Tesi: "Clinical Outcomes"

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Briggs, Timothy William Roy. "Clinical outcomes of autologous implantation". Thesis, University College London (University of London), 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.505121.

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Taylor, Michael Dennis. "Prostate cancer clinical practice guidelines clinical and economic outcomes /". [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0010098.

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Thesis (Ph.D.)--University of Florida, 2005.
Typescript. Title from title page of source document. Document formatted into pages; contains 99 pages. Includes Vita. Includes bibliographical references.

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Wilson, Katherine Ann. "Does safety culture predict clinical outcomes?" Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2919.

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Patient safety in healthcare has become a national objective. Healthcare organizations are striving to improve patient safety and have turned to high reliability organizations as those in which to model. One initiative taken on by healthcare is improving patient safety culture--shifting from one of a 'no harm, no foul' to a culture of learning that encourages the reporting of errors, even those in which patient harm does not occur. Lacking from the literature, however, is an understanding of how safety culture impacts outcomes. While there has been some research done in this area, and safety culture is argued to have an impact, the findings are not very diagnostic. In other words, safety culture has been studied such that an overall safety culture rating is provided and it is shown that a positive safety culture improves outcomes. However, this method does little to tell an organization what aspects of safety culture impact outcomes. Therefore, this dissertation sought to answer that question but analyzing safety culture from multiple dimensions. The results found as a part of this effort support previous work in other domains suggesting that hospital management and supervisor support does lead to improved perceptions of safety. The link between this support and outcomes, such as incidents and incident reporting, is more difficult to determine. The data suggests that employees are willing to report errors when they occur, but the low occurrence of such reportable events in healthcare precludes them from doing so. When a closer look was taken at the type of incidents that were reported, a positive relationship was found between support for patient safety and medication incidents. These results initially seem counterintuitive. To suggest a positive relationship between safety culture and medication incidents on the surface detracts from the research in other domains suggesting the opposite. It could be the case that an increase in incidents leads an organization to implement additional patient safety efforts, and therefore employees perceive a more positive safety culture. Clearly more research is needed in this area. Suggestions for future research and practical implications of this study are provided.
Ph.D.
Department of Psychology
Sciences
Psychology PhD

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Sharp, Charles Michael Francis. "Clinical outcomes in diffuse parenchymal lung disease". Thesis, University of Bristol, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.723507.

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Yee, Leland Jonathan. "Determinants of hepatitis C virus clinical outcomes". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2003. http://researchonline.lshtm.ac.uk/1620410/.

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Hepatitis C virus (HCV) infection is characterized by a broad spectrum of clinical outcomes. An estimated 14%-46% of individuals exposed to HCV are able to clear the virus, while the other portion develops chronic (persistent) infections. Among the individuals with chronic HCV who are treated with interferon-based therapies, only a portion are able to experience sustained virological suppression. Similarly, a number of chronically infected individuals have autoimmune extrahepatic manifestations such as the presence of autoantibodies. The pathological mechanisms behind these phenomena are not known, but it is believed that host genetic factors may play a role. This thesis examines the hypothesis that host genetic factors may contribute to the diverse spectrum of HCV clinical outcomes. In addition, it examines the pathogenesis of antinuclear antibodies (ANA) in chronic HCV, and the effect of ANA positivity on the natural history of HCV. Correlations were observed between female gender and geographic location and ANA positivity. No relationships were observed for an effect of ANA positivity on response rates to interferon therapy. We observed a trend of ANA positivity with faster progression of HCV-related fibrosis, although this failed to achieve statistical significance. ANA-positive individuals tended to have more plasma cells in their liver than ANA-negative individuals. This study also observed a number of correlations between genotypes of the interferon induced genes encoding the myxovirus resistance 1 protein (MxA), 2'-5'oligo-adenylate synthase 1 (OAS-1), and protein kinase (PKR), as well as genes encoding cytotoxic T-lymphocyte antigen-4 (CTLA4), and inducible nitric oxide synthase (iNOS) (encoded by the NOS2A gene) with several outcomes including self-limiting versus chronic HCV infection, along with the response to interferon therapy. This study identified several factors to be correlated with ANA positivity in HCV. These factors may serve as future points for investigation by basic scientists understanding the mechanisms of HCV-mediated autoimmunity. Importantly, this study suggests that low titre ANA positivity should not be a contraindication to therapy. This study also highlighted the importance of several genetic pathways in HCV infection. These may serve as targets for future pharmacologic interventions or genetic tests designed to screen for those who will not benefit from interferon therapies.

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Ritchie, Robert Wilson. "Improving clinical outcomes in renal HIFU therapy". Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.572839.

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The rising incidence of small, asymptomatic renal tumours discovered usmg abdominal imaging during the investigation of unrelated symptoms has fuelled the desire for new therapies which avoid surgical excision. Extracorporeal High Intensity Focused Ultrasound (HIFU) was proposed as one of these modalities but so far clinical research has been ,~." inconclusive. The present work was designed to improve these clii teal outcomes through the conduct of further clinical trials, laboratory based research and the translation of new technology into existing HIFU devices. A Phase II clinical trial of patients (n=13) with newly diagnosed <4cm renal tumours (clinical stage T1a) was designed, peer reviewed and received ethical approval (Ox REC 09/H0606104). Ten of 13 patients underwent renal HIFU using a clinical HIFU device (Model JCIJC200, HAIFU, China). One patient could not be treated due to poor tumour visualisation after anaesthesia and two patients could not be treated as they became unwell before or during anaesthesia. Histological evidence of HIFU ablation in either tumour or normal renal parenchyma was seen in all ten patients. Evidence of sub-total tumour ablation was seen in 8/10 of patients. Grade 1 «50%), 2 (50-90%) & 3 (90-99%) ablation was achieved in 4/10, 3/1 0 & 3/1 0 patients respectively but complete (100%) tumour ablation was not possible. HIFU treatment caused minimal morbidity - no Grade III- V (Clavien-Dindo) complications related to HIFU treatment occurred. Grade I skin pain and induration was seen in 9/1 0 patients; Grade II skin pain occurred in a single patient. Patient demographics, imaging and tumour characteristics were used to design parameters to improve patient selection for renal HIFU. The tumour location, thickness of peri-nephric fat and renal nephrometry score were useful predictors of successful screening for treatment. Page /ii Dr R. W Ritchie Nutiield Department of Surgical Sciences - TT 2012 Abstract Diligent use of these factors could limit unnecessary treatments and Improve ablation outcomes. , It is well known that ultrasound imaging of small renal masses can be challenging. Ultrasound imaging often deteriorates further during HIFU as the abdominal wall and fat tissues swell and cause increased attenuation. This loss of imaging quality was clearly demonstrated in this clinical trial and resulted in the early termination of treatment, before ,#,J' ... ~ .•.. endpoints were reached, in a number of cases. The current clinical method for monitoring the success of HIFU ablation using hyperecho analysis of B-mode ultrasound images is also questionable. Laboratory based studies using ex-vivo bovine liver subjected to HIFU confirmed that hyperecho monitoring had low sensitivity, predictive values and overall accuracy. A novel method of HIFU monitoring - passive mapping of the emissions received from acoustic cavitation activity and other sources of non-linearity during HIFU treatment - is believed to represent a significant opportunity to improve feedback. This technique uses the passively received signature of cavity activity which, when time-reversed, gives high- resolution images of the precise location of the activity. Laboratory-based ex-vivo work, using a commercially available ultrasound system (z.one, Zonare, USA), demonstrates its superiority over hyperecho monitoring. Indeed, thresholds could be applied to successfully predict HIFU ablation with high sensitivity and specificity. This technique was successfully translated into the clinical setting through the design of a Passive Acoustic Mapping (P AM) device. Custom-built receiving elements were applied without limiting the function of the existing HIFU devices. Both pre-clinical and ethically- Page [iii Dr R. W Ritchie Nuffield Department of Surgical Sciences - TT 2012 Abstract approved clinical studies demonstrated its safe integration without significant impact on the device energy output or treatment accuracy. Using similar passive beamfonning algorithms, acoustic cavitation activity was successfully mapped and corresponded with the location of thermal ablation in both ex-vivo tissue phantoms and during clinical HIFU therapy. ,~-' It is believed that the development of new patient selection paral~~tel's will elimil?ate target those patients who are most suitable for renal HIFU - small tumours, minimal peri-nephric fat & low nephrometry score .. The use of P AM will lead to a significant improvement in the efficacy of treatment. It can be successfully applied to existing devices and predicts the location and extent ofHIFU ablation with greater accuracy that existing techniques.

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Akhatova, Elena. "Do clinical pharmacy servicesimprove outcomes for patientswith heart failure (HF)? : Do clinical pharmacy servicesimprove outcomes for patientswith heart failure (HF)?" Thesis, Umeå universitet, Kemiska institutionen, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-106301.

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Fedt, Lauren Alexandra, e Lauren Alexandra Fedt. "Teleaudiology: Clinical Outcomes from Adults with Hearing Loss". Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/625383.

