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Vassallo, James M. A. "Major incident triage: development and validation of a modified primary triage tool." Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29232.
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Introduction
A key principle in the effective management of a major incident is triage, prioritising patients on the basis of their clinical acuity. However, existing methods of primary major incident triage demonstrate poor performance at identifying the Priority One patient in need of a life-saving intervention. The aim of this thesis was to derive an improved triage tool.
Methods
The first part of the thesis defined what constitutes a life-saving intervention. Then using a retrospective military cohort, the optimum physiological thresholds for identifying the need for life-saving intervention were determined; the combination of which was used to define the Modified Physiological Triage Tool (MPTT). The MPTT was validated using a large civilian trauma database and a prospective military cohort. Subsequently, to describe the safety profile of the MPTT, an analysis of the implications of under-triage was undertaken. Finally, pragmatic changes were made to the MPTT (MPTT-24) - in order to provide a more useable method of primary triage. Statistical analysis was conducted using sensitivities and specificities, with triage tool performance compared using a McNemar test.
Results
32 interventions were considered life-saving and the optimum physiological thresholds to identify these were a GCS <14, 12 < RR <22 and a HR < 100. Within both the military and civilian populations, the MPTT outperformed all existing methods of triage with the greatest sensitivity and lowest rates of under-triage, but at the expense of over-triage. Applying pragmatic changes, the MPTT-24 had comparable performance to the MPTT and continued to outperform existing methods.
Conclusion
The priority of primary major incident triage is to identify patients in need of life-saving intervention and to minimise under-triage. Fulfilling these priorities, the MPTT-24 outperforms existing methods of triage and its use is recommended as an alternative to existing methods of primary major incident triage. The MPTT-24 also offers a theoretical reduction in time required to triage and uses a simplified conscious level assessment, thus allowing it to be used by less experienced providers.
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Sprivulis, Peter Carl. "Evaluation of the prehospital utilisation of the Australasian Triage Scale /." Connect to this title, 2003. http://theses.library.uwa.edu.au/adt-WU2004.0055.
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Sands, Natisha. "Psychiatric triage nursing : the new frontier." Thesis, The Author [Mt. Helen, Vic.] :, 2002. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/67855.
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Forde, Colin Ainsworth. "Emergency Medicine Triage as the Intersection of Storytelling, Decision-Making, and Dramaturgy." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5354.
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This dissertation presents a comprehensive qualitative study of the decision-making aspects of emergency department (ED) triage at a large urban Trauma I hospital in the Southeast. Specifically, this study addresses the following research questions: (1) What do triage nurses perceive as the primary role of the triage process? (2) How do triage nurses interpret patient performances? These questions are explored through illuminating the intricacies of triage decision-making by the use of semi-structured interviews and observations.
The findings of this study indicate: (1) a better understanding of the triage decision- making process yielding more practical insights related to the informal, emergent, and often improvisational ways patients are received, categorized, and treated was needed, and (2) providing a clearer understanding of the processes involved in sorting patients may provide much-needed insight regarding clinical concerns and/or issues regarding patient categorization, adverse clinical events, and excessive patient wait times. These findings are of particular importance due to the widespread overuse of EDs for nonemergent care. Essentially, EDs are designed for patients to visit due to an alteration in their physical and/or mental state. Once a patient enters the ED, a medical professional is tasked with the responsibility of interpreting the physical and/or mental state of the patient, which is generally achieved by interpreting the patient story - the precipitating event that brought them into the ED. What this study contributes to the literature is a deeper understanding of the communicative processes that ED triage nurses leverage to make sense of patient stories.
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Sprivulis, Peter Carl. "Evaluation of the prehospital utilisation of the Australasian Triage Scale." University of Western Australia. Emergency Medicine Discipline Group, 2004. http://theses.library.uwa.edu.au/adt-WU2004.0055.
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[Truncated abstract] Background : Triage systems have evolved from battlefield casualty prioritisation tools to integral components of civilian emergency care systems over the last 50 years. There is significant variation in prehospital triage practices in Australia and little research has been undertaken to validate the triage systems used. There is considerable evidence to support the use of the Australasian Triage Scale (ATS) for triage in the emergency department setting and the ATS is used ubiquitously for emergency department triage in Australasia ... Conclusions : The findings of this thesis support integrating prehospital ATS allocations with emergency department triage processes. It is concluded that Paramedics apply the ATS similarly to nurses ... Allocations to ATS 1, 2 and 3 and most ATS 4 allocations by paramedics are valid when compared to nurse ATS allocations. Australasian Triage Scale category 5 is used inappropriately by paramedics and should be used rarely, if at all, by paramedics. The reliability of paramedic and nurse ATS allocations is sufficient to warrant a trial of the omission of retriage of ambulance presentations at Perth metropolitan emergency departments. However, early nursing assessment of a small proportion of ATS 3 patients may be required to ensure timely assessment for some mistriaged bone fide ATS 2 patients. Paramedic ATS allocations appear sufficiently reliable and valid to warrant a trial of their use as part of a two-tier trauma team activation system ... The implementation of standardised training between paramedics and nurses based on current Australasian College for Emergency Medicine guidelines is recommended. The implementation of paramedic triage audit, including comparison of paramedic ATS allocations with nurse ATS allocations may improve reliability between paramedics and nurses, and particularly the reliability of ATS 4 and ATS 5 allocations. Prehospital ATS allocations may prove useful in prehospital casemix analysis, the evaluation of prehospital service delivery and for prehospital research. Research opportunities include actual trials of the integration of prehospital use of ATS with emergency department triage and trauma system activation, and the evaluation of the ATS as a prehospital casemix and performance evaluation tool. Research into alternative triage tools to the ATS for use in the prehospital environment and into the impact of standardised triage training is also suggested.
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Fry, Margaret Mary. "Triage nursing practice in Australian emergency departments 2002-2004 an ethnography /." Connect to full text, 2004. http://hdl.handle.net/2123/701.
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Thesis (Ph. D.)--University of Sydney, 2005.Title from title screen (viewed 19 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Family and Community Health Nursing, Faculty of Nursing. Degree awarded 2005; thesis submitted 2004. Includes bibliographical references. Also available in print form.
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Opiro, Keneth. "Assessment of hospital-based adult triage at emergency receiving areas in hospitals in Northern Uganda." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23746.
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Background: Limited health service resources must be used in a manner which does "the most for the most". This is partly achieved through the use of a triage system, but health workers must understand it, and it must be used routinely. Whereas efforts have been made to introduce paediatric triage in Uganda, such as Emergency Triage Assessment and Treatment Plus (ETAT+), there is no unified adult triage system being used in Uganda, and it is not clear if hospitals have local protocols being used in each setting. There are limited data on adult triage systems in Uganda. This study aimed at determining how adult hospital-based triage is performed in hospitals in northern Uganda. Methodology: This was a descriptive study. Allocating numbers to the three sub-regions in the northern region, and using a random number generator, we randomly selected the Acholi sub-region for the study. The study was conducted in 6 of the 7 hospitals in the region - one hospital declined to grant permission for the research. It was a written questionnaire survey under supervision of the investigator. In each hospital, at least one representative of nurses in various duty shifts (night, morning and evening shifts), the nursing in-charge/leader, at least one doctor (head of department or any doctor on duty, if available) and a clinical officer (physician assistant, if available), making a minimum of 5-6 study participants who were health professional staff working in emergency receiving areas from each hospital consented and participated in the study. Results: Thirty-three participants from 6 hospitals including 5 doctors, 4 physician assistants, 11 registered nurses, 9 enrolled nurses and 4 nursing assistants consented and participated in the study. Experience of staff working in emergency receiving areas varied with 15(45.5%) greater than 2 years, 7(21.2%) 1-2 years, 5(15.2%) 6 - <12 months and 6(18.2%) for less than 6 months. Only one hospital (16.7%) of the 6 hospitals surveyed had a formal adult hospital-based triage protocol in place. The triage guide/protocol/charts were kept in drawers, had 3 colours - red, yellow and green. Staff rated it as "good", and all staff acknowledged the need to improve it. Only 2 (33.3%) hospitals had an allocated emergency department, the rest receive emergency patients/perform triage from Out Patient Department (OPD) and wards. Lack of training, variation of triage protocols from hospital to another, shortage of staff on duty, absence of national guidelines on triage and poor administrative support were the major barriers to improving/developing formal triage in all these hospitals. Conclusion: Formal adult, hospital-based triage is widely lacking in northern Uganda, and staff do perform subjective "eyeball" judgments to make triage decisions. Most hospitals do not have specifically allocated emergency department which risks disorganization in the flow of patients, crowding and consequently worse patient outcomes.
