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1
Tell, Roger. « Description and prediction of clinical radiosensitivity : emphasis on normal tissue reactions / ». Stockholm, 2004. http://diss.kib.ki.se/2003/91-7349-814-9.
Texte intégral
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Webster, Sam E. « A Description of Clinical Pharmacist Services in a Nurse Practitioner Managed Outpatient Clinic with Recommendations for Future Studies ». The University of Arizona, 2009. http://hdl.handle.net/10150/623983.
Texte intégralRésumé :
Class of 2009 AbstractOBJECTIVES: The purpose of this study is to describe clinical pharmacist services in a nurse practitioner (NP) run clinic and how clinical pharmacists might influence prescribing. METHODS: The description of the clinical pharmacist services is based on a 12-week experience of a clinical pharmacist and senior student pharmacist working with the nurse practitioner and nurse practitioner students. A questionaire was developed and consisted of items relating to the nurse practitioners ability to identify possible interactions of OTC medications, herbals and prescription medications. In addition, the questionnare assessed the comfort level of NP’s taking a prescription medication history, checking a patient’s prescription formulary, and selecting appropriate medication therapies. The questionaire uses a retrospective pretest format and was tested as a method of collecting data on how a pharmacist influenced NP prescribing. The site selected for this study was the Arizona State University Center for Healthcare Innovation (ASU Center) located in the heart of Downtown Phoenix (3rd Ave and Van Buren). RESULTS: Only one nurse practitioner worked at the ASU Center. The facility is new to the neighborhood and does not see many patients. The nurse practitioner partner in this project responded that working with a clinical pharmacist on a regular basis, with more patients would definitely help her hone skills necessary to identify interactions and prescribe according to a patients formulary. CONCLUSIONS: Pharmacists provide value-added services in an ambulatory care clinic run by nurse practitioners and provide valuable education and consultation on drug interactions. Pharmacist influence can be measured successfully to using a questionnaire in a retrospective pretest-posttest study design.
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Kao, Alina. « Redefining postmenopausal dyspareunia : Critical review, description, and biopsychosocial correlates of an understudied pain disorder ». Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110388.
Texte intégralRésumé :
Dyspareunia (pain during intercourse) is highly prevalent in postmenopausal women and constitutes one of the most common presenting complaints in menopause clinics. Traditionally, postmenopausal dyspareunia has been almost exclusively attributed to declining endogenous estrogen levels and consequent vulvovaginal atrophy. This view still predominates today despite the lack of conclusive supporting evidence. The first chapter of this thesis critically reviews the literature on postmenopausal dyspareunia, examining the widely held conceptualization that postmenopausal dyspareunia is a direct symptom of hormonal decline. This review suggests that postmenopausal dyspareunia, similar to premenopausal dyspareunia, can be conceptualized as a pain syndrome. This conclusion motivated the collection of data from 182 postmenopausal women who suffered from pain during intercourse. A biopsychosocial protocol collecting hormonal, gynecologic, pain, as well as individual and interpersonal psychosocial data was carried out. Chapter two presents a systematic description of the clinical pain and medical attributes of postmenopausal dyspareunia. Cluster analytic techniques applied to these data suggest that several subtypes of postmenopausal dyspareunia can be distinguished. Chapter three investigates biopsychopsychosocial correlates of postmenopausal dyspareunic pain. Results demonstrate that the traditional hypoestrogen and vulvovaginal atrophy conceptualization of postmenopausal dyspareunia may be an insufficient explanatory model. Postmenopausal dyspareunic pain is also correlated with cognitive, affective, and dyadic factors. Overall, the results provide evidence that dyspareunia in postmenopausal women is a heterogenous disorder and underlines the need for research and clinical effort that integrates biological, psychological, and relationship factors to address the complexity of this condition.La dyspareunie (douleurs ressenties au cours des rapports sexuels) est très répandue chez les femmes post-ménopausées et constitue l'une des principales plaintes formulées par les femmes dans les cliniques de la ménopause. La dyspareunie post-ménopausique a traditionnellement été attribuée presque exclusivement à la baisse des niveaux d'oestrogènes endogènes et l'atrophie vulvo-vaginale qui en résulte. Ce point de vue prédomine encore aujourd'hui malgré l'absence de preuve permettant de l'établir de façon concluante. Le premier chapitre de cette thèse analyse de façon critique la littérature portant sur la dyspareunie post-ménopausique, examinant la conceptualisation largement répandue selon laquelle la dyspareunie post- ménopausique est un symptôme directement attribuable à une baisse hormonale. Cette analyse donne à penser que la dyspareunie pré-ménopausique, à l'instar de la dyspareunie post-ménopausique, peut être conceptualisée comme un syndrome douloureux. Cette conclusion nous a conduit à collecter des données auprès de 182 femmes post-ménopausées éprouvant de la douleur lors des rapports sexuels. Un protocole biopsychosocial de collecte de données hormonales, gynécologiques, et de la douleur, ainsi que de données psychosociales individuelles et interpersonnelles fut mis en œuvre. Le deuxième chapitre présente une description systématique de la douleur clinique et des caractéristiques médicales de la dyspareunie post-ménopausique. Des techniques d'analyse de groupement appliquées à ces données indiquent qu'il est possible de distinguer plusieurs sous-types de dyspareunie post-ménopausique. Le troisième chapitre examine les corrélats biopsychosociaux de la douleur dyspareunique post-ménopausique. Les résultats démontrent que la conceptualisation traditionnelle de la dyspareunie post-ménopausique fondée sur l'hypo-œstrogénie et l'atrophie vulvo-vaginale pourrait bien s'avérer un modèle explicatif incomplet. Par ailleurs, la douleur dyspareunique post-ménopausique est aussi corrélée à des facteurs cognitifs, affectifs et dyadiques. Dans l'ensemble, les résultats tendent à confirmer que la dyspareunie chez les femmes post-ménopausées constitue un trouble hétérogène, et témoignent de la nécessité pour la recherche et le travail clinique d'adopter une approche qui intègre les facteurs biologiques, psychologiques et relationnels afin de pouvoir appréhender ce problème dans toute sa complexité.
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Garon, Marie-Lou. « The photopic ERG luminance-response function : description, physiological basis and clinical application ». Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=95160.
Texte intégralRésumé :
In order to further define the photopic ERG luminance-response function and explore its potential value in the investigation of normal and pathological phenomena involving the cone visual pathways of the human retina, we recorded photopic ERGs on a broad range of intensities: 1) in response to very dim flashes of red, blue and white light; 2) during changes in the retinal light adaptation level; and 3) in patients affected with selected retinal diseases. Our experimental approach revealed that the photopic ERG luminance-response function is a useful tool to understand the basis of retinal physiology and can be used to some extent to facilitate segregation/dissociation of retinopathies involving specifically the ON or OFF-retinal pathways. ERG specialists would thus benefit from adding luminance-response recordings to their standard protocols.Afin de mieux définir la fonction luminance-réponse de l'ERG photopique et de déterminer son potentiel pour étudier les phénomènes normaux et pathologiques des voies visuelles liées aux cônes, nous avons enregistré des ERGs photopiques sur une large étendue d'intensités de stimulation dans les 3 trois conditions suivantes : 1) en réponse à de faibles stimuli de lumière rouge, bleue et blanche; 2) pendant l'adaptation de la rétine à la lumière; 3) chez des patients atteints de maladies rétiniennes choisies. Notre approche expérimentale a montré que la fonction luminance-réponse de l'ERG photopique est un outil utile pour comprendre les bases de la physiologie rétinienne et qu'elle permet également de catégoriser les rétinopathies affectant spécifiquement la voie ON ou la voie OFF de la rétine. Il serait donc indiqué d'ajouter l'enregistrement d'une courbe luminance-réponse aux protocoles cliniques standards.
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Short, Sotirios. « A description of the process of working intersubjectively with an insecurely attached young adolescent : a case study ». Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/11204.
Texte intégralRésumé :
Includes bibliographical references (leaves 57-61).The dissertation presents clinical case material from a psychodynamic therapy with a 12 year-old boy. He presents with minor conduct disturbance, difficulty in affective expression and withdrawal in the context of a dysfunctional family system. The case study research addresses the following aims. It uses information collected from initial interviews with the family and subsequent therapy and feedback sessions to explore the patient’s attachment patterns. It explores the links between the patient’s attachment style and his access to and expression of affect.
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Woodin, Nicola. « Charting domains of silence - a description of a process of feminist training addressing the rape of men in prison ». Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/17179.
Texte intégralRésumé :
The rape of adult males is a subject in need of attention. The rape of men within South African prisons particularly, has been inadequately researched and documented. Investigation is necessary in order to challenge myths which serve to maintain a 'cycle of silence' regarding the male rape, to guide preventative measures, and inform appropriate services. A training programme within Pollsmoor Prison, is described. The initiative addressed the rape of men in prison, upon request of a group of inmates and warders named 'Friends Against Abuse'. This record is a self-reflexive account of a facilitator's experiences of the research and training. It describes a process of reflection and action, its style consistent with the feminist values that informed the work. The methodological blend of Participatory Action Research, Experiential Training, and contributions from psychodynamic thinking, are elaborated. Discussion explores professional and personal challenges to women working within this domain. It raises questions regarding the impact of a feminist agenda on such work and considers issues of sustainability and the impact of similar interventions. Strategies to ensure effective implementation, monitoring and evaluation are suggested, as well as mechanisms to guarantee integrity, such as 'debriefings' and supervision.
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Erfanian, Nima, et Kaiser Ghodbeni. « Clinical Description of Patients Diagnosed with Oral and Genital Lichen Planus, a Register Study ». Thesis, Umeå universitet, Institutionen för odontologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-143876.
Texte intégralRésumé :
ABSTRACT The aim of this study is to chart a cohort of patients in the county of Västerbotten in Sweden who have been diagnosed with lichen planus. In addition to charting, the cohort has also been compared to similar previously studied groups. The studied group consist of patients who have been referred to the Department of Medical Biosciences and Pathology between years 2009-2015 with suspicious diagnosis of LP. After exclusion, 214 patients remained of which 130 were diagnosed with Oral LP and 84 with Genital LP. Different data such as age, medications and diseases was extracted from the dental journals. In this cohort women were more likely to be affected by LP. The mean age for females was 63 years and 53 years for men. In the studied group 17 % were being treated for hypertension, 14 % were treated with 5 or more different medications. Tobacco use was found in 17 % and 12 % were diagnosed with an autoimmune disease. The results from the studied cohort were in accordance with similar populations in previous studies. There is an undergoing discussion whether OLP and LP are the same disease that affects different sites.
