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Claridge, Martin Walton Charles. "Clinical assessment of arterial stiffness". Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/638/.
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Increased arterial stiffness is associated with ageing, cardiovascular disease diabetes and renal failure. The aims of this thesis were to investigate the reproducibility of a tissue Doppler imaging (TDI) based ultrasound system to calculate indices of arterial stiffness, and to investigate changes in arterial wall stiffness in subjects with increased age, peripheral arterial disease (PAD), chronic kidney disease (CKD) and angiotensin converting enzyme inhibitors (ACE-Is). A reproducibility study demonstrated good reproducibility. A study of healthy subjects demonstrated a stronger relationship with age for arterial stiffness than intima media thickness (IMT). Case control studies investigating changes in subjects with PAD and CKD demonstrated a greater increase in arterial stiffness than IMT when compared to healthy controls. An epidemiological study, investigating the effect of antihypertensives on collagen turnover, suggested an association between increased collagen turnover and ACE-Is. Investigating the effect of ACE-I administration on arterial stiffness in subjects with PAD, we demonstrated an increase in collagen turnover and a decrease in arterial stiffness. We have demonstrated that the TDI-based system is a reproducible method of measuring arterial stiffness. We suggest that arterial stiffness increases more than IMT with ageing, PAD and CKD and that it may increase before cardiovascular disease develops.
2
Lillie, Patrick. "Influenza vaccinology and clinical assessment". Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6949/.
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Influenza virus infection is a global health problem, causing both seasonal epidemics and episodic pandemics of influenza A which are associated with significant mortality and morbidity. The development of influenza vaccines stimulating protection against both antigenically drifted seasonal virus as well as new pandemic antigenically shifted virus would be a major advance. A vaccine that stimulates cellular immunity to conserved viral antigens is a potential area of interest, and could generate heterosubtypic immunity. I have been the lead clinician for both phase I and II studies of thenovel viral vectored vaccine MVA-NP+M1 (modified vaccinia virus Ankarra, expressing nucleoprotein and matrix protein 1), designed to induce cellular immunity to influenza A virus. In this role I have been involved in the design, ethical and regulatory approval of phase I studies of safety and immunogenicity of MVA-NP+M1, as well as recruiting and vaccinating volunteers. The phase I studies showed that the vaccine was safe and immunogenic in both young and elderly volunteers. In addition to my clinical role in the phase I studies, I performed laboratory based immunological assays of immunogenicity (ELISPOT testing) in both phase I and II studies. For the phase II study, I lead the safety challenge study as well as collecting, analysing and writing up the data from the quarantine challenge study. This phase II study showed that MVA-NP+M1 is partially protective against influenza challenge in healthy volunteers, that the challenge model to assess protection is safe and that further challenge studies are warranted. I have also initiated two separate clinical studies on influenza, one comparing early clinical features of influenza with those of malaria, both from volunteer challenge studies, while the other study was of the clinical assessment of severity of influenza during a busy winter influenza season, with particular reference to those patients requiring critical care. For both studies I conceived the idea, organised the data collection and analysed the data. These data are of use in pandemic settings in allowing the assessment of patients with influenza and in determining the appropriate setting for their care.
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Akin, Faith W. "Best Practice: Clinical Vestibular Assessment". Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/2441.
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Maart, Ronel. "Aligning the clinical assessment practices with the assessment practices". Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17888.
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Thesis (MPhil)--Stellenbosch University, 2011.ENGLISH ABSTRACT: Removable Prosthetic Dentistry (PRO400) is a fourth year module of the undergraduate dentistry programme which consists of a large clinical component. After reviewing relevant literature and conducting module evaluations, clinical tests were introduced and implemented in 2008 as an additional clinical assessment method. The intention of introducing the clinical tests was an attempt to ensure that students were assessed fairly, that their theoretical knowledge and the ability to apply it clinically were properly assessed, and to provide feedback on their clinical performance. The purpose of this concurrent mixed methods study was to compare the relationship between the students‟ performance in the clinical tests and daily clinical grades with their theoretical performance in the PRO400 module. The second part of the study explored the academic staff s‟ perceptions of the clinical test as clinical assessment tool in the PRO400 module. The case study design enabled the researcher to explore the question at hand in considerable depth. The mixed methods approach was useful to capture the best of both the qualitative and quantitative approaches. For the quantitative data-collection, record reviews of the results of fourth-year dental students‟ who completed the PRO400 module at the end of 2007 were used, and included 110 students. For the qualitative component three full-time lecturers within the Prosthetic department were interviewed. The clinical test marks and clinical session marks of all the students (n=109) in PRO400 were compared to their theory mark of that year. The tests marks were entered into a spreadsheet in Microsoft Excel and the data analysis was done with the assistance of a statistician. The analytical abstraction method was used to assist with the qualitative data analysis; first the basic level of analysis was done in the narrative form, followed by second higher level of data analysis. The basic and higher levels of analysis were discussed under the following themes: clinical tests, student performances, alignment of theory and clinical assessment and personal influence on supervisors‟ assessment practices and attitude. Role-taking and the supervisors‟ perceptions and concerns regarding the students were explored as emergent themes. The quantitative findings were displayed using tables and graphs. Forty five students. clinical marks were 10% higher than their theory mark, while only 8 students. theory marks were 10% higher than their clinical test mark. There appeared to be hardly any relationship between the students. clinical daily grade assessment marks and their theory marks. The average theory mark was 47%, the average clinical test marks were 55% and the average daily clinical grade was 63%. Integration of the data obtained from the different data collection methods was done at the level of data interpretation. The clinical test as an assessment tool is well accepted by the supervisors and they agreed that it is more reliable and accurate than the clinical daily grade assessment method. The quantitative findings relate well to other reported studies that concluded that the daily grade was poorly correlated with the competency exams (a similar phenomenon in the clinical test of the PRO400 module). From the findings of this study it appeared that there is a better correlation of the clinical test mark and the theory mark, than clinical daily mark and the theory mark. This finding related well with the lecturers. views that the clinical tests were more reliable as a clinical assessment tool than the daily clinical mark.
