
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A neonatologia é uma subespecialidade da pediatria relativamente nova iniciando-se
como uma área altamente tecnológica e que tende a ser cada vez menos invasiva.
Foram vários os avanços que permitiram uma redução da mortalidade do recém-nascido
prematuro: o transporte in utero, os corticóides prenatais, o "milagre" do surfactante,
cuidados regionalizados (de que Portugal é um bom exemplo), ...
Com a evolução dos tempos a preocupação dos neonatologistas "transferiu-se" da
mortalidade para a morbilidade, os cuidados passaram de centrados no doente a
centrados na família, a ventilação tornou-se não invasiva, a maior importância
da nutrição, sono, redução da infecção, luz, ruído e dor, variáveis conjuntas
influenciando o neurodesenvolvimento.
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Johannesson, Eva. "Learning manual and procedural clinical skills through simulation in health care education." Licentiate thesis, Linköpings universitet, Sjukgymnastik, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-75505.
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The general aim of this thesis was to contribute to a deeper understanding of students’ perceptions of learning in simulation skills training in relation to the educational design of the skills training. Two studies were conducted to investigate learning features, what clinical skills nursing students learn through simulation, and how. Undergraduate nursing students were chosen in both studies. Study I was conducted in semester three, and study II in semester six, the last semester. Twenty-two students in study I practised intravenous catheterisation in pairs in the regular curriculum with an additional option of using two CathSim® simulators. In study II, ten students practised urethral catheterisation in pairs, using the UrecathVision™ simulator. This session was offered outside the curriculum, one pair at a time. In study I, three questionnaires were answered - before the skills training, after the skills training and the third after the skills examination but before the students’ clinical practice. The questions were both closed and open and the answers were analysed with quantitative and qualitative methods. The results showed that the simulator was valuable as a complement to arm models. Some disadvantages were expressed by the students, namely that there was no arm model to hold and into which to insert the needle and that they missed a holistic perspective. The most prominent learning features were motivation, variation, realism, meaningfulness, and feedback. Other important features mentioned were a safe environment, repeated practice, active and independent learning, interactive multimedia and a simulation device that was easy to use. In study II the students were video-recorded during the skills training. Afterwards, besides open questions, the video was used for individual interviews as stimulated recall. The interview data were analysed with qualitative content analysis. Three themes were identified: what the students learn, how the students learn, and how the simulator can contribute to the students’ learning. When learning clinical skills through simulation, motivation, meaningfulness and confidence were expressed as important factors to take into account from a student perspective. The students learned manual and procedural skills and also professional behaviour by preparing, watching, practising and reflecting. From an educational perspective, variation, realism, feedback and reflection were seen as valuable features to be aware of in organising curricula with simulators. Providing a safe environment, giving repeated practice, ensuring active and independent learning, using interactive multimedia, and providing a simulation tool that is easy to use were factors to take into account. The simulator contributed by providing opportunities to prepare for skills training, to see the anatomy, to feel resistance to catheter insertion, and to become aware of performance ability. Learning features, revealed from the students’ thoughts and experiences in these studies, are probably general to some extent but may be used to understand and design clinical skills training in all health care educations. In transferring these results it is important to take the actual educational context into account.
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Yu, Tin-men, and 余天敏. "An evidence-based patient education intervention to reduce pre-procedural anxiety." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44627105.
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Dufberg, Emil, and Josephine Edung. "Sjuksköterskors uppfattningar kring lustgasadministrering till barn vid smärtsamma procedurer : - en kvantitativ studie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-241329.
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Bakgrund: Inom vården förekommer det ofta smärtsamma procedurer i form av behandlingar och undersökningar. Dessa procedurer kan vara obehagliga för barn vilket gör smärtlindring till en viktig del av pediatrisk vård. Lustgas är ett bra alternativ till barn på grund av att den har lugnande effekt, inte kräver någon ytterligare smärtsam procedur som nålstick och har snabb och kortvarig effekt. Lustgasens lämplighet inom pediatrisk vård kan motivera en ökad användning. Syfte: Det huvudsakliga syftet var att undersöka vad sjuksköterskor på Akademiska barnsjukhuset med utbildning i lustgasadministrering ser för möjligheter och hinder i att administrera lustgas till barn (0-18 år) vid smärtsamma procedurer. Ett andra syfte var att undersöka hur dessa uppfattningar skiljer sig mellan avdelningar samt i förhållande till erfarenhet och utbildning. Metod: Studiens design var kvantitativ metod med en enkät-tvärsnittsstudie bestående av 25 frågor. Enkäten besvarades av samtliga 24 tillfrågade sjuksköterskor på Akademiska barnsjukhuset med utbildning i lustgasadministrering. Resultat: Sjuksköterskorna som deltog i studien ansåg att lustgasadministrering är en bra smärtlindringsmetod vid de flesta smärtsamma procedurer och de ansåg att de hade goda förutsättningar att administrera lustgas. Sjuksköterskorna föreslår lustgas generellt cirka 3-4 gånger per månad och de sjuksköterskor med längre erfarenhet ser fler tillfällen till lustgas och föreslår det oftare som smärtlindringsmetod. De uppfattade låg ålder som ett hinder då de ansåg att små barn har svårt att samarbeta vid lustgasadministrering. Slutsats: Sjuksköterskorna upplever i stort att de har goda möjligheter att administrera lustgas till barn vid smärtsamma procedurer och att de har fått tillräcklig utbildning i ämnet. Sjuksköterskors inställning till lustgas är övervägande positiv och de anser att lustgas är lämpligt till barn över fyra år.Background: In healthcare, treatments and examinations can often include some level of pain. For children, such painful procedures can be difficult to understand and accept, making pain management a key part of pediatric care. Nitrous oxide is a good option for children since it is inhaled and its effect is transient and rapid. Nurses trained in administration of nitrous oxide to children can safely administer it, allowing for a wider use. The suitability of nitrous oxide in pediatric care can justify an increased usage. Aim: The main purpose was to investigate how nurses at Akademiska Children's Hospital with training in nitrous oxide administration view their possibilities and obstacles in administering nitrous oxide in children (0-18 years) during painful procedures. A second objective was to investigate how these perceptions differ between departments and in relation to experience and training. Method: The study design was a quantitative method with a questionnaire-sectional study consisting of 25 questions. The questionnaire was answered by 24 nurses at Akademiska Children's Hospital with training in nitrous oxide administration. Main results: Nurses at Akademiska Children's Hospital consider nitrous oxide to be a good method of pain relief for most painful procedures and that they had good opportunities to administer nitrous oxide. The nurses suggested nitrous oxide on average about three to four times per month and the nurses with long experience saw more opportunities for nitrous oxide and suggested it more often. Conslusion: The nurses generally felt that they have good opportunities to administer nitrous oxide to children during painful procedures and that they have received adequate training for the task. The nurses have a predominantly positive attitude towards nitrous oxide and they consider nitrous oxide to be suitable for children over four years of age.