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Matthews, Ryan. « A description of practices of analgesia administration by advanced life support paramedics in the City of Cape Town ». Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21187.
Texte intégralRésumé :
Introduction: Emergency Medical Services (EMS) are ideally placed to provide relief of acute pain and discomfort. EMS frequently follow locally prescribed guidelines and have a variety of qualifications each with differing capabilities and scopes of practice. The objectives of this study are to describe prehospital pain management practices by EMS in the Western Cape, South Africa. Methods: A retrospective descriptive survey was undertaken of analgesic drug administration by advanced life support (ALS) paramedics. Patient care records (PCRs) generated in t he City of Cape Town during an 11 month period containing administrations of Morphine, Ketamine, Nitrates and 50% Nitrous Oxide/Oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results: A total of 530 PCRs were included (N=530). Morphine was administered in 70% (95% CI 66 - 74, n=371) of cases, Nitrates in 37 %(95% CI 33 - 41, n=197) and Ketamine in 1.7% (95% CI 1 - 3, n=9) of cases. A total of 5mg or less of Morphine was administered in 75% (95% CI 70 - 79, n=278), with the mean dose being 4mg (IQR 3 - 6). Single doses were administered in 72.2% (95% CI, 67 - 77, n=268) of Morphine administrations, 56% (95% CI, 21 - 86, n=5) of Ketamine administrations and 82% (95% CI, 76 - 87, n=161) of Nitrate administrations. Chest pain was the reason for pain management in 43% (n=226) of cases. ALS providers have a median experience level of 2 years (IQR2 - 4). Conclusion: ALS providers in the Western Cape appear to use low doses of Morphine, with most analgesia administered as a single dose. Chest pain is an important reason for drug administration in acute prehospital pain. Paramedics do not appear to be using a weight based nor a titration based strategy.
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Jerrom, David William Andrew. « A description and evaluation of the introduction of a primary care clinical psychology service in one health district ». Thesis, University of Stirling, 1985. http://hdl.handle.net/1893/24393.
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The introduction of a primary care clinical psychology service into one Scottish Health District is described and evaluated. The service was widely used by G.P.s, and the volume of referrals increased each year. After 5 years of operation 83% of G.P.s had referred cases. The types of problems referred are described, two thirds of patients were suffering from generalised anxiety or phobias. The patients were a chronic population, the average length of problem being 6.9 years. G.P. and psychiatrist referred patients were compared, the latter had longer histories and there were differences in the types of problem referred. Outcome was evaluated using a number of measures. Consultation rate fell significantly post treatment and a significant proportion of patients stopped psychotropic medication. There were significant reductions in psychologist ratings of severity and in handicap, and in patient self-ratings of severity and General Health Questionnaire scores. Patient satisfaction with treatment 6 months post discharge was surveyed. The G.P.s satisfaction with the service was surveyed and found to be high. At follow up G.P.s rated 69% of patients as receiving "definite benefit" and 31% as "unchanged". A study of treatment of the commonest problem referred, generalised anxiety, was conducted using a waiting-list control group. Treatment group patients improved significantly on self rating questionnaires, controls did not change, but showed a similar order of treatment response when they did enter treatment. The costs of the service are compared to another report in the literature, and it is concluded that the service was cost-effective. A number of recommendations are made for further research in the field. It is concluded that primary care psychology services are feasible in terms of staffing levels, and also lead to significant patient benefit.
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Makhupane, Ntoetse. « Insecure attachment : a case study of the relationship between a mother and her daughter. A description of the competitive and tyrannical nature of an ambivalently attached girl ». Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11020.
Texte intégralRésumé :
Includes bibliographical references.This research is focused on an ambivalently attached girl who presented with adversarial and tyrannical behaviour. To understand her dynamics a self psychology lens was used as well as attachment theory. A qualitative method was used in this research which focuses on a single case study. To avoid the effects of subjectivity the illustrative material was discussed during supervision with both clinical supervision and research supervisor. The research ends with a discussion about the findings and how therapy has helped Jane to overcome her fears.
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Moga, Daniela Claudia. « Bladder antimuscarinics use in the veterans affairs community living centers : description of medication use and evaluation of risks and benefits ». Diss., University of Iowa, 2012. https://ir.uiowa.edu/etd/2586.
Texte intégralRésumé :
Urinary incontinence, one of the most prevalent conditions in elderly living in nursing homes (NH) was shown to significantly impact patient's quality of life (QOL) and health outcomes. Bladder antimuscarinics (BAM), the main drug class to treat urinary incontinence, have limited effects in managing the condition; however, given their anticholinergic properties and the characteristics of those living in NH, BAM could potentially lead to serious health consequences in this population.
We conducted a retrospective cohort study with a new-users design by linking existing Veterans Affairs (VA) data (inpatient, outpatient, pharmacy administrative files, and Minimum Data Set- MDS) between fiscal years 2003 and 2009. Potential risks (i.e. fractures and negative impact on cognitive performance) and benefits (i.e. improvement in urinary incontinence, social engagement and overall QOL) associated with initiation of a BAM were assessed in elderly (65+) admitted for long-term care in the VA Community Living Centers.
Descriptive statistics were used to compare BAM new-users and non-users at baseline; in addition, logistic regression was used to identify important predictors of BAM initiation. Treatment selection bias was addressed by using the propensity score matching method. After balancing the groups on baseline characteristics, the risk of fractures (hip fracture, any fracture) in relationship with BAM initiation was evaluated using Cox proportional hazard analysis. BAM impact on the cognitive status measured by the MDS-Cognitive Performance Scale (CPS) was evaluated through generalized estimated equations (GEE) method. Similarly, possible benefits measured through MDS were assessed via GEE.
The final cohort included 1195 BAM new-users (with the majority being prescribed Oxybutynin immediate-release) and 22,987 non-users. Predictors of BAM initiation included demographic characteristics, bladder and bowel continence status, comorbidities, medication use, cognitive performance and functional status.
Our study showed that BAM improved urinary continence (OR=1.27, 95%CI: 1.07-1.50) in those treated; social engagement as measured by MDS-Index of Social Engagement also improved in users, although at a level that is not clinically significant (difference in mean MDS-ISE=0.2074, 95%CI: 0.0550-0.3598). However, BAM initiation increased the risk of fractures (hip: HR=3.69, 95% CI: 1.46 - 9.34, p=0.0059; any fracture: HR=2.64. 95% CI: 1.37 - 5.10, p=0.0039). Our results showed no difference between new-users and non-users with regard to mean CPS and overall QOL.
The purpose of the study was to clarify the proper role of medication use in the management of urinary incontinence in elderly in the VA CLC. The results raise questions about the continued use of Oxybutynin IR, the main BAM prescribed in this population. Given the increased risk for fractures in the context of potential improvement in urinary continence with no clinically significant improvement in social engagement, a wiser step might be to investigate the safety profile for newer BAM for situations when an addition to non-pharmacologic management for urinary incontinence is desired for elderly in long-term care.
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Radcliff, Zach. « Implementing Integrated Care in Family Medicine : Description and Outcomes in an Underserved Population ». VCU Scholars Compass, 2017. https://scholarscompass.vcu.edu/etd/5592.
Texte intégralRésumé :
Introduction: Family physicians provide access to medical and behavioral healthcare for many underserved populations. Integrating behavioral health clinicians into primary care practices has been proposed as one of the most effective ways to increase access to necessary behavioral health services for many Americans. Integrated behavioral healthcare (IBHC) has begun to be implemented in family medicine practices but there is limited research examining the impact for patients and clinic staff. This study begins to fill this gap in the literature by examining the effects of implementing integrated behavioral healthcare in an urban family medicine clinic in a medically underserved area.
Objective: The objective of this study is to describe patients who use IBHC services, examine behavioral health outcomes, and study patient and staff satisfaction with IBHC services. This is done in the context of the Quadruple Aim of Healthcare which purposes to improve population health, provide a better patient experience, create smarter healthcare spending, and improve medical staff work quality of life. Aspects of implementation are addressed as well, namely the appropriateness, acceptability, adoption, feasibility, and penetration of IBHC services.
Methods: IBHC services were introduced to an urban family medicine clinic in a medically underserved area with a census of greater than 4,500 patients (56.17% African American, 24.4% White, 1% Asian, 22.9% Latino/a; 33.3 % Children under 18). Using information from medical records, a description and comparison of the general clinic population and those that use IBHC services is provided. Behavioral health outcomes were measured by tracking patient anxiety and depression over time, from initial session through follow-up at least 3 months after their final session for a subset of patients. Patient and clinic staff satisfaction were assessed using qualitative and quantitative methods. Supplemental analysis compare behavioral health outcomes against a previous sample of patients from the same clinic before IBHC services were present.
Results: Demographic information is presented and compared to highlight the unique difference between race/ethnicity, age, and gender. This study showed that adult patients experienced a significant reduction over time from initial session to follow-up with regards to anxiety, F(1.77, 130.63) = 65.65, p < .001, and depression, F(1.78, 131.68) = 37.88, p < .001. Patient interviews and surveys were analyzed and found that patients generally reported high satisfaction with IBHC services and found their behavioral health needs where addressed in the way they wanted them to be. Finally, medical staff reported high satisfaction with IBHC services and reported that they had reduced stress, increased comfort in caring for patients with behavioral health needs, and improved work quality of life.
Discussion: IBHC services were implemented at a family medicine clinic with a population that is overrepresented by minorities and uninsured patients. This study showed that implementation of IBHC addressed components of the Quadruple Aim of Healthcare, namely improvement of population health, enhanced patient experience, and improvement of clinic staff work life. IBHC services were found by patients and staff to be acceptable, appropriate, and feasible. Further, this study demonstrated the ability of a clinic to adopt IBHC services with sufficient penetration (10.8% of patients received at least brief services) after 2 years. Implications for practice and research and future directions are also discussed.
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Leonard, Martha Maria. « A description of final year nursing students' ability to recognize abnormal vital signs recordings and clinical decision-making process ». Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/6663.
Texte intégralRésumé :
Includes abstract.Includes bibliographical references.
The aim of this study was to determine whether final year nursing students can recognize and respond to abnormal vital sign recordings, and to analyse their clinical decision-making processes.
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Potts, James A. « Description, Classification, and Prediction of Dengue Illnesses in a Thai Pediatric Cohort : A Dissertation ». eScholarship@UMMS, 2010. https://escholarship.umassmed.edu/gsbs_diss/465.