AFRIKAANSE OPSOMMING: "Removable Prosthetic Dentistry (PRO400)" is 'n vierdejaar-module in die voorgraadse tandheelkundeprogram wat 'n groot kliniese komponent bevat. Na 'n oorsig gedoen is van die relevante literatuur, en nadat die module-evaluering afgehandel is, is kliniese toetse in 2008 ingevoer en geimplementeer as 'n bykomende metode van kliniese assessering. Die kliniese toetse is ingestel in 'n poging om te verseker dat studente se teoretiese kennis en hul vermoe om dit klinies toe te pas op . regverdige wyse geassesseer word en om terugvoer te kan gee oor die studente se kliniese prestasie. Die doel van hierdie studie, waarin gelyktydige gemengde metodes gebruik is, was om die verband tussen die studente se prestasie in die kliniese toetse, asook hul daaglikse kliniese punte en hul teoretiese prestasie in die PRO400-module vas te stel. Die tweede deel van die studie het ondersoek ingestel na die akademiese personeel se persepsies van die kliniese toets as 'n instrument vir kliniese assessering in die PRO400-module. 'n Dwarssnit-gevallestudie-ontwerp is gebruik en 'n gemengdemetode-benadering was nuttig om sowel kwalitatiewe as kwantitatiewe data in te samel. Vir die kwantitatiewe data-insamelingverslae is die uitslae van 109 vierdejaar-tandeheelkundestudente in die PRO400-module aan die einde van 2007 gebruik. Vir die kwalitatiewe data-insameling is onderhoude gevoer met drie voltydse dosente in die Prostetiese Tandheelkunde-departement. Die kliniese toetspunte en die kliniese sessiepunte van al die studente (n=109) in die PRO400-module is met hul teoriepunte van daardie jaar vergelyk. Die toetspunte is op 'n sigblad in Microsoft Excel ingevoer en die data-analise is met die hulp van 'n statistikus gedoen. Die analitiese abstraksiemetode is vir die analise van die kwalitatiewe data gebruik. Die basiese vlak van data-analise in die narratiewe vorm is eerste gedoen. Dit is gevolg deur 'n tweede, hoervlak-data-analise. Die basiese en hoer vlakke van analise is onder die volgende temas bespreek: kliniese toetse, studenteprestasie, ooreenstemming van teorie en kliniese assessering, en persoonlike invloed op studieleiers se assesseringspraktyke en houding. Rol-aanneming en die studieleiers se persepsies, asook kwessies rakende die studente is as ontluikende temas ondersoek. Die resultate van hierdie studie het aangetoon dat die kliniese punte van 45 studente 10% hoër was as hul teoriepunte, en dat slegs agt studente se teoriepunte 10% hoër as hul kliniese toetspunte was. Dit het geblyk dat daar feitlik geen verband was tussen die studente se kliniese daaglikse assesseringspunte en hul teoriepunte nie. Die gemiddelde teoriepunt was 47%, die gemiddelde kliniese toetspunt was 55% en die gemiddelde daaglikse kliniese punt was 63%. Al die studieleiers het die kliniese toets as assesseringsinstrument goed aanvaar en hulle het saamgestem dat dit meer betroubaar en akkuraat is as die daaglikse kliniese assesseringsmetode. Die kwantitatiewe bevindings hou goed verband met dié van soortgelyke studies waarin daar bevind is dat die daaglikse prestasie swak gekorreleer het met die bevoegdheidseksamen (ʼn soortgelyke beginsel as die kliniese toets van die Pro400). Dit het ook uit die bevindings van hierdie navorsing geblyk dat daar ʼn beter korrelasie is tussen die kliniese toetspunt en die teoriepunt as tussen die daaglikse kliniese punt en die teoriepunt. Hierdie bevinding het ʼn duidelike verband getoon met die dosente se siening dat die kliniese toetse as ʼn kliniese assesseringsinstrument meer betroubaar is as die daaglikse kliniese punt in die PRO400-module in die Tandheelkunde-program.
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Verhagen, Arianne Petra. "Quality assessment of randomised clinical trials". [Maastricht] : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1999. http://arno.unimaas.nl/show.cgi?fid=6863.
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Wright, Mark P. J. "The clinical assessment of laser prostatectomy". Thesis, University of Bristol, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.341512.
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Eager, Rachel A. "Clinical pain assessment in the horse". Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/29743.
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Male thoroughbred horses (n=10/group) underwent castration or sham castration (control) performed under either standing surgical sedation (SS) or general anaesthesia (GA). Undisturbed behaviour was monitored for 24 hours pre-operatively and 48 hours post-operatively. Additionally, seven acute laminitic horses and paired age, sex and breed-matched controls were monitored for up to five days. Assessments were made using time-lapse video recording/direct observation of undisturbed spontaneous behaviour and video recording of evoked behaviour during a standardised human interaction test. Data were acquired using The Observer and analysed using generalised mixed effects (GME) and discriminant analysis (DA). GA and SS castrates spent more time with their ears back and displayed a higher frequency of stepping away than controls in interactive tests (P<0.017, GME). Head level with withers increased post-operatively in SS castrate, but not control horses (P<0.001, GME). Additionally, sham GA resulted in increased inattentive behaviour and hindlimb resting and reduced ‘head up’ and recumbency (P<0.039, GME). Laminitic horses showed reduced hindlimb resting and walking with increased lying, ‘head level’ and forelimb lifting compared to controls (P<0.046, GME). Accuracy of discrimination (DA) between ‘painful’ and ‘pain-free’ horses was >78.6% in acute and chronic pain. This study identified behavioural parameters indicative of pain and discomfort in acute and chronic pain states. Acute pain may be most accurately identified through the examination of evoked behaviour, whilst changes in spontaneous behaviour appear more altered in chronic pain. Behavioural changes general to both acute and chronic pain were also identified.
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Murnane, Owen D. "Clinical Assessment of Otolith Organ Function". Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/1930.
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Jackson, Bridgett Alveta. "Nursing Students' and Novice Clinical Instructors' Experiences With Clinical Instruction and Assessment". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1264.
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Adjunct faculty members make up a growing proportion of nursing school clinical faculty in the United States due to a nurse educator shortage in higher education. Many of the nurses hired as clinical faculty members have years of experience providing patient care, but they lack experience in clinical instruction and assessment. At a state community college in the southeastern United States, nursing students have expressed dissatisfaction in their course evaluations with inexperienced faculty in clinical programs. The experiences of both nursing students under the guidance of novice clinical instructors and clinical faculty were examined in this case study. The National League for Nursing's (NLN) standards for practice for academic nurse educators served as the conceptual framework for this study and was used to develop research questions related to clinical practice and assessment. Data were collected from 9 students and 6 clinical nursing faculty members who participated in anonymous, open-ended electronic questionnaires regarding use of the standards in instruction and assessment. Student clinical experience collective evaluations from 3nursing programs across the state were also used for data collection and analysis. Data were coded and themes were identified and verified through triangulation. Themes were inconsistent with the NLN standards and included no formal orientation, no preparation for the clinical instructor role, use of subjective instructor evaluations, and lack of instructor feedback. Results were used to develop a professional development program to prepare novice clinical instructors for the clinical environment according to the NLN standards. This study may result in positive social change by improving clinical experiences for nursing students in community colleges, resulting in better patient care as they assume their roles in the larger medical community.
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KUSIAK, ROBERT, i PETER L. PELMEAR. "CLINICAL ASSESSMENT OF HAND-ARM VIBRATION SYNDROME". Nagoya University School of Medicine, 1994. http://hdl.handle.net/2237/16052.
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Warburg, Richard. "Assessment of memory problems by clinical neuropsychologists". Thesis, Bangor University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390999.
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Wu, Xi Vivien. "Holistic clinical assessment for undergraduate nursing students". Doctoral thesis, Högskolan i Jönköping, Hälsohögskolan, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-29937.
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A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. Difficulties in the development of valid and reliable assessment measures in nursing competency continue to pose a challenge in nursing education. A holistic approach in the assessment of competency comprises knowledge, skills and professional attitudes, wherein the notion of competency incorporates professional judgement and management skills in the clinical situation. Therefore, the thesis aims to develop a holistic clinical assessment tool with a reasonable level of validity and reliability to meet the needs of clinical education. The conceptual framework underlying this research is formed by establishing a theoretical connection between the practice of learning, and of pedagogy and assessment. This research consists of five studies. In Study I, a systematic review was conducted to explore the current assessment practices and tools for nursing undergraduates. In Studies II, III and IV, a qualitative approach with focus group discussions was adopted to explore the views of final-year undergraduate nursing students, preceptors, clinical nurse leaders and academics on the clinical assessment. Based on the multiple perspectives, it therefore addresses concerns in clinical assessment. In Study V, a holistic clinical assessment tool was developed, for which a psychometric testing was conducted. The systematic review indicated that limited studies adequately evaluate the psychometric properties of the assessment instrument. The qualitative studies have raised an awareness of professional and educational issues in relation to clinical assessment. Workload, time, availability of resources, adequate preparation of preceptors, and availability of valid and reliable clinical assessment tools were deemed to influence the quality of students’ clinical learning and assessment. In addition, the presence of support systems and formal educational programs for preceptors influenced their preparation and self-confidence. Nursing leaderships in hospitals and educational institutions have a joint responsibility in shaping the holistic clinical learning environment and making holistic clinical assessment for students. The involvement of all stakeholders in the development of a valid and reliable assessment tool for clinical competency is also essential to the process. The Holistic Clinical Assessment Tool (HCAT) was developed by the author based on the systematic review, qualitative findings and the core competencies of registered nurse from the professional nursing boards. The HCAT consists of 4 domains and 36 assessment items. Furthermore, testing of the psychometric properties indicated that the HCAT has satisfactory content validity, construct validity, internal consistency and test-retest reliability. In conclusion, the HCAT is meritorious in that it carries the potential to be used as a valid measure to evaluate clinical competency in nursing students, and provide specific and ongoing feedback to enhance the students’ holistic clinical learning experience. The HCAT not only functions as a tool for self-reflection for the students, but also guides the preceptors in clinical teaching and assessment. In addition, the HCAT can be used for peer-assessment and feedback. It is imperative that the clinical and academic institutions establish various levels of ongoing support for both students and preceptors in the process of clinical assessment.