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Flaherty, Lauren E. "Effectiveness of nonpharmacological techniques for procedural analgesia in the neonatal intensive care unit." Honors in the Major Thesis, University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/380.
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The purpose of this thesis is to provide a critical analysis of research findings about nonpharmacological techniques used independently of pharmacological techniques to prevent or reduce procedural pain for infants in the neonatal intensive care unit (NICU). A synthesis of the current research related to nonpharmacological pain relief techniques for infants was conducted for this thesis. Nonpharmacological interventions reviewed in this study include: Kangaroo Care, swaddling, facilitated tucking, positioning, music, non-nutritive sucking and sucrose. An interdisciplinary review of the research was performed using the interdisciplinary databases Cumulative Index of Nursing and Allied Health, PubMED, and PsychINFO. Inclusion criteria for this thesis consists of research focused on preterm neonates (born less than] 37 weeks gestational age) in the neonatal intensive care unit, the use of nonpharmacological interventions for procedural analgesia, peer reviewed articles, and those written in the English language. This study excludes full term neonates due to the significant number of preterm neonates in the NICU. A total of 18 studies were included in this review. All interventions except for positioning show statistically significant evidence to support their use to reduce procedural pain in preterm neonates. Findings of this thesis may promote further studies and exploration into this field. In addition, this thesis establishes the role of the nurse in providing pain relief for infants in the NICU, as well as provide for enhancement of interdisciplinary care amongst other health care providers.B.S.N.
Bachelors
Nursing
Nursing
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Tessmann, Oliver. "Collaborative design procedures for architects and engineers." Norderstedt : Books on Demand, 2008. http://d-nb.info/994900066/34.
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Wineblad, Hanna, and Linda Lundgren. "Föräldrars upplevelser och erfarenheter av barns rädslor i samband med sjukhusförlagda procedurer : En intervjustudieParents´ experiences of children´s fears during hospital procedures - an interview study." Thesis, Umeå universitet, Institutionen för omvårdnad, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-136136.
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Background: Hospital-procedures can be perceived as intimidating by children. There are situations in pediatric care where the childrens' care can be compromised if they are afraid and therefore not treated.Purpose: The purpose of the study was to highlight the parents' experiences of childrens' fear of hospital procedures and how the fears could have been relieved.Design: Descriptive interview study.Method: The study's design was qualitative where data was collected using eleven interviews. The interviews were analyzed using qualitative content analysis with inductive approach. Participants were caregivers to children aged six to twelve years, who were hospitalized. Twelve parents participated in the study. Data collection took place in February to March in 2017.Results: The results of the study are presented on the basis of two categories with eight subcategories: Cause of fear including four subcategories: experiencing pain, the feeling of being disadvantaged, hospital stay and medical procedures. Factors causing security including four subcategories: family presence, preparedness and participation, cared for by child-qualified staff and staff continuity.Conclusion: The study shows that hospitalized children experience fear due to varied causes. The cause for hospitalization is not always the reason for their fears. Child-focused care is required where healthcare staff ask for the child's perspective. Through child-focused nursing, dialogue is conducted with the child allowing expressions of what causes fear. Based on that information the healthcare staff and the child can address the unpleasant experiences and try to reduce the fear.Bakgrund: Procedurer kan upplevas som skrämmande av barn. Det finns situationer inom pediatrisk vård där barnets vård kan äventyras om de är rädda och de av den anledningen inte får sin behandling.Syfte: Syftet med studien var att belysa föräldrars upplevelser och erfarenheter av barns rädslor i samband med sjukhusförlagda procedurer samt hur rädslorna hade kunnat lindras.Design: Deskriptiv intervjustudie.Metod: Studiens design var kvalitativ där data samlades in med hjälp av elva intervjuer. Intervjuerna analyserades med kvalitativ innehållsanalys med induktiv ansats. Deltagarna var vårdnadshavare som hade barn inlagda på sjukhus i åldern sex till tolv år. Totalt deltog tolv föräldrar i studien. Data samlades in under februari-mars månad, år 2017.Resultat: Studiens resultat presenteras utifrån två kategorier med åtta underkategorier: Orsak till rädsla innefattande fyra underkategorier: upplevelsen av smärta, känslan av att vara i underläge, sjukhusvistelse samt medicinska procedurer. Trygghetsskapande faktorer innefattande fyra underkategorier: närhet till familjen, förberedelse och delaktighet, vård av barn kompetent personal samt personalkontinuitet.Slutsats: Studien visar att barn som befinner sig på sjukhus upplever rädsla av varierande orsaker. Inläggningsorsaken är inte alltid grunden till deras rädslor. Det krävs ett barnfokuserat omhändertagande där vårdpersonalen efterfrågar barnets perspektiv. I den barnfokuserad omvårdnad förs en dialog med barnen där de själva får berätta vad som gör dem rädda. Utifrån den informationen kan vårdpersonalen tillsammans med barnet ta sig an obehagliga upplevelser och försöka reducera rädslan.
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Liu, Xinliang. "The Effect Of Physician Ownership On Quality Of Care For Outpatient Procedures." VCU Scholars Compass, 2012. https://scholarscompass.vcu.edu/etd/2886.
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Ambulatory surgery centers (ASCs) play an important role in providing surgical and diagnostic services in an outpatient setting. They can be owned by physicians who staff them. Previous studies focused on patient “cherry picking” and over-utilization of services due to physician ownership. Few studies examined the relationship between physician ownership and quality of care. Using a retrospective cohort of patients who underwent colonoscopy, this study examined the effect of physician ownership of ASCs on the occurrence of adverse events after outpatient colonoscopy. Agency theory is used to as a conceptual framework. Depending on the extent to which consumers are able to assess quality of care differences across health care settings, physician ownership can function as a mechanism to improve quality or as a deterrent to quality. Four adverse event measures are used in this study: same day ED visit or hospitalization, 30-day serious gastrointestinal events resulting in ED visit or hospitalization, 30-day other gastrointestinal events resulting in ED visit or hospitalization, and 30-day non-gastrointestinal events resulting in ED visit or hospitalization. Physician ownership status is determined based on a court decision in California in 2007. Data sources include the State Ambulatory Surgery Databases (SASD), State Inpatient Databases (SID), Emergency Department Databases (SEDD), State Utilization Data Files, the Area Resource File (ARF), and HMO/PPO data from Health Leaders. After controlling for confounding factors, the study found that colonoscopy patients treated at a physician-owned ASC had similar odds of experiencing same day ED visit or hospitalization and 30-day non-gastrointestinal events resulting in ED visit or hospitalization as those treated in a hospital-based outpatient facility. But the former had significantly higher odds of experiencing 30-day serious gastrointestinal events and 30-day other gastrointestinal events resulting in ED visit or hospitalization. The results are robust to changes in propensity score adjustment approach and to the inclusion of a lagged quality indicator. They suggest that physician ownership of ASCs was not associated with better quality of care for colonoscopy patients. As more complex procedures are shifted from hospital-based outpatient facilities to ASCs, expanded efforts to monitor and report quality of care will be worthwhile.