Texte intégralRésumé :
Dengue fever (DF) and dengue hemorrhagic fever (DHF) are emerging infectious diseases which are endemic in many regions of the globe, many of which are resource-poor areas. DHF and DF impose a severe economic health burden in tropical and subtropical areas. Dengue virus causes an acute febrile illness that can be a self-limited febrile illness, as seen in most cases of DF, or a life-threatening illness with plasma leakage and shock, as seen in cases of DHF. A systematic review of the literature revealed gaps in the knowledge base of clinical laboratory findings of dengue illness with regards to longitudinal dynamics and classification and predictive modeling of disease severity. The objective of this thesis was to investigate the utility of clinical laboratory variables for classification and prediction of disease outcomes.
The data used in this investigation was derived from a prospective study of Thai children presenting to either of two study hospitals within 72 hours of onset of an acute febrile illness. Systematic data collection, including clinical laboratory parameters, and routine clinical management continued each day until 24 hours after the fever had subsided. A final diagnosis of DHF, DF, or other febrile illness (OFI) was assigned by an expert physician after chart review.
The first research objective of this study was to describe the temporal dynamics of clinical laboratory parameters among subjects with DHF, DF, or OFI. Data were analyzed using lowess curves and population-average models. Quadratic functions of clinical variables over time were established and demonstrated significantly divergent patterns between the various diagnostic groups.
The second research objective was to establish and validate tools for classification of illness severity using easily obtained clinical laboratory measures. Bivariate logistic regression models were established using data from one hospital in an urban area of Thailand as a training data set and validated with a second data set from a hospital in a rural area of Thailand. The validated models maintained a high sensitivity and specificity in distinguishing severe dengue illnesses without using the hallmark indicators of plasma leakage.
The third research objective used classification and regression tree (CART) analysis to established diagnostic decisions trees using data obtained on the day of study enrollment, within the first 3 days of acute illness. Decision trees with high sensitivity were established for severe dengue defined either as: 1) DHF with evidence of shock (dengue shock syndrome, DSS); or 2) DSS or dengue with significant pleural effusion.
This study expands existing knowledge of the potential utility of clinical laboratory variables during different phases of dengue illness. The application of the results of these studies should lead to promising opportunities in the fields of epidemiological research and disease surveillance to reduce the health burden, and improve the clinical management, of dengue illness. Future directions involve application of these algorithms to different study populations and age groups. Additionally, other analytical techniques, such as those involving CART analysis, can be explored with these data.
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Daniel, Öberg. « Clinical Assessment for Deep Vein Thrombosis using Support Vector Machines : A description of a clinical assessment and compression ultrasonography journaling system for deep vein thrombosis using support vector machines ». Thesis, KTH, Skolan för datavetenskap och kommunikation (CSC), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-178419.
Texte intégralRésumé :
This master thesis describes a journaling system for compression ultrasonography and a clinical assessment system for deep vein thrombosis (DVT). We evaluate Support Vector Machines (SVM) models with linear- and radial basis function-kernels for predicting deep vein thrombosis, and for facilitating creation of new clinical DVT assessment. Data from 159 patients where analysed, with our dataset, Wells Score with a high clinical probability have an accuracy of 58%, sensitivity 60% and specificity of 57% these figured should be compared to those of our base models accuracy of 81%, sensitivity 66% and specificity 84%. A 23 percentage point increase in accuracy.The diagnostic odds ratio went from 2.12 to 11.26. However a larger dataset is required to report anything conclusive. As our system is both a journaling and prediction system, every patient examined helps the accuracy of the assessment.I denna rapport beskrivs ett journalsystem samt ett system för klinisk bedömning av djupvenstromboser.Vår modell baserar sig på en stödvektormaskin (eng. Support Vector Machine) med linjär och radial basfunktion för att fastställa förekomsten av djupa ventromboser samt att hjälpa till i skapandet av nya modeller för bedömning. 159 patientjournaler användes för att fastställa att Wells Score har en klinisk precision på 58%, 60% sensitivitet och specificitet på 57% somkan jämföras med våran modell som har en precision på 81%, 66% sensitivitet och specificitet på 84%. En 23 procentenheters ökning i precision.Den diagnostiska oddskvoten gick från 2.12 till 11.26. Det behövs dock en större datamängd för att rapportera något avgörande. Då vårt system både är för journalskapande och klinisk bedömning så kommer varje undersökt patient att bidra till högre precision i modellen.
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Ovejero, Crespo Diana. « The clinical description, molecular etiology, and pathophysiological studies in cutaneous skeletal hypophosphatemia syndrome : a mosaic disorder of activating RAS mutations ». Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/405963.
Texte intégralRésumé :
Introducción: El síndrome Cutaneo Esquelético Fosfatémico (SCEF) es una enfermedad mosaica ultrarara causada por mutaciones RAS postzygóticas que se define por la asociación de nevus epidérmicos y/o melanocíticos, sobreproducción de factor de crecimiento fibroblastico-23 (FGF23), y lesiones displásicas óseas. Dada su rareza, el SCEF no ha sido caracterizado adecuadamente. Asimismo, se desconoce el papel de las mutaciones RAS en la génesis de las lesiones óseas, así como la fisiopatología de la sobreproducción de FGF23 en el SCEF. Hipótesis: 1) El fenotipado de pacientes con SCEF así como el análisis de todos los casos de SCEF publicados proveerán información clínica relevante, 2) Las lesiones óseas displásicas son la fuente de sobreproducción de FGF23 en el SCEF, y 3) La creación de modelos experimentales adecuados informarán sobre la fisiopatología del SCEF. Objetivos: 1) Caracterizar el SCEF clínicamente mediante el estudio de una cohorte de sujetos y una revisión bibliográfica de todos los casos publicados, 2) Identificar el tejido responsable de la sobreproducción de FGF23 en el SCEF, y 3) Investigar los efectos de las mutaciones RAS en el desarrollo de lesiones óseas. Sujetos y métodos: 5 sujetos con SCEF fueron fenotipados de manera exhaustiva. Se identificaron 51 casos en la revisión bibliográfica compatibles con SCEF. Se recogieron y analizaron datos sobre la histología ósea, alteraciones esqueléticas, minerales, cutáneas y de otros tejidos, así como las respuestas a diferentes tratamientos para la hipofosfatemia en los sujetos de la cohorte y la literatura. Se evaluaron los efectos de las mutaciones RAS en la producción/expresión de FGF23 en células humanas mesenquimales de médula ósea (hBMSCs) y en células IDG-SW3 transducidas con adenovirus portadores de mutaciones RAS, en hBMSCs mutantes procedentes de un paciente con SCEF, y en células IDG-SW3 tratadas con medio de cultivo de hBMSCs mutantes. Se trasplantaron subcutáneamente hBMSCs mutantes en ratones inmunocomprometidos para generar osículos con características histológicas de SCEF. Se crearon 3 modelos de ratones transgénicos mediante la recombinación Cre-Lox que se basaban en la activación del transgén LoxP-STOP-LoxP-KrasG12D mediante los siguientes promotores de recombinasa Cre: la porción 3.6kb del colágeno 1 alpha-1 inducible por tamoxifeno, Prx1 inducible por tamoxifeno, y Prx1 no inducible. Resultados: La mayor parte de sujetos con SCEF presentaban fracturas, deformidades esqueléticas, y escoliosis. La hipofosfatemia no estaba presente en el nacimiento. Se detectó osteomalacia severa en la histología ósea sin otras alteraciones. Se identificaron lesiones diplásicas en todos los compartimentos esqueléticos. La suplementación con fosfato y calcitriol fue efectiva en la mayoría de sujetos para el raquitisimo/hipofosfatemia. La extirpación de los nevus no se asoció de manera clara con un incremento de la fosfatemia. Se observó una mejoría de las alteraciones minerales asociadas a la edad. Se identificaron en muchos sujetos varias manifestaciones extra-óseas/extra-cutáneas, incluyendo neoplasias, pero no se identificaron cánceres óseos. No se detectaron incrementos de FGF23 en ninguno de los experimentos in vitro. No se pudieron caracterizar adecuadamente los osículos dada una formación ósea insuficiente. No se identificaron anormalidades en los modelos de ratón inducibles. No se identificó ningún ratón doble transgénico para la Prx1 cre-recombinasa y LoxP-STOP-LoxP-KrasG12D. Conclusiones: el fenotipado de la cohorte y la revisión bibliográfica proporcionó información clínica relevante. No obstante, el tejido responsable de la sobreproducción de FGF23 en el SCEF sigue sin conocerse pero los resultados sugieren que los nevus no son la fuente. Otras conclusiones incluyen la falta de idoneidad de las hBMSCs para estudiar la producción FGF23, la escasa eficiencia/reproducibilidad de la formación ósea mediante la implantación de hBMSCs en ratones inmunocomprometidos, y la letalidad de la expresión generalizada de mutaciones Kras en células esqueléticas embrionarias murinas.Introduction: Cutaneous Skeletal Hypophosphatemia Syndrome (CSHS) is an ultra-rare mosaic disorder caused by postzygotic RAS mutations that is defined by the association of epidermal and/or melanocytic nevi, fibroblast growth factor-23 (FGF23) excess, and a skeletal dysplasia. Because of its rarity, CSHS has been inadequately characterized. Further, unknown are the roles of RAS mutations in dysplastic bone formation and the source and physiopathology of FGF23 overproduction in CSHS. Thesis hypotheses: 1) A thorough phenotypic assessment of patients with CSHS, and the analysis of all potential reported CSHS cases will provide important clinical information, 2) Dysplastic bone is the source of FGF23 overproduction in CSHS and, 3) The generation of appropriate experimental models will inform of CSHS’s physiopathology. Objectives: 1) To clinically characterize CSHS through the study of a cohort of subjects and a review of all reported cases, 2) To identify the physiopathology of FGF23 overproduction in CSHS, 3) To investigate the effects of hyperactive Ras on dysplastic bone formation. Subjects and methods: Five CSHS subjects were phenotyped and underwent prospective data collection. A review of the literature identified 51 subjects in whom the findings were compatible with CSHS. Data on nevi, bone histology, mineral and skeletal alterations, abnormalities in other tissues, and response to treatments of hypophosphatemia were analyzed. To assess the effects of RAS mutations on FGF23 production in “bone-like” cells, FGF23 production/gene expression was measured in 1) human bone marrow stromal cells (hBMSCs) and 2) IDG-SW3 cells transduced with mutated adenoviral RAS constructs, in 3) mutant hBMSCs from a CSHS patient, and in 4) IDG-SW3 cells treated with media in which mutant CSHS hBMSCs had been cultured. To further characterize CSHS bone histology, an ossicle formation assay was performed by transplanting mutant CSHS hBMSCs subcutaneously into immunocompromised mice. Finally, 3 tissue-specific mutant Ras knock-in mouse models were designed through Cre-Lox recombination technology to investigate the effects of activating Ras mutations in bone. The models consisted in the activation of a LoxP-STOP-LoxP-KrasG12D (LSL-KrasG12D) transgene through 3 different Cre-recombinases driven by the following promoters: 1) tamoxifen-inducible 3.6 kb collagen type I α-1, 2) tamoxifen-inducible paired-related homeobox gene-1(Prx1), and 3) non-inducible Prx1. Results: From a clinical standpoint, fractures, limb deformities, and scoliosis affected most CSHS subjects. Hypophosphatemia was not present at birth. Bone histology only revealed severe osteomalacia without other obvious abnormalities. Skeletal dysplasia was reported in all anatomical compartments. Phosphate and calcitriol supplementation was effective in treating rickets in most patients. Convincing data that nevi removal improved blood phosphate levels was lacking. An age-dependent improvement in mineral abnormalities was observed. A spectrum of extra-osseous/extra-cutaneous manifestations that included both benign and malignant neoplasms was present in many subjects, although osteosarcoma remains unreported. From an experimental standpoint, increased FGF23 production/expression was not detected with any of the experimental conditions in the in vitro experiments. Poor bone formation with the ossicle assay hampered histological characterization of the ossicles. No abnormal findings were detected in the models featuring the tamoxifen-inducible promoters. No double transgenic offspring harboring both LSL-KrasG12D and the non-inducible Prx1-Cre recombinase were identified. Conclusions: The study of patients and reports of subjects with CSHS provided relevant and novel clinical information. Also, the analysis of affected patient tissues allowed further appreciation of the effects of hyperactive RAS in different organs. Still, the source of excess FGF23 in CSHS remains unknown, although data indicate it is probably not produced by the nevi. Other conclusions include the lack of suitability of BMSCs to study FGF23 production/expression, the poor reproducibility of the subcutaneous ossicle formation assay, and the lethality of widespread Kras mutations in early embyrionic skeletal cells in mice.