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Wilson, Merna Akram. "Triage Template to Improve Emergency Department Flow." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1622280768033809.
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Phukubye, Thabo Arthur. "Strategies to enhance knowledge of triage amongst nurses working in the emergency departments of the Sekhukhune district hospitals, Limpopo province, South Africa." Thesis, University of Limpopo, 2019. http://hdl.handle.net/10386/3159.
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Thesis(M.Sc.(Nursing)) --University of Limpopo,2019Background: Many deaths in hospitals occur within 24 hours of admission. Some of these deaths could be prevented if the patients were effectively triaged, identified quickly and treatment initiated without delay. Triage and emergency care have always been weak and under-emphasized components of healthcare systems in Africa and yet, if well organized, could lead to saving many lives and reducing the ultimate costs of care. Purpose: The purpose of this study is to develop strategies to enhance knowledge of triage amongst nurses working in the Emergency Departments of the Sekhukhune District, Limpopo Province, South Africa. Study method: By employing a quantitative, non-experimental research method, 84 nurses working in the Emergency Departments, completed and submitted structured questionnaires. Validity and reliability were insured by pre-testing the data collection instrument on respondents who were not part of the main study. Data were analyzed by using the SPSS and Excel computer programmes with the assistance of the University statistician. Results: Findings indicated that there is an association between triage knowledge and Job title (p-value = 0.046). Registered nurses, specialty nurses and enrolled nurses were found to have more knowledge than auxiliary nurses. However, from those nurses with the knowledge, the study discovered that most of the respondents (61%) exercised poor triage practice compared with those nurses (30%) exercising good practice. Conclusion: The results of this study show that having triage knowledge does not automatically equate with good triage practice. Therefore, it is recommended to integrate knowledge with experience and continued professional development to yield good triage practice.
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Dippenaar, Enrico. "Standardisation and validation of a triage system in a private hospital group in the United Arab Emirates." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23397.
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Introduction: Upon inspection and evaluation of the Mediclinic Middle East emergency centres in the United Arab Emirates, inconsistencies related to triage were found. Of note, it was found that the use of various international triage systems within and between the emergency centres may have caused potentially harmful patient conditions. The aim of this thesis was to study the reliability and validity of existing triage systems within Mediclinic Middle East, and then to use these systems as a starting point to design, standardise and validate a single, locally appropriate triage system. This single triage system should be able to accurately and safely assign triage priority to adults and children within all of Mediclinic Middle East emergency centres. Methods: A System Development Life Cycle process intended for business and healthcare service improvement was expanded upon through an action research design. Quantitative and qualitative components were used in a five-part study that was conducted by pursuing the iterative activities set by an action research approach to establish the following: the emergency centre patient demographic and application of triage, the reliability and validity of the existing triage systems, a determination of the most appropriate triage system for use in this local environment and development of a best-fit novel triage system, establishment of validation criteria for the novel triage system, and determination of reliability and validity of the novel triage system within Mediclinic Middle East emergency centres. Results: Low-acuity illness profiles predominated the patient demographic; high acuity cases were substantially smaller in number. The emergency centres used a combination of existing international triage systems; this was found to be inappropriate for this environment. Poor reliability and validity performance of the existing triage systems led to the development of a novel, four-level triage system. This novel triage system incorporates early warning scores through vital sign parameters, and clinical descriptors. The novel triage system proved to be substantially more reliable and valid than the existing triage systems within the Mediclinic Middle East emergency centres. Conclusion: Through an initial systems analysis, it became clear that the Mediclinic Middle East emergency centres blindly implemented an array of international triage systems. Using an action research approach, a novel triage system that is both reliable and valid within this local environment was developed. The triage system is fit to be implemented throughout all the Mediclinic Middle East emergency centres and may be transposed to similar emergency centre settings elsewhere.
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Riordan, Geraldine M. "Triage in Health Department of Western Australia accident and emergency departments." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1995. https://ro.ecu.edu.au/theses/1182.
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A survey of triage systems used in Health Department of Western Australia accident and emergency departments was undertaken to examine differences in practices between departments with and without designated triage nurses (TNs). One questionnaire surveyed 93 nurses in seven departments with TNs, a similar second questionnaire surveyed 89 nurses in 16 departments without TNs, and a third questionnaire was used in a structured telephone interview of receptionists in hospitals without TNs. Data were analysed using frequencies, percentages, means, standard deviations and ranges with common themes identified for open ended questions. The study was guided by Donabedian's systems evaluation model. The structures and processes of triage within each department were examined in relation to the outcome standards recommended by the Australian Council on Healthcare Standards. The study results revealed that triage nurses were employed in all departments where patient attendances exceeded 300 per week and nursing staff coverage in the department was higher than five per day. Three departments had introduced triage on weekends only, and these departments had the lowest nurse-patient ratio of one nurse per day to 74 patients per week. The highest nurse-patient ratio was in departments with TNs (1-35). Conclusions drawn from the findings suggest that when receptionists are the first person to see patients, they triage patients using an unsatisfactory two category priority system. The average waiting time to see nursing staff is too long in departments without TNs, 7.6 minutes, as compared to 3. 7 minutes in department with TNs. Nursing staff perceived that triage systems could be improved by having only experienced staff as the triageur. The surveillance of patients entering the department is unsatisfactory as 81% of departments without TNs and 43% of departments with TNs are unable to provide nurse surveillance. The surveillance of the waiting room is similarly unsatisfactory in many departments. All triage areas are inadequate, as facilities for private conversation, hand washing and physical assessment are not always available. The majority of departments without TNs do not have a satisfactory triage priority category system in place. The average time taken by nursing staff to triage patients is an acceptable 3.2 minutes in departments with TNs, and 5.3 minutes in departments without TNs. The practice of redirecting patients away from the department could compromise patient safety as patients are redirected away from most departments by any level of staff employed in the department, without any written documentation kept or any written criteria for the redirection of these non-urgent patients. The practice of ordering investigations and treating minor problems without referring to a doctor could also compromise patient safety, as most departments do not have written policies and guidelines to cover this practice. Most departments offer an inadequate triage training program of preceptoring only. Recommendations are focused on the reviewing of existing triage practices to comply with the standards identified.
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Hedding, Kirsty. "A descriptive study of demographics, triage allocations and patient outcomes for a private emergency centre in Pretoria for 2018." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32761.
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Background Triage aims to detect critically ill patients and to prioritise those with time-sensitive needs. It also contributes to the overall efficiency of an emergency centre (EC). International systems have been relatively well researched; however, no data exists on the use of the SATS score in private healthcare settings in SA. Objectives This study aimed to describe the demographics, triage allocations, time spent in EC and disposition of all patients presenting to a private hospital EC in Pretoria, South Africa in 2018. Methods A retrospective descriptive study was undertaken. Data relating to demographics, triage, and hospital disposition were collected on all patients presenting to the EC during the 2018 calendar year. Descriptive data analyses were conducted in Microsoft Excel. Results A total of 29 055 patients were included in this study. More than half (57.6%) were adults aged 18 to 60 years and approximately one-fourth (27.5%) were paediatrics (<18 years). The majority of patients were triaged yellow (73.5%); 17.4% were triaged as red and orange. It took, on average, 28 minutes to be seen by a provider and patients spent an average of 2 hours and 20 minutes in the EC. Delays to be seen exceeded standards for red and orange patients at 8 and 18 minutes respectively, and the mean time these patients spent in the EC was higher (2h 51 minutes and 2h 47 minutes respectively). Most patients (76.1%) were discharged; 5.6% were admitted to ICU/high care, 14.4% to the general ward, and 3.9% either absconded or refused hospital treatment. Of patients triaged red and orange, 11.1% and 49.3% were discharged respectively, and these patients used the most resources . Conclusion This study found that most of the patients were triaged into low acuity categories (yellow and green) and discharged home. High acuity patients were usually admitted to ICU or high care; however, these patients experienced delays in being treated and admitted. Causes of these issues, and implications on patient outcomes remain unknown. Large numbers of high acuity patients were ultimately discharged home. Further studies are needed to understand the influence of triage accuracy on these patients' outcomes.
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Ochoa, Cesar G. "Using arena simulation software to predict hospital capabilities during CBRNE events." To access this resource online via ProQuest Dissertations and Theses @ UTEP, 2007. http://0-proquest.umi.com.lib.utep.edu/login?COPT=REJTPTU0YmImSU5UPTAmVkVSPTI=&clientId=2515.