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Buron, Cyprien. "Interactive generation and rendering of massive models : a parallel procedural approach." Thesis, Bordeaux, 2014. http://www.theses.fr/2014BORD0014/document.
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Afin de créer des productions toujours plus réalistes, les industries du jeu vidéo et du cinéma cherchent à générer des environnements de plus en plus larges et complexes. Cependant, la modélisation manuelle des objets 3D dans de tels décors se révèle très coûteuse. A l’inverse, les méthodes de génération procédurale permettent de créer facilement une grande variété d’objets, tels que les plantes et les bâtiments. La modélisation par règles de grammaire offre un outil de haut niveau pour décrire ces objets, mais utiliser correctement ces règles s’avère très souvent compliqué. De plus, aucune solution de modélisation basée grammaire ne supporte l’édition et la visualisation d’environnements massifs en temps interactif. Dans un tel scénario, les artistes doivent modifier les objets en dehors de la scène avant de voir le résultat intégré.Dans ces travaux de recherche, nous nous intéressons à la génération procédurale et au rendu d’environnements à grande échelle. Nous voulons aussi faciliter la tâche des artistes avec des outils intuitifs de contrôle de grammaires. Tout d’abord nous proposons un système permettant la génération procédurale en parallèle sur le GPU en temps interactif. Pour cela, nous adoptons une approche d’expansion indépendante par segment, permettant une amplification des données en parallèle. Nous étendons ce système pour générer des modèles basés sur une structure interne, tels que les toits. Nous présentons aussi une solution utilisant des contextes externes pour contrôler facilement les grammaires par le biais de surface ou de texture. Pour finir nous intégrons un système de niveaux de détails et des techniques d’optimisation permettant la génération, l’édition et la visualisation interactives d’environnements à grande échelle. Grâce à notre système il est possible de générer et d’afficher interactivement des scènes comprenant des milliers de bâtiments et d’arbres, représentant environ 2 téraoctets de donnéesWith the increasing computing and storage capabilities of recent hardware, movie and video games industries desire huger realistic environments. However, modeling such sceneries by hand turns out to be highly time consuming and costly. On the other hand, procedural modeling provides methods to easily generate high diversity of elements such as vegetation and architecture. While grammar rules bring a high-level powerful modeling tool, using these rules is often a tedious task, necessitating frustrating trial and error process. Moreover, as no solution proposes real-time generation and rendering for massive environments, artists have to work on separate parts before integrating the whole and see the results.In this research, we aim to provide interactive generation and rendering of very large sceneries, while offering artist-friendly methods for controlling grammars behavior. We first introduce a GPU-based pipeline providing parallel procedural generation at render time. To this end we propose a segment-based expansion method working on independent elements, thus allowing for parallel amplification. We then extend this pipeline to permit the construction of models relying on internal contexts, such as roofs. We also present external contexts to control grammars with surface and texture data. Finally, we integrate a LOD system with optimization techniques within our pipeline providing interactive generation, edition and visualization of massive environments. We demonstrate the efficiency of our pipeline with a scene comprising hundred thousand trees and buildings each, representing 2 terabytes of data
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Latimer, Margot. "The examination of nurse, organizational and infant factors associated with effective procedural pain care in hospitalized infants /." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=102670.
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Background. Hospitalized infants still experience pain from regularly performed tissue-damaging procedures. Nurses have knowledge to manage the pain but do not apply that knowledge. There is agreement that hospital organizational factors influence quality of care outcomes and some indication that patient factors may influence level of care.Objective. This study examined the factors from a conceptual model entitled Knowledge Use for Pain Care. These were (1) nurse, (2) organizational and (3) infant factors in relation to nurses' management of tissue-damaging procedures in hospitalized infants.
Research design. A prospective study using two neonatal intensive care units in two Canadian provinces in 2005 was used.
Participants. Ninety-three nurses who performed 170 tissue-damaging procedures.
Measures. Nurse demographic data included education, and years of experience. Nurses' knowledge of pain was measured using the new Pain Knowledge and Use instrument. Organizational factors were measured using the nurse-doctor Collaboration and Satisfaction about Care Decisions Scale (Baggs, 1994), and the Environmental Complexity Scale (O'Brien, Irvine, Peereboom & Murray, 1997). Infant factors included age and intensity of care required. Actual pain care was measured by a scorecard of nurses' assessment, management and documentation for the tissue-damaging procedure. Estimates of professional nurse, organizational and infant effects on nurses' pain care for the tissue-damaging procedures were derived from general estimating equations.
Results. Higher procedural pain care was associated with higher nurse doctor collaboration (odds ratio {OR}, 1.44; 95% confidence intervals {CI} 1.05-1.98), infants with higher intensity of care (OR, 1.21; 95% CI, 1.06-1.39), unanticipated increases in the work of nurse assignments (OR, 1.55; 95% CI, 1.04-2.30). Nurse's level of pain knowledge was adequate but did not translate into actual care for tissue-damaging procedures.
Conclusion. The results suggest that the model was partly supported. In particular the importance of nurse-physician collaboration in pain care delivery, a variable amenable to intervention and further study was significant. Overall, the factors that influence nurse's use of their pain knowledge to provide better care remain a complex issue.
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Wheeler, Anthony J. "Procedural Rates, Economic Costs, and Geographic Variation of Primary and Revision Lumbar Total Disc Replacement." DigitalCommons@USU, 2013. https://digitalcommons.usu.edu/etd/1764.