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Taylor, Demetra T. "Investigation of a Clinical Suicide Risk Assessment". The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1408981316.
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Shenoy, Ravikiran. "Novel methods for clinical assessment of nociception". Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9039.
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Pain is a leading cause of morbidity in neuro-orthopaedic conditions, and remains an unmet clinical need. In this study, I aimed to advance the assessment of the pain states using novel objective methods in patients with neuro-orthopaedic disorders, and to develop biomarkers that could be useful in clinical trials of new therapies. Quantitative sensory testing, the current method of assessment of small fibre (nociceptor) function, was compared to novel objective methods including skin biopsy, contact heat evoked potentials (CHEPS) and functional magnetic resonance imaging (fMRI), in human volunteer models and patients. The clinical conditions studied were congenital insensitivity to pain presenting as orthopaedic disorders, complex regional pain syndrome, osteoarthritis, small-fibre pain syndromes, nerve and spinal root injuries. Cutaneous sensitisation biomarkers and mechanisms were identified in topical capsaicin pain models in human volunteers with study of skin biopsies, contact heat and laser evoked cerebral potentials, and fMRI. The models showed features observed in patients with neurogenic hypersensitivity, including hypersensitivity associated with regenerating nerve fibres. In patient groups, congenital insensitivity of pain patients showed absent CHEPS and lack of intra-epidermal nerve fibres, a novel finding. In patient groups with pain / hypersensitivity, CHEPS distinguished neuropathic from inflammatory mechanisms, while skin biopsies showed changes in nerve fibre density, particularly of nerve fibres positive for GAP43, a marker of regenerating nerve fibres, and of TRPV1, the heat and capsaicin receptor. As these changes require p38 MAP kinase activation in neurons, an inhibitor of p38MAP kinase was studied in a neuropathic pain clinical trial, which showed efficacy and support of the biomarkers. fMRI studies showed increased activation in regions of the brain associated with pain processing in the capsaicin model and painful osteoarthritis affecting the hand. These findings advance the assessment and understanding of pain disorders, and provide biomarkers for the development of new analgesics.
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Akin, Faith W., i Owen D. Murnane. "ASHA Perspectives: Clinical Assessment of Otolith Function". Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/1794.
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The two otolith organs (the saccule and utricle) are positioned perpendicular to each other and sense linear acceleration, head tilt, and gravity, with the primary role of providing input to the vestibulospinal reflex for postural stability. The vestibulospinal reflex serves to modulate posture via two descending pathways that aid in tonic contractions of the antigravity muscles in the arms and legs (lateral vestibulospinal tract) and activate neck motoneurons for the coordination of neck and eye movements (medial vestibulospinal tract). The lateral vestibulospinal tract receives the majority of its input from the otoliths and the cerebellum, whereas the medial vestibulospinal tract receives the majority of its input from the semicircular canals.
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Rosenberg, Mariam. "The development of a clinical practice assessment portfolio for the clinical nursing science, health assessment, treatment and care programme". Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86651.
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Thesis (MCurr)--Stellenbosch University, 2014.ENGLISH ABSTRACT: The support for portfolio-based learning as an authentic assessment method is increasing globally. However, there are no guidelines in South Africa for a clinical practice assessment portfolio (CPAP) for primary clinical practitioner training. The study set out to develop a CPAP for the Clinical Nursing Science, Health Assessment Treatment and Care programme. An exploratory, descriptive design was used that developed over three phases. In phase one, a CPAP was developed based on an extensive review of the literature. The CPAP was validated in phase two by experts and finally, student primary clinical practitioners assessed the possible contribution of the developed CPAP to their learning in phase three. The study sample for the three phases comprised of selected relevant studies published on portfolio development (n=15); experts in the field of primary health care and education in the Cape Metropole (n=11); and student primary clinical practitioners of one higher education institution in the Cape Metropole (n=45). Structured questionnaires were used for data collection from expert and student participants after they reviewed the CPAP. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences (N09/09/233), Stellenbosch University. Permission to conduct the research was obtained from the higher education institution. The content validity index for items (I-CVI) was used to determine the degree to which expert participants agreed with the content of the CPAP. Results identified an I-CVI of between 0.91 and 1.00, indicating that the contents and technical format of the CPAP constitute a suitable learning tool for student practitioners. Experts suggested minor revisions regarding the clarity of items, and those were included in the final CPAP. The data analysis of the student’s responses showed that adequate guidance was provided to complete the activities in the CPAP and that the CPAP would have a positive contribution to learning. Portfolio-based learning is an important teaching and learning strategy in the Clinical Nursing Science, Health Assessment Treatment and Care programme, whereby students can demonstrate their acquired clinical competencies. Recommendations include the use of a competency framework and consensus amongst stakeholders when developing the contents of a portfolio.
AFRIKAANSE OPSOMMING: Die ondersteuning vir portefeulje-gebaseerde leer as ’n outentieke assesseringsmetode is besig om globaal te verhoog. In Suid-Afrika is daar egter nie riglyne vir ’n kliniese praktyk-assesseringsportefeulje (KPAP) vir primêre kliniese praktisynsopleiding nie. Hierdie studie het ten doel om ’n kliniese praktyk-assesseringsportefeulje vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram te ontwikkel. ’n Verkennende, beskrywende ontwerp wat oor drie fases ontwikkel het, is gebruik. In fase een is ’n KPAP ontwikkel gebaseer op ’n ekstensiewe literatuurstudie. Die geldigheid van die KPAP is in fase twee deur kundiges verklaar en in fase drie is die moontlike bydrae van die KPAP tot die leerproses deur primêre kliniese praktisynstudente geassesseer. Die studiegroep vir die drie fases het bestaan uit geselekteerde relevante studies wat handel oor portefeulje ontwikkeling (n=15), kenners op die gebied van primêre gesondheidsorg en opvoeding in die Kaapse Metropool (n=11); en primêre gesondheidsorg studentpraktisyns van een van die tersiêre instansies in die Kaapse Metropool (n=45). Gestruktureerde vraelyste is gebruik vir data-insameling van kenners en studentedeelnemers nadat hulle die KPAP ondersoek het. Etiese toestemming is verkry van die Gesondheidsnavorsingsetiekkomitee van die Fakulteit Gesondheidswetenskappe (N09/09/233), Stellenbosch Universiteit. Toestemming om die navorsing uit te voer, is van die tersiêre instansie verkry. Die inhoud van die item-geldigheidsindeks is gebruik om die mate waarmee kenner-deelnemers met die inhoud van die KPAP saamstem, te bepaal. Resultate van die inhoud van die item-geldigheidsindeks van tussen 0.91 en 1.00 is geïdentifiseer, wat ’n aanduiding is dat die inhoud en tegniese formaat van die KPAP ’n toepaslike leerinstrument vir studentpraktisyns is. Kenners het klein veranderings vir die duidelikheid van items voorgestel en dit is ingesluit in die finale KPAP. Die data-analise van die studente se antwoorde het aangedui dat genoegsame leiding voorsien was om die aktiwiteite in die KPAP te voltooi en dat die bydrae van die KPAP positief is tot die bevordering van die leerproses. Portefeulje-gebaseerde leer is ’n belangrike onderrig- en leerinstrument vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram, waardeur studente kan demonstreer dat hulle die kliniese bevoegdhede bekom het. Aanbevelings sluit in die gebruik van ’n bevoegdheidsraamwerk en konsensus onder belanghebbendes wanneer die inhoud van ’n portefeulje ontwikkel word.