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Kuriyama, Akira. "Impact of age on the discriminative ability of an emergency triage system : A cohort study." Kyoto University, 2019. http://hdl.handle.net/2433/244525.
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Bruins, Stevan Raynier. "A prospective evaluation of the feasibility of using enrolled nursing auxiliaries to triage patients in the emergency unit of an urban public hospital in South Africa." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/2856.
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Bello, George. "Is it possible to improve the analytical approach to the evaluation of cluster-randomised trials where the complexity of the intervention demands a small number of clusters? : the case of the triage plus 'Integrated TB-HIV community intervention project in Lilongwe Rural, Malawi'." Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2014620/.
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Introduction In this thesis, analytical approaches for the design and evaluation of cluster randomised trials are presented and reviewed. In particular, statistical power/sample size issues relating to the design of cluster randomised trials for which only a limited number of clusters are available are assessed using a series of simulation studies. The use of computer simulation methods made it possible to investigate how well cluster randomised trials with limited numbers of clusters available can be optimised both in terms of statistical power and also the accuracy of parameter estimates. The study design conditions performing best in the simulation studies were then applied to a community intervention study involving informal healthcare providers: the 'Triage Plus integrated tuberculosis (TB) and human immuno-deficiency virus (HIV) community intervention project in Lilongwe rural, Malawi'. Aims and objectives The general aims of this dissertation were to: 1. investigate if it is possible to improve the analytical approach to the evaluation of cluster-randomised trials where the complexity of the intervention demands a small number of clusters and in which the primary outcome measure is a count of events occurring in a specified time interval; 2. investigate the effectiveness of engaging informal healthcare providers in integrated TB and HIV community intervention in treatment initiation rates and testing access rates, a cluster randomised trial was conducted in Malawi for which only a limited number of clusters were available to the researchers. The specific objectives were: 1. to review cluster randomised trials and the statistical methods used in the assessment of the effectiveness of the intervention in this type of trial when the primary outcome measure is a count of events occurring in a specified time interval; 2. to assess the statistical efficiencies of different design conditions in terms of statistical power and the accuracy of parameter estimates when determining the effectiveness of complex interventions with a limited number of clusters in this situation; iii 3. to identify the circumstances under which each of the statistical methods would be most robust in detecting significant intervention effects or providing accurate estimates of intervention effects; 4. to apply these statistical approaches to the data collected in the cluster randomised clinical trial of community based interventions for TB and HIV (the 'Triage Plus' study); 5. to assess the effect of involving non-paid informal healthcare providers in integrated TB and HIV community interventions aimed at improving testing and treatment initiation rates for these two diseases. Methods Two research approaches were used in this dissertation: 1. Simulation studies were used to investigate statistical efficiencies in terms of statistical power and accuracy in parameter estimation under different study design conditions for cluster randomised trials in which the primary outcome measure is a count of the number of events occurring during a specified period of time. 2. These statistical approaches were then applied to obtain robust estimates of the effect of the test intervention using the data collected during the “Triage Plus” study. The Triage Plus intervention, implemented in rural areas of Lilongwe, involved informal healthcare providers in an integrated TB and HIV community intervention. This intervention specifically involved empowering the informal healthcare providers in disease recognition, sputum specimen collection, referral of presumptive TB cases, and conducting community TB and HIV awareness meetings. Results The simulation studies showed that statistical efficiency and power both varied considerably under the different design conditions investigated. Non-coverage rates within the nominal value of 5% and negligible biases in the estimated fixed effects parameters (regression coefficients) were observed for all scenarios investigated including the (minimal) 3 cluster per arm design. However, it was discovered that, in order to achieve adequate power in low incidence disease conditions such as TB treatment initiation rates, more repeated measurement times were required to achieve adequate power of 80% with a true effect size of 20% or lower (for example, 12 measurement times were needed to achieve adequate power in this situation in a 3 cluster per arm design when the ICC was 0.00154). With an ICC of 0.081 iv at least 9 clusters were needed to achieve adequate statistical power of ≥80% with an effect size of 20% with 6 and 12 measurement time points respectively for high and low incidence disease conditions. For an effect size of 40%, at least 3 clusters per arm were needed to achieve adequate power with 4 repeated measurement times in low incidence diseases and 3 measurement times for high incidence diseases. For ICCs of 0.321 and above, no adequate statistical power was achieved with an effect size of ≤40% in both high and low disease incidence conditions. In the analysis of the TB services access data from the Triage plus study, the intervention significantly increased the number of presumptive TB cases accessing testing sites by 15.2% (p=0.003) in the first 12 months of the intervention; however, this was followed by a statistically non-significant reduction of 18.3% (p=0.224) when the intervention was rolled-out into the control clusters. Overall, the intervention was associated with a non-significant increase in TB treatment initiation rates of 18% (p=0.112). In the analysis of HIV services access rates, antiretroviral therapy (ART) initiation rates increased significantly by 34.7% (p=0.048) in the intervention clusters in the first 12 months of intervention, and the ART initiation rates were similar after rolling-out the intervention to the control clusters. Overall, the intervention was associated with a 61% increase in HIV testing uptake rates (p<0.001). Conclusion: To achieve adequate statistical power and improved precision in parameter estimation in cluster randomised trials with a count outcome measure, with the ICC of 0.00154 the simulation results suggested that a minimum of 3 clusters per arm is required with at least 12 measurement times for the estimation of an effect size of 20% (or higher) in low incidence disease situations. However, for high incidence outcomes, a minimum of 3 clusters per arm with 3 or more measurement times may be adequate to achieve a statistical power of at least 80%. For an ICC of 0.081, at least 3 clusters per arm were needed to achieve adequate power if the effect size was 40% after 4 repeated measurement times in low incidence diseases and 3 measurement times for high incidence diseases. With ICCs of 0.321 and above, no adequate statistical power was achieved with an effect size of ≤40% in both high and low disease incidence conditions. For the TB and HIV interventions in the “Triage Plus” study, engaging informal health care providers was clearly effective in improving TB and HIV testing uptake as well as ART v initiation. This reinforces the need for community participation in integrated TB and HIV interventions to combat the two diseases. However, for these providers to be effective in promoting TB treatment initiation, the number of sites offering TB testing and treatment initiation in rural areas should be increased to make them more accessible to the population.
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Spangler, Douglas. "An evaluation of nurse triage at the Emergency Medical Dispatch centers in two Swedish counties." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-324317.
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Sjuksköterskor vid Sjukvårdens Larmcentral (SvLC) i Uppsala och Västmanlands län hänvisar regelbundet lågakuta patienter som bedöms inte vara i behov av ambulanssjukvård till alternativa vårdformer. I denna studie kopplades patientdata från SvLC till sjukhusregister för att identifiera patienter som besökte en akutmottagning inom 72 timmar efter en hänvisning vid SvLC. Prevalensen av ett antal utfallsmått undersöktes och logistisk regression användes för att fastställa effekten av ett antal variabler. 20% av hänvisade inringare besökte en akutmottaging inom 72 timmar. Av dessa fick 57% vård på specialistnivå och 37% lades in vid en slutenvårdsenhet. 86% av akutmottagningsbesöken gällde det besvär som patienten kontaktade SvLC för. Äldre patienter hänvisades mindre ofta till alternativa vårdformer, men löpte större risk att kräva vård på specialistnivå och läggas in vid sjukhuset till följd av ett akutmottagningsbesök. Samtal med personer som ringde in flera gånger per månad hänvisades oftare av SvLC än patienter med en kontakt under studiens lopp, medan patienter som ringt in endast ett fåtal gånger besökte akutmottagningen oftare och blev där oftare inlagda. Icke-användning av SvLCs beslutsstöd var vanligare bland hänvisade patienter. Uppdrag som avlsutades utan vidare hänvisning till en annan sjukvårdsinstans resulterade mindre ofta i ett akutmottagningsbesök. Prevalensen av akutmottagningsbesök och inläggningar vid sjukhus efter hänvisning liknar nivån som funnits i andra studier av nordisk prehospital triage. Baserat på resultaten från denna studie föreslås ett antal kvalitetsutvecklingsprojekt samt framtida studier.Nurses working at the Emergency Medical Dispatch (EMD) centers in the Swedish counties of Uppsala and Västmanland routinely refer patients determined to not require an ambulance to non-emergency care. In this study, hospital records were reviewed to match calls to patients visiting an Emergency Department (ED) within 72 hours of being referred to non- emergency care by an EMD nurse. The prevalence of a number of outcomes was examined, and logistic regression models were used to analyze the effects of several variables of interest. 20% of callers referred to non-emergency medical care visited an ED within 72 hours. Of these, 57% received specialist level care, and 37% were admitted to the hospital. 86% of ED visits were found to be in regards to the condition the patient contacted the EMD for. Elderly patients were less likely to be referred to non-emergency care, but more likely to receive specialist care and be admitted. Very frequent callers were more likely to be referred to non-emergency care, while a moderate rate of contact was associated with increased odds of ED visitation and hospital admission from the ED. Non-utilization of the EMDs’ decision support tool was more common among callers referred to non-emergency care. Calls closed by dispatchers without further referral to other healthcare providers were less likely to result in an ED visit. The prevalence of ED visitations and admissions found in this study are similar to those found in other studies of Scandinavian pre-hospital triage, and a number of possibilities for quality improvement and future studies were identified.