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Lumbar degenerative disc disease is a remarkably common condition among patients presenting with chronic low back pain and physical disability. When a surgical treatment option is warranted, patients now have the option of undergoing lumbar total disc replacement (TDR), a relatively new procedure that is designed to replace lumbar fusion, the traditional surgical intervention for degenerative disc disease. The lumbar TDR procedure has demonstrated clinical efficacy equivalent to that of lumbar fusion, although concern remains about the longevity, safety, and costs related to the procedure. These issues were addressed in three separate observational studies using administrative claims data. The first study estimated the revision burden and economic revision burden of lumbar TDR. The second study examined the lumbar TDR hybrid procedure, where both a lumbar TDR and lumbar fusion are performed simultaneously. No observational data have been reported on the frequency, cost, and diagnostic indications related to the TDR hybrid procedure. The third study mapped the geographic variation of procedural rates of lumbar TDR. Previous research has found substantial geographic variation in lumbar spine surgery rates and a similar analysis of lumbar TDR variation has yet to be reported. The present series of studies found the revision burden and economic revision burden of lumbar TDR to be similar to data reported for this procedure from the mid-2000s, though the overall occurrence of the procedure appears to have declined. The economic revision burden made this a lower-cost procedure than lumbar fusion, with a tradeoff in terms of revision burden being higher for lumbar TDR. The lumbar TDR hybrid procedure was found to make up approximately 16% of the total number of TDR procedures, involving much higher costs than a single-level TDR procedure. Finally, geographic variation of the procedural rate of lumbar TDR varied dramatically across the U.S., surpassing the variation observed in lumbar fusion surgery. Limitations of the observational data used in these studies are described. Recommendations for future observational research are offered as well. Finally, implications for these studies on practice guidelines and reimbursement policies are provided.
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Lewis, Lory A. "Nursing Care Procedures, Thermal Regulation and Growth of the Moderately Premature Neonate in the Neonatal Intensive Care Unit." Kent State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=kent1405595920.
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Havran, Adam. "The introduction of the new health care procedure for the Czech market." Master's thesis, Vysoká škola ekonomická v Praze, 2014. http://www.nusl.cz/ntk/nusl-201078.
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The objective of this work is to analyse the possibility of use of micro -- needles technology as the method of drug delivery in the Czech Republic. The characteristics of this product (application, connection with drug, etc.) suggest three possible target groups: patients, health care providers or pharmaceutical companies. One of the goals is to analyse legal requirements on such products, evaluate current market situation and according to this information choose the best group for the product consumption. Also product itself presents a challenge and there are several designs of micro -- needle or needleless drug applicators. Combined together, this study aims to find, whether is the Czech market able to accept new method of drug delivery, in which form and how can patient reach this technology.
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Dimapilis, Ben. "Service line extension| Acquisition of fluoroscopy equipment to supplement pain management procedures." Thesis, California State University, Long Beach, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1598635.
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Managed care through a series of comprehensive health care services is a trend in today’s healthcare; and it includes specialized services that can provide plenty of opportunities to many healthcare organizations. Private Medical Service of San Diego currently does not have the necessary medical equipment to provide a comprehensive pain management and the ability to retain availability and flexibility to grow at its own pace and convenience. The new business plan is to acquire fluoroscopic equipment that will be staged in-house to equip its interdisciplinary pain management program. This will help increase the efficacy and safety of the pain management procedures as well as a potential for good profit.
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Nitsche, Philippe. "Safety-critical scenarios and virtual testing procedures for automated cars at road intersections." Thesis, Loughborough University, 2018. https://dspace.lboro.ac.uk/2134/34433.
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This thesis addresses the problem of road intersection safety with regard to a mixed population of automated vehicles and non-automated road users. The work derives and evaluates safety-critical scenarios at road junctions, which can pose a particular safety problem involving automated cars. A simulation and evaluation framework for car-to-car accidents is presented and demonstrated, which allows examining the safety performance of automated driving systems within those scenarios. Given the recent advancements in automated driving functions, one of the main challenges is safe and efficient operation in complex traffic situations such as road junctions. There is a need for comprehensive testing, either in virtual testing environments or on real-world test tracks. Since it is unrealistic to cover all possible combinations of traffic situations and environment conditions, the challenge is to find the key driving situations to be evaluated at junctions. Against this background, a novel method to derive critical pre-crash scenarios from historical car accident data is presented. It employs k-medoids to cluster historical junction crash data into distinct partitions and then applies the association rules algorithm to each cluster to specify the driving scenarios in more detail. The dataset used consists of 1,056 junction crashes in the UK, which were exported from the in-depth On-the-Spot database. The study resulted in thirteen crash clusters for T-junctions, and six crash clusters for crossroads. Association rules revealed common crash characteristics, which were the basis for the scenario descriptions. As a follow-up to the scenario generation, the thesis further presents a novel, modular framework to transfer the derived collision scenarios to a sub-microscopic traffic simulation environment. The software CarMaker is used with MATLAB/Simulink to simulate realistic models of vehicles, sensors and road environments and is combined with an advanced Monte Carlo method to obtain a representative set of parameter combinations. The analysis of different safety performance indicators computed from the simulation outputs reveals collision and near-miss probabilities for selected scenarios. The usefulness and applicability of the simulation and evaluation framework is demonstrated for a selected junction scenario, where the safety performance of different in-vehicle collision avoidance systems is studied. The results show that the number of collisions and conflicts were reduced to a tenth when adding a crossing and turning assistant to a basic forward collision avoidance system. Due to its modular architecture, the presented framework can be adapted to the individual needs of future users and may be enhanced with customised simulation models. Ultimately, the thesis leads to more efficient workflows when virtually testing automated driving at intersections, as a complement to field operational tests on public roads.
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Ramakrishnan, Vijaya. "Use of Simulation for Tracheostomy Care, a Low Volume, High Risk Nursing Procedure." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4981.
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Often, education regarding low volume and high-risk procedures, like tracheostomy, are ignored. Lack of experience, skills, and human resources can lead to decreases in confidence levels, diminished quality of care, and potentially an adverse event. The purpose of this DNP project was to prepare simulation-based education on the tracheostomy procedure and provide hands-on education to bedside nurses. The project answered the question: To what extent will a simulation-based teaching method adequately prepare staff nurses in a post-acute surgical unit to perform this high risk low volume procedure? The Johns Hopkins evidence-based model method was used to assist in translation of the practice change process. The International Nursing Association for Clinical Simulation and Learning standards were used to design simulation scenarios. Surgical acute care nurses (n = 35) including day and night shift nurses, new graduates, and experienced nurses participated. Groups of five to eight nurses participated in a two-hour simulation session at hospital simulation center. Pre- and post-surveys on confidence level data, and National League of Nursing evaluation tool data on educational practices and simulation designs were collected from all participants. Paired t-test statistics showed a significant increase in confidence level from pre to post education (p < .001). Because of the significant impact on patient care due to preventing complications and by improving nursing staff's level of confidence, the project may contribute to positive social change.