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Cabeli, Vincent. « Learning causal graphs from continuous or mixed datasets of biological or clinical interest ». Electronic Thesis or Diss., Sorbonne université, 2021. http://www.theses.fr/2021SORUS331.
Texte intégralRésumé :
Les travaux de cette thèse s’inscrivent dans la théorie principalement développée par Judea Pearl sur les diagrammes causaux; des modèles graphiques qui permettent de dériver toutes les quantités causales d’intérêt formellement et intuitivement. Nous traitons le problème de l’inférence de réseau causal à partir uniquement de données d’observation, c’est-à-dire sans aucune intervention de la part de l’expérimentateur. En particulier, nous proposons d’améliorer les méthodes existantes pour les rendre plus aptes à analyser des données issues du monde réel, en nous affranchissant le plus possible des contraintes sur les distributions des données, et en les rendant plus interprétables. Nous proposons une extension de MIIC, une approche basée sur les contraintes et la théorie de l’information pour retrouver la classe d’équivalence du graphe causal à partir d’observations. Notre contribution est un algorithme de discrétisation optimale basé sur le principe de description minimale pour simultanément estimer la valeur de l’information mutuelle (et multivariée) et évaluer sa significativité entre des échantillons de variables de n’importe quelle nature : continue, catégorique ou mixte. Nous mettons à profit ces développements pour analyser des jeux de données mixtes d'intérêt clinique (dossiers médicaux de patients atteints de troubles cognitifs; ou du cancer du sein) ou biologique (réseaux de régulation génique de cellules précurseur hématopoïétiques)The work in this thesis follows the theory primarily developed by Judea Pearl on causal diagrams; graphical models that allow all causal quantities of interest to be derived formally and intuitively. We address the problem of causal network inference from observational data alone, i.e., without any intervention from the experimenter. In particular, we propose to improve existing methods to make them more suitable for analyzing real-world data, by freeing them as much as possible from constraints on data distributions, and by making them more interpretable. We propose an extension of MIIC, a constraint-based information-theoretic approach to recover the equivalence class of the causal graph from observations. Our contribution is an optimal discretization algorithm based on the minimum description length principle to simultaneously estimate the value of mutual (and multivariate) information and evaluate its significance between samples of variables of any nature: continuous, categorical or mixed. We use these developments to analyze mixed datasets of clinical (medical records of patients with cognitive disorders; or breast cancer and being treated by neoadjuvant chemotherapy) or biological interest (gene regulation networks of hematopoietic stem and precursor cells)
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Mohanna, K. « A description of some of the features of general practice consultations in a clinic in India with reference to the Clinical Skills Assessment (CSA) of the United Kingdom Royal College of General Practitioners ». Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1538682/.
Texte intégralRésumé :
This thesis describes some of the features of general practice consultations in a clinic in India with reference to the Clinical Skills Assessment (CSA) of the United Kingdom Royal College of General Practitioners. There is a significant difference in the success rate in this postgraduate licensing assessment between those doctors trained in India and those trained in the UK, the reasons for which are not known. Some doctors from India feel that this is in part due to family medicine being performed differently in India. The results presented here first explore the reported experience of doctors working in family medicine in India through focus group and interviews looking at contextual aspects of practice; and then through conversation analysis explore the work done by talk-in-interaction in video recordings of actual family medicine consultations in India; a unique study. The CSA heavily emphasises the assessment of talk as used in three domains - data gathering, clinical management and interpersonal skills. I will propose a definition of ‘interactional fluidity’, based on the expectations of RCGP examiners about markers of competence, and consider its implications in this high stakes assessment process. Using a model that differentiates between ‘core business work talk’ , ‘work-related talk’ , ‘social talk’ and ‘phatic communion’, which last two are grouped as ‘small talk’, the talk in these consultations will be analysed. The impact of Indian societal norms and the risk of examiners mistaking unfamiliar patterns of talk for lack of medical competence are discussed. Reflecting on the journey from clinician-educator to practitioner-researcher the thesis describes the impact the study has had on the personal practice of the author and also the implications for maintaining fairness in training and assessing international medical graduates within the UK.
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Sennsfelder, Laëtitia. « Troubles du Spectre de l'Alcoolisation Foetale (TSAF) : Description clinique d'une série de patients réunionnais et recherche de biomarqueurs épigénétiques à visée diagnostique ». Electronic Thesis or Diss., La Réunion, 2024. https://elgebar.univ-reunion.fr/login?url=http://thesesenligne.univ.run/24_11_L_SENNSFELDER.pdf.
Texte intégralRésumé :
Les Troubles du Spectre de l’Alcoolisation Fœtale (TSAF), reconnus comme problème majeur de Santé Publique, représentent la première cause évitable de handicap neurocognitif et d’inadaptation sociale. De nos jours, malgré la présence de lignes directrices, le diagnostic de ces troubles reste difficile, notamment pour les formes non syndromiques, sans signe physique évocateur, tels que les Troubles Neuro-Développementaux Liés à l’Alcool (TNDLA). Les raisons pouvant expliquer cette errance diagnostique sont multiples : 1 - la confirmation de l’exposition prénatale et/ou préconceptionnelle à l’alcool (EPA) repose sur une démarche déclarative, souvent difficile pour les parents et compliquée en cas de placement ou d’adoption ; 2 - les TSAF, encore peu connus ou sous-évalués par certains professionnels de santé peuvent être confondus avec d’autres syndromes et volontiers considérés comme un diagnostic différentiel ; 3 – le diagnostic est uniquement clinique, en l’absence de tests biologiques fiables. Ce retard voire cette absence diagnostique limite la prise en soins et l’accompagnement, pourtant déterminants pour améliorer la trajectoire de vie. La recherche de nouveaux biomarqueurs diagnostiques est devenue un enjeu considérable au cours de ces dernières années. Pour répondre à cet enjeu, nous proposons de décrire une série de 147 enfants et adolescents suivis au CHU de La Réunion, tant sur le plan clinique (anamnestique et phénotypique), que biologique (génétique et épigénétique) afin de proposer des éléments diagnostiques utiles pour un repérage précoce de ces patients et de leurs familles. Sur le plan clinique, notre étude vient conforter les critères diagnostiques classiquement proposés dans la littérature, en décrire de nouveaux, telle la camptodactylie des extrémités, et met en lumière l’état de vulnérabilités associées chez ces enfants porteurs de TSAF (exposition préconceptionnelle paternelle, exposition à de multiples toxiques, prématurité, situation socio-familiale complexe, anomalie génétique associée dont l’origine questionne sur la possibilité d’une fragilité chromosomique sous-tendue par des mécanismes épigénétiques). Cette description clinique, la première réalisée sur une large série de patients Réunionnais, vient renforcer la nécessité d’un dépistage précoce afin d’améliorer le pronostic, limiter les handicaps surajoutés et les handicaps secondaires, afin d’optimiser la qualité de vie, d’une part des enfants atteints, mais aussi de la fratrie potentiellement atteinte et d’impliquer, d’accompagner et au besoin de prendre en soin les parents.Au niveau épigénétique, nous avons identifié chez des enfants atteints de TSAF âgés de 0 à 18 ans, une expression différentielle et persistante de microARN. Les sous-profils d’expression diffèrent selon le tissu étudié (cellules épithéliales buccales ou plasma) mais aussi selon les catégories diagnostiques (SAF complet, SAF partiel ou TNDLA). Ces résultats, à confirmer sur une plus large série, pourraient laisser entrevoir la possibilité d’une signature épigénétique chez les patients, déterminante pour proposer un diagnostic le plus précoce possibleRecognized as a major public health problem, Fetal Alcohol Spectrum Disorders (FASD) are the leading cause of avoidable neurocognitive disorders and social maladjustment. Despite diagnostic guidelines, the diagnosis of FASD remains complex, particularly in non-syndromic forms without physical signs such as ARNDs. There are several possible reasons for this misdiagnosis : 1- the confirmation of prenatal and/or preconceptional alcohol exposure (PAE) is based on a declarative approach, which is often difficult for parents and complicated in the case of placement or adoption; 2- FASD, which are still little known or underestimated by some health professionals, may be confused with other genetic syndromes and easily considered as a differential diagnosis; 3- This delay or even this absence of diagnosis limits care and support, which are nevertheless decisive in improving the life trajectory. The search for new diagnostic biomarkers has become a major challenge in recent years. In response to this challenge, we propose to describe a series of 147 children and adolescents followed at the University Hospital of Reunion Island, both clinically and biologically (genetic and epigenetic data), in order to provide useful diagnostic information for the early identification of these patients and their families. Our clinical study confirmed the diagnostic criteria classically proposed in the literature; new criteria are also described describes new ones, such as camptodactyly of the extremities, and highlights the vulnerabilities associated with FASD in these children (paternal preconceptional exposure, exposure to multiple toxins, prematurity, complex socio-familial situation, associated genetic anomaly whose origin raises questions about the possibility of chromosomal fragility underpinned by epigenetic mechanisms). This precise clinical description, the first carried out on a large series of patients from Reunion, reinforces the need for early detection to improve the prognosis, limit additional and secondary disabilities, optimize the quality of life of affected children and potentially affected siblings, and offers, if necessary, parental care.Considering the epigenetic analyses, we identified differential and persistent miRNAs expression in children with FASD aged 0-18 years. The expression sub-profiles differed according to the tissues studied (buccal epithelial cells or plasma), but also according to the diagnostic categories (FAS, partial FAS, ARND). These results, which need to be confirmed in a larger series, could indicate the possibility of an epigenetic signature in patients, which would be crucial in proposing an early diagnosis of patients
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Placzek, Hilary. « A Population-Based Epidemiological Description of Socio-Demographic Characteristics and Predictors of Severity Among Hospitalized 2009 H1N1 Influenza Cases in Massachusetts : A Dissertation ». eScholarship@UMMS, 2012. https://escholarship.umassmed.edu/gsbs_diss/602.