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Esteves, Ana Luísa Roque de Andrade. "Implementação de um sistema de triagem no hospital escolar da Faculdade de Medicina Veterinária." Bachelor's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2010. http://hdl.handle.net/10400.5/2667.
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Dissertação de Mestrado Integrado em Medicina VeterináriaA triagem surgiu associada à actividade militar, com o principal objectivo de salvar o maior número de soldados, de forma a manter o poderio militar. No final da década de 1980 surgiu o 1º sistema de triagem civil, o Ipswich Triage Scale, com boas indicações de performance e de aceitação pela comunidade de emergência médica. Assim, durante as décadas de 1990 e 2000 surgiram outros sistemas de triagem: o Canadian Triage and Acuity Scale, o Manchester Triage System, o Emergency Severity Index e o Cape Triage Score. A triagem está, actualmente, distribuída um pouco por todo o mundo ocidental, sendo um tema bastante comum e com o qual a maioria da população está familiarizada, incluindo Portugal. No campo veterinário, a triagem aparece ligada aos casos de pacientes politraumatizados, apesar de não existir um verdadeiro sistema de triagem padronizado, como ocorre na medicina humana. A presente dissertação de mestrado procurou testar o efeito da implementação de um sistema de triagem no Hospital Escolar da Faculdade de Medicina Veterinária da Universidade Técnica de Lisboa (HEFMV), à semelhança dos que foram desenvolvidos para aplicação nos serviços de urgência dos hospitais civis. Para tal, foram feitos 2 estudos no HEFMV: o 1º para estudar os tempos de espera e distribuição dos casos nas diferentes categorias, com o actual sistema em vigor no hospital (por ordem de chegada), e o 2º estudo, já com a aplicação do sistema de triagem previamente desenvolvido, estudando também os mesmos parâmetros, de forma a poder comparar os 2 estudos. Apesar do esforço em padronizar os 2 estudos, há que ter sempre em conta os factores variáveis e que, neste caso, tiveram grande influência: o número de clientes que se dirigiram à consulta e o próprio número de médicos veterinários em serviço, que foram diferentes em ambos os estudos. Assim, não foi possível concluir qual o verdadeiro efeito da triagem nos tempos de espera dos pacientes mais urgentes. Há, contudo, que salientar os efeitos positivos da triagem no funcionamento do HEFMV: redução do tempo de consulta, ou pelo menos, um melhor encaminhamento da mesma, e a atenção dada a cada cliente, logo após a sua entrada no HEFMV, demonstrando preocupação pelos mesmos.
ABSTRACT - IMPLEMENTATION OF A TRIAGE SYSTEM IN THE TEACHING HOSPITAL OF FACULDADE DE MEDICINA VETERINÁRIA – UTL - Triage appeared linked to military activity, with the main goal of saving the highest number of soldiers, in order to keep the military power. With the end of the 1980s came the 1st civil triage system, Ipswich Triage Scale, with good performance indicators and acceptance by the medical emergency community. Thus, in the 1990 and 2000 other triage systems have emerged: Canadian Triage and Acuity Scale, Manchester Triage System, Emergency Severity Index and Cape Triage Score. Triage is now spread throughout the Western world, being a fairly common theme and with whom most of the world population are familiar with, including the portuguese. In the veterinary field, triage appears linked to cases of polytraumatized patients and there is no real standardized triage system, as occurs in human medicine. The present dissertation tried to test the effect of implementing a triage system in the Teaching Hospital of Faculdade de Medicina Veterinária of Universidade Técnica de Lisboa (HEFMV), similar to those that have been developed for application in the emergency services of civilian hospitals. For that purpose the author made 2 studies in HEFMV: the first one to study the distribution of patients and waiting times in the different triage categories, with the current system at the Hospital (in order of arrival), and the second study, already implementing the previously developed triage scale, studying the same parameters, in order to being able to compare the 2 studies. Despite the effort to standardize the 2 studies, it’s always necessary to count with variables and factors that, in this case, had great influence: the number of customers who went to the consultations and the actual number of veterinarians in service, that were different in both studies. Thus, it was not possible to conclude what is the true effect of triage in waiting times for patients with more urgency. Despite it all, there are, however, positive effects of triage on the functioning of HEFMV: there was a consultation time reduction, or at least a better routing of it, and the attention given to every customer, shortly after arriving at HEFMV, showing concern by them.
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Fleming, Susannah. "Measurement and fusion of non-invasive vital signs for routine triage of acute paediatric illness." Thesis, University of Oxford, 2010. http://ora.ox.ac.uk/objects/uuid:840d94b0-041f-4b15-8b37-c2e37c999f3e.
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Serious illness in childhood is a rare occurrence, but accounts for 20% of childhood deaths. Early recognition and treatment of serious illness is vital if the child is to recover without long-term disability. It is known that vital signs such as heart rate, respiratory rate, temperature, and oxygen saturation can be used to identify children who are at high risk of serious illness. This thesis presents research into the development of a vital signs monitor, designed for use in the initial assessment of unwell children at their first point of contact with a medical practitioner. Child-friendly monitoring techniques are used to obtain vital signs, which can then be combined using data fusion techniques to assist clinicians in identifying children with serious illness. Existing normal ranges for heart rate and respiratory rate in childhood vary considerably, and do not appear to be based on clinical evidence. This thesis presents a systematic meta-analysis of heart rate and respiratory rate from birth to 18 years of age, providing evidence-based curves which can be used to assess the degree of abnormality in these important vital signs. Respiratory rate is particularly difficult to measure in children, but is known to be predictive of serious illness. Current methods of automated measurement can be distressing, or are time-consuming to apply. This thesis therefore presents a novel method for estimating the respiratory rate from an optical finger sensor, the pulse oximeter, which is routinely used in clinical practice. Information from multiple vital signs can be used to identify children at risk of serious illness. A number of data fusion techniques were tested on data collected from children attending primary and emergency care, and shown to outperform equivalent existing scoring systems when used to identify those with more serious illness.
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Valette, Pierre. "Du tri à l'autre : éthique et médecine d'urgence." Phd thesis, Université Paris-Est, 2011. http://tel.archives-ouvertes.fr/tel-00714219.
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Comment aborder l'éthique médicale à l'heure de la grande confusion entre déontologie, morale, éthique, éthique de la biomédecine, éthique appliquée, éthique du care, méta-éthique, bioéthique...? Peut-être par un retour " aux choses mêmes " comme aurait dit Husserl, un retour à la médecine pour y chercher, comme nichée en son sein, matière à penser l'éthique de la médecine et non une éthique fabriquée de toute pièce qui constituerait, au final et de façon définitive, une éthique pour la médecine.Un mode d'exercice particulier, la médecine d'urgence, permet d'étudier l'acte médical, dans sa puissance et son actualisation (au sens que prennent ces termes chez Aristote) et ses intersections avec le geste technique. Qu'est-ce qu'un acte médical, qu'est-ce qu'un geste technique et comment les distinguer ? Ou encore, comment reconnaître un acte sans geste et un geste sans acte ? C'est le médecin, auteur de l'acte, qui fait de l'acte un acte médical. Même lorsque le geste technique recouvre la totalité d'un acte, il ne peut que se distinguer de l'acte médical si son auteur n'est pas médecin, non en qualité statutaire mais en celle de dépositaire du savoir (épistémè) médical. L'acte sans geste rencontré au cours de la régulation médicale est la preuve que la médecine d'urgence ne se réduit pas à des gestes techniques.Comme beaucoup de disciplines à orientation scientifique, la médecine d'urgence tend à transformer le temps en espace pour mieux quantifier sa pratique mais finit par se heurter à la vérité d'adéquation des autres spécialités médicales. La vérité qui se réduit à l'exactitude mathématique donne à la paraclinique la place centrale de l'exercice médical, participant peu à peu à éloigner le médecin du patient.Le tri médical, exercice singulier de la médecine de masse, de la médecine de catastrophe, met en évidence, de façon inattendue, l'éthique médicale. La catégorisation des victimes, au principe du tri médical n'est qu'un reflet exacerbé de la pensée rationnelle. Car penser, c'est trier. L'irruption du tiers dans la relation médecin malade limite la responsabilité médicale laquelle, sinon, serait insupportable. La responsabilité infinie de chacun vis-à-vis de l'autre, redoublée par la condition de soignant précède et fonde la liberté. Le Tiers empêche de faire l'impossible pour Autrui, il contraint à partager. Introduit au moment du tri médical, il donne la chance au politique de s'enraciner profondément dans l'éthique.