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Outside of major metropolitan areas, Arizona has limited options for hearing healthcare. The Arizona Affordable Hearing Aid Task Force proposed the development of a statewide program to provide low-cost hearing aids and audiologic care to low-income residents. The purpose of this review was to determine the status of the literature on the clinical outcomes of teleaudiology services for evaluations and hearing aid fittings which could be used to serve inhabitants of rural counties and address the goals of the Task Force. A literature search was performed to identify articles with original research in teleaudiology in the areas of evaluation and treatment and yielded 234 results. After exclusion criteria were applied, there were 15 articles for review; 10 articles focused on audiological evaluation and 5 articles focused on verification, validation, and counseling for hearing aid fittings. Evaluation-related articles showed that pure-tone air conduction testing was generally within the ± 5 dB acceptable range of variability, with little evidence on bone conduction or speech testing reliability. Studies reporting real-ear measurements with probe microphones were shown to yield similar results in traditional and teleaudiology fitting sessions and validation measures documented similar or better outcomes from teleaudiology fittings. Based on the literature, it is concluded that the use of teleaudiology is feasible for hearing aid fittings and counseling in rural areas, if associated barriers related to costs and limitations related to the availability of technology are overcome.

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Mazlan-Kepli, Wardati. "Antiplatelet therapy and clinical outcomes in cardiovascular diseases". Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7831/.

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Cardiovascular diseases (CVD) is a leading cause of death in the world. Despite effective treatment regimens for ischaemic heart disease (IHD) and ischaemic stroke, mortality and recurrence rates remain high. Antiplatelet therapy is on effective treatment and reduces the risk of recurrent heart attack and stroke. Nevertheless, there are patients who stopped or interrupted their antiplatelet therapy for certain reasons or some patients may be resistant or poor responders to antiplatelet therapy. Furthermore, there is evidence of rebound effect in platelet activity after antiplatelet cessation and this may associate with increased risk of cardiovascular event. This thesis is divided into five main chapters (chapters 3 to 7) which attempt to provide data to help resolve the uncertainty. Chapter 1 highlights the background of cardiovascular diseases and the global burden of cardiovascular and cerebrovascular diseases. The metabolism of platelets, antiplatelet therapy and current antiplatelet therapy guidelines are described, followed by discussion of the risk of cardiovascular event and changes in antiplatelet therapy. Chapter 2 describes the data source from Virtual International Stroke Trial Archive (VISTA) and National Health Service Greater Glasgow and Clyde (NHSGGC) Safe Haven, followed by definition of outcome measures. In chapter 3, Virtual International Stroke Trial Archive (VISTA) data was examined to test whether continue with the same antiplatelet therapy or changing to a new antiplatelet regimen reduces the risk of subsequent events in patients who experience a stroke whilst taking antiplatelet therapy. The findings indicate that subjects who switch to a new antiplatelet regimen after stroke did not have a lower early recurrence rate than subjects who continued with the same antiplatelet therapy. Observations on bleeding complications were similar in both groups. However, changing antiplatelet regimen after stroke was associated with more favourable functional outcome across a full scale modified Rankin Scale (mRS) at 90 days. In chapter 4, association between early or later initiation of antiplatelet with a recurrent ischaemic stroke and bleeding complications was assessed using VISTA data. The findings indicate that there was no association between a recurrent ischaemic stroke and timing of initiation of antiplatelet drug after stroke. However, early initiation was associated with increased risk of bleeding. In terms of functional outcomes, this study demonstrated that the mid-time and late initiation of antiplatelet therapy after acute stroke are associated with better functional outcomes compared with early initiation. In chapter 5, a nested case-control study was performed to explore the rate of antiplatelet cessation and interruption in a sample of patients with recent ischaemic stroke and to assess the risk of cardiovascular events associated with cessation and interruption of antiplatelet. It was found that there was no increased risk of cardiovascular event among patients who had early cessation or interrupted/stopped antiplatelet therapy within 90 days following acute ischaemic stroke. In chapter 6, the incidence and predictors of cardiovascular events after DAPT cessation were evaluated. The incidence of cardiovascular event while taking DAPT and following discontinuation of DAPT was 15.7% and 16.7% respectively. This study found that increasing age was associated with an increased risk of cardiovascular event, whereas, revascularization-treated patients and longer duration of DAPT, were each associated with a decreased risk. The duration of DAPT six months and less was associated a significantly higher risk for cardiovascular event. In chapter 7, an untargeted metabolomics analysis was performed while on DAPT (aspirin plus ticagrelor) and once they stopped ticagrelor to identify metabolite changes associated with cardiovascular events after stopping DAPT. Ten ACS patients were recruited in this study and data were analysed for seven patients. Three hundred eleven putative metabolites were identified. This study found 16 putative metabolites significantly altered following ticagrelor cessation. Of these, seven metabolites were from lipid pathway and down-regulated some up to 3-fold. On the other hand, adenosine, from nucleotide metabolism was upregulated up to 2.6-fold. It concluded that there are changes in numerous pathways following DAPT discontinuation and whether these changes differ in patients who have cardiovascular event after stopping DAPT warrant further investigation. In chapter 8, a summary of the findings of this thesis are presented as well as the future directions of research in this area.

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Okasheh, Rasha Othman Ahmad. "Clinical measurement of functional outcomes of pulmonary rehabilitation". Thesis, Sheffield Hallam University, 2011. http://shura.shu.ac.uk/20771/.

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Chronic Obstructive Pulmonary Disease "COPD" is a chronic condition characterised by progressive deterioration in the lung function. COPD co exists with other clinical conditions resulting into complex cases. People with COPD suffer from progressive functional limitations and participation restrictions. Pulmonary Rehabilitation "PR" is a multidisciplinary intervention designed to improve functional outcomes in people with COPD. Despite the established effectiveness of PR, a number of clinical problems in the provision of PR services remain unresolved. In order to address these problems an outcome measure that is appropriate for implementation in clinical settings is required. The aim of this thesis was to develop a clinical tool for the measurement of functional outcomes of PR in people with COPD. The research process included three phases. A "conceptualisation" phase, the phase of "development", and a "clinical testing" phase. During the phase of conceptualisation a critical review of the literature was performed. This resulted in the development of a framework for the measurement of functioning in people with COPD, and the identification of the specifications for a clinical outcome measure. The phase of development resulted in the selection of the TELER method of measurement and the development and validation of TELER "function" indicators using extensive qualitative research that used indepth interviews and focus groups methods. The final phase was testing the indicators in clinical PR settings. This resulted in providing evidence of the usefulness of the TELER "function" indicators in producing informative data appropriate for full clinimetric analysis. The clinimetric analysis of TELER data developed new insights about the provision of PR. This thesis has contributed to the development in the measurement of the functional outcomes of PR, by providing a new clinical tool that is underpinned by sound theoretical, clinical and empirical knowledge. The tool is appropriate for use in clinical evaluation, and has the potential to resolve clinical problems in the provision of PR.

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Sinha, Ian. "Outcomes in clinical trials in children with asthma". Thesis, University of Liverpool, 2011. http://livrepository.liverpool.ac.uk/3193/.

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The selection of outcomes is a critically important decision when designing randomised controlled trials (RCTs). Informed clinical decisions can only be based on the results of RCTs that have measured outcomes of importance to both clinicians and patients. It can be difficult to know which outcomes should be measured in RCTs. Some groups advocate core outcome sets, which are a minimum set of outcomes that should be measured, and reported, in all clinical trials in a given condition. These increase the likelihood that important outcomes are measured, reduce nonuniformity between studies, and reduce the risk of outcome reporting bias. We systematically reviewed studies that determined which outcomes to measure in clinical trials in children, and found that such work had been conducted in only few conditions, and the quality of existing work was variable. Few studies used structured consensus techniques to reach agreement about which outcomes to measure in trials, and parents were seldom involved. No studies included children. One condition in which there were no robust recommendations about which outcomes to measurein RCTs was childhood asthma, which is a condition of considerable global importance. We subsequently aimed to assess whether the absence of a core outcome set for RCTs of children with asthma meant that certain outcome domains were measured less frequently than others, and whether there was nonuniformity between studies in terms of outcomes selected. We conducted a systematic review of RCTs of children with asthma, published between January 1988 and December 2007, and found that the included studies focussed on short-term disease activity, but quality of life, functional status, and long-term outcomes were infrequently measured. Certain outcomes were measured and reported in various ways. We recommended that a core outcome set should be developed for childhood asthma, using structured consensus techniques, such as the Delphi process. In order to aid the development of such a core set, we first systematically reviewed studies that used the Delphi process to determine which outcomes to measure in clinical trials. We observed variations in the methodology used, identified potential sources of bias, and provided recommendations about how such studies could be conducted and reported. In order to develop a core outcome set for childhood asthma, we used a Delphi process to ascertain the views of 46 clinicians, and around 100 parents and young people, about which outcomes are most important and relevant from their perspective, when making shared decisions about regular therapies which control asthma. The most important outcomes were symptoms, exacerbations, and quality of life. Although consensus still needs to be reached amongst other groups of individuals involved in clinical trials, we conclude that these outcomes should be measured, and reported, in all RCTs that aim to evaluate the effectiveness of regular therapies for children and young people with asthma.

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Jones, Rebecca. "Borderline personality disorder : clinical outcomes and personal recovery". Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2005900/.

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This thesis focuses on outcomes and recovery from a diagnosis of borderline personality disorder (BPD). It comprises two distinct journal papers, namely a systematic literature review and an empirical paper.

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Bosco, Cecilia Teresita. "Clinical outcomes for men diagnosed with prostate cancer". Thesis, King's College London (University of London), 2018. https://kclpure.kcl.ac.uk/portal/en/theses/clinical-outcomes-for-men-diagnosed-with-prostate-cancer(d04cce3e-8865-4be4-86e2-f22e197049d8).html.