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Clounch, Kristopher L. "Sex offender assessment clinical utility and predictive validity /". Diss., St. Louis, Mo. : University of Missouri--St. Louis, 2008. http://etd.umsl.edu/r3221.
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Cao, Xinyuan. "Assessment of Clinical Engineering Departments in developing countries". Thesis, University of Ottawa (Canada), 2004. http://hdl.handle.net/10393/26594.
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This study was to evaluate the development level of Clinical Engineering Departments (CEDs) in hospitals in developing countries. The method of data collection was a survey done by structured questionnaire sent by Email and Listserv. In total, 61 responses (9% response rate) were grouped into two regions: Latin America (27 from Venezuela, Mexico, Brazil) and Asia (34 from India, Bangladesh, P.R. China, Indonesia, Saudi Arabia, South Africa); The responses from those developing countries were compared with those from developed countries acquired in previous studies done by Frize and Glouhova. In this study, results indicate that CEDs that responded to the survey from developing countries have similar organizational structure as developed countries, but there are differences in personnel educational levels, responsibilities, and resources. We also identified differences in the level of development of CEDs in respondents from Asia and those from Latin America. The latter were more advanced overall than those in Asia, but CEDs in both regions need to improve their level of development. Future research should focus on collecting more data from CEDs of developing countries, and expand the quantitative analysis that will be possible with a larger sample.
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Schiller, Catharine-Joanne. "Clinical utility of two neonatal pain assessment measures". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0005/MQ45414.pdf.
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Hellgren, Laila. "Heart Valve Surgery : Preoperative Assessment and Clinical Outcome". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5929.
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Quinn, Terence J. "Improving outcome assessment for clinical trials in stroke". Thesis, University of Glasgow, 2010. http://theses.gla.ac.uk/1648/.
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Abstract Clinical trials are at the centre of advances in our understanding of stroke and its optimal treatment. In this thesis the uses and properties of outcome assessment scales for stroke trials are described, with particular attention given to the modified Rankin Scale (mRS). Through comprehensive literature review I will show that mRS is the most frequently used functional outcome scale in clinical trials but efficacy of the scale is potentially limited by inter-observer variability. Using a “mock” clinical trial design I demonstrate that inter-observer mRS variability in contemporary practice is moderate (k=0.57). Adding these data to systematic review of published data, confirms an overall moderate inter-observer variability across ten trials (k=0.46). Differing strategies to improve mRS reliability will then be described. I will outline development of a bespoke training package, international training scores across 2942 raters again confirms suboptimal reliability (k=0.67). A pilot trial using endpoint committee review of video recorded interviews demonstrates feasibility of this approach. Attempts to improve reliability by deriving mRS from data recorded in patients’ hospital records are not successful (k=0.34). In the final chapters I present a novel methodology for describing stroke outcomes – “home-time”. This measure shows good agreement with mRS, except at extremes of disability. Finally to put mRS in a historical context, the career of John Rankin and the development of his eponymous scale is recounted.
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Thompson, Simon. "Advancing knowledge into the clinical assessment of dementia". Thesis, Bournemouth University, 2010. http://eprints.bournemouth.ac.uk/16247/.
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Collectively, these writings significantly contribute to our academic and clinical knowledge of assessing dementia. We have learned a great deal from studying and helping people with Down's syndrome; however, perhaps more importantly, this work should contribute significantly to our rather limited knowledge of assessing dementia in people with Down's syndrome and thus may step towards improving and widening access to service provision for these valued people.
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Judge, Joseph Gerard. "Clinical practice of risk assessment of sexual violence". Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/7775.
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Background: Risk assessment of sexual violence involves evidence based evaluation of the risks posed by sexual offenders. It informs risk management; the provision of treatment that reduces the risk of future sexual violence. Previous research has focused on assessment of the predictive accuracy of different risk assessment tools, as well as the identification of risk factors that are associated with recidivism. In contrast, the clinical practice of risk assessment is a research area that has been neglected. The aim of this thesis was to explore the practice of risk assessment in a specialist sex offender liaison service (SOLS). Particular attention was paid to the structured professional judgement method of risk assessment. Method: A systematic review of the literature identified psychological factors associated with sexual recidivism in adult male offenders. Study 1 employed a cohort quantitative design and aimed to ascertain whether risk judgements made by the SOLS were predicted by factors that were identified by the systematic review (and previously existing meta-analyses) as being evidence based. Ordinal logistic regression and linear regression analyses (N = 96) were used to investigate the hypothesised predictive associations between variables. Study 2 utilised a qualitative framework analysis (N = 31) and aimed to explore the views of users of SOLS risk assessments with respect to their practical utility. Results: The systematic review suggested that psychopathy and sexual deviance were supported as risk factors for sexual recidivism. Inconsistent results were found with respect to denial. Study 1 found that psychopathy, denial, and sexual preoccupation were significantly associated with risk judgement scores made by the SOLS, while sexual deviance, and problems with intimate relationships, were not. The best explanatory model accounted for only 40 per cent of the variance in risk judgement score. Study 2 revealed five major themes: informing risk management; confirming what was known and giving weight; understanding personality; treatment; and the usefulness and limitations of risk assessment.
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Edwards, Lucy. "Clinical psychologists' decision-making processes during therapy assessment". Thesis, Canterbury Christ Church University, 2002. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.744235.
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Konstantakopoulou, Evgenia. "Colour vision assessment : fundamental studies and clinical significance". Thesis, City University London, 2012. http://openaccess.city.ac.uk/1194/.
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Cobb, Mark. "The clinical assessment of spirituality in palliative care". Thesis, University of Liverpool, 2013. http://livrepository.liverpool.ac.uk/14993/.
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Background: The practice of palliative care and the specialty of palliative medicine emerged from the modern hospice movement and its foundational philosophy of treating the whole person. This holistic approach recognises that the needs of dying patients are complex and multifaceted. Spirituality is one of the dimensions of palliative care practice and it was assumed that there was sufficient robust primary data to support a synthesis of evidence. However, a critical examination of the published data found that many studies make use of unexamined assumptions and ambiguous constructs. The research in this field is therefore missing an important methodological step in the inductive cycle by failing to articulate explicit theory or identify critical concepts. Aim: To construct a conceptual model of spirituality that provides a systematic way of illustrating the essential properties, functions and relationships of how spirituality operates in the lives of palliative care patients that can be subject to empirical testing. Methods: Conceptual model building was used as a method of theoretical investigation to construct a minimal abstract and indirect representation of the way that spirituality potentially operates in the lives of patients. The model was then subject to empirical testing through generating quantitative and qualitative data from palliative care patients participating in a questionnaire and interview. Analysis: Quantitative data from the questionnaires was subject to descriptive statistics and exploratory data analysis using techniques of visual representation. Qualitative data was subject to deductive content analysis based upon categories derived from the conceptual model. Results: A Synoptic Model was developed whose theoretical claims were congruent with the findings from this sample with the exception of the disease construct. 19 patients participated in the questionnaire phase of the study and 10 participated in an interview. Patients discussed multiple aspects of spirituality including their beliefs, practices and experiences. For some patients spirituality provided an orientation to life and helped make sense of illness and its consequences. Spirituality was also a resource for some patients in helping them to face their current situation and their mortality. Discussion: The Synoptic Model provides empirically supported theoretical knowledge of spirituality that can be utilised in the context of palliative care and has implications for clinical practice in terms of patient care, education and development, and assessment. Further development and testing is required in different settings to refine the Synoptic Model’s content and specification.