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Maher, Patricia. "Florida Adult Trauma Scorecard Methodology and Scene Transportation Choice." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7694.
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Prehospital management of patients who are traumatically injured within the state of Florida starts with the use of the Florida Adult Trauma Scorecard Methodology. The scorecard methodology may indicate that a patient is a Trauma Alert based on applied physiological and other judgment criteria. However, patients may be transported via Helicopter Emergency Medical Services (HEMS) without justified physiological needs. Rawls’ theory of justice posits that a fair and equal distribution of social resources is essential to public wellbeing. To evaluate this premise regarding prehospital trauma transports, archival 2015 data from the Florida Department of Health Trauma Registry was obtained. Using logistic regression, each trauma scorecard assessment criteria was individually and collectively evaluated regarding its predictive likelihood of a scene responder requesting HEMS versus ground ambulance transport. Controlling for trauma center locations, all five of the triage classifications illustrated a significant likelihood (p = 0.000) of HEMS transportation requests. Category 4 (EMS Judgment) predicted the highest likelihood of HEMS transport requests (b = 2.39, Wald X2(1) = 2026.88, OR = 10.9, p = .000, CI [9.83, 12.09]). Categories 4 (14.7%) and 6 (Local Criteria; [25.8%]) illustrated unexpectedly high percentages of emergency department discharge when Trauma Alert patients were HEMS transported. Over triage of patients to HEMS without meeting physiologic criteria provides less than an equal and fair distribution of public and private resources. State-level social change can be realized through HEMS transport criteria modifications applying more stringent application of physiologic patient condition scoring when determining the mode of prehospital scene response transport.
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Barkensjö, My, and Therese Tikka. "Patientupplevelse av triage." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-20376.
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Tidigare studier har visat vad patienten anser vara tillfredställande i samband med triage. Där framkommer att i mötet med vårdpersonalen vill patienten känna sig värdig, sedd och bekräftad. Detta ställer krav på vårdpersonalen och den kompetens de besitter. En förutsättning för patienttillfredsställelse är information om väntetider, patienternas medicinska tillstånd och en god vårdrelation. I mötet med patienten krävs kunskap om vad dessa tycker är viktigt och betydelsefullt i samband med triage. Kunskapen om vad som är viktigt är fortfarande inte tillräckligt belyst, ur ett patientperspektiv. Syfte var att beskriva patientens upplevelse av vad som var betydelsefullt för denne i samband med triage. En kvalitativ forskningsansats med en påföljande innehållsanalys valdes. 11 stycken intervjuer genomfördes på en mindre akutmottagning i väst Sverige.Informanterna som valdes ut var patienter på denna akutmottagning. I resultatet framträdde två domäner, bemötande och information. Kategorierna som följde var omvårdnad, trygghet, delaktighet, kompetens, omhändertagande, integritet, tid och kommunikation. Informanterna ansåg det vara betydelsefullt att bli bemötta på ett individuellt plan, detta innefattade allt från basal omvårdnad till att informanterna litade på triageteamets goda kompetens. Sanningsenlig information kring väntetider och prioriteringssystemet visade sig ha betydelse. Tidigare studier har visat att vården upplevdes som god om vårdpersonalen hade ett öppet förhållningssätt, visade hänsynsfullhet och lugn. Detta bekräftas i vårt resultat. Triageteamet skulle kunna tillgodose detta genom att våga uppskatta väntetiden, men också genom att vara tydliga i att informationen kan komma att förändras.Program: Magisterprogram i vårdvetenskap med inriktning mot akutsjukvård
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Kashyap, Sonya. "Assisted reproductive medicine: Systematic reviews and randomized controlled trials." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/26940.
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The objective for this thesis was to propose a question in the area of reproductive medicine that could be addressed by a clinical trial. In preparation for such a trial we conducted a systematic review of the topic.
Our first question was whether metformin is of benefit compared to clomiphene citrate for ovulation induction and achievement of pregnancy in women with polycystic ovarian syndrome (PCOS). We conducted a systematic review (SR) and meta-analysis of the subject before designing and implementing a randomized controlled trial (RCT). The RCT was terminated for recruitment issues. Our PCOS SR led us to develop a novel ovarian stimulation protocol for poor responders. We used the lessons learned from our failed RCT and another systematic review to design and conduct a feasibility randomized controlled trial on the use of aromatase inhibitors to improve pregnancy outcomes for in-vitro fertilization in poor responders. We successfully completed the pilot study and found a trend towards increased clinical pregnancy rates for patients who received the study versus the standard protocol. The pilot study provides recommendations for the definitive trial.
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Higham, Ruchi. "Clinical trials in regenerative medicine : negotiating process, practice and outcomes." Thesis, University of York, 2017. http://etheses.whiterose.ac.uk/19879/.
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There has been significant progress in the basic science of regenerative medicine over the past two decades, but clinical translation has been more halting. Clinical trials are a key step in the translational process and have been highlighted as a particular challenge for the field. This thesis adopts an analytical framework informed by Jasanoff's idiom of co-production to investigate trials of one particular type of regenerative medicine: cell therapies. A mixed-methods design was used, which included quantitative analysis of secondary data, 17 semi-structured interviews with cell therapy trialists, and a longitudinal observational study of a cell therapy trial. The findings indicate that the cell therapy trials landscape in the UK is small, fragmented and dominated by academic-led, publicly-funded studies. This conflicts with a policy environment that is largely aligned with a commercial development model, and a trials process that was designed for drug trials funded by large corporations. Trials tend to be affected by a specific set of local factors, the most important being financial constraints, the logistics of working with cells, the temporality of the trial and the need to align the work of disparate domains. These issues create a challenging translational environment, with the linearity and abstracted nature of the trials process conflicting with the recursive, situated nature of innovation. They also highlight the significant contingency involved in trials, which is at odds with the priority evidence-based medicine places on this supposedly neutral, objective method. Whilst cell therapy trials must without a doubt be held to the highest regulatory standards, it is also important that the clinical research framework takes into account the challenges they pose and the contingent nature of the evidence they generate, and the thesis concludes with some recommendations as to how this might be achieved.
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Dynesius, Anna. "Triagering av patienter med psykisk ohälsa inom primärvården : En kvalitativ studie." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-43326.
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Bakgrund: Distriktssköterskan triagerar dagligen patienter med psykisk ohälsa i primärvården. Psykisk ohälsa är mångfacetterat och till viss del tabubelagt i samhället. Detta kräver att distriktssköterskan har god kännedom om psykisk ohälsa och hur den kan uttrycka sig hos olika patienter. Distriktssköterskan behöver även ha ett holistiskt synsätt med personcentrerad vård i fokus. Syfte: Syftet med studien var att belysa distriktssköterskans erfarenheter av triagering av patienter med psykisk ohälsa inom primärvården. Metod: En kvalitativ intervjustudie med åtta distriktssköterskor/sjuksköterskor verksamma i primärvården. Analysmetoden var kvalitativ innehållsanalys. Resultat: Resultatet var tre kategorier och tio underkategorier. De tre kategorierna var: Brister i utbildning, Utmaningar vid triagering samt Brister i samverkan. Resultatet visade att distriktssköterskan behöver ha mer kunskap om psykisk ohälsa samt ha de förutsättningar som krävs för att genomföra en bra triagering såsom stödverktyg och trygghet i dialog om självmordstankar hos patienten. Distriktssköterskan behöver vara medveten om somatisering och dess påverkan i triageringen. Samarbetet mellan primärvården och öppen psykiatriska mottagningen behöver förbättras. Konklusion: För att triagering av psykisk ohälsa ska bli bättre behöver distriktssköterskan erhålla mer utbildning av psykisk ohälsa. Där har både arbetsgivare och utbildningsansvariga ett ansvar att påverka möjligheterna till triagering av psykisk ohälsa i primärvården. Distriktssköterskan behöver även ha stödverktyg för att säkerhetsställa likvärdig triagering av psykisk ohälsa i primärvården.Background: The district nurse triage daily patients with mental illness in primary care. Mental illness is multifaceted and to some extent taboo in society. This requires that the district nurse has a good knowledge of mental illness and how it can express itself in different patients. The district nurse also needs to take a holistic approach with person-centred care in focus. Aim: The aim was the district nurse experiences with triage of patients with mental illness in primary care. Method: A qualitative research approach based on interviews with eight district nurse/nurse active in primary care. Qualitative content analysis. Result: The result was three categories and ten subcategories. The three categories were: Deficiencies in education, Challenges in triage and Deficiencies in collaboration. The results showed that the district nurse needs to have more knowledge about mental illness and have the conditions required to carry out a good triage, such as support tools and security in dialogue about suicidal thoughts in the patient. The district nurse needs to be aware of somatization and its impact on triage. The collaboration between primary care and the open psychiatric clinic needs to be improved. Conclusion: In order for triage of mental illness to improve, the district nurse needs to receive more training in mental illness. There, both employers and education managers have a responsibility to influence the opportunities for triage of mental illness in primary care. The district nurse also needs support tools to ensure equivalent triage of mental illness in primary care.
