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Simonenko, N. O. "Terminology of clinical medicine". Thesis, Сумський державний університет, 2014. http://essuir.sumdu.edu.ua/handle/123456789/34665.
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The present paper offers an up-to-date view of the status of Latin as the language of medicine, especially in its terminological component. Latin terminology is used originally as an international language of scholars and persisted within some areas, e.g. anatomy and pharmacy. Its universal usage ensures its continuation.
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2
Sjöwall, Johanna. "Clinical and Immunological Aspects of Lyme borreliosis". Doctoral thesis, Linköpings universitet, Infektionsmedicin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-68745.
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Lyme borreliosis (LB) is a tick-borne infection caused by spirochetes of the Borrelia (B.) burgdorferi sensu lato complex. The infection is associated with several clinical features, of which erythema migrans (EM) and neuroborreliosis (NB) are the most common in Europe. The prognosis after antibiotic therapy is generally good. However, some patients may have residual symptoms post-treatment. The cause of the delayed convalescence is unclear. There are several factors that may affect the clinical outcome of LB, for example, the early interaction between the host’s immune response and B. burgdorferi, the spirochete genotype, antibiotic therapy, as well as the host’s vulnerability. This thesis aimed to explore the type of early immune response that is generated to B. burgdorferi and its importance for the clinical outcome of LB, and to study the condition of persistent symptoms post-NB from clinical, immunological and diagnostic perspectives. In total, 125 adult patients with different clinical features and outcomes of LB and 23 healthy controls were included. In a prospective follow-up study of EM, we confirmed that the prognosis of EM is good after antibiotic therapy, and that B. afzelii is the most common B. burgdorferi genotype associated with EM in the Nordic countries. Seven patients (8%) reported persistent symptoms more than six months post-treatment. These patients had also a decreased early expression of inflammatory, Th1-type cytokines in the EM lesions, suggesting an importance of early, local Th1-type immunity to B. burgdorferi for a successful clinical outcome of LB. No correlation between clinical characteristics, allergic predisposition, B. burgdorferi genotype or serology and the development of symptoms post-treatment was found. Asymptomatic B. burgdorferi-seropositive individuals are interesting from clinical and immunological points of view, since they apparently have encountered B. burgdorferi without developing symptoms of LB. In this thesis, asymptomatic individuals were shown to display an enhanced innate inflammatory immune response to live B. garinii spirochetes, induced by dendritic cells and whole blood cells, in comparison with patients with a history of subacute NB and healthy controls. Whether this is the optimal immune response to B. burgdorferi remains to be determined. A randomized, placebo-controlled cross-over study showed that three weeks of doxycycline therapy did not significantly improve objective neurological signs, subjective symptoms or quality of life in NB patients with persistent symptoms post-treatment. Nor could any doxycycline-mediated effects on systemic cytokine responses be demonstrated. Brain magnetic resonance imaging (MRI) findings in NB patients with persistent symptoms post-treatment were shown to be nonspecific and to correlate with age, but not with the duration of symptoms. In conclusion, this thesis shows that there is an association between the early immune response to B. burgdorferi sensu lato and the clinical outcome of LB. The cause of prolonged convalescence post-treatment remains unknown and needs further investigation. However, repeated treatment with doxycycline does not lead to improvement of the persistent symptoms; nor does brain MRI facilitate diagnosis of, or provide an explanation for the post-treatment symptoms.
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Lukhozi, Sipho Michael. "Dual obligations in clinical forensic medicine". Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86537.