27
Zhu, Haogang. "Knowledge mining in the clinical assessment of glaucoma". Thesis, City, University of London, 2010. http://openaccess.city.ac.uk/17567/.
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Glaucoma is a leading cause of irreversible blindness and visual impairment. In the clinic, glaucomatous damage can be characterized by structural changes in the optic nerve head (ONH) and retinal nerve fibre layer (RNFL) that can be evaluated by various retinal-imaging techniques such as scanning laser polarimetry and optical coherence tomography (OCT). The structural damage can lead to functional damage in the visual field (VF), normally assessed with standard automated perimetry, which assesses the differential light sensitivity in the field of view. The clinical measurements of retinal structure and visual function play an important role in the detection and management of glaucoma, but the data generated is often complex and highly variable, thus making it hard to clinically interpret. The purpose of this thesis was to investigate knowledge mining procedures for extracting clinically useful information from these measurements. Knowledge mining describes iterative divide-and-conquer type analyses of large-scale questions: solutions to individual smaller problems are used to generate better quality knowledge, which in the case of work reported in this thesis can be translated into clinically useful analysis tools. This thesis describes five knowledge mining procedures specifically developed and applied to structural and functional measurements in glaucoma: (1) probabilistic inference to aid image acquisition of OCT images; (2) a robust and efficient segmentation algorithm to extract features of retina tissue layer structures in large-scale 3-dimensional image volumes acquired by OCT; (3) a predictive structure-function relationship model to bridge the retinal structure and visual function measurements in glaucoma; (4) quantification and visualization of structure-function discordance using the model about structure-function relationship; (5) integration of structural and functional measurements to improve the reproducibility of the measurements. In conclusion the knowledge mining approaches improved the acquisition and/or accuracy of the measurements and provide new clinical analysis tools to detect and manage glaucoma.
28
Perez, Leon Andres Alfredo. "A Smartphone-based System for Clinical Gait Assessment". Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6350.
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Patients with lower limbs problems are an increasing population in the US and many of them require surgery and its subsequent post-op Physical Therapy (PT). For all these patients, tracking their progress and evolution towards full recovery is very important. To assess the patients and track their progress, patients are usually required to perform very specific tests administered by a physical therapist. These tests either require very expensive equipment or rather require the subjective experience of the physical therapist who administer them. One of these tests is the Functional Gait Assessment (FGA) test, perhaps the most widely adopted one for gait assessment.
This thesis presents a system for Clinical Gait Assessment using exclusively the sensors embedded in today’s smartphones. The system processes the raw sensor data to perform the FGA test and calculate additional metrics, capable of identifying problems in the human gait. The system is therefore objective, as it is based on measurements; cheap, as it only requires a smartphone; mobile, as it can be used pretty much anywhere; and self-care, as it does not need the presence of a physical therapist.
The system was designed and tested on the Android OS with the phone attached to the back of the user using a belt or elastic band. It includes a new step detection algorithm with a mean absolute error of ±1 and algorithms to detect the deviation from a straight path with an accuracy of 90%, 80%, 35%, and 30% for each of the required deviation levels of the FGA test. Additionally, the system includes autocorrelation and DTW metrics, which provide additional information to detect different impediments of the user gait.
29
Louie, Tiffany M. "Clinical assessment of early demineralization using PS-OCT". Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1465486.
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Chen, Tzurei. "Clinical and Laboratory Balance Assessment in the Elderly". Thesis, University of Oregon, 2013. http://hdl.handle.net/1794/12945.
Pełny tekst źródłaStreszczenie:
Falls can have severe consequences for elderly adults. In 2000, nearly 10,300 people aged 65 years or older died as a result of falls, and 2.6 million individuals were treated for non-fatal fall-related injuries. In order to reduce fall incidences, it is important to identify possible causes of falls, such as muscle weakness and imbalance. In this study, we examined balance control in the elderly during task transitions while performing the Timed Up and Go test (TUG). The TUG is a commonly used clinical balance test that includes transition phases between three daily activity tasks: sit-to-stand, walking and turning.
Our findings suggested that elderly adults, especially fallers, have reduced balance control ability while making transitions during TUG. During sit-to-walk (STW), when compared to young adults, elderly adults demonstrated a smaller forward center of mass (COM) velocity, a smaller anterior-posterior (A-P) COM-Ankle angle, and a larger upward kinetic energy ratio at seat-off. Additionally, the medial-lateral COM control in elderly fallers was also perturbed due to their significant reduction in forward COM velocity. The reduced initial hip extensor moment and increased ankle plantarflexor moment in elderly fallers was associated with their reduced generation of horizontal momentum during STW. Smaller A-P COM-Ankle angles and taking more steps when making a turn demonstrated a reduction in balance control ability in elderly adults. Our analyses suggest that balance control is an important factor contributing to longer STW and turning durations of TUG. Furthermore, lower extremity muscle strength at hip and knee joints demonstrated a stronger association with STW than turning duration.
To enhance the early detection of fall risk, we also assessed the ability of balance tests to predict future risk of falling in elderly adults. Our results indicated that biomechanical balance parameters measured during TUG were associated with future fall status. Among all biomechanical parameters investigated, frontal plane balance control parameters appear to be the most significant predictors for future falls.
This dissertation includes unpublished co-authored material.
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Williams, A. Lynn, Jan Edwards, Benjamin Munson, Amy Glaspey i Shelley Velleman. "Assessment of Speech Sound Disorders: Clinical Decision Making". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/2055.
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This session is developed by, and presenters invited by Speech Sound Disorders in Children. A case-based approach will be used to assess the complexity of SSD through assessment and analysis measures that guide clinical decisions regarding differential diagnosis, intervention planning, and progress monitoring.
32
Jackson, Rebecca L. "Contextualized Risk Assessment in Clinical Practice: Utility of Actuarial, Clinical, and Structured Clinical Approaches to Predictions of Violence". Thesis, University of North Texas, 2004. https://digital.library.unt.edu/ark:/67531/metadc4603/.
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Assessing offenders' risk of future violent behavior continues to be an important yet controversial role of forensic psychologists. A key debate is the relative effectiveness of assessment methods. Specifically, actuarial methods (see Quinsey et al., 1998 for a review) have been compared and contrasted to clinical and structured clinical methods (see e.g. Hart, 1998; Webster et al., 1997). Proponents of each approach argue for its superiority, yet validity studies have made few formal comparisons. In advancing the available research, the present study examines systematically the type of forensic case (i.e., sexual violence versus nonsexual violence) and type of assessment method (i.e., actuarial, structured clinical, and unstructured clinical). As observed by Borum, Otto, and Golding (1993), forensic decision making can also be influenced by the presence of certain extraneous clinical data. To address these issues, psychologists and doctoral students attending the American Psychology Law Society conference were asked to make several ratings regarding the likelihood of future sexual and nonsexual violence based on data derived from actual defendants with known outcomes. Using a mixed factorial design, each of these assessment methods were investigated for its influence on decision-makers regarding likelihood of future violence and sexually violent predator commitments. Finally, the potentially biasing effects of victim impact statements on resultant decisions were also explored.