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Chan, Wing-shuen Jacqueline. "Characteristics of sponsored trials registered in the United States National Library of Medicine Clinical Trials Register." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36887092.
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Chan, Wing-shuen Jacqueline, and 陳永璇. "Characteristics of sponsored trials registered in the United States National Library of Medicine Clinical Trials Register." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B39723926.
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Witt, Claudia, Mikel Aickin, Daniel Cherkin, Chun Che, Charles Elder, Andrew Flower, Richard Hammerschlag, et al. "Effectiveness guidance document (EGD) for Chinese medicine trials: a consensus document." BioMed Central, 2014. http://hdl.handle.net/10150/610258.
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BACKGROUND:There is a need for more Comparative Effectiveness Research (CER) on Chinese medicine (CM) to inform clinical and policy decision-making. This document aims to provide consensus advice for the design of CER trials on CM for researchers. It broadly aims to ensure more adequate design and optimal use of resources in generating evidence for CM to inform stakeholder decision-making.METHODS:The Effectiveness Guidance Document (EGD) development was based on multiple consensus procedures (survey, written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders, including patients, clinicians, researchers and payers were involved in creating this document.RESULTS:Recommendations were developed for "using available data" and "future clinical studies". The recommendations for future trials focus on randomized trials and cover the following areas: designing CER studies, treatments, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication.CONCLUSION:The present EGD provides the first systematic methodological guidance for future CER trials on CM and can be applied to single or multi-component treatments. While CONSORT statements provide guidelines for reporting studies, EGDs provide recommendations for the design of future studies and can contribute to a more strategic use of limited research resources, as well as greater consistency in trial design.
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Whitelegg, Margaret Ellen. "Paradigm shift and the use of science in orthodox and alternative medicine." Thesis, Lancaster University, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.240451.
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Murphy, Jeremy James. "Clinical trials in cerebrovascular disease." Thesis, University of Nottingham, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.293328.
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Beda, Boniface. "TRIAGE PÅ AKUTMOTTAGNING SJUKSKÖTERSKANS UPPLEVELSER AV TRIAGEPROCESSEN - EN KVALITATIV STUDIE." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24461.
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Bakgrund: RETTS-PSY är ett triageinstrument som sjuksköterskan använder vid triageprocessen för att genomföra prioriteringar och bedömningar av patienter på psykiatriska akutmottagningar. Syfte: Att undersöka sjuksköterskornas upplevelser av att bedöma patienter vid triagering med RETTS-PSY på en psykiatrisk akutmottagning. Metod: En kvalitativ deskriptiv studie gjordes och tretton sjuksköterskor och psykiatrisjuksköterskor från de större regionsjukhusens akutpsykiatriska mottagningar i Skåne intervjuades om RETTS-PSY bedömningsinstrumentet. Intervjuerna analyserades utifrån Burnards manifesta analysmodell. Resultat: Fyra kategorier och åtta subkategorier beskriver akutsjuksköterskors upplevelser av triagearbete. Dessa kategorierna är: Att känna stöd och trygghet, Känslor av god samstämmighet och överensstämmelse, Vikten av en professionell bedömning och Betydelsen av personliga egenskaper. Triageskalan utgör en trygghet och ett arbetsredskap för sjuksköterskans triagearbete. Det krävs kunskap om bedömningsinstrumentet för att den akutpsykiatriska sjuksköterskan ska kunna erbjuda god patientsäkerhet på mottagningen samt undvika dubbel dokumentation. Nackdelen är att triageskalan inte täcker alla tecken och symtom som patienten uppvisar. Slutsats: Triageprocessen med RETTS-PSY upplevdes som positiv men kräver professionalism. Triageinstrument bör utvecklas och detaljeras så att sjuksköterskan får möjlighet att utnyttja hela sin kompetens och därigenom öka patientsäkerheten. Nyckelord: Akutpsykiatriska, Psykisk ohälsa, RETTS-PSY, Triagering, UpplevelseBackground: RETTS-PSY is a triage instrument used by the nurses during the triage process to implement priorities and assessments of patients in psychiatry care. Aim: To investigate the nurses' experiences of assessing patients with RETTS-PSY at a psychiatric emergency service. Method: A qualitative descriptive study was conducted, and thirteen nurses and psychiatric nurses were interviewed about using the RETTS-PSY as an assessment tool. Interviews were performed at major regional hospitals psychiatric emergency units in Scania, Sweden. The interviews were analyzed by Burnard, a qualitative content manifest analysis. Results: Four categories and eight subcategories described experiences of triage work. The categories were: Feeling support and safety, Feelings of consistency and conformity, Importance of professional assessment and Importance of personal qualities. The Triage scale RETTS-PSY was experienced as a safety tool for the nurse's triage work. Triage work requires knowledge and experience to provide good patient safety care and avoid duplication of documentation. One disadvantage was experienced, namely that the instrument does not cover all patient signs and symptoms. Conclusion: The triage with RETTS-PSY requires professionalism. The triage scale should be developed and refined so that the nurse is given the opportunity to practice all her skills for the safety and benefit of the patient. Keywords: Emergency psychiatry, Experience, Mental illness, RETTS-PSY, Triage,
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Karlsson, Jeanette, and Sofie Granath. "Sjuksköterskan och triage : Hur kompetens, trygghet och följsamhet påverkar triagebeslutet." Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-75044.
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Van, Wyk Anthea. "Evaluation of guidelines for clinical trials of traditional plant medicines." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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The World Health Organization estimates that 4 billion people use herbal medicine for some aspect of primary health care. These herbal products are however mostly used without the necessary clinical trial done to prove their pharmacological activities and, therefore, their quality, efficacy and safety. It was the objective of this study to review the current international guidelines for the evaluation of herbal medicineto gain a perspective on the number, type and quality of clinical trials that have been done on herbal medicine and to adopt a set of guidelines that could be used to conduct trial on a traditional herbal medicine used in South Africa. To verify these guidelines, a protocol for a clinical trial was drafted and submitted for approval to the regulatory and ethical authorities in South Africa.
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譚郭雅欣 and Gloria Tam. "Non-small cell lung cancer clinical trials on new medicines." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41711956.
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Woodruffe-Peacock, Charlotte Anne. "Clinical trials on over-the-counter medicines in community pharmacies." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299861.
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Tam, Gloria. "Non-small cell lung cancer clinical trials on new medicines." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41711956.
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Gossas, Håkan, and Liselotte Berg. "Hur ambulanspersonalens rapport och triage används på akuten." Thesis, Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-67122.
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Introduktion: En viktig del i vårdprocessen är kommunikation. Därför är det viktigt att den fungerar tillfredställande. En mycket bra och beprövad kommunikationsmodell är SBAR. Ambulanssjuksköterskan ska kunna överrapportera på ett adekvat och patientsäkert sätt. Triage används för att få ett bra flöde på akutmottagningen och patientsäker vård. Syfte: Att kartlägga hur ambulanspersonalen överrapporterar patienten till akutens personal. Samt hur ambulanspersonalens triage används av akutens personal. Metod: En observationsstudie med kvantitativ design samt kompletterande enkät av kvalitativ karaktär där personalen med fritext kunde beskriva vad som var positivt samt negativt med överrapporteringen den hade en kvalitativ karaktär. Resultat: i resultatet framkom det i samtliga observationerna att det finns en klar och tydligfältdiagnos samt att bakgrund finns med. Vitalparametrar som rapporteras varierar från inga alls till korrekt rapporterat. Att ge en rekommendation till mottagande enhet sker sällan. När det gäller ESS så rapporterades det i mindre än hälften av fallen. Arbetets betydelse: Det finns en ganska stor förbättringspotential när det gäller överrapportering från ambulanspersonal vad gällande SBAR och hur den ska användas. Samtidigt en förbättringspotential från akutens personal gällande att vara intresserad av vad ambulanspersonalen överrapporterar.