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Genesoni, L. "Kangaroo Care procedure as a primary environment for preterm infants and their caregivers." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1343963/.
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Background: A preterm birth, usually accompanied by the need for neonatal intensive care (NICU) and subsequent parents-infant separation, can disrupt infants’ early development, parental psychological well-being and parent-infant bonding. Recent research indicates that the early environment and experiences play a critical role in infant development and parenting processes. Kangaroo Care (KC) procedure has been introduced in high technology settings to supplement incubator care and to reduce the initial parents-infant separation through skin-toskin contact. Research has demonstrated its medical benefits but only partially documented its psychological effects on infants’ long-term development and parenting outcomes, and controversial data has emerged in the UK. Aim: The aim is to evaluate the psychological and behavioural impact of KC in high technology NICU during the first year of life. The domains investigated are: 1) parental psychological stress; 2) parents-preterm infant relationships; 3) mother-infant dyadic interaction; 4) proximal environment and 5) preterm infants cognitive, motor, socio-emotional and behavioural development. Method: 56 mother-preterm infant dyads in KC were compared to a control group of 34 in traditional care. Within this sample, a study was conducted with 28 fathers whose partner experienced KC contact with their infant and 16 fathers who were part of the Control group. Data was collected at 6 stages: before the initiation of KC procedure, after discharge from hospital, and at 3, 6, 9 and 12 months. Results: KC mothers have less parental stress, better attachment and interaction with their preterm infant across the research times and they provide a better home environment at 3 months than the Control group. Moreover, KC infants are more responsive during interaction, present better development in terms of motor and adaptive behaviors skills at 6 months, and better communication skills at 12 months than the TC group. Conversely, KC does not directly influence fathers’ psychological stress and the formation of father-infant relationships. Conclusions: The KC procedure promotes maternal psychological well-being and mother-infant dyadic relationships with a consequent positive influence on mother-child attachment and infant development.
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Aderum, Oskar, and Jonathan Åkerlund. "Controllable Procedural Game Map Generation using Software Agents and Mixed Initiative." Thesis, Malmö högskola, Fakulteten för teknik och samhälle (TS), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20483.
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Processen att skapa innehåll till digitala spel för hand är kostsamt och tidskrävande. Allteftersom spelindustrin expanderar ökar behovet av att minska produktionskostnaderna. En lösning på detta problem som det forskas om idag är procedurell generering av spelinnehåll. Kortfattat innebär detta att en algoritm gör det manuella arbetet istället för en designer. I denna uppsats presenterar vi en sådan metod för att automatisera processen att skapa kartor i digitala spel. Vår metod använder kontrollerbara agenter med blandade initiativ (dvs. designern och algoritmen turas om) för att skapa geometri. Vi använder stokastiska agenter för att skapa variation och deterministiska agenter för att garantera spelbarhet. För att kontrollera dessa agenter använder vi en uppsättning parametrar som kan manipuleras. Däröver har designern tillgång till ett antal verktyg inklusive möjligheten att låsa befintlig geometri, konvertera geometri till andra typer, lägga till geometri manuellt, och även möjligheten att använda agenter på specifika områden på kartan. Vi tittar på spelläget Battle i det digitala spelet Mario Kart 64 och visar hur vår metod kan användas för att skapa sådana kartor. Vi utförde en användarstudie på outputen från metoden och resultatet visar att kvaliteten är i allmänhet gynnsam.The process of creating content for digital games by hand is a costly and time consumingone. As the game industry expands, the need to reduce costs becomes ever more pressing.One solution to this problem being research today is procedural generation of content.In short, this means that an algorithm does the labor rather than a designer. In thisthesis we present such a method for automating the process of creating maps in digitalgames. Our method uses controllable software agents and mixed initiative (i.e. allowingthe designer and algorithm to take turns) to create geometry. We use stochastic agentsto create variation and deterministic agents to ensure playability. To control these agentswe use a set of input parameters which can be manipulated. Furthermore, the designerhas access to a number of tools including the ability to lock existing geometry, convertgeometry to other types, add geometry manually, as well as the ability to use agents onspecific areas of the map. We look at the game mode Battle in the digital game MarioKart 64 and show how our method can be used to create such maps. We conducted auser study on the output of the method and the results show that the quality is generallyfavorable.
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Sulfridge, Courtney A. "Understanding the Impact of Medical Procedures on Individuals with Asperger Syndrome." Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1460771195.
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Yen, Philip M. "A comparison of fospropofol to midazolam for moderate sedation during outpatient dental procedures." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1348777035.
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Ma, Hoi-ling Helen, and 馬海菱. "Appropriateness and feasibility of medical preparatory play in preparing children for anaesthetic procedure." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626022.
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Graudins, Maija Marika. "Exploring the Efficacy of Behavioral Skills Training to Teach Oral Care Providers to Administer Oral Care Procedures to Children with Autism." OpenSIUC, 2011. https://opensiuc.lib.siu.edu/theses/551.
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Various empirical investigations have focused on training children with autism as well as typically developing children to be compliant with oral assessments. But few studies have evaluated strategies on how to train the oral care providers to be able to work with children with autism for increased compliance. Using a multiple baseline design, the current investigation evaluated behavioral skills training procedures to teach three oral care providers basic behavior analytic skills, such as differential reinforcement, positive and negative reinforcement, and escape extinction, to implement while performing oral care procedures on children with autism. The procedures of the behavioral skills training included instructions, modeling, rehearsal, and feedback. This training resulted in an improvement from baseline performances for each participant in steps completed correctly, as well as various decreased levels of problem behavior displayed by the children. These results suggest that behavioral skills training is an effective way of teaching oral care providers basic behavior analytic techniques to use while working with children with autism.
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Archer, Elize. "Using simulation for achieving competency in the practical procedures of a Critical care nursing programme." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/2028.