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Kalezic, Nebojsa. "Autonomic reactivity in muscle pain : clinical and experimental assessment". Doctoral thesis, Umeå universitet, Kirurgisk och perioperativ vetenskap, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-919.
Pełny tekst źródłaStreszczenie:
There are numerous indications of possible involvement of the autonomic nervous system in the genesis of chronic pain. The possibility exists that sympathetic activation is related to motor dysfunction and changes in sensory processing, which have otherwise been implicated in musculoskeletal disorders. The primary aim of the thesis has been to investigate autonomic regulation at rest and in response to laboratory tests of autonomic function in subjects suffering from chronic pain in different localisations (lower back, neck-shoulder and neck-jaw), as well as to study the relations between autonomic regulation, proprioceptive acuity and clinical data. Secondary aim has been to assess autonomic regulation in fit, pain-free subjects in response to experimentally induced pain and in occupationally relevant settings. A total of 194 subjects suffering from chronic pain participated [low back pain (LBP) n=93; non-traumatic neck pain (NT) n=40, Whiplash associated disorder (WAD) n=40, Whiplash with temporomandibular dysfunction (WADj) n=21]. Each chronic pain group was subjected to a battery of autonomic function tests combining cognitive (Stroop Colour-Word conflict tests), physical (handgrip), sensory (unpleasant sound) and motor tasks (chewing tests) as well as the activation of reflex pathways (paced breathing and the orthostatic test) and compared to an age- and gender balanced control group. Autonomic regulation was also assessed in exposure to experimentally induced muscle pain in healthy subjects (n=24) in order to describe acute pain reaction. Further assessment was carried out during monotonous repetitive work and dynamic work in healthy subjects (n=10) and in a three-day monitoring of ambulance personnel (n=26) in occupational settings. Autonomic regulation was evaluated using cardiovascular (heart rate and heart rate variability, local blood flow and blood pressure), respiratory (breathing rate) electrodermal (skin conductance), muscular (trapezius and masseter EMG) and biochemical (insulin, cortisol, catecholamines) variables. Proprioceptive acuity was assessed using active-active repositioning tests. Pain levels were assessed using Visual-analogue or Numerical Rating scales. General health was evaluated through the Short-Form SF-36 Health Related Quality of Life questionnaire and Self-Efficacy Score questionnaires, whereas dysfunction was evaluated using the Oswestry Low Back Pain questionnaire, Pain Disability and Neck Disability Index questionnaires, the McKenzie evaluation and primary healthcare diagnoses. Self-reports of pain, stress and exertion were acquired prior to, during and post-testing. Chronic pain subjects were characterised by increased sympathetic and decreased parasympathetic activity as reflected in heart rate (LBP, WAD, WADj), heart rate variability (LBP, WAD, WADj), blood pressure (WADj) and electrodermal activity (LBP). In general, WAD showed more pain and dysfunction than NT, with lower self-efficacy and health-related quality of life. Differential reactivity was observed only in WAD, with increased responsiveness to sensory stimuli (heart rate variability, electrodermal activity), and motor tasks (heart rate) and a decreased response to cognitive challenge (heart rate variability, electrodermal activity). A significant part of WADj subjects showed sensorimotor impairment and low endurance in chewing tests, concomitant with a cardiovascular response that correlated with pain levels. Proprioceptive acuity was not found to be impaired among subjects suffering from chronic pain, and there were no indications of significant individual response specificity. Response to experimentally induced muscle pain in healthy subjects was also characterised by a prominent cardiovascular component. In simulated occupational settings autonomic activation and transient insulin resistance were detected in healthy subjects following monotonous repetitive work, with no similar effects following dynamic exercise. Modest deviations in circadian heart rate variability patterns during workdays were detected in ambulance personnel reporting more pronounced musculoskeletal symptoms, with no such effects on work-free days. Autonomic balance observed in chronic pain subjects was characterised by a trend towards increased sympathetic activity in comparison with pain-free controls. Moderate signs of affected reactivity to autonomic function tests were observed in patients with WAD, however no specific reaction patterns have been observed in any chronic pain group. Correspondence between the intensity of pain and autonomic activity was observed in acute pain and in chronic pain groups characterised by higher pain levels. As indicated by autonomic and neurohormonal changes in the recovery from real and simulated work, further studies with physiological monitoring of the effects of work-related stress are warranted for better understanding of the mechanism of musculoskeletal disorders.
34
Kalezić, Nebojša. "Autonomic reactivity in muscle pain : clinical and experimental assessment /". Umeå : Univ, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-919.
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Ng, Quan Sing. "Therapeutic targeting and clinical assessment of the tumour vasculature". Thesis, University College London (University of London), 2008. http://discovery.ucl.ac.uk/1444062/.
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The tumour vascular network is essential for tumour growth. Over the next few years, the use of vascular targeting drugs in the treatment of patients with cancer will escalate, which in turn will increase demand for non-invasive methods of assessing tumour vasculature. A perfusion CT technique was developed, allowing measurement of tumour vascular leakage (K) and blood volume (BV) of entire large tumours. This technique is shown to improve on measurement repeatability compared to conventional single level techniques, and can be used to measure tumour vascular changes following anti-cancer treatment. Ionising radiation has been shown to act synergistically with the vascular disrupting agent Combretastatin A4 Phosphate (CA4P) in animal tumour models. Patients with advanced non-small cell lung cancer were treated with fractionated radiotherapy in combination with CA4P. Radiation alone increases tumour K and BV, especially at the tumour rim, and appears to enhance the vascular disrupting activity of CA4P. The increase in K after radiotherapy correlates with subsequent decrease in BV after CA4P, and a sustained reduction in tumour BV was achieved with this combination. Nitric oxide (NO) is an important signalling molecule responsible for maintaining the vasodilator tone in tumour vessels, as well as having pro-angiogenic properties. As part of a phase I study, patients with cancer were treated with the nitric oxide synthase inhibitor N-nitro L-arginine (LNNA). Patients with measurable tumours were scanned using perfusion CT, and all patients demonstrated sustained reductions in tumour BV, demonstrating for the first time in man that NO inhibition has tumour anti-vascular activity. In summary, perfusion CT is a repeatable technique that can be used to measure vascular changes in whole tumours following therapy. The results presented here have provided further evidence that targeting the tumour vasculature is a promising approach in the treatment of cancer.
36
Lotz, Thomas Friedhelm. "High Resolution Clinical Model-Based Assessment of Insulin Sensitivity". Thesis, University of Canterbury. Mechanical Engineering, 2007. http://hdl.handle.net/10092/1571.
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Type 2 diabetes has reached epidemic proportions worldwide. The resulting increase
in chronic and costly diabetes related complications has potentially catastrophic
implications for healthcare systems, and economies and societies as a
whole. One of the key pathological factors leading to type 2 diabetes is insulin
resistance (IR), which is the reduced or impaired ability of the body to make use
of available insulin to maintain normal blood glucose levels.
Diagnosis of developing IR is possible up to 10 years before the diagnosis of
type 2 diabetes, providing an invaluable opportunity to intervene and prevent or
delay the onset of the disease. However, an accurate, yet simple, test to provide
a widespread clinically feasible early diagnosis of IR is not yet available. Current
clinically practicable tests cannot yield more than a crude surrogate metric that
allows only a threshold-based assessment of an underlying disorder, and thus
delay its diagnosis.