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Background and Aims: Early diagnosis of prostate cancer and improvement in treatment and palliative care has translated in more men living with prostate cancer for prolonged periods of time. The current thesis therefore assessed clinical outcomes for men diagnosed with prostate cancer by specifically focusing on those outcomes related to the disease itself and those related to prostate cancer-specific treatments. Methods: 1) Disease-related Outcomes a. Serum biomarkers and second primary tumours: The Swedish AMORIS cohort was used to investigate how a variety of serum biomarkers of different metabolisms (i.e. glucose, lipids, gamma-glutamyl transferase (GGT) and fructosamine) measured before prostate cancer diagnosis as a first primary tumour, are associated with patterns of secondly diagnosed primary tumours (SDPTs). This database contains information on > 350,000 men who provided measurements for these biomarkers. Cox proportional hazard models and multiple imputations were used to quantify these associations. 2) Treatment-related Outcomes For the next three projects, I used the PCBaSe Sweden database which covers >96% of prostate cancer patients in Sweden between 1998 and 2006. b. The association between radiotherapy and risk of thromboembolic disease: Using Cox proportional hazard models, I investigated the risk of thromboembolic disease (TED) after receiving radiotherapy for prostate cancer. c. Drugs for metabolic conditions and prostate cancer death in men on gonadotropin releasing hormone receptor agonists: I investigated how having a treatment for metabolic disease-related components (‘metabolic drugs’) at the time of androgen deprivation therapy initiation was associated with prostate cancer mortality and overall mortality. Cox proportional hazard models, cumulative incidence and competing risk analyses were applied. d. Anti-androgens versus on gonadotropin releasing hormone receptor (GnRH) agonists in relation to prostate cancer death: Using propensity score matching, Cox proportional hazard models and cumulative incidence analyses, I investigated whether there is any difference in terms of prostate cancer survival and overall survival amongst men treated either with anti-androgens or GnRH agonists. Results: My findings in the AMORIS study support the hypothesis that alterations in metabolic factors like cholesterol, triglycerides and GGT present several years before prostate cancer diagnosis may indicate a common biological background between prostate cancer and SDPTs. In more detail, my results showed higher risk of SDPTs for those with high serum levels of triglycerides (HR: 1.37, 95%CI: 1.17-1.60), total cholesterol (HR: 1.22, 95%CI: 1.04-1.42) and GGT (HR: 1.32, 95%CI: 1.02-1.71), as compared to the normal levels. My findings in the PCBaSe studies show that: a. After adjusting for all available confounding covariates, no association was found between radiotherapy (in the forms or external beam radiotherapy and brachytherapy) and TED (HR: 1.05, 95% C.I.: 0.61-1.79 and HR: 0.97, 95%C.I.: 0.29-1.44 respectively). Radiotherapy was not associated with an increased risk of thromboembolic events within 5 years of receiving this treatment. b. After competing risk analysis, I observed that ‘metabolic drugs’ did not improve or worsen prostate cancer mortality amongst men being treated with GnRH agonists. However, men on ‘metabolic drugs’ were more likely to die of cardiovascular disease than men not on these drugs (i.e. HR 1.87; 95%CI: 1.56-2.24 for anti-hypertensive drug use and HR 2.46; 95%CI: 2.03-2.98 for anti-hypertensive + lipid lowering drug use). c. Following propensity score matching, men on GnRH agonists had a similar risk of death from prostate cancer as men on anti-androgens, HR 1.09 (95% CI: 0.94-1.27), but a higher risk of death from all causes, HR 1.25 (95% CI: 1.14-1.37). Anti-androgens showed similar overall and prostate cancer mortality rates to GnRH agonists. Conclusion: Overall, my results showed that metabolic alterations in terms of high levels of lipids and GGT might have an impact on men after prostate cancer diagnosis by an association with an increased risk of SDPTs. However, treatment for metabolic syndrome related conditions did not increase the risk of prostate cancer death amongst those treated with GnRH agonists, but did increase the risk of CVD-related deaths. Also, my results help elucidate potential treatment side-effects and outcomes by showing that: a. radiotherapy did not increase the risk of TED, allowing patients and physicians to focus on other well-established RT side effects (i.e. erectile dysfunction, urinary incontinence or bowel incontinence); and b. that anti-androgens may be an alternative to GnRH agonists for men with advanced non-metastatic prostate cancer, given similar prostate cancer death and overall mortality risks.

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Hada, Adriana H. "Transforming patient outcomes through effective nursing clinical handover". Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/228671/14/Adriana%20Hada%20Thesis.pdf.

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This thesis explored the effect of nursing handover strategies to facilitate the provision of standardised handover communication and enhancement of patient safety in the inpatient wards of a tertiary metropolitan Australian hospital. The outcomes included improved nursing compliance with best practice nursing shift-to-shift handover, and improved direct patient outcomes, including a reduction in falls, pressure injuries, and medication errors. The findings of this research contribute to a theoretical understanding of best practice nursing shift-to-shift handover in the participating wards and could influence nursing practice, education, policy, and future research for the benefit of patient safety and quality of care.

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Coletti, Brock Jeff. "Clinical Use and Outcomes of Silver Diamine Fluoride in a Hospital Dental Clinic". The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1531705574496172.

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Aroney, Christine Margaret. "Patient Reported Outcomes From Clinical Trials in Medical Retina". Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/16054.

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Purpose: To determine the patient-centred effectiveness of treatment with the slow release dexamethasone intravitreal implant (DEX implant) and intravitreal bevacizumab using the Impact of Vision Impairment Questionnaire (IVI), a vision-related quality of life (VRQoL) measure, in patients with visual impairment secondary to centre-involving diabetic macular edema (DMO). Methods: Patients with DMO were enrolled in a phase 2, prospective, multicenter, randomized, single-masked clinical trial and received either DEX implant 4 monthly or bevacizumab monthly, both pro re nata. VRQoL was measured at baseline and 24 months, using the IVI’s three component scales, namely Reading, Mobility and Emotional Well-being. Rasch analysis was used to generate interval-level estimates of VRQoL, which were then analysed using t-tests to assess changes over time. Results: 48 patients completed the main study; 43 (90%) answered the IVI at the baseline and 24-month (final efficacy) visits. VRQoL improved significantly, with average increases of 1.44, 0.99 and 1.49 logits, for the Reading, Mobility and Emotional well-being scales respectively, from baseline to 24 months, (p<0.001). There was no significant between-group difference in improvement in VRQoL in the DEX implant only compared with the bevacizumab-only group, in any of the three scales listed above (with 1.41, 1.08 and 2.11 logits improvement, in Reading, Mobility and Emotional well-being respectively for DEX implant group, compared to 1.48, 1.06 and 2.11 for bevacizumab; p-values >0.1.) Conclusions: We found that both DEX implant and bevacizumab treatment result in significant and similar improvements in VRQoL in patients with DMO over a 24-month period.

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Raines, Diane Smith. "The Impact of the Clinical Nurse Leader/Navigator on Clinical Outcomes and Patient Satisfaction". UNF Digital Commons, 2013. http://digitalcommons.unf.edu/etd/479.

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In an era of value based purchasing and healthcare reform, hospitals face the challenge of delivering high quality care in an environment of diminishing resources. This performance improvement project describes the use of master’s prepared nurses on medical surgical units to improve quality and patient satisfaction. The setting was five medical surgical units in a 200+ bed hospital in the southeastern United States. Declining resources necessitated an increase in the nurse to patient ratios on the units (from 5:1 to 6:1). The project involved the modification of the model of care through the change in nurse/patient ratios and the addition of master’s prepared nurses to coordinate and supplement the care of the staff RNs for complex patients. While inconclusive, the literature review confirmed the impact of master’s prepared nurses on quality metrics and did not conclusively confirm that delivering high quality, safe care was not possible with nurse/patient ratios of 1:6. The goal of the project was to determine if the presence of the master’s prepared nurse could mitigate the changes in ratios and produce high quality and satisfaction outcomes. Measures of success were drawn from archived standardized quality measures in the realms of service (HCAHPS questions), patient safety (CABSI, HAPU) and quality outcomes (core measures and 30 day readmissions). The project design was a retrospective, one-group pre-post design looking at two six-month intervals—before and after project implementation. Results demonstrated sustained or improved quality in six of ten measures. Highest positive impact was in readmissions and nurse sensitive indicators. The most negative results were in patient satisfaction. Modifying the model of care is an iterative process requiring continued evaluation and changes to improve outcomes. Results of this project supported the further evaluation of staffing and expansion of the number of master’s prepared nurses on medical surgical units.

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Chung, Pui-yi Rebecca. "A clinical audit on Caesarean section indications and outcomes". Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971003.

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Shah, Syed Ghafoor. "Magnetic imaging colonoscopy effects on performance and clinical outcomes". Thesis, Imperial College London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.415562.

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Chung, Pui-yi Rebecca, e 鍾佩儀. "A clinical audit on Caesarean section indications and outcomes". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971003.

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Egan, Richard John. "Clinical outcomes and complications of laparoscopic adjustable gastric banding". Thesis, University of Bristol, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.664980.