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Thesis (MPhil)--Stellenbosch University, 2014.ENGLISH ABSTRACT: This thesis discusses ethical dilemmas faced by district surgeons in South Africa. District surgeons render clinical forensic services, which means that they deal mainly with detainees and victims of crime. The main functions of district surgeons are the collection of forensic evidence from patients and the care of detainees. So the focus is to assist in the administration of justice rather than improvement of patient wellbeing. The district surgeon may therefore find himself in a situation where patients’ interests are in conflict with those of law enforcement agencies. Being a medical practitioner in clinical forensic medicine, the district surgeon has an obligation to assist in the administration of justice, as opposed to the traditional obligation to care for patients and put patient’s interests first. This allegiance to both administration of justice as well as patient wellbeing lead to an ethical dilemma of dual loyalties. A dual obligations presents an ethical dilemma for the district surgeon, especially if they are in conflict and mutually exclusive. I discuss the detention and subsequent death of Steve Biko to illustrate how dual obligations can lead to serious human rights violations and even death. Dual obligations are however not limited to detainees and police custody settings, and I demonstrate this by discussing three other scenarios commonly encountered by district surgeons. There is a lack clear guidance for district surgeons who are faced with a conflict of obligations. I explore several ethical theories including consequentialism, deontology and virtue ethics, in search of an ethical framework suitable for resolving conflicts in clinical forensic medicine. I therefore argue that a duty based ethical framework is central to clinical forensic medicine and the resolution of loyalty conflicts. I recommend the resolution of conflicts by using an approach developed by Benjamin (2006). This approach involves weighing -up the different duties in conflict, applying philosophical reasoning and then amelioration. By adopting a structured and wellreasoned ethical framework, district surgeons will be able to deal with conflicts of obligations better.
AFRIKAANSE OPSOMMING: Hierdie tesis bespreek etiese dilemmas wat in die gesig gestaar word deur distriksgeneeshere in Suid-Afrika. Distriksgeneeshere lewer kliniese forensiese dienste, wat beteken dat hulle handel hoofsaaklik oor die gevangenes en slagoffers van misdaad. Die belangrikste funksies van distriksgeneeshere is die insameling van forensiese getuienis van pasiënte, en die sorg van gevangenes. Met hierdie benadering is die fokus om te help met die administratiewe doeleindes van geregtigheid, eerder as die verbetering van die pasiënt se welstand. Die distriksgeneesheer kan hom dus in 'n situasie vind waarby die pasiënte se belange in konflik is met dié van wetstoepassingsagentskappe. As 'n geneesheer in kliniese forensiese geneeskunde, het die distriksgeneesheer 'n verpligting om te help met die administrasie van geregtigheid, in teenstelling met die tradisionele verpligting om te sorg vir hul pasiënte, en hul welstand eerste te plaas. Hierdie getrouheid gaan gepaard met beide regspleging, sowel as die welstand van die pasiënt, wat kan lei tot 'n etiese dilemma van dubbele lojaliteit. Dubbele verpligtinge bied 'n etiese dilemma vir die distriksgeneesheer, veral as hulle in konflik en wedersyds uitsluitend is. Ek bespreek die aanhouding en die daaropvolgende dood van Steve Biko om te illustreer hoe dubbele verpligtinge kan lei tot ernstige skending van menseregte en selfs die dood. Dubbele verpligtinge is egter nie beperk tot die gevangenes en polisie-aanhouding instellings nie, en ek demonstreer dit deur die bespreking van drie ander “scenario's” wat oor die algemeen eervaar word deur distriksgeneeshere. Daar is 'n gebrek aan duidelike riglyne vir distriksgeneeshere wat 'n botsing van verpligtinge in die gesig staar. Ek verken verskeie etiese teorieë insluitende konsekwensialisme, deontologie en deugde-etiek, op soek na 'n etiese raamwerk geskik vir die oplossing van konflikte in kliniese geregtelike geneeskunde. Ek argumenteer dus dat 'n pligsgebaseerde etiese raamwerk sentraal is tot kliniese forensiese geneeskunde, en die resolusie van lojaliteit konflikte. Ek beveel die oplossing van konflikte deur die gebruik van 'n benadering wat ontwikkel is deur Benjamin (2006). Hierdie benadering behels 'n gewigsoorweging tussen die verskillende pligte in konflik, die toepassing van filosofiese redenasie en verbetering. Deur die aanneming van 'n gestruktureerde en beredeneerde etiese raamwerk, sal distriksgeneeshere dus in staat wees om konflikte van verpligtinge beter te hanteer.