Texte intégralRésumé :
The spread of pandemic influenza A (2009 H1N1 influenza) virus resulted in a global influenza pandemic in 2009. During the early stages of the pandemic, population surveillance was crucial. However, officials around the world realized that many of our surveillance and reporting systems were not prepared to respond in a coordinated, integrated way, which made informed public health decision-making very difficult. More accurate estimates of the total number of hospitalized 2009 H1N1 influenza cases were required to calculate population-based 2009 H1N1 influenza-associated mortality, morbidity and hospitalization rates. For instance, how many people were hospitalized with 2009 H1N1 influenza in Massachusetts? Of these, how many were admitted to the ICU and how many died? Compared to seasonal influenza, were some race/ethnic and age groups affected more than others, and what types of characteristics led to more severe manifestations of 2009 H1N1 influenza among these groups in Massachusetts?
To address the above questions, I proposed a retrospective cohort study using data from the Hospital Discharge Database (HDD), which contains data for all inpatients discharged from 76 acute care hospitals in Massachusetts, as well as Census information to provide a measure of socioeconomic status (SES). My specific aims are as follows: 1. Develop methods to identify influenza cases precisely and describe characteristics of those hospitalized with ILI in MA between April 26-Sept 30, 2009; 2. Conduct analyses to identify race/ethnicity-related trends in reference to 2009 H1N1 influenza-related hospitalizations; 3. Conduct analyses to identify age-related trends in reference to 2009 H1N1 influenza-related hospitalizations.
First, I established influenza case selection criteria using hospital discharge data. I addressed limitations in the published methods on defining cases of influenza using administrative databases, and evaluated ICD-9 codes that correspond with common and relatively serious respiratory infections and influenza using a ‘maximum’ and ‘minimum’ approach. Results confirmed that 2009 H1N1 influenza affected a younger population, and disproportionately affected racial minorities in Massachusetts. There were also higher rates of ICU admission compared to seasonal influenza.
I then presented epidemiological data indicating race/ethnic disparity among 2009 H1N1 influenza cases in Massachusetts. I found that Hispanics had significantly lower odds of 2009 H1N1 influenza-related ICU stay. SES gradients calculated using five-digit zip code information did not account for these differences. Within race/ethnic strata, Hispanics
Finally, I presented epidemiological data indicating differences among 2009 H1N1 influenza cases by age group in Massachusetts. I calculated measures of Diagnostic Cost Group (DxCG) comorbidity for the study population to provide a comorbidity measure at baseline. Main results indicate that although comorbidity scores were similar between the 2009 H1N1 influenza and seasonal influenza groups, 2009 H1N1 influenza caused more severe disease in younger age groups.
This is the first study to report population-based statewide outcomes in all acute care centers in MA. In this dissertation I address challenges surrounding influenza surveillance to create case selection criteria within an administrative database. Using my case selection criteria, I then provide data related to fatality and severity of 2009 H1N1 influenza in Massachusetts in reference to sociodemographic variables such as racial/ethnicity and age groups, and provide evidence for patient-level interventions to those hardest hit by influenza. These findings provide valuable information about using large administrative databases to describe pandemic influenza cases and guide resource allocation to reduce disparities in relation to pandemic influenza preparedness.
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Abler, Daniel Jakob Silvester. « Software architecture for capturing clinical information in hadron therapy and the design of an ion beam for radiobiology ». Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:c2d9cf79-7b2d-4feb-bb17-53f003a8557c.
Texte intégralRésumé :
Hadron Therapy (HT) exploits properties of ion radiation to gain therapeutic advantages over existing photon-based forms of external radiation therapy. However, its relative superiority and cost-effectiveness have not been proven for all clinical situations. Establishing a robust evidence base for the development of best treatment practices is one of the major challenges for the field. This thesis investigates two research infrastructures for building this essential evidence. First, the thesis develops main components of a metadata-driven software architecture for the collection of clinical information and its analysis. This architecture acknowledges the diversity in the domain and supports data interoperability by sharing information models. Their compliance to common metamodels guarantees that primary data and analysis results can be interpreted outside of the immediate production context. This is a fundamental necessity for all aspects of the evidence creation process. A metamodel of data capture forms is developed with unique properties to support data collection and documentation in this architecture. The architecture's potential to support complex analysis processes is demonstrated with the help of a novel metamodel for Markov model based simulations, as used for the synthesis of evidence in health-economic assessments. The application of both metamodels is illustrated on the example of HT. Since the biological effect of particle radiation is a major source of uncertainty in HT, in its second part, this thesis undertakes first investigations towards a new research facility for bio-medical experiments with ion beams. It examines the feasibility of upgrading LEIR, an existing accelerator at the European Organisation for Nuclear Research (CERN), with a new slow extraction and investigates transport of the extracted beam to future experiments. Possible configurations for the slow-resonant extraction process are identified, and designs for horizontal and vertical beam transport lines developed. The results of these studies indicate future research directions towards a new ion beam facility for biomedical research.
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Urruticoechea, Ribate Ander. « Description and Pre-clinical Validation of Dynamic Molecular Determinants of Sensitivity to Aromatase Inhibitors in Breast Cancer / Descripción y Validación Pre-Clínica de Marcadores Moleculares Dinámicos de Sensibilidad a Inhibidores de la Aromatasa en Cáncer de Mama ». Doctoral thesis, Universitat de Barcelona, 2008. http://hdl.handle.net/10803/1103.
Texte intégralRésumé :
DE LA TESIS:El cáncer primario de mama es un problema de salud de gran magnitud con una incidencia estimada de 1 de cada 10 mujeres. De entre los tratamientos sistémicos, el tratamiento hormonal cuenta con un papel más establecido como complementario a la cirugía y con un perfil de toxicidad/eficacia más favorable.
Los tratamientos hormonales considerados actualmente como de primera línea pertenecen a dos grupos. Un primero grupo es el formado por los fármacos con selectividad por el receptor de estrógeno y con actividad moduladora sobre el mismo (SERMs) de los cuales el más utilizado es el tamoxifeno o con actividad "destructora" el fulvestrant. El otro gran grupo, con actividad exclusiva en la mujer postmenopáusica y en el que se centra la presente tesis es el de los inhibidores de la aromatasa (letrozol, anastrozol o exemestano). Este último grupo basa su actividad en la deprivación de sustrato al receptor de estrógeno al impedir la producción de estradiol en los diversos tejidos.
Aunque estos fármacos producen una mejoría de las tasas de curación cuando se aplican como tratamiento complementario, la resistencia a dichos tratamientos en, sin embargo, un hecho frecuente. Dicha resistencia puede responder a dos supuestos: la denominada resistencia inicial o de novo y tardía o adquirida. La resistencia de novo es lo habitual en tumores que no expresan el receptor de estrógeno (RE), mientras que la resistencia adquirida no suele ir habitualmente acompañada de la negativización del RE.
Dado este escenario, dos grandes áreas se abren para la investigación con los fármacos actuales: la búsqueda de mejores valores predictivos que la simple positividad de RE y la descripción de nuevos indicadores de beneficio tras tratamiento hormonal más allá de la mera reducción tumoral. Este último aspecto en concreto va cobrando cada vez más importancia conforme se van conociendo los cambios que se producen en la biología tumoral tras la aplicación de tratamientos endocrinos y se va generando la convicción de que ni la falta de reducción tumoral significa siempre resistencia ni la existencia de la misma es el parámetro que mejor permite distinguir a aquellas pacientes con menos posibilidades de generar resistencia ulteriormente.
Una de las áreas de mayor interés en el ámbito de la predicción de respuesta al tratamiento es el estudio de los llamados biomarcadores dinámicos, es decir, en los que el valor predictivo no se basa en la determinación basal del estatus del marcador en cuestión sino en la observación del cambio biológico que este marcador experimenta de modo precoz tras iniciar el tratamiento. En este sentido el marcador más estudiado es Ki-67, una proteína nucleolar universalmente asociada a proliferación. El decremento en la expresión de KI-67 medido con técnicas de inmunohistoquímica en dos biopsias consecutivas obtenidas respectivamente antes y 10-15 días después de iniciar un tratamiento hormonal con inhibidores de la aromatasa ha demostrado, si bien no estando significativamente relacionado con la reducción del volumen tumoral, tener un valor potencial de discriminar comparativamente a aquellos tratamientos que asocian mayor beneficio a largo plazo. Este valor, en los primeros estudios, parece superar el de la respuesta tumoral es sí. El decremento de Ki-67 presenta, sin embargo, limitaciones tanto es su valor como en la técnica necesaria para su determinación.
Por todo lo anteriormente expuesto, el objetivo principal del presente trabajo de tesis doctoral es la descripción y validación preclínica de nuevos biomarcadores dinámicos que mejoren la utilidad de ki-67.
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Gaddis, Stephen R. « Narrative means to research ends : Learning about therapy from clients' descriptions ». Related electronic resource : Current Research at SU : database of SU dissertations, recent titles available full text, 2002. http://wwwlib.umi.com/cr/syr/main.
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RODRIGUEZ, AUBREY JOY. « JUDGEMENT OF SUB-CLINICAL DEPRESSION IN PRIVATE AND PUBLIC SELF-DESCRIPTIONS ». Thesis, The University of Arizona, 2008. http://hdl.handle.net/10150/192229.