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Laparoscopic adjustable gastric banding (LAGB) is a commonly performed bariatric procedure worldwide. Some of the short-term outcomes from LAGB are well documented but little is known about the mid-to-long term outcomes following this procedure in the UK within the National Health Service (NHS) framework. This thesis will focus specifically on the outcomes of LAGB on an NHS population of patients. A review of the literature will summarise the current evidence supporting the use of bariatric surgery in the morbidly obese population. Following on from this introduction into the subject, a small case series is presented. The results of this pilot study suggest that LAGB can be considered as a valid treatment for idiopathic (benign) intracranial hypertension. Over the following two chapters the results from a prospective cohort study will explore in depth the outcomes of a cohort of morbidly obese, type 2 diabetic patients following LAGB. This will address both potential improvements in diabetes and the evolution of several obesity-related co-morbidities following surgically induced weight loss. Subsequent chapters will attempt to clarify some of the controversy associated with long-term complications following LAGB. An in-depth literature review will highlight variations in the definition and reporting of several of the well recognised complications associated with this procedure and suggest a reporting framework to aid clarity in future publications. This is followed by a prospective cohort study addressing those complications specifically associated with oesophageal function, and clinical outcomes following the implication of a simple management regimen when such complications arise. It is hoped that the detailed and transparent analysis of a large surgical cohort reported within this thesis will provide guidance for surgical teams within the NHS who perform this bariatric procedure.

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Comyn, O. J. "Clinical outcomes of ranibizumab treatment in diabetic eye disease". Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1460411/.

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Background: The vascular endothelial growth factor (VEGF) inhibitor ranibizumab is emerging as an efficacious treatment for diabetic macular oedema. Large clinical trials have shown improvements in visual acuity and reduced central retinal thickness. Details of its effect on other retinal functional parameters are lacking. There is a concern that repeated ranibizumab treatment could exacerbate macular ischaemia or lead to global retinal dysfunction by inhibiting physiological isoforms of VEGF. Outcomes of surgery for advanced proliferative retinopathy remain variable and post-operative complications including recurrent haemorrhage can limit visual recovery. VEGF is strongly implicated in the pathogenesis of advanced retinopathy, so VEGF inhibition prior to surgery may improve outcomes. Trials have failed to demonstrate a clear benefit for bevacizumab, so investigation of the licensed intraocular agent ranibizumab represents a logical next step. Aims: To investigate the effects of ranibizumab and laser treatment in diabetic macular oedema on the following parameters: visual acuity, protan and tritan colour contrast sensitivity, 4° and 12° macular sensitivity by microperimetry, electrophysiological indices from pattern and full field electroretinograms. To report structural retinal changes following ranibizumab and laser treatment in terms of qualitative and quantitative optical coherence tomography outcomes, and to quantify macular ischaemia by fluorescein angiography. To investigate the effect on visual acuity at three months post-surgery of ranibizumab pre-treatment in patients undergoing vitrectomy for advanced proliferative diabetic retinopathy. Methods: Randomised clinical trial of intravitreal ranibizumab vs. laser in 36 subjects with centre-involving diabetic macular oedema (The LUCIDATE study). Randomised clinical trial of pre-operative intravitreal ranibizumab vs. subconjunctival saline injection in 30 subjects undergoing vitrectomy-delamination for advanced proliferative diabetic retinopathy (The RaDiVit study). Results: Thirty six subjects with diabetic macular oedema were recruited and 33 completed the trial. Ranibizumab treated subjects gained a mean of 6 letters compared with 0.9 letter loss for laser at 48 weeks. Retinal sensitivity improved in the central macular 4° and 12° in both groups but to a greater extent with ranibizumab. There was no evidence of worsening global retinal dysfunction by electroretinograms in either group. Retinal thickness decreased in both groups: there was a 132 µm reduction in central macular thickness with ranibizumab compared with 103 µm for laser. Fluorescein angiography showed no evidence of significantly increased macular ischaemia in either group. Thirty subjects with advanced proliferative diabetic retinopathy were recruited, underwent surgery, and completed the study. At three months post-surgery, visual acuity in the ranibizumab group was 53 letters compared with 47 letters in the control group. Conclusion: In diabetic macular oedema, there is evidence that ranibizumab leads to greater improvements in visual acuity and retinal sensitivity than laser, with a corresponding greater reduction in retinal thickness. There is no evidence that it worsens macular ischaemia or indices of global retinal electrophysiological function, but larger trials designed to address each of the outcomes investigated here would be required to confirm these findings. In proliferative diabetic retinopathy, there is evidence from this small pilot study that ranibizumab treatment leads to better visual acuity at 3 months post-surgery. An appropriately powered trial would be required to confirm this.

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Bark, Charles. "CLINICAL SYMPTOMS AND MICROBIOLOGICAL OUTCOMES IN TUBERCULOSIS TREATMENT TRIALS". Case Western Reserve University School of Graduate Studies / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=case1307630776.

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Xu, Gang. "Improving clinical outcomes in acute kidney injury through education". Thesis, University of Leicester, 2015. http://hdl.handle.net/2381/32230.

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Acute Kidney Injury (AKI) is caused by a sudden decline in kidney function, which may be caused by numerous pathologies such as hypovolaemia or septicaemia. It has only recently been recognised that patients who develop AKI have significantly worse outcomes. The aim of this project was to develop, deploy, and evaluate a multifaceted education package aimed at improving clinician knowledge on AKI in a real life postgraduate clinical setting. We developed a web based learning resource on AKI that was recognised for its ease of use and quality in the 2013 BMJ Awards. In addition, specific AKI teaching sessions were developed, based on sound educational theory and delivered using interactive presentation software, which helped to increase audience engagement. Our findings show that it is possible for a multifaceted educational intervention to have a positive impact on clinicians’ self-reported confidence in managing AKI; as well as a trend towards better performance in knowledge based multiple choice questions. There was also a trend towards improved clinical outcomes including reduced mortality and shorter length of stay, though the significance of these findings is not clear. This thesis demonstrates the need for us to develop a better understanding about AKI prognosis, especially in the community setting. The trends shown in the mortality and length of stay data could be a consequence of factors that are currently poorly understood. The results also showed that despite increasing presence of technology in our lives, clinicians still prefer learning when it is delivered in a face-to-face setting. Much more work needs to be done in this area, so that we can better understand how to develop future postgraduate education tools that are effective and sustainable in a real world clinical setting.

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Goodlad, Catriona. "Clinical and cytokine predictors of outcomes in peritoneal dialysis". Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/17763.

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Background Changes in the structure and function of the peritoneal membrane limit the duration of PD. Rarely (and unpredictably) these changes progress to severe fibrosis and bowel encapsulation (encapsulating peritoneal sclerosis, EPS) with substantial morbidity and mortality. Methods PD fluid and serum samples from 50 patients were added to 100 previously analysed samples (Dr S Ahmad). CCL18, IL-6, MCP-1 and angiogenin were measured by ELISA. CCL15 was measured for the first time in 125 serum and dialysate samples. Fifty one year follow up samples were analysed. Serum cytokines were measured in patients with and without EPS. Peritoneal mesothelial cells were cultured and media cytokine levels measured. CCL15 stimulation of cytokine production was investigated. Protein transfer across the peritoneal membrane by size was investigated. CT scans from 20 pre-EPS PD patients were scored and compared with scans of non-EPS patients. Results Levels of CCL18, MCP-1, CCL15, angiogenin and IL-6 in dialysate correlate with clinically important measures such as glucose exposure and D/P creatinine. Mesothelial cells in culture produce MCP-1, IL-6, angiogenin and CCL18. High dialysate levels of MCP-1, IL-6 and CCL15 are found in patients who subsequently developed EPS. High levels of CCL18 are also seen in haemodialysis patients with EPS. CT screening of PD patients used alone does not predict future EPS; in combination with abdominal symptoms CT scans may be of use. Conclusions There is local peritoneal production of chemokines such as MCP-1, CCL18, IL-6 and angiogenin, and the correlation of levels of these cytokines with clinically relevant parameters suggests they may be involved in the pathogenesis of long term changes in the peritoneum. At present neither clinical nor cytokine levels can reliably be used to predict future EPS. CT scanning may be helpful in patients at risk of EPS who develop new abdominal symptoms.

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Chavez-Gehrig, Arturo. "Modeling correlations in clinical trial outcomes using machine learning". Thesis, Massachusetts Institute of Technology, 2019. https://hdl.handle.net/1721.1/123075.

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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2019
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 69-71).
This thesis explores the problem of characterizing the covariance of clinical trial outcomes using drug and trial features. The binary nature of FDA approvals makes drug development risky, but approaches in finance theory could better manage that risk, allowing more high potential drugs to be developed. To apply these methods confidently, it is necessary to understand the covariance between projects. The paper outlines several approaches for this task and their theoretical foundations, such as finding the nearest valid covariance matrix, online sequence prediction, and a new approach using function approximation via random forest. This function approximation approach to estimating covariance is implemented and tested on historical clinical trial data.
by Arturo Chavez-Gehrig.
M. Eng.
M.Eng. Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science

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Ensor, Hannah Margaret. "Statistical evaluation of surrogate outcomes : methodological extensions to ordinal outcomes with applications in acute stroke". Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22931.