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Thesis (MPhil (Curriculum Studies))--Stellenbosch University, 2008.Background to the study: The Critical Care nursing programme at the Faculty of Health Sciences (Stellenbosch University) is a one-year programme. The practical component consists of practical procedures and case presentations. Students have limited time available in the clinical areas to reach competency in the practical skills. Students tend to use the majority of the clinical teaching time available to reach competency in these practical procedures, rather than discussing the patient and learning the skills to integrate and understand the patient’s condition and treatment, which they can acquire by doing case presentations. The end result of this misuse of clinical contact time is that some of the students, by the end of their programme, still have difficulty to integrate a patient’s diagnosis and treatment regime, although they have managed to complete the expected practical procedures. Summary of the work: A case study design was used. I wanted to investigate whether one could make use of simulation and the Clinical Skills Centre (CSC) to complete the majority of the practical procedures so that more time would be available in the clinical areas for the students to do case presentations. The study focuses on describing how the tutors and students involved experienced the use of simulation, as well as how it impacted on the available teaching time in the clinical areas. Conclusions and recommendations: Some of the most important issues that were highlighted in the study and needs to be mentioned are the following: · The students highly valued supervision by a Critical Care tutor when practising their skills in the CSC. · Students indicated that they valued the opportunity to practise some of the more risky procedures in simulation, because it presents no risk to patients. · Case presentations seem important to be added to the CSC’s practical sessions in order to attempt making the practical simulated scenarios even more realistic. · The teaching at the bedside in the clinical areas used to be done somewhat ad hoc. With the teaching in the CSC now being much more structured, this necessitates the teaching at the bedside to be revisited and to be structured to a certain extent. Summary of the results: The information obtained from the Critical Care tutors and the students indicated that these two groups were largely in agreement that simulation seems to be valuable and can effectively be used in a Critical Care nursing programme.
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Gulland, Jacqueline. "Complaining, appealing or just getting it sorted out : complaints procedures for community care service users." Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/1743.
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The primary aim of this thesis is to consider whether the social work complaints procedure in Scotland is an appropriate means of dealing with dissatisfaction experienced by users of community care services. Debate in the socio-legal literature has focused on different models of justice in grievance and appeal mechanisms for users of public services. Set in the context of this wider debate, this study looks at the operation of the social work complaints procedure in Scotland, focusing on the experiences of complainants in two local authorities. Setting the research in context, the thesis looks at recent policy developments in community care in Scotland, at recent changes to the health complaints procedure and at proposals to change the social work complaints procedure in Scotland, England and Wales. The main source of data is interviews with people who had made complaints in the two local authorities. As well as looking at complainants’ views, the study also considers the views of people responsible for running the complaints procedure in both local authorities. Focus groups with community care service users were used to explore the views of those who may not have used the complaints procedure. A key concern is whether it is possible to distinguish different types of complaints: those which are primarily ‘appeals’ against refusal of services; and those which are about the way that people are treated. Using the experiences of people who had made complaints in both local authorities and a database of all complaints to one local authority, it is shown that it is not easy to make this distinction although some complaints fall more clearly into one category or the other. The classification of complaints relates closely to what people want from a complaints procedure. The purpose of a grievance procedure can be considered in terms of ‘models of justice’. The motivations of complainants and the views of those who operate the procedure are considered in the context of literature on models of justice. The thesis looks at how the complaints procedure operates in each of the two local authorities and considers the relative value of ‘informal’ and ‘formal’ processes. It goes on to look at what happens when people make formal complaints, whether complaints are resolved and what people think about this. Barriers to complaining are also considered. Finally the thesis looks at complaints which reach the end of the complaints procedure - the complaints review committee - and those which reach the Scottish Public Services Ombudsman. The thesis concludes that there is considerable ambiguity as to the purpose of the community care complaints procedure. Some complainants use the procedure as an ‘appeal’ against decisions made by the local authority, while others just want to get their problems ‘sorted out’. Some complainants are, at least in part, attempting to get the local authority to improve services for others. The emphasis of local authority staff in this study is primarily on ensuring that complainants have an opportunity to have their ‘voice’ heard. The word ‘complaining’ itself carries connotations which some service users see as negative, although others are more assertive in their use of the word. In procedural terms there is much that can go wrong between the initial ‘informal’ complaint and the more independent level of the procedure: the complaints review committee. There are considerable problems in defining ‘complaints’ and ensuring that they are handled within the guidelines. This means that it is difficult for justice to be seen to be done.
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Ramirez, Enrique. "Opioid Prescribing Practices Following Pediatric Dental Procedures in Ohio." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1593441575248724.
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Håkanson, Bengt. "Studies of preoperative evaluation and surgical procedures for gastroesophageal reflux disease /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7357-022-2/.
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Hull, Stephen Robert. "The improvement of an automatic procedure for the digital simulation of hydraulic systems." Thesis, University of Bath, 1986. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.377780.
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Jones, Kevin Allen. "Automated Coding, Billing, and Documentation Support for Endoscopy Procedures." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1337018374.
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Raynor, Desiree. "Visitor Hand-washing Compliance According to Policies and Procedures at a Regional Neonatal Intensive Care Unit." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/honors/124.
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Hospital-acquired infections cost hospitals approximately $30.5 billion per year and also result in longer hospital stays, chronic conditions, and even death with associated malpractice costs. According to the Centers for Disease Control and Prevention, hand hygiene is a simple, effective way to prevent illness and infection. The purpose of this research was to determine if visitors to a neonatal intensive care unit (NICU) in a regional medical center comply with hand-washing policies and procedures. If NICU visitors wash their hands properly, they can prevent potentially fatal infections from spreading to patients, healthcare workers, and unaffected family members. Hand-washing compliance has been previously studied in NICU staff and other healthcare workers, but not solely visitors. The researcher observed more than 120 visitors as they entered the NICU to determine the number who washed their hands for the required three minutes. Based on the findings, NICU staff and administration will be encouraged to provide more effective education, post informative signs, and install equipment to encourage visitors to use proper hand-washing techniques. Effective hand-washing should result in lower infection rates among NICU patients and lower health care costs.
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Engström, Joakim. "Patient safety in the Intensive Care Unit : With special reference to Airway management and Nursing procedures." Doctoral thesis, Uppsala universitet, Anestesiologi och intensivvård, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-275170.
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The overall aim of the present thesis was to study aspects of patient safety in critically ill patients with special focus on airway management, respiratory complications and nursing procedures. Study I describes a method called pharyngeal oxygen administration during intubation in an experimental acute lung injury model. The study showed that pharyngeal oxygenation prevented or considerably increased the time to life-threatening hypoxemia at shunt fractions by at least up to 25% and that this technique could be implemented in airway algorithms for the intubation of hypoxemic patients. In study II, we investigated short-term disconnection of the expiratory circuit from the ventilator during filter exchange in critically ill patients. We demonstrated that when using pressure modes in the ventilator, there was no indication of any significant deterioration in the patient's lung function. A bench test suggests that this result is explained by auto-triggering with high inspiratory flows during the filter exchange, maintaining the airway pressure. Study III was a clinical observational study of critically ill patients in which adverse events were studied in connection with routine nursing procedures. We found that adverse events were common, not well documented, and potentially harmful, indicating that it is important to weigh the risks and benefits of routine nursing when caring for unstable, critically ill patients. In study IV, we conducted a retrospective database study in patients with pelvis fractures treated in the intensive care unit. We found that the incidence of respiratory failure was high, that the procedure involved in surgical stabilization affected the respiratory status in patients with lung contusion, and that the mortality was low and probably not influenced by the respiratory condition. In conclusion, the results obtained in the present thesis have increase our knowledge in important areas in the most severely ill patients and have underlined the need for improvements in the field of patient safety.