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Haworth, Navine. « Developing chiropractic students clinical practice skills - elements of best practice : a qualitative exploratory descriptive study ». Thesis, Federation University Australia, 2021. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/176916.
Texte intégralRésumé :
Background Although chiropractic has 125 years as an established profession, scrutiny of the literature proves that few studies have examined the clinical education of chiropractic students with a call for research from academics. This thesis is significant as it develops knowledge that can inform chiropractic bodies and help them improve an essential component of chiropractic education: clinical skill development. Research Purpose and Aims The purpose of this study was to identify elements of best practices in clinical education by critically examining, exploring and describing the aspects of an exemplar chiropractic clinical program that develops students’ clinical practice skills for transition into practice. This study explored the innovative clinical program of a reputable American chiropractic institution providing a scaffolded clinical program across varied clinical settings, patient populations and amongst other health disciplines. Research Design A six-phase exploratory descriptive qualitative design (EDQD) study was conducted to explore and describe the phenomenon being examined (Flick, 2014). This design enabled the collection of information about perceptions and lived experiences of three stakeholder cohorts: clinical faculty members, students and new graduates. Methods Purposive sampling (of students and clinical faculty members) and snowball sampling techniques (of new graduates) were used to derive the sample. Data were collected in three cycles across a two-year period using in-depth, semi-structured interviews. Interviews were conducted with 15 clinical faculty members and eight new graduates, and semi-structured focus groups were conducted with 20 students. All data were audio recorded, transcribed and thematically analysed using an inductive approach. Findings Chiropractic clinical education programs ought to be developed within a framework that incorporates adult learner principles; situated, social and experiential learning theories. Valued was a student-centred learning experience that includes authentic and diverse clinical placements, supervision and mentoring from multiple clinical educators which enhances students’ access to varied perspectives of clinical practices that contributes to developing clinical skills and professional identity. Business knowledge and entrepreneurial skills was an area of deficiency, which is problematic when the objective is to build graduates’ independence in clinical practice and professional prospects are predominantly private practice (NBCE, 2020). Embedding evidence-based practice within curricula and clinical training for educators and students are necessary to ensure this becomes a part of clinical practice. Conclusion This thesis posits best practice in chiropractic clinical education consists of the following: (a) using a scaffolded longitudinal clinical program, (b) varying clinical placements and case mix, (c) supervision and mentoring from multiple clinical educators, (d) educating the clinical educator, (e) curricula designed around industry standards and desired graduate attributes and capabilities, (f) an evidence-based practice approach in the curricula and clinical context, (g) aligning business skills, knowledge and practices with the professional context and (h) interprofessional learning and practice opportunities. Although this study has made a contribution to scholarly discourse, there remain many gaps in our knowledge where further studies are needed.Doctor of Philosophy
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Aguiton, Rhonda Lisa. « A Descriptive Study of Teacher Candidates’ Reflective Thinking During Literacy Tutoring Clinical Experiences ». University of Toledo / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1525124978865095.
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Valverde, Sarah Hatheway. « THE MODERN SEX DOLL-OWNER : A DESCRIPTIVE ANALYSIS ». DigitalCommons@CalPoly, 2012. https://digitalcommons.calpoly.edu/theses/849.
Texte intégralRésumé :
Over the last fifteen years, the sex doll industry has grown from producing inexpensive novelty items to creating a multimillion-dollar global industry featuring high- quality, realistic love dolls. These dolls are designed and advertised for sexual stimulation, companionship, artistic representations of human fantasy, and other creative pursuits, such as photography. Made of flesh-like silicone, modern sex dolls sell from $3,500-$10,000.
The use of human simulacra for sexual stimulation is an enduring practice. However, the psychological community has said little on the subject. Early sexologists briefly reference Agalmatophilia or Statuphilia, a rare sexual attachment to statues. Today, the sex doll phenomenon appears increasingly prevalent across the globe. Media coverage of this phenomenon has been featured in online magazines, television programs, music, documentaries and major motion pictures. More often than not, sex doll-ownership is portrayed as pathological. Sex doll-owners are members of a marginalized population, and accessing the population is challenging as many members of the community wish to remain anonymous for fear of judgment, persecution, and psychiatric labeling.
The purpose of this study was to increase psychology’s understanding of this interesting and growing population. Specifically, a 45-item online survey addressing demographics was constructed and assessed. Additionally, participants were asked to describe their relationship status, doll-ownership status, and satisfaction with human and sex doll partners, including sexual satisfaction and performance. Quality of life was also assessed via the Satisfaction with Life Scale (SWLS).
Sixty-one participants were recruited from an online doll-owner community forum. It was hypothesized that most doll-owners sampled would be middle-aged, White, single, heterosexual males who are neither significantly better nor worse in terms of psycho-sexual functioning and life satisfaction than the general population. Descriptive data and statistical analysis partially supported the hypotheses. Implications and future direction are discussed, as are methodological considerations.
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Chikosi, Veronica. « Clinic-referred conduct problem children, a description of child and family characteristics ». Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1996. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/MQ33353.pdf.
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James, Sharon Yvonne. « An exploratory descriptive study of Clinical stress and Burnout among Critical Care Health Care professionals ». DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 1995. http://digitalcommons.auctr.edu/dissertations/3897.
Texte intégralRésumé :
The purpose of this study was to examine the impact of clinical stress and burnout on health care professionals on critical care units.
Thirty individuals who were employed at a local public hospital participated in the study. Participants completed a 25 item questionnaire on clinical stress and a 20 item questionnaire on burnout. A bivariate analysis was computed using Pearson's(r) correlation. The study found that there is a significant relationship between clinical stress and burnout.
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Garout, Mohammed Ahmed. « A descriptive study of colorectal surgery in England using routine administrative data and a clinical database ». Thesis, Imperial College London, 2006. http://hdl.handle.net/10044/1/7672.
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Zapien, Nicolle Marie Gottfried. « The experience of beginning an extra-marital affair| A descriptive phenomenological psychological study and clinical implications ». Thesis, Saybrook University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3721331.
Texte intégralRésumé :
Extra-marital affairs are common in the US and frequently result in difficulties for individuals, families, and society as a whole. Empirical research on the topic is problematic. There is no universally accepted psychological definition of what behaviors or experiences constitute an affair; there are value-laden assumptions about marriage and affairs that are not usually questioned as part of the design or discussion of studies; and, there are non-trivial non-response biases in sampling on the topic. As a result there is a lack of meaningful psychological understanding of affairs and a dearth of evidence to support clear treatment directions for those who seek psychotherapy for this common issue. In an attempt to understand the essential psychological structure of the beginning of affairs, a descriptive phenomenological psychological study of the experiences from three adults who have had affairs (as they define them) and who had promised monogamy was undertaken. These interviews were transcribed, transformed and analyzed using Giorgi’s (2009) descriptive phenomenological method for psychology. The resulting structure of the experience includes the following constituents: dissatisfaction with the marriage and hopelessness about it improving; a sense of the self and the spouse having a fixed character that does not change; a lack of curiosity for the spouse; a preference for passion and novelty; a sense of deserving sexual satisfaction; the experience of passion overriding judgment; and, a lack of real consideration of divorce as a solution to the dilemma prior to the affair. In addition, passive intentionality, (Husserl, 2001), is offered to explain how a series of interactions with another outside the marriage develops into an affair before it is grasped as such. This structure is potentially clinically meaningful as thus far it has not been articulated in a descriptive and complete manner. It offers direction for the future development of clinical interventions and provides entry points into: discussions of ethics, values, intimacy, passion and subjectivity; marriage reform; and, the socio-historical contexts in which the meaning of affairs is located. Keywords: Extra-marital affair, monogamy, non-monogamy, marriage, infidelity, couples’ counseling, Giorgi, phenomenological research methods, intentionality.
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Fisher, Rachel. « Clinical whole exome sequencing in an academic pediatric hospital : A descriptive study of the diagnostic odyssey ». University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1427813369.
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Alton, Julie R. « The Current State of Music Therapy Clinical Practice with Adults with Neurologic Disorders : A Descriptive Questionnaire ». Ohio University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1430747960.
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Royek-Purtee, Kelly. « A Descriptive Study of the Impact of a Pharmacist Run Diabetes Management Clinic ». The University of Arizona, 2009. http://hdl.handle.net/10150/623974.
Texte intégralRésumé :
Class of 2009 AbstractOBJECTIVES: The purpose of this study is to determine if a pharmacist run diabetes management clinic assists patients in the successful management of type 1 or type 2 diabetes. METHODS: Patients must have been enrolled and participated in at least one visit to the pharmacist run diabetes management program at North Country Health Care Clinic (“NCHCC”). A retrospective chart review was completed to determine patient outcomes. RESULTS: A total of 82 charts were reviewed and 49 patients were qualified for the study. A total of 19 men (mean age 42.1; SD 12.1) and 30 females (mean age 55.0; SD 14.4) completed at least one visit to the pharmacist run diabetes management program. HbA1c levels were significantly lower after one or more visits to the pharmacist run diabetes clinic (p=<0.001) for all patients. CONCLUSIONS: Patients who participate in the pharmacist run diabetes management clinic appear to successfully lower HbA1c values after at least one visit to the program.
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Basili, Laura Anne. « A descriptive analysis of the social support perceptions and resources of children with cancer and their parents ». Case Western Reserve University School of Graduate Studies / OhioLINK, 1991. http://rave.ohiolink.edu/etdc/view?acc_num=case1059748555.
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Scolio, Jay. « EFFICACY OF A SELF-ADMINISTERED TECHNIQUE COMBINING DESCRIPTIONS AND REFLECTIONS OF PROBLEM-SPECIFIC FEELINGS AND THOUGHTS ». Miami University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=miami1294461405.
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Maple, Marilyn. « A descriptive analysis of nonverbal status displays demonstrated by dental educators in clinical and/or laboratory settings ». Gainesville, FL, 1985. http://www.archive.org/details/descriptiveanaly00mapl.
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Gabbe, Belinda, et belinda gabbe@deakin edu au. « The descriptive epidemiology of Australian football injuries presenting to sports medicine clinics ». Deakin University. School of Health Sciences, 1999. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20080603.160908.
Texte intégralRésumé :
Sports injury prevention has been the focus of a number of recent public health initiatives due to the acknowledgement that sports injuries are a significant public health problem in Australia Whilst Australian football is one of the most popular participation sports in the country, only very limited data is available about football injuries The majority of sports injury data available for this sport is from hospital emergency departments and elite-level injury surveillance Overall there is a paucity of data from treatment settings other than hospitals In particular, there is a lack of information about the injuries sustained by community-level, junior and recreational Australian football participants.