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Background Surrogate outcomes are measures of treatment effect that can be used to predict treatment effect on the true outcome of interest. Surrogates are valued as they can be used in place of true outcomes to reduce the length, size, or intrusiveness of a clinical trial. However, validation of surrogacy is a conceptually complicated area and much theoretical and practical statistical development has been conducted in recent years. Methods A systematic review was conducted to identify which surrogate evaluation approach was best suited to be extended to ordinal outcomes. I extended a foremost approach to the case where the surrogate, the true clinical outcome, or both are ordinal outcomes. This extension investigated surrogacy at both the trial and individual levels; trial level surrogacy was based on a two stage method. The extension was developed through large simulation studies and used to investigate whether deep venous thromboembolism (DVT) was a surrogate for the ongoing measure of death and disability the Oxford Handicap Scale (OHS), using data from the stroke trial CLOTS3. CLOTS3 was a large multi-centre randomised clinical trial which investigated whether intermittent pneumatic compression (IPC) applied to the legs reduced the occurrence of deep venous thromboembolism (DVT) in stroke clinical trial patients. Results The systematic review identified the information theory approach as the most intuitively and practically worthwhile approach to surrogacy evaluation. I extended this approach to: a binary surrogate and ordinal true outcome (the binary-ordinal setting); the ordinal-binary and the ordinal-ordinal settings. The simulation studies showed that the approach worked well in most scenarios tested. However, trial level surrogacy was impacted by loss of efficiency due to the use of the two stage method. Bias imposed at the trial level by separation of discrete outcomes was effectively dealt with using a penalised likelihood method. The information theory approach for ordinal outcomes identified no surrogate that would predict treatment effect of IPC on the true outcome OHS measured at six months in the stroke trial CLOTS3.

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Taylor, Amanda Christine. "Employment specialists' competencies as predictors of employment outcomes". Thesis, Purdue University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10160186.

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Employment specialist competencies were examined as predictors of employment outcomes for consumers with severe mental illness participating in supported employment. Using a cross-sectional correlational design a variety of self-report and supervisor-rated performance measures were examined for their association with three consumer employment outcomes (e.g., the percentage of consumers on their caseload competitively employed, the percentage of consumers on their caseload employed 90 consecutive days, and the rate in which consumers dropped out of employment services). Six mental health agencies with a total of 57 employment specialists and 14 supervisors from across the nation participated in the study. Competitive employment rates ranged among employment specialists from 0% to 80%. Higher supervisor-rated job performance, supervisor-rated employment specialist efficacy, percentage of work time spent in the community during the past month, and number of contacts with consumers during the past month were related to improved consumer employment outcomes. However, employment specialist attitudes, knowledge of supported employment, conscientiousness, and self-efficacy were unrelated to employment outcomes. This study is one of the first of its kind to examine employment specialist competencies as they relate to supported employment for consumers with severe mental illness. While supported employment is a great improvement over traditional vocational programs, further examination of employment specialist competencies could hold the key to unlocking employment success for many more consumers.

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Suksomboon, Naeti. "Impact of clinical pharmacist intervention on clinical outcomes and quality of life in elderly hypertensives". Thesis, Robert Gordon University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395749.

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Saunders, Dinah Jo. "Clinical decision-making and clinical judgment outcomes by nursing students in traditional or nontraditional curricula". W&M ScholarWorks, 1997. https://scholarworks.wm.edu/etd/1539618497.

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The purpose of this study was to investigate the claim that nursing students in nontraditional curricula achieve program outcomes consistent with nursing students in traditional generic curricula. Clinical decision making and clinical judgment are essential components of critical thinking in nursing. Self-perception as a decision-maker was measured by the Clinical Decision Making in Nursing Scale (CDMNS) and clinical judgment was measured by the Clinical Judgment in Nursing Series #1: Emergencies in Adult Client Care Test (CJS:EACC).;Participants were recruited from three regional universities. One curricular group consisted of a generic (traditional) BSN group. One nontraditional curricular design was RN-BSN Completion programs designed for RN's to return for degree completion. The second nontraditional curricular group represented an Accelerated BSN program designed for adult learners with a previous baccalaureate degree to achieve a career change to nursing.;No significant outcome differences in self-perception as a clinical decision-maker as measured by mean scores on the CDMNS or in the decision making process as measured by subscale scores on the CDMNS were found between Traditional and nontraditional student groups. The hypotheses that there would be no differences in either self-perception as a decision maker or the decision making process were supported.;A significant difference was found between group scores related to clinical judgment as measured by the CJS:EACC. The nontraditional curricular groups, primarily adult learners, achieved higher scores than the generic group. The attributes of age, work experience, self-directedness, and readiness to learn may have influenced the adult learner's ability to achieve, through nontraditional program structures, at the same level or higher as traditional students. Age was an influencing variable on CJS:EACC scores. The instrument measures nursing assessment and intervention related to adult medical/surgical clients. The hypothesis that there would be no difference in clinical judgment could not be supported.;Interview responses representative of each curricular group were consistent with previous studies of the goals, barriers, learning needs, and characteristics of the adult learner.

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Rubenstein, Liza M. "Emotional Clarity and Psychosocial Outcomes During Adolescence". Diss., Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/520162.

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Psychology
Ph.D.
Past research on emotional clarity (EC), the ability to identify and label one’s own emotions, has illustrated a connection between EC deficits and poor psychosocial outcomes during the adolescent years. For youth ages 12-17, low EC is associated with internalizing problems, dysfunction in peer and parental relationships, and risky behavior such as substance use. Likewise, high EC is linked with positive outcomes, such as psychosocial maturity and adaptive emotion regulation skills. Although past research has connected EC to psychosocial outcomes during adolescence in cross-sectional and longitudinal designs, no studies have traced the trajectory of EC over time to determine the developmental course of the construct during adolescence. Thus, this study investigated how EC developed over five years during adolescence and what factors were associated with the developmental trajectory of emotional clarity. Results indicated that EC tended to decrease over adolescence, and females, on average, had a steeper decline of EC over time than males. The trajectory of EC change predicted psychosocial outcomes, including depression, family functioning, well-being, and the trajectory of peer victimization over time. Results are discussed with the ultimate goal of informing novel prevention and intervention programs to promote adaptive emotional functioning during an influential time in human development.
Temple University--Theses

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Benet, Cabero Arnau. "Surgical Assessment of Insular Gliomas: Operative Technique and Clinical Outcomes". Doctoral thesis, Universitat de Barcelona, 2020. http://hdl.handle.net/10803/670023.

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BACKGROUND: Surgical treatment of Insular gliomas is technically challenging and may lead to high postoperative morbidity. However, previous research has proven that maximal safe resection is critical for maintaining quality of life as well as enhancing overall and progression-free survival. Insular gliomas are currently resected through either a transsylvian or transcortical approach. However, there is no objective evidence to aid surgical management to maximize safe resection rates. OBJECTIVES: To define an optimal treatment strategy for the neurosurgical management of insular gliomas using a sequential research protocol. Phase A1- Design a custom embalming formula for preserving native brain features in cadavers to optimize the validity and clinical applicability of laboratory-based operative research. A2- Design a laboratory method to obtain objective data to assess -and compare- neurosurgical techniques in cadavers. Phase B- Define an optimal surgical technique for the management of each insular glioma of the Berger-Sanai classification system using our surgical simulation method in cadavers. Phase C- Validate the existing anatomical classification of insular gliomas to predict extent of resection (extent of resection) and anticipate neurological morbidity. METHODS: We aimed to provide sound objective evidence to the surgical management of insular gliomas through a multidisciplinary, sequential method including basic laboratory research, neurosurgical simulation using cadavers and a prospective clinical study. We first developed a customized embalming formula to create a neurosurgical simulation method that best resembles life surgery (a). We then used this optimized surgical simulation method to objectively determine and quantify the best surgical approach (transsylvian vs transcortical) for each type of insular tumor according to the Berger-Sanai insular glioma classification (b). Finally, we carried out a prospective clinical study to assess the predictability of the Berger-Sanai insular glioma classification regarding extent of resection and patient outcomes (c). RESULTS: We designed an embalming solution that dramatically improved validity and applicability of research using neurosurgical simulation in cadavers. Our formula optimizes resemblance to life surgery (lower retraction pressure and greater retraction area) compared to the gold standard (formaldehyde). Our embalming method preserved specimens for significantly longer use than un-embalmed cadavers, which allows for complex research designs (such as Phase B of this work). We described cutting-edge surgical simulation techniques to objectivize surgical techniques in the laboratory. Our surgical simulation experiments show that the transcortical approach performs better than the transsylvian approach on all parameters for zones I and IV. On Zones II and III, cortical mapping and specific anatomical features may make the transsylvian approach more favorable. Our prospective clinical study showed that the Berger-Sanai insular glioma classification is a reliable tool to predict extent of resection (highest on zone I, IV) and postoperative complications (lowest on zone II and IV) following surgical treatment. CLINICAL AND SCIENTIFIC IMPACT: Overall, this work improved the field of neurosurgical simulation research by providing a detailed description of cadaver preparation (including public disclosure of the embalming chemical formula) and methodology to carry objective measurements to compare surgical techniques. For the first time, we provided objective data to aid the neurosurgeon in choosing the best surgical approach to maximize resection rates of insular gliomas tailored to the Berger-Sanai insular glioma classification. Finally, we validated the Berger-Sanai insular glioma classification as a tool to anticipate resection rates and postoperative neurological complications. As a whole, this work will substantially impact management of insular gliomas and patient informed decisions.
En la present tesis doctoral es presenten els resultats de sis anys d’investigació del doctorand sobre els gliomes que afecten el lòbul de l'Insula. La present tesis doctoral es divideix en tres parts en les que es desenvolupa un programa seqüencial dirigit a la investigació i optimització del tractament quirúrgic de les lesions de la Insula (amb especial atenció als gliomes cerebrals d’alt grau). En primer lloc es desenvolupa un treball de laboratori per al disseny d’una metodologia òptima per a la simulació quirúrgica d’abordatges Neuroquirúrgics intracerebrals en un model cadavèric. Es descriuen els mètodes i estratègies per al disseny de la composició química del líquid de embalsamament que el cervell humà així com la metodologia per avaluar objectivament l’esmentada fórmula química i el mètode de embalsamament. Es descriu la superioritat del mètode desenvolupat respecte de l’estàndard de preparació de cadàvers però simulació quirúrgica i es discuteixen els avantatges principals del mètode dissenyat respecte la investigació referent a la tècnica neuroquirúrgica. Aquests són, en breu, la millora substancial d’elastança cerebral que permet la retracció del teixit cerebral de forma similar a la cirurgía en ésser humà viu, la disminució de l’exposició del personal de recerca a components carcinogènics com el formaldehid, la superioritat en la preservació del material cadavèric respecte el teixit no embalsamat, etc. L’esmentada metodologia és la base per la segona fase de la present tesi doctoral. En segon lloc es desenvolupa un projecte d’investigació sobre la tècnica quirúrgica per la ressecció de lesions del lòbul de l'Insula, amb especial atenció als gliomes insulars. Prenent el mètode de simulació neuroquirúrgica desenvolupat a la primera fase d’aquesta tesi, es comparen les dues tècniques principals per l’accés a la Insula: l’abordatge Transilvià i l’abordatge Transcortical. Es descriuen els perfils quirúrgics d’ambdues tècniques quirúrgiques respecte a l’accés a cada una de les parts de la Insula (anterior superior, posterior superior, posterior inferior, i anterior inferior). Es descriu, per primera vegada, la tècnica quirúrgica més favorable per cada part de la Insula i s’introdueixen conceptes claus per la decisió preoperatòria. En termes generals l’abordatge transilvià demostra superioritat en tumors que afecten la part anterior de la Insula, mentre que l’abordatge transcortical és superior en tumors de la part posterior. En tercer lloc s’estudien els resultats clínics de les tècniques quirúrgiques estudiades en un model de simulació descrit a la fase anterior, per mitjà de la revisió retrospectiva de casos clínics en els quals es varen realitzar cirurgies de glioma insular. L’esmentada investigació retrospectiva es va desenvolupar a University of California San Francisco, Califòrnia, USA (Centre de notable prestigi vers la cirurgia de gliomes insulars), així com a Barrow Neurological Institute, Arizona, USA (centre de prestigi mundial en microneurocirurgia). En aquesta última fase es resumeixen els resultats de laboratori així com l’experiència clínica desenvolupats en aquest treball de tesis doctoral per proveir les bases sòlides per la decisió clínica i tècnica vers el tractament de pacients que pateixen de glioma insular. Específicament, s’estableix que el grau de resecció quirúrgica determina la supervivència del pacient amb glioma insular. Així doncs és important identificar l’abordatge quirúrgic (transsilvià o transcortical) que permet arribar als nivells de resecció quirúrgica superior al 80% del volum del tumor, per optimitzar el resultats clínics tot mantenint la funció cerebral.