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Larsson, Adam, and Daniel Carlson. "Sjuksköterskors uppfattningar av triage av barn vid Prehospital Sjukvårdsledning." Thesis, Karlstads universitet, Institutionen för hälsovetenskaper (from 2013), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-82924.
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Vickers, Andrew J. "Homoeopathy and clinical trials." Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.302395.
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Qian, Wendi. "Bayes methods in group sequential clinical trials." Thesis, University of Kent, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263693.
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McArthur, Kate S. "Improving efficiency in stroke trials : an exploration of methods to improve the use of the modified Rankin Scale in acute stroke trials." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/5350/.
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The modified Rankin Scale (mRS) is the preferred outcome measure in stroke trials. Typically, mRS assessment is based on a clinician’s rating of a patient interview and interobserver variability is common. Meta-analysis suggests an overall reliability of k=0.46 but this may be less (k=0.25) in multi-centre studies. Mandatory training in mRS assessment is employed in most trials to mitigate this but the problem persists. Variability in assigning outcomes may lead to endpoint misclassification increasing the challenge of accurately demonstrating a treatment effect. We aimed to assess the impact of endpoint misclassification on trial power and explore methods to improve the use of the mRS in acute stroke trials. First we used the mRS outcome distributions of previous phase III randomised controlled trials (RCT) in stroke (NXY059 study and tPA NINDS study) to perform statistical simulations. We generated power estimates and sample sizes from simulated mRS studies under various combinations of sample size, mRS reliability and adjudication panel size. Simulations suggest that the potential benefit of improving mRS reliability from k 0.25 to k 0.5, k 0.7 or k 0.9 may allow a reduction in sample size of n= 386, n= 490 or n= 488 in a typical n=2000 RCT. We then developed a method for providing group adjudication of mRS endpoints and examined the feasibility, reliability and validity of its use in a multicentre clinical trial. We conducted a “virtual” acute stroke trial across 14 UK sites. Local mRS interviews were scored as normal but also recorded to digital video camera. Video clips were uploaded via secure web portal for scoring by adjudication committee reviewers. We demonstrated excellent technical success rates with acceptability to both participants and investigators. 370 participants were included in our “virtual” acute stroke trial and 563 mRS video assessments were uploaded for central review. 96% (538/563) of study visits resulted in an adjudicated mRS score. At 30 and 90 days respectively, 57.5% (161/280) and 50.8% (131/258) of clips were misclassified. Agreement was measured using kappa statistics (k/kw) and intraclass correlation coefficient. Agreement between the adjudication committee was very good (30 days kw 0.85 [95%CI 0.81-0.86], 90 days kw 0.86 [95% CI 0.82-0.88]) with no significant or systematic bias in mRS scoring in comparison to the local mRS. We demonstrated criterion and construct validity of centrally adjudicated mRS scores through comparison with the locally assigned mRS score and other measures known to affect stroke outcome including baseline NIHSS (bNIHSS), Systolic Blood Pressure (SBP), blood glucose and home time. We studied our cohort of mRS video clips to identify any features predictive of variability in mRS scoring. Patient specific variables included participant age, pre stroke mRS, baseline stroke severity as graded by baseline NIHSS (bNIHSS) and presence of language disorder. Interview specific variables included length of interview, poor sound quality, location of the interview, use of a proxy or discussion of prior disability. At both 30 and 90 days only “interview length” was a significant predictor of agreement in mRS scoring. Using a sample of mRS video clips in English and Mandarin, we conducted a pilot study to assess the effect of translation of mRS interviews on interobserver reliability. The interobserver reliability of the translated mRS assessments was similar to native language clips (Native (n=69) kw 0.91 [95%CI 0.86-0.99], Translated (n=89) kw 0.90 [95% CI 0.83-0.96]). We then incorporated a translation step into the central adjudication model using our existing web portal. Inter observer reliability seen in the modified clips (kw 0.85 [95% CI 0.74-0.95]) was similar to that seen in the original video files (kw 0.88 [95% CI 0.78-0.99]). Finally we aimed to investigate the ability of raters to detect more subtle degrees of disability within mRS ranks through blinded assessment of pairs of clips with matching mRS grades. These pairs contained either two clips with full agreement in mRS grade at initial group review or one clip with full agreement and one clip where scores were skewed in the direction of “more” or “less” disability. Pairs were randomly assigned to multiple raters. We could not identify any reliable pattern in identification of the “less disabled” mRS clip. More sensitive grading of the mRS with “good” or “bad” forms of each grade is not reliable on the basis of this exploratory study. Perhaps alternative methods of converting the ordinal ranks of the mRS scale into a more continuous distribution should be investigated; such as the use of a mean mRS score following multiple mRS ratings. Prior estimates of mRS reliability in multicentre studies are poor [k=0.25]. The risks of endpoint misclassification affecting trial power are substantial. Simulations suggest that the effect of improving interobserver reliability and multiple mRS assessments may reduce study sample size by 25%, resulting in substantial ethical and financial benefits. Agreement between our adjudication committee was good [k=0.59(95% CI:0.53-0.63), kw=0.86(95% CI:0.82-0.88)]. Central review may bring many additional potential benefits: “expert” review, quality control and improved blinding in complex trial design. Central adjudication of mRS assessments is feasible, reliable and valid, including the use of translated mRS assessments. This model of outcome assessment has been incorporated into four ongoing large clinical trials: CLEAR-3, MISTIE-3, EUROHYP-1 and SITS-OPEN.
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Hee, Siew Wan. "Designing a series of clinical trials." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/50306/.
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This thesis presents designs for a series of clinical trials where instead of designing clinical trials individually, each of the trials is designed as part of a series of trials. The framework of the design is based on a combination of classical frequentist and Bayesian approaches which is sometimes known as the hybrid approach. The unknown parameter of the treatment efficacy is assumed to be random and follows a prior distribution in the design stage but at the end of the trial a frequentist test statistic is used on the observed data to infer the parameter. The design introduced in Chapter 5 aims to determine an optimum sample size for each trial by optimizing the average power of each trial and the overall resources while fixing the conventional type I error. The design has the exibility to either run sequentially or concurrently. The design is then extended to allow interim analyses in each trial (Chapter 6). The focus of the extended design is on a series of Bayesian decision-theoretic phase II trials and one frequentist phase III trial. At each interim stage, a decision is made based on the expected utilities of subsequent actions. There are four possible actions to choose from, namely, to continue the current trial by recruiting more patients, to initiate a new phase II trial, to abandon the development plan or to proceed to a phase III trial with this treatment against a control arm. For the last action, the phase III trial is designed with the hybrid methodology as described above. Finally, the prior distributions for each treatments are assumed to be correlated and as information is gathered from the previous and current trials, the current and following prior distributions are updated (Chapter 7).
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Hodkinson, Alexander. "Assessments of harms in clinical trials." Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2023762/.
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Introduction and Aims Healthcare interventions are usually associated with a risk of harmful events that must be balanced against the potential favorable outcomes. However reliable evidence on harms for interventions is often inadequate, and hampered by the many challenges that stem from the reporting, analysis and interpretation of harms data in clinical trials. This thesis addresses some of these issues. Methods Reporting of harms data is assessed in a systematic review of reviews and a case study investigating the additional value of harms data reported in clinical study reports (CSRs). A framework for searching and identifying relevant sources of harms data is outlined, and then explored further in a survey assessing current practices in clinical trial units (CTUs). Signal detection methods are introduced, and evaluated using simulated data to assess their performance when detecting safety signals in CTU databases. Results The systematic review highlights that the reporting of harms in RCTs is inconsistent, and often inadequate. In the case study, CSRs presented data on harms, including SAEs which are not reported or mentioned in publications, they also provide more detail about the design, conduct and analysis of the trial which facilitate the assessment of risk of bias in evidence synthesis. A wide range of sources for harms data have been identified, each with distinct strengths and limitations discussed. Selection of appropriate sources depends on the research question, and whether a hypothesis generating or hypothesis testing approach should be taken. Relevant sources have been identified for each approach, with examples of their exploitation in CTUs evaluated in the survey. The simulation study has shown that some of the current available signal detection methods are not able to control the false discovery rate well, and are only able to detect few safety signals for small or sparse data. Conclusions The work carried out within this thesis provides some recommendations to address the reporting, conduct, and analysis of harms in clinical trials. Wider adoption of recommendations made by the CONSORT-harms guideline will enhance the quality of reporting and improve subsequent evidence synthesis. Recent initiatives to promote open access to clinical trials data including CSRs is a major step towards supporting better data transparency. It is important to identify and consider different sources that are most likely to yield robust data on harms of interest, rather than relying on studies that cannot reliably detect harm. The survey identified published literature and systematic reviews as the most common source being used in the trial safety monitoring within CTUs. Signal detection methods are potentially unsuitable for use in CTUs. Further tools and guidelines for enhanced signal detection are needed in clinical trials.