One good potential source of football injury data is sports medicine clinics. Analysis of injury presentations to sports medicine clinics was undertaken to provide a detailed description of the epidemiology of Australian football injuries that present to this treatment setting and to determine the implications for injury prevention in this sport. In addition, the data from sports medicine clinics was compared with existing sources of Australian football injury data to determine how representative sports medicine clinic data is of other football injury data sources and to provide recommendations for future injury surveillance n Australian football.
The results contained in this thesis show that Australian football is the sport most associated with injury presentation at sports medicine clinics. The majority of injured Australian football players presenting to sports medicine clinics are community-level or junior participants which suggests that sports medicine clinics are a good source of information on the injuries sustained by sub-elite football participants.
Competition is the most common context in which Australian football players presenting to sports medicine clinics are injured. The major causes of injuries to Australian football players are being struck by another player, collisions and overuse. Injuries to Australian football players predominantly involve the lower limb. Adult players, players who stopped participating immediately after noticing their injury and players with overuse injuries are the most likely to sustain a more severe injury (i.e. more than four weeks before a full return to football participation and a moderate/significant amount of treatment expected). The least experienced players (five or less years of participation) are more likely to require a significant amount of treatment than the more experienced players.
The prevention of lower limb injuries, injuries caused by body contact and injuries caused by overuse should be a priority for injury prevention research in Australian
football due to the predominance of these injury types in the pattern of Australian football injuries Additionally, adult players, as a group, should be a focus of injury prevention activities in Australian football due to the association between age and injury severity.
Overall, the pattern of Australian football injuries presenting to sports medicine clinics appears to be different than reported by club-based and hospital emergency department injury surveillance activities. However, detailed comparison of sports medicine clinic Australian football data with other sources of Australian football injury data is difficult due to the variable methods of collecting and reporting injury information used by hospital emergency department and club-based injury surveillance activities. The development of a standardised method for collecting and reporting injury data in Australian football is strongly recommended to overcome the existing limitations of data collection in this sport.
In summary, sports medicine clinics provide a rich source of Australian football injury data, especially from the community and junior levels of participation. The inclusion of sports medicine clinic data provides a broader epidemiological picture of Australian football injuries. This broader understanding of the pattern of Australian football injuries provides a better basis for the development of injury prevention measures in this sport.
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Cutler, Ame. « The "ideal self" stands alone| A phenomenological psychological descriptive analysis of Anglo Saxon American self-concept formation in relation to ancestral connectedness ». Thesis, Saybrook Graduate School and Research Center, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3611459.
Texte intégralRésumé :
This descriptive phenomenological study investigated Anglo Saxon Americans' lived experience of self-identity. The focus was to determine if construction of their self-concepts was influenced by Ancestral connectedness, characterized by: (a) lived recognition of one's Ancestral origins and the experience of connection to one's larger constellation of familial lineage, (b) reverent encounter with one's Ancestors on a daily basis as expressed in Ancestor communion, and (c) felt responsibility to ensure the Ancestors' continued well-being and positive disposition toward the living through the practice of remembering the Ancestors in active storytelling, prayers to the Ancestors, and the making of libations and offerings to the Ancestors. Three Anglo Saxon Americans participated in the study. Each participant completed two half-hour, one-on-one, in-person interviews and also completed a demographic questionnaire about his or her background. Participants were asked to describe (a) their identities and how they understand themselves, (b) their understanding or definition of Ancestor, (c) how they think about their Ancestors, and (d) how their connectedness to their Ancestors influence their self-identities. Giorgi's (1985, 2009) four-step descriptive phenomenological method was used to analyze the data and produce a psychological description of the phenomenon studied. Study results revealed a general structure for the Anglo Saxon American self-concept in relation to Ancestral connectedness consisting of eight constituents: (a) a lack of importance placed on the question of self-identity, (b) an emphasis on individuality and separation, (c) a negative approach to self-identity, (d) changes in self-identity independent of Ancestry, (e) awareness of the White race and its privileges, (f) socioeconomic status, (g) an unconscious Ancestral influence, and (h) no establishment of a positive Ancestral influence on self-identity. The results also revealed a limited amount of conscious understanding of one's Ancestral origins and personal connection to a larger constellation of familial lineage, suggesting partial fulfillment of the first criterion of Ancestral connectedness. However, this was the extent of the lived experience of Ancestral connectedness in relation to the Anglo Saxon American self-identity formation.
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Bange, Jennifer. « A descriptive study of the impact of intrinsic and extrinsic factors on the career paths of clinical nutrition managers ». Thesis, Kansas State University, 2014. http://hdl.handle.net/2097/17585.
Texte intégralRésumé :
Master of ScienceDepartment of Hospitality Management and Dietetics
Kevin Sauer
Registered Dietitians (RDs) attribute the success of their careers to a variety of factors, including formal education, influential mentors, specific skill sets, flexibility, and even having a supportive spouse. RDs with strong management skills are increasingly in demand in order to coordinate nutrition care and services in a cost effective manner. Clinical Nutrition Managers (CNMs) specifically coordinate medical nutrition therapy across the continuum of patient care. To aid in the career development of CNMs, research is necessary to determine the factors that have positive and negative effects on their career paths. This study examined intrinsic and extrinsic factors that impact the career paths of CNMs in addition to perceived career satisfaction. A five-part online survey was disseminated to members of the Clinical Nutrition Management Dietetic Practice Group (CNM DPG). CNMs were also defined as RDs who coordinate medical nutrition therapy and who manage personnel, finances, or both. Results (n=146) of both quantitative and qualitative analyses identified key intrinsic factors that demonstrated a positive effect on CNMs’ career paths including self-motivation, communication skills, teamwork, and leadership skills. The study also examined CNMs’ perceptions about the extrinsic factors on their career paths. Support from upper-level management and administration was identified as a crucial factor in career advancement. Having support from family was shown to be a positive influence, while many CNMs also reported that family needs and expectations, unforeseen life circumstances, and the economic climate had limited their career paths. Social service motivation had a slightly positive influence on career paths. Perceptions about career satisfaction indicated that CNMs were moderately satisfied with overall career success but less satisfied with income and career ladders. This study serves as an important precursor to future research which could explore CNMs’ perceptions regarding pay equity as well as the intrinsic and extrinsic factors that are more critical at various junctures in their career paths. Results from the study also help to fill an existing gap in the dietetics and career path literature and will also assist the Academy of Nutrition and Dietetics and others in developing strategies to foster the career development of CNMs.
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Stubenberg, Patricia Anne. « Descriptions of Clinical Teaching Excellence in the First Two Years of Medical School : The Views of Academic and Community-Based Preceptors ». Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4780.
Texte intégralRésumé :
The changing dynamics in patient care, along with the increasing role of early clinical experiences and community-based teaching models, can be a catalyst in furthering important research and training for clinical teaching excellence. Curricular challenges as well as limited scholarly work generate educational possibilities for study. Embracing a strong educational doctrine of teaching excellence in undergraduate medical education will help shape the future of health care and ultimately enhance patient care.
This grounded theory study (a) described and explained descriptions of teaching excellence among first and second year academic and community-based preceptors in the Longitudinal Clinical Experience (LCE) program at the University of South Florida (USF), Morsani College of Medicine and (b) generated theory related to the explanation of the phenomenon of clinical teaching excellence. The single site study drew upon preceptors in the Longitudinal Clinical Experience (LCE) course who were nominated for a teaching excellence award by second, third, and fourth year medical students through a voluntary, online survey. Based on these surveys, 17 academic and 17 community-based preceptors who represented someone who had gone above the student's expectations in providing an exceptional learning experience were nominated. From the list of 34, 13 eligible preceptors were invited to participate in the study and a sample of eight (four academic and four community-based preceptors) were interviewed.
The semi-structured, one-hour face-to-face interviews were conducted between April and December 2012 using an interview process. All interviews were located in the preceptor's academic, hospital, or practice setting except one, which took place in the preceptor's private residence. Interview questions were distributed to participants in preparation of the meeting. After obtaining written informed consent by the participants, interviews were tape recorded and lasted an average of 60 minutes.
Data analysis was completed using a complimentary, manual and electronic coding method to categorize and develop initial concepts and themes. Data were continuously tested with field notes, observations of the interviews and settings, and thoughts from the researcher's journal, supporting the fluid and constant comparative analysis of grounded theory. The following four thematic categories, supported by preceptors' reflective and reframing practices, emerged from the presentation of data for theory development: (a) preceptors have an awareness of, and adapt to, each student's readiness to learn; (b) preceptors demonstrate an intrinsic commitment to teaching; (c) preceptors create supportive learning environments; and (d) preceptors utilize sound pedagogical practices. As a result of an in-depth, reciprocal analysis from the selected categories and descriptions of clinical teaching excellence, a higher-order construct (theory) was generated, and suggested transforming and implementing adult learning principles and strategies into early clinical education experiences can have a positive influence on medical education and strengthen student learning.
Recommendations for practice and future research include (a) utilizing findings in curriculum planning, (b) expanding the study to increase awareness of the value of reflection and reframing in clinical teaching, (c) investigating the impact of clinical teaching excellence on patient care practices, and (d) expanding the study to compare primary care and specialty disciplines. Professional development programs should include designing activities based on preceptors' instructional needs, sound pedagogical practices, and in compliance with continuing medical education requirements.
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Bolhuis, Rebecca. « A Description of a Pharmacist-Based Treatment Adherence Program at Special Immunology Associates, an HIV Ambulatory Care Clinic ». The University of Arizona, 2008. http://hdl.handle.net/10150/624307.
Texte intégralRésumé :
Class of 2008 AbstractObjectives: To describe a pharmacist-based treatment adherence program at an HIV ambulatory care clinic setting; to describe the patient population that the pharmacist provided services to from 2005 to 2007; and to describe the clinical outcomes of the program. Methods: A retrospective chart review of 381 patients enrolled in the pharmacist-based treatment adherence program from 2/01/05 to 03/01/2007. Inclusion criteria: HIV positive; greater than or equal to 18 years of age; a medical record; and enrollment in the treatment adherence program. The program provided support, education, and clinical management. Results: Patients were predominately male (86%), ages 45-64 (58%) or 25-44 (38%), identifying as Caucasian (57%) or Hispanic (31%), with psychiatric (50%) or substance abuse (39%) comorbidities (with 25% reporting both comorbidities). Baseline HIV viral loads were compared at four different follow-up periods: 90-180 days, 181-365 days, greater than 365 days, and the entire period of follow-up through the pharmacist-based HIV treatment adherence program. At baseline 34% of the patients had an undetectable HIV viral load (< copies/mL) and a mean CD4 count of 340. All follow-up periods reported significant improvements. At follow-up >365 days, 76% of the patients had undetectable virus (p<0.001) and a mean CD4 count of 442 (p<0.001). There were no significant results when viral load and mean CD4 counts were examined within the context of number of pharmacist visits and SA and/or psychiatric comorbidities. Conclusions: Patients in the pharmacist-based treatment adherence program showed significant improvements in CD4 count and percent of patients with undetectable virus from baseline to all follow-up periods. The magnitude of the improvement increased during each follow-up period suggesting an additive effect of continued enrollment in the program.