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Julian, Sophia. "Impact of the clinical process on outcomes of menstrual disorders". Thesis, University of Leicester, 2007. http://hdl.handle.net/2381/29534.

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Introduction: Menstrual disorders have a significant impact on the health and well being of women. There are wide, unexplained variations in treatment and investigation in primary care. Rates of referral to secondary care, where surgery is a more likely outcome, also vary. Aim: To examine the outcomes of a new model of care for women with menstrual disorders, known as the Bridges Project, involving implementation of an evidence based, GP led pathway of care integrated across primary and secondary sectors. Study Design: A prospective non-random comparison of two services: women attending the Bridges pathway and those attending a consultant-led one-stop menstrual clinic (OSMC). Outcomes were assessed after eight months and included treatment modalities, health status (SF-36 and menstrual questionnaire), an investigation of patient experience of care using the Patient Career Diary (PCD) and qualitative interviews, resource use and cost, adherence to guidelines and patient preferences for care. Setting: A large teaching hospital and one Primary Care Trust (PCT). Results: Between March 2002 to June 2004, 99 women in the Bridges pathway were compared to 94 women attending the OSMC. There were no statistically significant differences in mode of treatment or health status between them at eight months. Interviews demonstrated that women experience significant problems when accessing care for menstrual disorders and perceive their problems to be of low priority within the health service. The PCD demonstrated statistically significant differences for the Bridges group in several aspects of care: information and ease of access (P<0.001), choice of doctor (P = 0.020), waiting time (P<0.001), and sense of co-ordination between sectors (P< 0.001). There were significantly fewer outpatient appointments in the Bridges scheme (PO.001) with no increase in primary care workload. The cost per patient for the Bridges project was Â£751.72 compared to Â£1022.54 in the OSMC group. Conclusion: Although there were no differences between groups in the types of treatment (conservative, medical or surgical) women received, the new model of care resulted in significant improvements in patients' experiences of care whilst maintaining clinical quality at reduced cost through more efficient resource use.

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McLain, Nina E. "Anesthesia Clinical Performance Outcomes: Does Teaching Methodology Make A Difference?" Availabe to VCU users online at:, 2007. http://hdl.handle.net/10156/1778.

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Martin, Andrew C. "Acute asthma in children : relationships between genetics and clinical outcomes". Thesis, University of London, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.542954.

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Luo, Y. H. "Argus® II Retinal Prosthesis System : clinical & functional outcomes". Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1559629/.

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Developing artificial visual systems to restore sight in blind patients has long been the dream of scientists, clinicians and the public at large. After decades of research, the greatest success in the field has been achieved with electronic retinal prostheses. To date, 3 retinal prosthetic systems have made the transition from laboratory / clinical research to entering the commercial market for clinical use, namely the Argus® II Retinal Prosthesis System (Second Sight), the alpha-IMS system (Retinal Implant AG), and the IRIS® II (Pixium Vision). The following body of work describes the Argus® II Retinal Prosthesis system, which obtained regulatory approval in the European Economic Area in 2011 (CE marking) and later on in the USA (FDA approval in February 2013), based on the results of an international multi-centre clinical feasibility trial (Clinical Trial identifier: NCT 00407602). This thesis aims to examine the long-term clinical and functional outcomes in an early cohort of subjects chronically implanted with the Argus® II system, from the original feasibility study. A further aim is to elucidate the characteristics of the artificial vision that is perceived and its long-term repeatability and reproducibility in individual subjects. These two broad aims will assist in understanding the nature of the visual performance provided by this device, as well as to add to the current data that is defining the feasibility of constructing predictable pixelated patterns to achieve useful artificial vision in the future. Finally, we explored the feasibility of real-time imaging of visual cortex activation in response to electrical retinal stimulation with the Argus® II system, using functional near infra-red spectroscopy (fNIRS). Development of this real-time imaging tool will enable future investigations into the differences in the cortical activities in response to different stimulations and in different subjects. This may in turn help us understand the variability in their visual performance, as well as to further explore the extent and effect of cross-modal plasticity at the cortical level, in this cohort of patients who have been deprived of visual inputs for decades. Visual function was assessed in terms of: a) form recognition and b) spatial localisation under both 2-dimensional (2D) screen-based laboratory settings and 3-dimensional (3D) paradigms simulating real-life settings. A prospective study of 11 Argus® II subjects showed that the subjects could identify distinct geometric shapes presented in high contrast better with the prosthetic system switched on (median % of correct identification = 20.0%, IQR = 18.8), versus off (median = 12.5%, IQR = 5.0). The accuracy of shapes identification could be further improved by enhancing the outlines of the geometric shape (median = 33.1%, IQR = 21.6). A further prospective study from a subset of 7 subjects showed that this 2D shape identification could be translated into improved identification of 3D objects. These subjects could identify 8 common daily-life objects presented in high contrast with the prosthetic system switched on (median = 31.3%, IQR = 20.3) versus off (median = 12.5%, IQR = 12.5). Scrambling of the transmission signals within the prosthetic system in order to separate light information from form information (i.e. “scrambled mode”) hindered the identification in some but not all subjects (median = 25.0%, IQR = 12.5). The accuracy of object identification could also be improved by enhancing the edges of objects (median = 43.8%, IQR = 15.6). Previously published data showed that Argus® II subjects were able to locate and point to white squares presented on touch screens against a black background more accurately with the prosthetic system switched on versus off. We demonstrated with a prospective study of 5 subjects that they could localise an object on the table, reach out and grasp the object (prehension) with great accuracy (66.7 – 100%) when the prosthetic system was switched on, versus no object prehension (0%) with the system switched off. A prospective study of 6 Argus® II subjects illustrated that while there was a wide variation in the shape and size of the phosphenes perceived by individual subjects, the elicited phosphenes were consistently reproducible in each subject using fixed stimulating parameters, with inter-stimuli intervals ranging from 20 minutes apart, down to 1 second. The perceived location of the phosphenes grossly matched retinotopic agreement, with 4 subjects drawing phosphenes in the same visual field quadrant as predicted by the relative stimulus-fovea position, and 2 subjects depicting phosphenes in the same hemi-field as the expected locations. A retrospective study of 3 Argus® II subjects who underwent MRI brain scan (for unrelated medical reasons) showed that MRI brain scans of up to 1.5 Tesla field strength appeared to have no detrimental effect on the subjects and their implant function. The Argus® II implant produced an artefact of around 50mm x 50mm in size which would prevent visualisation of structures within the orbit, but visualisation of surrounding tissues outside this areas are unaffected. The use of functional MRI as a tool of exploring visual cortex activation in Argus® II subjects was discounted, due to concerns of signal interference from the radiofrequency telemetry of Argus® II system with that of MRI. Subsequently, we have demonstrated in a prospective study that an alternative neuro-imaging technique, functional near infra-red spectroscopy (fNIRS), was capable of capturing real-time cortical activation in 5 out of 6 Argus® II subjects, and maybe a feasible tool for future investigation into cortical function and interactions. The work in this thesis has shown that the Argus® II retinal prosthesis system could improve visual function both in terms of form recognition, as well as object localisation in 3D in situations simulating real-life settings, in a cohort of patients with end-stage retinitis pigmentosa or other outer retinal diseases such as choroideremia. The wide variation in the visual performance level observed could in part be attributable to the diversity in the phosphene features perceived by these subjects. Nevertheless, the consistency and reproducibility with which these phosphenes could be elicited, with fixed stimulating parameters within each subject, provides an encouraging basis for the construction of more complicated pixelated images. Future work to determine the underlying factors influencing the perceived phosphene characteristics, may allow for better prediction of functional outcome, which could in turn be useful for patient selection and tailored preoperative counselling. For those subjects already implanted with the Argus® II system, future work into determining the suitable stimulating parameters for each electrode / quad stimulation may be required for individual subjects, to achieve the construction of optimised and useful, pixelated prosthetic vision.