This thesis develops, analyses and pilots a model-based insulin sensitivity
test that is simple, short, physiological and cost efficient. It is thus useful in a
practical clinical setting for wider clinical screening. The method incorporates
physiological knowledge and modelling of glucose, insulin and C-peptide kinetics
and their pharmaco-dynamics. The clinical protocol is designed to produce
data from a dynamic perturbation of the metabolic system that enables a unique
physiologically valid assessment of metabolic status. A combination of a-priori information
and a convex integral-based identification method guarantee a unique,
robust and automated identification of model parameters.
In addition to a high resolution insulin sensitivity metric, the test also yields
a clinically valuable and accurate assessment of pancreatic function, which is also
a good indicator of the progression of the metabolic defect. The combination of these two diagnostic metrics allow a clinical assessment of a more complete
picture of the overall metabolic dysfunction. This outcome can assist the clinician
in providing an earlier and much improved diagnosis of insulin resistance and
metabolic status and thus more optimised treatment options.
Test protocol accuracy is first evaluated in Monte Carlo simulations and subsequently
in a clinical pilot study. Both validations yield comparable results in
repeatability and robustness. Repeatability and resolution of the test metrics
are very high, particularly when compared to current clinical standard surrogate
fasting or oral glucose tolerance assessments. Additionally, the model based insulin
sensitivity metric is shown to be highly correlated to the highly complex,
research focused gold standard euglycaemic clamp test.
Various reduced sample and shortened protocols are also proposed to enable
effective application of the test in a wider range of clinical and laboratory settings.
Overall, test time can be as short as 30 minutes with no compromise in diagnostic
performance. A suite of tests is thus created and made available to match varying
clinical and research requirements in terms of accuracy, intensity and cost. Comparison
between metrics obtained from all protocols is possible, as they measure
the same underlying effects with identical model-based assumptions.
Finally, the proposed insulin sensitivity test in all its forms is well suited for
clinical use. The diagnostic value of the test can assist clinical diagnosis, improve
treatment, and provide for higher resolution and earlier diagnosis than currently
existing clinical and research standards. High risk populations can therefore be
diagnosed much earlier and the onset of complications delayed. The net result
will thus improve overall healthcare, reduce costs and save lives.
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Bryant, Martyn John. "The long-term clinical assessment of the hip arthroplasty". Thesis, Queen's University Belfast, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.334466.
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Williams, Jarred. "A Biomechanical Assessment of Clinical Conditions in the Horse". The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1373972544.
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Hurcomb, Peter G. "The clinical assessment of systemic hypertension in optometric practice". Thesis, Aston University, 2003. http://publications.aston.ac.uk/14559/.
Pełny tekst źródłaStreszczenie:
This thesis sets out to examine in detail the condition of systemic hypertension (high Blood Pressure) in relation to optometric practice in the United Kingdom. Systemic hypertension, which is asymptomatic in the early stages, is diagnosed from the Blood Pressure (BP) measurement recorded by a sphygmomanometer and/or from the complications that have developed in target organs. Optometric practice based surveys revealed that diagnosed systemic hypertension was the most prevalent cardiovascular medical condition (20.5%). Measurement of BP of patients in this sample revealed that if an optometrist included sphygmomanometry into the sight examination then at least one patient each day would be referred for suspect systemic hypertension. Optometric opinion felt that the measurement of BP in optometric practice would advance the profession, being appreciated by both patients and General Practitioners (GPs), but was felt to be an unnecessary routine procedure. The present sight examination for the systemic hypertensive is similar to that of the normotensive patient, but may involve an altered fundus examination and a visual field test. The GPs were in favour of optometric BP measurement and a future role in the share care management of the systemic hypertensive. The application of a new pictorial grading scale for the grading of vascular changes associated with pre-malignant systemic hypertension was found to be both accurate and reliable. Clinical trial of the grading scale in optometric practice found positive correlations between BP and increasing severity of the retinal vascular features. The application of the pictorial grading scale to optometric practice and training the optometrist in the use of sphygmomanometry would improve the management of the systemic hypertensive patient in optometric practice. Future advances in image analysis hold substantial benefits for the detection and monitoring of subtle vascular changes associated with systemic hypertension.
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Williams, A. Lynn. "Making Phonology Functional: Assessment and Intervention in Clinical Settings". Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/2024.
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Williams, A. Lynn. "Models of Assessment and Intervention: Phonology in Clinical Settings". Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/2090.
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Williams, A. Lynn. "Making Phonology Functional: Assessment and Intervention in Clinical Settings". Digital Commons @ East Tennessee State University, 2000. https://dc.etsu.edu/etsu-works/2025.
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Levy, Lisa-Ann. "Assessment of children for brief psychodynamic psychotherapy : training implications". Master's thesis, University of Cape Town, 1991. http://hdl.handle.net/11427/13539.
Pełny tekst źródłaStreszczenie:
Includes bibliography.The aim of this study is to develop a framework for the assessment of children for short-term psychodynamic psychotherapy, with a particular emphasis on the training of child therapists. For this purpose the literature on brief child psychotherapy is reviewed, and selection criteria mentioned in the literature are collated and summarized. These criteria are then applied to 5 cases seen by trainees or newly qualified clinicians in order to assess their usefulness in a training setting. Potential sources of difficulty for inexperienced clinicians in the assessment for and process of this specialized form of child psychotherapy are considered, and guidelines as to how this approach could be usefully employed in a training institute are suggested. On the basis of the literature and case discussions, a format for the assessment of children for brief psychotherapy is devised in order to assist the trainee.
44
Mirman, Jennifer Lauren. "AN ASSESSMENT OF CURRENT CLINICAL ORTHODONTICS: CLINICIAN KNOWLEDGE, IDENTIFICATION AND TREATMENT PLANNING OF RESTRICTED AIRWAY". Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/580484.
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Oral BiologyM.S.
Objectives: The naso- and oropharyngeal airways are influenced by a myriad of factors: jaw shape and position, tongue shape and position, lymphoid tissue, sleep apnea, chronic mouth breathing, and swallowing patterns. It is unknown if the relationships of these factors are recognized and routinely assessed in clinical orthodontics. This cross-sectional study sought to determine the proportion of participating orthodontists whom: 1) Are knowledgeable about airway restriction and its etiology, 2) Learned about these topics in post-graduate orthodontic education, 3) Consider airway restrictions in orthodontic treatment planning. Methods: A survey was administered through an online survey management platform, and sent to the email listings of 2,084 active American Association of Orthodontists (AAO) members. Survey questions are evidence-based and developed from findings in current literature. The questionnaire results were analyzed by coding and cleaning data through SAS 9.3 software. Univariate and bivariate analyses were performed to assess responses. Results: The survey received responses from 117 orthodontists. Most received their orthodontic certification from a two-year program (71.82%). The majority were knowledgeable about tongue adaptations, swallowing mechanisms, mouth breathing, and sleep apnea. Respondents were less confident about the relationship airway patency has with lymphoid tissue and with jaw position. Only half (50.51%) were taught about restricted naso- and oropharyngeal airway in post-graduate orthodontic education. A low majority, 66.32%, reported that they refer for medical consultation to the appropriate clinician before they begin treatment if a patient presents with restricted airway. Conclusions: Although the majority of respondents are knowledgeable about factors that influence airway patency, the survey identified areas in which understanding of and education in certain topics (lymphoid tissue, jaw position) may be lacking. Further emphasis should be placed on these topics to improve patient care. Orthodontics nationwide would benefit from more thorough post graduate orthodontic residency curriculum and general guidelines for clinical management of patients that present with airway obstruction.