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Thivierge, Mélanie. « Étude descriptive du coaching mobilisateur utilisé par des infirmières gestionnaires clinico-administratives de l’hébergement ». Thesis, Université Laval, 2011. http://www.theses.ulaval.ca/2011/27812/27812.pdf.
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Thivierge, Mélanie. « Étude descriptive du coaching mobilisateur utilisé par des infirmières gestionnaires clinico-administratives de l'hébergement ». Master's thesis, Université Laval, 2011. http://hdl.handle.net/20.500.11794/22569.
Texte intégralRésumé :
Les infirmières gestionnaires clinico-administratives représentent un pivot important des établissements de santé. Toutefois, leurs conditions d'exercice actuelles se dégradent, la pénurie de personnel de soins et les transformations organisationnelles s'accentuent, ce qui entraînent un écart important entre les rôles attendus et la réalité quotidienne. Les équipes de soins réclament une plus grande présence et un soutien plus constant de leur gestionnaire. Comme possible avenue de mobilisation des équipes de soins, la littérature indique une nouvelle stratégie soit celle du coaching. Cette recherche qualitative d'inspiration phénoménologique décrit la stratégie de coaching mobilisateur de trois infirmières gestionnaires et deux cadres supérieurs de l'hébergement d'un établissement de santé de Québec. Ces derniers ont participé à des entrevues individuelles semi-dirigées. Les résultats identifient des compétences-clés telles que communiquer efficacement, agir avec caring et adopter un mode de gestion participative. S'ajoutent aux résultats, les obstacles, les effets attendus et les attentes des cadres supérieurs.
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Grobler, Christoffel. « A cross-sectional descriptive study of clinical features and course of illness in a South African population with bipolar disorder ». Thesis, University of Pretoria, 2012. http://hdl.handle.net/2263/24414.
Texte intégralRésumé :
There is generally a lack of studies examining prevalence and phenomenology of bipolar disorder in Africa. In literature, a unipolar manic course of illness in particular is reported to be rare. The purpose of this study was to investigate and describe the course of illness and clinical features in a cross-section of patients diagnosed with bipolar disorder attending public hospitals in Limpopo Province, South Africa and to determine the rate of a unipolar manic course in this sample of patients. This was a descriptive, cross-sectional study of patients presenting with a history of mania between October 2009 and April 2010, to three hospitals in Limpopo Province. A purposeful sample of 103 patients was recruited and interviewed using the Affective Disorders Evaluation. This study confirms that a unipolar manic course is indeed much more common than rates suggested in present day literature with57% of the study sample only ever experiencing manic episodes. The study also confirms the debilitating nature of bipolar disorder with more than two-thirds being unemployed in spite of a quarter of the study subjects having a tertiary education. The high rates of attempted suicide, history of violence and history of drug abuse all furthermore points to the devastating effects bipolar disorder has on individuals and their families. Treatment choice appeared to be a combination of a mood-stabilising agent in combination with an anti-psychotic. It was found that two-thirds of study subjects had consulted with faith- or traditional healers. Significant gender differences appeared in that females were more likely to suffer from comorbid anxiety disorders, have a history of sexual trauma, and be HIV positive whilst men were more likely to have a forensic- and substance-abuse history, experience hallucinations and receive clozapine. Patients presenting with a unipolar manic course of illness, as described in this thesis, may contribute to the search for an etiologically homogeneous sub-group which presents unique phenotype for genetic research and the search for genetic markers in mental illness. A unipolar manic course therefore needs to be considered as a specifier in diagnostic systems in order to heighten the awareness of such a course of illness in bipolar disorder, with a view to future research.Thesis (MD)--University of Pretoria, 2012.
Psychiatry
unrestricted
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De, Sousa Barroca José Duarte. « Verification and validation of knowledge-based clinical decision support systems - a practical approach : A descriptive case study at Cambio CDS ». Thesis, Linnéuniversitetet, Institutionen för datavetenskap och medieteknik (DM), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-104935.
Texte intégralRésumé :
The use of clinical decision support (CDS) systems has grown progressively during the past decades. CDS systems are associated with improved patient safety and outcomes, better prescription and diagnosing practices by clinicians and lower healthcare costs. Quality assurance of these systems is critical, given the potentially severe consequences of any errors. Yet, after several decades of research, there is still no consensual or standardized approach to their verification and validation (V&V). This project is a descriptive and exploratory case study aiming to provide a practical description of how Cambio CDS, a market-leading developer of CDS services, conducts its V&V process. Qualitative methods including semi-structured interviews and coding-based textual data analysis were used to elicit the description of the V&V approaches used by the company. The results showed that the company’s V&V methodology is strongly influenced by the company’s model-driven development approach, a strong focus and leveraging of domain knowledge and good testing practices with a focus on automation and test-driven development. A few suggestions for future directions were discussed.
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Holden, Sarah E. « A study of the descriptive epidemiology and clinical effectiveness of treatment for type 2 diabetes using routine general practice data ». Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/77715/.
Texte intégralRésumé :
The prevalence of type 2 diabetes is increasing in the UK. Many people with type 2 diabetes require glucose-lowering therapy including insulin when lifestyle interventions fail to provide adequate glucose control. Some epidemiological studies report an association between insulin use in type 2 diabetes and an increased risk of serious adverse events when compared with other glucose-lowering therapies. However, these findings should be interpreted with caution due to the risk of confounding by indication. The aim of this thesis was to characterise the epidemiology of type 2 diabetes and to investigate the risk of serious adverse events associated with increasing insulin dose in people with type 2 diabetes prescribed insulin therapy. A series of retrospective, observational studies were conducted using data from the Clinical Practice Research Datalink. People with type 2 diabetes were identified and prevalence and incidence rates calculated. The risk of all-cause mortality, major cardiovascular events and cancer in people with type 2 diabetes who progressed to insulin with or without metformin were evaluated using multivariate models. Between 1991 and 2010, the estimated incidence and prevalence of clinically diagnosed and recorded type 2 diabetes increased three-fold. During the same period, the estimated number of people with diagnosed and recorded type 2 diabetes treated with insulin increased seven-fold. Estimated insulin dose was associated with an increased risk of all-cause mortality in people with type 2 diabetes receiving insulin monotherapy (aHR 1.54, 95% CI 1.32–1.78, for 1 unit/kg/day increase in insulin dose) and in those treated with insulin with or without metformin (1.48, 1.31–1.70). However, the use of metformin in combination with insulin was associated with a reduction in risk compared with insulin alone (0.60, 0.52–0.68). Due to the limitations associated with observational studies, further research is required in order to improve our understanding of the risks and benefits of exogenous insulin in type 2 diabetes.
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Mendez-Shannon, Elizabeth C. « "We will always be in the shadows" - a qualitative descriptive study of undocumented Latino immigrants surviving in the United States ». Diss., University of Iowa, 2010. https://ir.uiowa.edu/etd/555.
Texte intégralRésumé :
Research studies have pointed to specific challenges for undocumented Latino immigrants including exploitation in the workplace (Stoddard, 1976), denial of health care (Angel, Frias & Hill, 2005; Passel, 2005) and lack of access to higher education (Seif, 2004). In addition, fear is never far from their consciousness. Fear of being identified as illegal and faced with possible arrest and deportation are realities for undocumented Latino immigrants. Both work and home are unsafe, particularly because of immigration raids by federal agents. In addition they are stigmatized by mainstream society (Padilla & Perez, 2003). Even the word "undocumented" has been used interchangeably with words like "illegal" and "alien" suggesting criminal behavior. These hardships make it difficult for these immigrants to become part of mainstream society and create barriers to opportunities.
All of these factors should logically discourage Latin Americans from immigrating to the United States. However, both the documented and undocumented Latino populations in the United States continue to increase. Although the situation of new Latino immigrants, especially those who are undocumented, seems extremely difficult, there is something unexplained occurring that has not been accounted for in current research that allows them to survive these hardships. In addition, there is a gap in information about the immigration process gathered from immigrants themselves. Therefore, this study uses a qualitative descriptive approach to learn from undocumented immigrants about their experiences when they first came to the United States and how they negotiate their situation while living in the United States.
The major findings of this study offer an inside look into the world of undocumented Latino immigrants. The obstacles these immigrants face were language barriers, limited education and unfair wages at work. On the other hand, they also identify facilitators that were helpful during their initial transition into the U.S such as getting help in finding a job, knowing someone in the United States before immigrating, being connected to support networks, and receiving support from others who shared their struggles. However, these findings do not reflect the whole story.
Even though most of these Latino immigrants underwent stress and adversity as new undocumented immigrants, the study shows how they transformed their suffering using their personal strengths and drawing on support from a close-knit community. At the same time they maintained their cultural identity both in their immigrant community and within the larger community where they resided. An additional factor which contributed to their survival was that this particular community is unique in preserving the different cultures of ethnic groups rather than fusing them into a "melting pot."
Recommendations for practice include using a strengths perspective with clients and community; recommendations for teaching include using interdisciplinary educational strategies and involving students in experiential learning experiences with immigrants. Additional recommendation for policy and research are made.
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Rausch, Kerstin. « A descriptive study exploring community- and clinic-based tuberculosis treatments in two Western Cape communities ». Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/7940.
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Bibliography: leaves 201-209.This descriptive study focused on two clinics in the Western Cape's South Peninsula (Retreat and Ocean View), with relatively successful cure rates. These successes were explored within the ecological frameworks of comprehensive primary health care (PHC) and the Healthy Cities concept. Clinic-based and community-based anti-tuberculosis treatments were compared in both areas. The relative influence of the Healthy Cities pilot project in Ocean View was also explored.
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Scroggins, Marissa Joy. « Survey of Compassion Fatigue Education in APA-Accredited Clinical and Counseling Psychology Programs ». Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1434588375.
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