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Higham, Ruchi. "Clinical trials in regenerative medicine : negotiating process, practice and outcomes". Thesis, University of York, 2017. http://etheses.whiterose.ac.uk/19879/.

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There has been significant progress in the basic science of regenerative medicine over the past two decades, but clinical translation has been more halting. Clinical trials are a key step in the translational process and have been highlighted as a particular challenge for the field. This thesis adopts an analytical framework informed by Jasanoff's idiom of co-production to investigate trials of one particular type of regenerative medicine: cell therapies. A mixed-methods design was used, which included quantitative analysis of secondary data, 17 semi-structured interviews with cell therapy trialists, and a longitudinal observational study of a cell therapy trial. The findings indicate that the cell therapy trials landscape in the UK is small, fragmented and dominated by academic-led, publicly-funded studies. This conflicts with a policy environment that is largely aligned with a commercial development model, and a trials process that was designed for drug trials funded by large corporations. Trials tend to be affected by a specific set of local factors, the most important being financial constraints, the logistics of working with cells, the temporality of the trial and the need to align the work of disparate domains. These issues create a challenging translational environment, with the linearity and abstracted nature of the trials process conflicting with the recursive, situated nature of innovation. They also highlight the significant contingency involved in trials, which is at odds with the priority evidence-based medicine places on this supposedly neutral, objective method. Whilst cell therapy trials must without a doubt be held to the highest regulatory standards, it is also important that the clinical research framework takes into account the challenges they pose and the contingent nature of the evidence they generate, and the thesis concludes with some recommendations as to how this might be achieved.

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Ashfaq, Awais. "Predicting clinical outcomes via machine learning on electronic health records". Licentiate thesis, Högskolan i Halmstad, CAISR Centrum för tillämpade intelligenta system (IS-lab), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-39309.

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The rising complexity in healthcare, exacerbated by an ageing population, results in ineffective decision-making leading to detrimental effects on care quality and escalates care costs. Consequently, there is a need for smart decision support systems that can empower clinician's to make better informed care decisions. Decisions, which are not only based on general clinical knowledge and personal experience, but also rest on personalised and precise insights about future patient outcomes. A promising approach is to leverage the ongoing digitization of healthcare that generates unprecedented amounts of clinical data stored in Electronic Health Records (EHRs) and couple it with modern Machine Learning (ML) toolset for clinical decision support, and simultaneously, expand the evidence base of medicine. As promising as it sounds, assimilating complete clinical data that provides a rich perspective of the patient's health state comes with a multitude of data-science challenges that impede efficient learning of ML models. This thesis primarily focuses on learning comprehensive patient representations from EHRs. The key challenges of heterogeneity and temporality in EHR data are addressed using human-derived features appended to contextual embeddings of clinical concepts and Long-Short-Term-Memory networks, respectively. The developed models are empirically evaluated in the context of predicting adverse clinical outcomes such as mortality or hospital readmissions. We also present evidence that, surprisingly, different ML models primarily designed for non-EHR analysis (like language processing and time-series prediction) can be combined and adapted into a single framework to efficiently represent EHR data and predict patient outcomes.

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Pollard, Louise. "Improving clinical outcomes in rheumatoid arthritis : a patient centred approach". Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/improving-clinical-outcomes-in-rheumatoid-arthritis(af50a85a-be7c-46b4-83b0-d4a21c4639a3).html.

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The existing medical model for managing rheumatoid arthritis (RA) focuses on minimising joint inflammation using suppressive treatments. However, patients have broader concerns spanning other symptoms like fatigue and pain and the way their health care is delivered. This thesis used qualitative and quantitative research methods to address three inter-related aspects of clinical care. Firstly, identifying critical challenges for providing patient-centred care. Secondly, defining outcomes important to patients like fatigue and pain and concomitant fibromyalgia. Finally, examining temporal changes in the RA management and evaluating aspects of clinical decision making. Firstly the thesis shows current care is not optimal. Key limitations include: being insufficiently patient-centred, failing to integrate management across the primary/secondary divide, over-emphasising drug treatment and overlooking "whole-person" care. Secondly, care overlooks several crucially important areas to RA patients. Many patients had high levels of fatigue, associated with pain, disability and psychological factors. Their fatigue spanned several domains. Current fatigue questionnaires are heavily weighted towards psychological aspects, and a more balanced assessment is needed. Pain, a dominant RA symptom, is often not directly addressed. The research showed central sensitisation causes persistent pain in many RA patients; it may require different management approaches. The research also characterised patients with the fibromyalgic rheumatoid clinical phenotypes; their higher disease activity scores may not fully reflect disease activity. Despite changes in treatment over the years their disease activity scores have not improved significantly, unlike RA patients in general. Different treatment strategies are needed to improve their outcomes. Finally although patients with high disease activity usually have their treatment changed when reviewed in rheumatology clinics, patients with moderate disease activity often have insufficient treatment changes; patients' age has a significant influence on treatment decisions. Strategies are needed to better target moderate disease activity and overcome the limiting effect of age on treatment decisions.

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Saunders, John Alexander. "Quality, clinical outcomes and treatment costs in acute intestinal failure". Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/415503/.

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Type 1 and type 2 intestinal failure (IF) are associated with significant morbidity and mortality, with little published data reporting outcomes from clinical practice. This thesis will therefore examine the definitions, quality of care, clinical outcomes and treatment costs of these conditions within the setting of an acute hospital which cares for many type 1 IF patients as well as running a regional intestinal failure service for type 2 and 3 IF patients. Observational studies were conducted to examine; the parenteral nutrition (PN) care provided to patients with all types of IF, screening tools and criteria to identify type 2 IF in clinical practice and an assessment of clinical outcomes and treatments costs in this complex patient group. The multidisciplinary nutrition and intestinal failure team were involved in 90% of decisions regarding initiation of PN in this hospital compared to only 52.7% reported by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report. Standards of assessment, monitoring and catheter complications were also better than those in the NCEPOD report. Rates of catheter related sepsis were lower in patients managed within a specialised IF unit compared to other wards; 1.8 episodes/1000 PN days versus 8.21 episodes/1000 PN days (p < 0.0001). The requirement for PN for > 28 days had a 91% sensitivity and 96% specificity for identifying type 2 IF but a low positive predictive value of only 59%. IF surgery criteria had a sensitivity of 96% and a positive predictive value of 100% for identifying type 2 IF.Mortality during an acute admission for type 2 IF patients (n=44) was 4.2%. Following reconstructive surgery (n=37) there were no post-operative deaths, no readmissions within 30 days and only one post-operative fistula recurrence. After surgery 94% of patients were independent of artificial nutrition. The median calculated treatment costs per day for patients with type 2 IF was £572. Current funding mechanisms within the NHS only allow hospitals to recover 44.7% of the treatment costs in type 2 IF.These studies confirm that standards of PN care in IF can be high within a regional specialist centre, with low rates of mortality, fistulae recurrence and PN dependence in type 2 IF. Criteria for screening and defining type 2 IF are relevant to clinical practices and their wider use could result in earlier access to specialist treatment, improvements in outcome reporting and a mechanism for establishing future IF funding.

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Ramzam, Naveen, Hemang Panchal, Edward Leinaar, Christian Nwabueze, Shimin Zheng e Timir Paul. "Investigating the Association between Chronic Kidney Diseasse and Clinical Outcomes". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6300.

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Background: Chronic Kidney Disease (CKD) can be described as the loss of the kidney function over time. Symptoms usually develop slowly and it may not appear in early stages. Lab tests can confirm a CKD diagnosis. The approximate number of incidents per year is more than 200,000 cases and approximately 30 million people are living with CKD today in the United States. This long-standing disease ultimately leads to renal failure at the end. At this present time, there are no known cures for CKD and the only treatment available is dialysis. Objectives: The purpose of this study is to determine the association between CKD and further with Hemodialysis (HD) and medical condition such as cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications, and death. Methods: The study employed secondary data in a cross-sectional design. A sample of 106,969 was drawn from the population. The outcome variables were a diagnosis of CKD and/or CKD with HD. The predictor variables were cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death. Logistic regression was conducted to analyze the relationship between outcome variable and each independent variable. Variables with a p-value <0.05 were considered significant. Odds Ratio (OR) and 95% Confidence Intervals (CI) were reported and discussed. The statistical analysis was performed using SAS version 9.4. Results: Analysis shows that subjects with cardiac complications were 17% less likely to have CKD as compared to those who did not have cardiac complications (OR: 0.83, 95% CI: 0.78-0.88). CKD patients who had cardiac complications were 18% more likely to have HD than the subjects who did not have cardiac complications (OR: 1.18, 95% CI: 1.01-1.39). Patients with cardiogenic shock were 86% more likely to have CKD than the subjects who did not have cardiogenic shock (OR: 1.86, 95% CI: 1.82-1.91). CKD patients who had cardiogenic shock were also 18% more likely to have HD than the subjects who did not have cardiogenic shock (OR: 1.18, 95% CI: 1.11-1.25). Similar results have been reported if a patient had other conditions. Conclusion: Chronic kidney disease with hemodialysis is significantly associated by the other medical conditions such as cardiac complications cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death in the United States. Further studies are needed to confirm the results and to understand the prognosis.