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Jadad-Bechara, Alejandro Ricardo. "Meta-analysis of randomised clinical trials in pain relief." Thesis, University of Oxford, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.239290.
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Facey, Karen Maria. "Sequential procedures for clinical trials design, monitoring and analysis." Thesis, University of Reading, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.315536.
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Whitehead, Laura. "Identifying a core outcome set for cardiac arrest effectiveness trials." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/93947/.
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Cardiac arrest research seeks to improve survival rates and the quality of patient survival, but the comparability of research is limited by heterogeneous outcome reporting. The Core Outcome Set for Cardiac Arrest effectiveness trials (COSCA) study sought to identify the most important outcome domains that should be reported as minimum across all cardiac arrest effectiveness trials as part of a core outcome set (COS). Multiple perspectives were sought across COS development to ensure relevance. Potential outcome domains for COS inclusion were identified in: a systematic review of outcomes reported in published randomised controlled trials (RCTs) and interviews with survivors of cardiac arrest and their partners to understand the health outcomes that really matter. Consensus on the most important outcome domains was achieved in: an international modified Delphi survey and an international consensus meeting. Great heterogeneity (164 outcomes) was reported across current RCTs, failing to capture a number of outcomes important to cardiac arrest survivors identified in interviews. Across 2 rounds of ranking and rating exercise 48 outcome domains (18 health domains across 5 time points) were scored on their importance in the modified Delphi survey. Subsequently, 30 outcome domains were further discussed at a face to face consensus meeting. Three core outcome domains were defined: survival to hospital discharge/30 days, neurological outcome at hospital discharge/30 days and health related quality of life (HRQoL) within 1 year. Preliminary guidance on appropriate assessment tools were made but further evidence and understanding of the most appropriate measurement tools is required. Implementation of the defined COS has the potential to improve outcome reporting across cardiac arrest effectiveness trials, aiding the comparison of findings through homogeneous outcome reporting and ensuring the most important outcome domains to key stakeholders are reported.
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Al-Qasem, Leena. "Exploitation and clinical trials in developing countries." Thesis, Keele University, 2015. http://eprints.keele.ac.uk/1190/.
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This thesis discusses comprehensively the issue of exploitation from a normative perspective specifically relating to clinical trials within developing countries using a normative definition. Exploitation is defined from an unfairness perspective as the unfair use of an individual (group of individual) by another. In order to ease the flow of the arguments within this thesis, unfairness will be assessed from two different perspectives: a procedural perspective and an outcome perspective. The procedural perspective discusses whether the procedures followed when obtaining informed consent from the potential participants fulfilled the requirements of informed consent or failed to do so. Though the use of this approach it is concluded that informed consent is not a necessary condition for the avoidance of exploitation. Similarly, it is concluded that even if morally transformative, valid consent is given by potential participants, exploitation may still be lurking in the shadows of the interaction between the trial participants and the researchers/sponsors. The outcome perspective of unfairness focuses on the effect of the interaction on the parties involved within it and whether they benefit from their interaction with each other, are not affected by it, or are actually harmed as a result of the interaction. As an extension of this argument, the thesis will also consider the post-trial perspective of the interaction. The thesis concludes that post-trial access (reasonable availability) has a very narrow view of benefit and does not ensure that there is a fair share of the benefits between the parties involved. Instead of this narrow approach, a wider, post-trial benefit approach is adopted in order to prevent exploitation. Further discussion within the thesis will include, the requirements of an ethical review, the makeup of the review boards, and priority decision making in keeping with the current research ethics discussion in the literature.
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Engels, Colin. "Medicare & Medicaid vs. TRICARE: a benefits and cost comparison." Thesis, Monterey, California: Naval Postgraduate School, 2014. http://hdl.handle.net/10945/43907.
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Approved for public release; distribution is unlimitedThe current fiscal environment for the Department of Defense (DOD) is constrained. TRICARE and the military health system are an area where DOD military leaders have expressed serious concern over the balance between rising costs and retention. Medicare and Medicaid face similar budgetary challenges as spending for both these federal programs continues to rise. The purpose of this research was to determine the similarities and differences in coverage provided between TRICARE, Medicare, and Medicaid, compare costs and provider payment rates, and analyze cost implications for the federal budget. This research project accomplished the following: 1) determined that TRICARE and Medicare exhibited almost identical provider payment rates across all three of the states compared in this study, 2) determined that Medicaid payment rates in California and Connecticut are higher than TRICARE while rates in Mississippi are lower, 3) determined that TRICARE exhibited lower per capita spending and lower spending growth rates than Medicare or Medicaid.
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Maguiña, Duran Pamela Katherine. "Factores de riesgo que predisponen a hipertensión arterial en adultos que acuden al servicio de triaje del Centro de Salud "Max Arias Schreiber" - 2013." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2014. https://hdl.handle.net/20.500.12672/3536.
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El presente estudio de Investigación titulado “FACTORES DE RIESGO QUE PREDISPONEN A HIPERTENSIÓN ARTERIAL EN ADULTOS QUE ACUDEN AL SERVICIO DE TRIAJE DEL CENTRO DE SALUD “MAX ARIAS SCHREIBER” – 2013, tuvo como objetivo determinar los factores de riesgo que predisponen a Hipertensión Arterial en las personas adultas que acuden al Servicio de Triaje del Centro de Salud “Max Arias Schreiber”.
Dicho estudio es del tipo cuantitativo, nivel aplicativo, método descriptivo, lo cual permitió tener una visión de la situación de la variable estudiada en la población de los adultos.
La muestra estuvo conformada por 80 personas adultas, la técnica utilizada en la recolección de datos fue la entrevista y como instrumento se aplicó un cuestionario, concluyendo que los factores de riesgo que predisponen a hipertensión arterial en los adultos usuarios en dicho Centro de Salud, se encuentran presentes en la población de estudio. Los factores de riesgo modificables que predominan son el consumo de grasas, ausencia del control del índice de masa corporal y de la presión arterial, así como el consumo excesivo de sal y presencia de estrés. Los factores de riesgo no modificables que predisponen a hipertensión arterial prevalentemente son los antecedentes familiares de HTA y de obesidad.
Se concluyó que la población estudiada en su totalidad presentan los factores de riesgo modificables, los cuales fueron mencionados en el párrafo anterior. Esto sugiere desarrollar en el centro de salud, estrategias y actividades dirigidos a la promoción y prevención de la salud; como la implementación de un programa educativo sobre los factores de riesgo que predisponen a HTA y su prevención; de esta manera se logrará un mejor control de estos factores y se contribuirá para mejorar la calidad de vida de las personas.*** This research study entitled “RISK FACTORS THAT PREDISPOSE TO ARTERIAL HYPERTENSION IN ADULTS WHO COME TO THE SERVICE’ TRIAGE THE HEALTH CENTER MAX ARIAS SCHREIBER-2013”, had as objective to determine the risk factors that predispose to hypertension in adults who come to the service of triage of the Health Center. This study is quantitative, application level, descriptive method, which allowed us to create a vision of the situation of the variable studied in the population of adults. The sample consisted of 80 adults, the technique used in the data collection was the interview and data collection instrument was a questionnaire, concluding that the risk factors that predispose to hypertension in the adult users in the center of Health, are present in the study population. The modifiable risk factors that are dominated by the consumption of fats, absence of the control of the body mass index and blood pressure, as well as inadequate consumption of salt and the presence of stress. The risk factors not modifiable that predispose to hypertension are predominantly family history of hypertension and obesity. This study suggests that develop in the health center, strategies and activities related to preventive and promotional programs, directed to the healthy life styles; as the implementation of an educational program on the risk factors that predispose to hypertension and prevention; in this way can there be a better control of these factors and contribute toward the quality of life of the people.
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Frison, Lars Johan. "Analysis of repeated measures in clinical trials using summary statistics." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388955.
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