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Kushner, Lester M. "A matching process: More effective placement procedures for court dependent children." CSUSB ScholarWorks, 1987. https://scholarworks.lib.csusb.edu/etd-project/174.
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Hatler, Carol W. "Examination of the influences of hospital context on outcomes for patients undergoing cardiac catheterization procedures." Diss., The University of Arizona, 2004. http://hdl.handle.net/10150/280611.
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Despite the time and resources focused on health care outcomes, few empirical links exist between healthcare activities, healthcare costs and outcomes of care. As a result, outcome evaluations that take into account the characteristics of the healthcare system as well as the desires of a number of stakeholders may have relevance to knowledge development as well as to implementation of needed changes in health care delivery. Using the framework of General Systems Theory (von Bertalanffy, 1968) and a modification of the model proposed by the American Academy of Nursing Expert Panel (Mitchell, Ferketich, Jennings, 1998), this investigation addressed broad categories of outcomes, including clinical and financial aspects, and examined the factors influencing them in a condition-specific population. Further, the contextual characteristics of the healthcare organization and the work group were examined and compared to the effects of the individual patient characteristics on cost, length of stay and morbidity/mortality outcomes. Organizational factors included structural characteristics such as volume and technology availability, work unit factors included perceived collaboration, access to power structures and control over nursing practice and individual patient factors included pre-hospital health conditions and socio-economic status. For this study outcomes consisted of adverse events, derived length of stay and direct costs. This study used a non-experimental, descriptive design. Contextual regression analysis indicated that organizational structure variables had a greater influence on cost and the work group-level variables had a greater influence on derived length of stay than did the individual-level variables. Total average costs for cardiac catheterization procedure and associated post-procedure hospitalization were 3758 (range 777-12,796). While the study has several limitations, the findings add to the body of knowledge that explains how the processes of nurses' work influence the outcomes of that work. The findings deserve consideration by nurse executives and others interested in enhancing work environments and patient care outcomes.
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Morin, Diane. "The comparison of the impact two comprehensive geriatric assessment procedures on quality of life and service use." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://researchonline.lshtm.ac.uk/901043/.
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Home care of the elderly is of increasing concern not only to purchasers and providers of health care but also to the public and to those responsible for providing social care. As with any service, the aim must be to provide care that is appropriate for each individual. To achieve that, valid and reliable measures of a person's needs are required and resources are to be used as efficiently as possible. A considerable amount of work has been carried out to develop such normative-based measures for assessing the home care needs of the elderly in the form of comprehensive geriatric assessment (CGA). CGA is a commonly used technology which has been shown to be associated with improved health status and lower service use. Despite widespread use, however, the effectiveness of different CGAs has not yet been fully investigated. In the Province of Quebec, Canada, two CGAs which differ in comprehensiveness and resource requirements are being used to assess needs at entry to home care. The aim of this study is to compare the differential impact of these two CGA procedures on patient outcomes: the Systdme de mesure de l'autonomie fonctionnelle, the longer, more comprehensive and resourceintensive CGA, and the Admission au maintien d domicile which is a shorter and less resource-intensive form of CGA. In a prospective cohort study, 158 elderly patients aged 65 years or over were assessed at admission to home care using one or the other CGA and changes in health-related quality of life as well as service use were monitored and compared at the end of a 12-week follow-up. Costs related to the use of a long or a shortform CGA were also explored. These comparisons were made while controlling for patient (age, gender, living alone, quality of life at entry, depression), process (type and intensity of care received) and structural variables (budget and staff mix). Results from comparative and multivariate analyses are in favour of not rejecting the null hypothesis that both forms of CGAs are similarly associated with outcomes. Depression was the strongest predictor of changes in quality of life and high intensity of care and a low proportion of nurses on the home care teams were the strongest predictors of service use outside HC. These results lead us to discuss whether long or shortform CGAs were developed on a comparative rather than a normative definition of needs. The implications of these findings for home care policy and practice are discussed and suggestions for future research are presented.
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Onukogu, Dr Claret. "Streamlining Hospital Administrative Procedures to Reduce Costs." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4810.
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Americans spent nearly $2.6 trillion, or $8,000 per person for medical and administrative costs in 2010. By 2015, healthcare spending in the United States increased to 5.8% reaching $3.2 trillion or $9,990 per individual. By tackling healthcare administrative costs, it is estimated that healthcare providers could reduce these costs by $20 billion yearly. This case study explored strategies for streamlining hospital administrative procedures to reduce costs. The business process reengineering model formed the conceptual framework for this study. Data were gathered through semistructured face-to-face interviews guided by open-ended questions with a purposeful sample of 4 hospital managers in Atlanta, Georgia. This study identifies important themes regarding cost reduction and hospital administration based on participant interviews. Themes included participants' unfavorable perspectives of the Spell out PPACA (PPACA) legislation, employment of physicians, PPACA reimbursement method, follow-up services, hospital administrative governance, and lack of business education. The themes comprised steps hospital managers could take to streamline administrative procedures to reduce costs. The implications for positive social change included the potential to provide strategies for streamlined processes that could lead to savings passed on to patients from low socio-economic backgrounds through accessibility to affordable healthcare services.
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Au, Man-yee, and 區敏儀. "Appropriateness and feasibility of music intervention in reducing anxiety for patients undergoing minor operative procedures in Accidentand Emergency Department." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44622740.
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Eldstål, Emil. "Generating Procedural Environments using Masks : Layered Image Document to Real-time environment." Thesis, Luleå tekniska universitet, Institutionen för konst, kommunikation och lärande, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74667.