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Lapere, Steven. "Cytomegalovirus retinitis at Groote Schuur Hospital : clinical management and outcomes". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19885.

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Includes bibliographical references
Objectives 1. To review the clinical presentation, management and outcomes of patients who were diagnosed and treated for cytomegalovirus (CMV) retinitis at Groote Schuur Hospital over a 10 year period 2. To review and compare the treatment protocols of thirteen public hospital centres in South Africa that treat patients for CMV retinitis Design & method This is a retrospective cohort study. A record review of 141 eyes in 91 patients diagnosed with and treated for CMV retinitis between 2003 and 2013 was performed. Additionally, a standard questionnaire was sent to thirteen public hospitals in South Africa that treat patients for CMV retinitis to determine current treatment protocols. At Groote Schuur Hospital, all cases of suspected CMV retinitis undergo a vitreous biopsy for polymerase chain reaction (PCR) confirmation. Treatment consists of weekly intravitreal ganciclovir injections until clinical resolution has taken place. Patients not on highly active anti-retroviral treatment (HAART) are referred for initiation of treatment. Ganciclovir treatment is continued until immune reconstitution has taken place.

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Stulberg, Jonah James. "Variations in Adherence to Surgical Process Measures and Clinical Outcomes". Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1248214650.

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Sterrett, Emily C. M. D. "Are Quality Improvement Outcomes Sustainable within a Dynamic Clinical Environment?" University of Cincinnati / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470752684.

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Shah, Silvi. "Pre-Dialysis Acute Hospitalizations and Clinical Outcomes in Dialysis Patients". University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522420107855715.

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Ramzan, Naveen, Shimin Zheng, Hemang Panchal, Edward Leinaar, Christian Nwabueze e Timir K. Paul. "Investigating The Association Between Chronic Kidney Disease and Clinical Outcomes". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/21.

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Background Chronic Kidney Disease (CKD) can be described as the loss of the kidney function over time. Symptoms usually develop slowly, and it may not appear in early stages. Lab tests can confirm a CKD diagnosis. The approximate number of incidents per year is more than 200,000 cases, and approximately 30 million people are living with CKD today in the United States. This long-standing disease ultimately leads to renal failure at the end. At this present time, there are no known cures for CKD, and the only treatment available is dialysis. Objectives The purpose of this study is to determine the association between CKD and further with hemodialysis (HD) and medical condition such as cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications, and death. Study design The study employed secondary data in a cross-sectional design. Methods A sample of 106,969 was drawn from the population. The outcome variables were a diagnosis of CKD and/or CKD with HD. The predictor variables were cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death. Logistic regression was conducted to analyze the relationship between outcome variable and each independent variable. Variables with a p-value Results Analysis shows that subjects with cardiac complications were 17% less likely to have CKD as compared to those who did not have cardiac complications (OR: 0.83, 95% CI: 0.78-0.88). CKD patients who had cardiac complications were 18% more likely to have HD than the subjects who did not have cardiac complications (OR: 1.18, 95% CI: 1.01-1.39). Patients with cardiogenic shock were 86% more likely to have CKD than the subjects who did not have cardiogenic shock (OR: 1.86, 95% CI: 1.82-1.91). CKD patients who had cardiogenic shock were also 18% more likely to have HD than the subjects who did not have cardiogenic shock (OR: 1.18, 95% CI: 1.11-1.25). We have similar results if a patient had other conditions. Conclusion Chronic kidney disease with hemodialysis is significantly associated by the other medical conditions such as cardiac complications cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death in the United States. Further studies are needed to confirm the results and to understand the prognosis.

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Gross, Benjamin. "Automated System for Gathering and Reporting Clinical Outcomes to Providers". Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:22837780.

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BACKGROUND: Automated communication systems can help healthcare providers learn about their patients’ outcomes to detect patients who haven’t improved as expected. OBJECTIVE: To provide feedback to healthcare providers on patient outcomes following acute care visits. DESIGN: A cross-sectional study was conducted at two primary care clinics at Massachusetts General Hospital in which consenting patients received follow-up survey emails one and three weeks after acute care visits. In both surveys, patients were asked about the status of the problem for which they were seen and about subsequent provider contact. Patients’ responses were sent to their providers. Patients and providers were surveyed regarding satisfaction with the system. PRIMARY GOAL: To test the feasibility of implementing the system. Primary outcomes included: patient enrollment and response rate, problem resolution, and provider and patient satisfaction with the system. KEY RESULTS: Of 936 patients who had acute care visits during the study period, 326 (35%) agreed to participate in the study. One hundred forty-four patients responded to at least one of the two surveys they received (44% of participants, 15% of all patients who had urgent care visits). Twenty-two patients (15% of responders) reported lack of improvement in at least one of the surveys. The system informed providers of eight unimproved patients who had not contacted any provider since their visit. Seventy-seven percent of responding patients recommended that the clinic continue to send patients follow-up emails in the future. Ninety-seven percent of responding providers said they liked receiving the reports from our system. CONCLUSIONS: Gathering and reporting clinical outcomes to providers is feasible using an asynchronous and secure online survey system initiated via standard email. A system that requires minimal effort from clinic staff allows providers to detect and focus their attention on unimproved patients while improving overall patient satisfaction.

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Farhidzadeh, Hamidreza. "Learning to Predict Clinical Outcomes from Soft Tissue Sarcoma MRI". Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7398.

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Soft Tissue Sarcomas (STS) are among the most dangerous diseases, with a 50% mortality rate in the USA in 2016. Heterogeneous responses to the treatments of the same sub-type of STS as well as intra-tumor heterogeneity make the study of biopsies imprecise. Radiologists make efforts to find non-invasive approaches to gather useful and important information regarding characteristics and behaviors of STS tumors, such as aggressiveness and recurrence. Quantitative image analysis is an approach to integrate information extracted using data science, such as data mining and machine learning with biological an clinical data to assist radiologists in making the best recommendation on clinical trials and the course of treatment. The new methods in “Radiomics" extract meaningful features from medical imaging data for diagnostic and prognostic goals. Furthermore, features extracted from Convolutional Neural Networks (CNNs) are demonstrating very powerful and robust performance in computer aided decision systems (CADs). Also, a well-known computer vision approach, Bag of Visual Words, has recently been applied on imaging data for machine learning purposes such as classification of different types of tumors based on their specific behavior and phenotype. These approaches are not fully and widely investigated in STS. This dissertation provides novel versions of image analysis based on Radiomics and Bag of Visual Words integrated with deep features to quantify the heterogeneity of entire STS as well as sub-regions, which have predictive and prognostic imaging features, from single and multi-sequence Magnetic Resonance Imaging (MRI). STS are types of cancer which are rarely touched in term of quantitative cancer analysis versus other type of cancers such as lung, brain and breast cancers. This dissertation does a comprehensive analysis on available data in 2D and multi-slice to predict the behavior of the STS with regard to clinical outcomes such as recurrence or metastasis and amount of tumor necrosis. The experimental results using Radiomics as well as a new ensemble of Bags of Visual Words framework are promising with 91.66% classification accuracy and 0.91 AUC for metastasis, using ensemble of Bags of Visual Words framework integrated with deep features, and 82.44% classification accuracy with 0.63 AUC for necrosis progression, using Radiomics framework, in tests on the available datasets.

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Limosani, Mark. "Clinical outcomes and practitioner's opinions on regenerative procedures in endodontics". Thesis, NSUWorks, 2011. https://nsuworks.nova.edu/hpd_cdm_stuetd/6.

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Wesolowski, Andrew. "An Evidence-Based Clinical Guideline to Improve Pediatric Asthma Outcomes". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7519.

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Asthma is a disease that compromises the airways of the respiratory system, and is a prominent reason for hospitalization and emergency care needs. Over 6.1 million children are estimated to suffer from asthma. Asthmatic patients at an urban pediatric hospital emergency department (ED) were found to have higher revisit rates than the national average for large urban hospitals. The lack of a clinical guideline for educating families in patient care management at home could have contributed to readmission rates. The purpose of this project was to develop an evidence-based pediatric asthma education clinical guideline to aide healthcare providers with discharge education and home management of the pediatric asthmatic patient. The practice question that guided this project focused on discovering what evidence-based pediatric asthma guidelines could be found in the literature for providing discharge education instructions for the pediatric asthma patient from which the guideline for the ED could be developed. The appraisal of guidelines research and evaluation II instrument was used to guide and score the project. An expert panel consisting of the nurse educator of the ED and medical directors of the ED and Pulmonology scored the guideline resulting in an overall score of 83%. The experts recommended the guideline without modification. Providing families with education on home patient management might enable caretakers to identify problems, recognize potential exacerbations, and prevent return visits to the ED, resulting in social change by improving the wellbeing of pediatric patients with asthma and their families.

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Tesi sul tema "Clinical Outcomes"

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