Temple University--Theses
45
Slade, Mike. "A model of needs assessment : why are there differences between assessments of need made by staff and by psychotic patients?" Thesis, University of Surrey, 1997. http://epubs.surrey.ac.uk/2753/.
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Lewis, Sarah Elizabeth. "Assessment of mental health for looked after children". Thesis, University of Hull, 2014. http://hydra.hull.ac.uk/resources/hull:10528.
Pełny tekst źródłaStreszczenie:
The portfolio has three parts: Part One: A systematic literature review, in which the literature relating to the assessment and identification of mental health problems in looked after children is reviewed. Part Two: A mixed methods empirical research study which qualitatively explores foster carer’s perceptions of screening measures used with looked after children and the ability of these to capture need. Clinicians’ views regarding the same issue are also explored both quantitatively and qualitatively. Part Three: Appendices including all relevant documents related to the systematic literature review and empirical papers and a reflective statement from the researcher on the process of completing the portfolio.
47
Pauwels, J. B. "Thermal assessment of burn depth : An animal and clinical study". Thesis, University of Strathclyde, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.381702.
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Viljoen, Gary. "Neuropsychological assessment of Zulu-speaking school children : some normative data". Master's thesis, University of Cape Town, 1992. http://hdl.handle.net/11427/14400.
Pełny tekst źródłaStreszczenie:
Includes bibliography.This study investigates the Bender Gestalt and the Draw-a-Bicycle tests in South Africa by evaluating the applicability of the existing norms (Koppitz, 1975; Kolb & Whishaw, 1985) and by exploring the variables age, sex, educational level, and geographical area as they affect test performances in Zulu-speaking school children. Zulu-speaking subjects (N = 882), ranging in age from 6 - 18 years, completed both tests. Tests were administered in group form and independently scored. The study sample's performances on both tests were compared to the respective foreign norms and some significant discrepancies were apparent in each case, thereby confirming the hypothesis that these foreign norms are inappropriate for use with Zulu-speaking children. Initial normative data 'are presented for both tests for Zulu-speaking children. Results indicated that age accounted for most of the variance in both. tests. For the Bender Gestalt test, sex and geographical area were also significantly correlated to performance but their respective effect sizes were small enough to warrant excluding them as significant variables from the normative data. For the Draw-A-Bicycle test, sex was highly correlated to performance, and was therefore included in the normative data, with geographical area's small effect size warranting exclusion. Performances per age group, on both tests were found to correlate highly, suggesting inter-test reliability. The implications of these findings for further clinical use of the Bender Gestalt and the Draw-a-Bicycle tests, are considered. Limitations of the present study, in conjunction with suggestions for further research, are discussed.
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Collier, Angela. "Approachability of Nursing Clinical Instructors: Psychometric Assessment of a Scale Development". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etd/3350.
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Approachability of nursing clinical instructors is largely unknown and misunderstood, yet critical for millennial students which currently comprise 82% of nursing students (National League for Nursing, 2014). Nursing education consists of both a didactic and a clinical component. Clinical education is dynamic and allows the student an experiential learning opportunity. Therefore, clinical nursing educators are vitally important. Approachability has been identified in many studies as a leading characteristic of an effective instructor. Although the importance of approachability of the instructor is established, currently no scale exists to measure this concept. The purpose of this study was to examine the validity and reliability of the newly developed Approachability of Nursing Clinical Instructor (ANCI) scale. Based on the results of this study, the newly developed ANCI scale meets all four aspects of validity (face, content, construct and criterion-related) and reliability is established. The confirmatory analysis indicated a one-factor scale with 56.102 of the variance explained. There are multiple future recommendations for the ANCI scale which include further psychometric testing the new scale, potential theory testing, education and screening of new clinical instructors and expanding the ANCI within nursing and to other disciplines.
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Olm-Madden, Tammie. "A reliable approach to psychological assessment using cognitive testing batteries". University of Southern Queensland, Faculty of Sciences, 2008. http://eprints.usq.edu.au/archive/00006240/.
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[Abstract]Cognitive tests are rarely used in isolation. Instead the collection of tests into batteries is common place in clinical assessment. Clinical batteries range from fixed collections of tests administered unchanged to each client, to batteries flexibly constructed according to a process of hypothesis testing whic varies between clients. Reviews of clinical practice indicate that clinicians predominantly employ a semi-flexibly constructed battery, comprised of a core group of measures with the addition of others drawn as needed from an available pool. While this accommodates for clinical concerns, the psychometric characteristics of such a battery tend to be unevaluated and clinicians draw inferences without reference to the resultant associated measurement error. This has been duly noted in the research literature which increasingly cites the need for psychometric evaluation at the battery level. The current investigation was undertaken to address this difficulty of clinical practice and aimed to develop a psychometrically and practically driven actuarial model with practicing clinicians could structure and analyse cognitive batteries with due reference to reliability, validity and clinical utility. To this end, a review of psychometric literature was undertaken to dermine theorical guidelines for the control and measurement of error at the individual test and battery level. Reviews indicated that to successfully accommodate for the impact of random measurement error, clinicians must apply reliability theory to evaluation of the error associated with domain-based combinations of tests. Additionally, to ensure the validity of test-based inferences and avoid errors in decision-making, clinicians must apply empirically vaidated structures of cognitive function to guide test selection and combination. Given the pressing necessity of battery flexibility, it was concluded that clinicians could best accommodate psychometrid and clinical factors by the use of flexibly constructed composite scores. A reliable approach to psychological testing (RAPT) was proposed which applied psychometric theory and clinical factors to the development of a robust battery structure. The RAPT method focussed on the use of composite scores of domain-specific tests, grouped according to empirically validated domains and moderated by direct estimation of composite reliability. The RAPT was developed with the aim of facilitating the application of psychometric, actuarial methodology to a flexible collection of cognitive tests. In explicating the RAPT model, fifteen primary algorithms were derived from psychometric literature and outlined according to 3 stages of battery usage: test selection; test analysis; and, test interpretation. The utility of the RAPT was examined in terms of its capacity to improve psychometric robustness within a flexible battery. Specifically, using simulated demonstration, RAPT was demonstrated to provide a means of formalising empirically validated structure within a battery of tests, of controlling and improving the reliability of domain-based composite scores, of reducing the impact of artifactual errors on domain-based inferences and of applying actuarial methods typically associated with fixed batteries to a flexible collection of measures. Following this, RAPT was demonstrated to replicate existing psychometrically valid and stable interpretative structures. Specifically, RAPT algorithms were used to re-create the normative information provided for the Wide Ranbe Achievement Test, Fourth Edition (WRAT-4)Reading Compoiste. Norms calculated using RAPT were compared with those provided in the WRAT-4 interpretative manual with minimal differences found. RAPT algorithms were then used to re-create normative and ipsative tables, summary scores intercorrelations, and reliability coefficients for the Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) summary scores: Full Scale IQ (FSIQ); Verbal IQ (VIQ); Performance IQ (PIQ); Verbal Comprehensive Index (VCI); Perceptual Organisation Index (POI); Processing Speed Index (PSI); and, Working Memory Index (WMI). Again, RAPT, was demonstrated to successfully replicate these data. Finally, the clinical utility of RAPT was demonstrated with the illustration of case examples which outlined the capacity of RAPT to apply psychometrically sound methodology to the tasks of modifying existing composites, modifying existing battery structure and developing battery structure and analyses according to a factor analysis investigation of an Australian normative sample (n=1045). These investigations provided comprehensive evidence of the capacity of the RAPT to enable the direct application of psychometric theory to semi-flexible battery construction in a manner suitable for use in current clinical practice.