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This paper will explore the possibilities of using an automated self-made procedural tool to create real-time environments based on simple image masks. The purpose of this is to enable a concept artist or level designer to quickly get out results in a game engine and to be able to explore ideas. The goal of this thesis was to better understand how you can break down simple ideas and shapes into more complex details and assets. In the first part of this thesis, I go over the traditional workflow of creating a real-time environment. I then go on and break down my tool, what it does and how it works. I start off with a Photoshop file, make tools in Houdini and then utilize those in Unreal for the end result. I also argument about the time-saving possibilities with these tools. From the work, I draw the conclusion that these kinds of tools save a lot of time for repeating tasks and the creation of similar environments.
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Linam, William Matthew. "Risk Factors Associated with Surgical Site Infection after Pediatric Posterior Spinal Fusion Procedure." University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1243362179.
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Barrera, Gutierrez Juan Carlos. "Transjugular Intrahepatic Portosystemic Shunt (Tips), Duration of Procedural Time and Correlation with Early Morbidity and Mortality." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1628778237908844.
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Ernhagen, Larsson Manfred, and Hampus Swensson. "Procedurell generering av grottsystem med hjälp av kubiska Bézier-splines." Thesis, Malmö högskola, Fakulteten för teknik och samhälle (TS), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20186.
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I denna uppsats presenteras ett verktyg för att assistera skapandet av spelbanor i dungeon-miljö. Skapandet av sådana banor är ofta resurskrävande under produktionen och har fokus på design. För att behålla designaspekten men underlätta arbetet är verktyget framtaget för att med tillgängliga parametrar producera grottgångar för sådana banor. Vi undersöker med användartester hur verktyget kan användas för att effektivisera en känd metod för att skapa spelbanor, men samtidigt skapa den kvalité som eftertraktas. Med detta avser vi inte bara att ta fram ett effektivt verktyg, utan även att demonstrera en metod för att använda procedurell generering av spelinnehåll för ett nytt ändamål inom speldesign.In this article a tool for assisting the creation of game levels in a dungeon environment is presented. Creating such game levels often requires a large amount of resources during a game production and has focus on design. To keep the aspect of design but ease work, the tool is created to produce caverns for such game levels with accessible parameters. We examine with user tests how the tool can be used to make an existing method for creation of game levels more effective. But at the same time producing the quality that is coveted. With this we do not only hope to produce an effective tool, but also to demonstrate a method for using procedural generation for a new purpose in game design.
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Krueger, Hans. "The relationship between long-term adherence to recommended clinical procedures and health care utilization for adults with diagnosed type 2 diabetes." Thesis, University of British Columbia, 2006. http://hdl.handle.net/2429/80.
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Background: Diabetes is a common and serious chronic condition. If not well-managed, significant multi-system complications often arise, resulting in increased health care utilization and poor health outcomes. There is considerable evidence that people with diagnosed diabetes are not receiving recommended care. A comprehensive program aimed at improving adherence to recommended care can improve patient outcomes and result in cost-savings. The key aim of this study was to determine whether the long-term receipt of appropriate clinical procedures by patients with type 2 diabetes was associated with higher medical care costs.
Methodology: A cohort of 20,288 diagnosed type 2 diabetes patients was identified using physician and hospital records. An analytic file was created by linking information on patient characteristics with utilization of physician and acute care services during a five-year period (1996 to 2001). Adherence to recommended clinical procedures for the assessment of blood glucose, blood pressure and cholesterol levels, as well as retinopathy and nephropathy, were measured during this same five-year period. Subjects were assigned to both a categorical (low, medium and high) and a binary (low and high) adherence group. Physician and acute care resource use was converted to constant 2000 Canadian dollars. Multivariate logistic regression was used to assess the relationship between patient characteristics, including adherence as a categorical variable, and utilization of physician and acute care services.
Results: Long-term adherence was suboptimal, with patients receiving just 53% of recommended procedures. Adherence to recommended procedures, however, improved during the five year period. Patient characteristics associated with poor adherence include being male, younger, low socio-economic status, having no diabetes-specific complicating conditions and living in certain geographic areas. Patients with high long-term adherence (receiving 73% of recommended clinical procedures) were 59% more likely to use a high level of physician resources but 22% less likely to use a high level of acute care resources. On the other hand, patients with low adherence (receiving 31% of procedures) were 28% less likely to use a high level of physician resources but 17% more likely to use a high level of acute care resources. The utilization difference related to adherence was particularly noticeable in older adults with higher levels of morbidity. Elderly patients in this low adherence group were more likely to be hospitalized (64.3% vs. 55.8% over the five-year period) and, when they were hospitalized, tended to stay in hospital for longer periods of time (11.9 vs. 6.7 days) than patients in the high adherence group.
Conclusion: Improving long-term adherence may result in the avoidance of $4 in acute care costs for every additional $1 in physician costs. If all patients moved into the high adherence category, as much as $3.1 million in annual costs might be avoided across the study sample. If this analysis is applied to all adults with diagnosed diabetes in the province of British Columbia, the annual costs avoided could reach the level of $34.4 million. Systemic changes are required in the provision of primary care to promote long-term adherence to recommended diabetes care.
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Payne, Katherine. "Can parents predict and accurately their child's behavior during a first dental restorative procedure?" The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1495558867749048.
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Lourenço, Tânia P. C. "The introduction of new interventional procedures to health care : exploring information needs and the feasibility of providing additional information." Thesis, University of Aberdeen, 2010. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=131530.
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This thesis is about UK healthcare decision-makers’ responses to guidance that a new interventional procedure is safe and efficacious, and whether additional information would be helpful. The aims were to conceptualise how evidence could be used to best inform decision-making; investigate the ways in which decision-makers currently respond to such guidance; identify types of additional useful information, and assess the feasibility and value of providing these. The study was based on the UK Interventional Procedures Programme (IPP). A multidimensional framework for categorising evidence (explanatory vs. pragmatic) was developed and tested using IPP-evaluated procedures. A qualitative study explored how local NHS decision-makers respond to IPP guidance and whether additional information might be useful to them. A range of approaches – from simple descriptive data, through evidence syntheses, to economic models of cost-effectiveness – were explored in a case study of radiofrequency ablation (RFA) for snoring. NHS decision-makers’ responses to IPP guidance varied and they indicated additional information would be helpful. Available evidence on the effects of procedures went beyond ‘efficacy’. The case study showed it was possible, within limitations, to provide useful additional information but at increasing costs as complexity increased. Decision-makers vary in their responses to IPP guidance. Additional information (such as prevalence, incidence, costs and likely cost-effectiveness), which they indicated would be useful, is potentially available but the feasibility of providing this varies depending on the nature of the evidence available and the related costs. The thesis indicates that the quality of decision-making would be improved if guidance that a new procedure is safe and efficacious were to be contextualised through specific extra information.