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Blackwelder, Reid B. "Review of Complementary Medicine and Clinical Practice". Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/6912.
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Reviews the book, Complementary medicine and clinical practice edited by David P. Rakel and Nancy Faass (2006). Complementary and alternative medicine, or CAM, as it is known, has been an important and controversial topic for allopathic medicine. Although the majority of the patients in this country will use one or more forms of complementary medicine, and spend more out-of-pocket money on CAM techniques and practitioners than on allopathic ones, there is still a great deal of uncertainty among practicing physicians about what exactly CAM consists of. This book goes a long way toward helping to clarify this diverse and changing topic. Overall, each of the topics in the book emphasizes a refreshing focus on health compared with the antidisease focus of many more traditional medical articles and books. Each of the chapters integrates the technique and philosophy of the topic explored into an overall health-oriented approach to patient care. Rakel and Faass's book creates a template for a new model of medicine. Given its broad scope, it is ideal for family physicians to consider as we envision the evolution of our practices.
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Koch, Andrea. "Clinical Aspects of Inflammation in Non-small Cell Lung Cancer". Doctoral thesis, Linköpings universitet, Internmedicin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-68749.
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Lung cancer is the most common cause of cancer death worldwide, with about 1.2 million deaths every year. In Sweden, about 3500 new cases are diagnosed every year. The majority of patients presents with advanced non-small cell lung cancer (NSCLC) and is treated with palliative intent. Standard treatment in these patients in performance status 0-2 is combination chemotherapy. Radiotherapy may be added for palliative purposes. Median survival time with such treatment is 6-10 months. New treatment strategies are urgently needed. There is growing evidence for a link between cancer and inflammation and consequently, inflammation may be a possible target for the treatment of lung cancer. The aim of this thesis was to study clinical aspects of inflammation in non-small cell lung cancer. A central issue was to adapt the projects as close to clinical routine as possible. In a retrospective study of 289 patients (paper I), we investigated the prognostic value of Creactive protein (CRP), a nonspecific marker of systemic inflammation, and smoking in patients with advanced NSCLC treated with palliative first-line chemotherapy. We found that patients with elevated CRP values (≥10 mg/ml) and current smokers at onset of treatment had inferior survival compared to patients with normal CRP values and patients who were not smoking. CRP and smoking status were independent prognostic factors and provided additional information to established prognostic factors such as stage of disease and performance status. The expression of COX-2, an important enzyme involved in inflammation, was prospectively analysed in 53 patients with cytologically diagnosed lung cancer (paper II). The study showed that the analysis of COX-2 expression in cytological material is technically easy to perform with routine diagnostic methods and results in good quality slides. There was great variation in the proportion of COX-2 positive cells between the patients as well as in the intensity of staining between individual cells in many single cases. The major project (paper III) of this thesis was the CYCLUS study, an academic, randomised, double-blind, phase III trial. The scientific question was if addition of the COX-2 inhibitor celecoxib to first-line palliative chemotherapy would prolong survival in patients with advanced NSCLC. 316 patients were included at 13 centres in Sweden. There was no survival difference between the treatment arms. Celecoxib appeared to have more favourable effect on survival in women than in men, but the differences were not significant. Small but not statistically significant differences in global quality of life and pain were seen favouring the celecoxib group. No increased incidence of cardiovascular events was observed in the celecoxib group.
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Smith, Luisa J. "Evidence-based medicine in equine clinical practice". Thesis, University of Glasgow, 2006. http://theses.gla.ac.uk/5004/.
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The principles of Evidence-Based Medicine (EBM) have been well documented in the medical literature, with many examples of the successful application of these principles to the clinical environment. Despite this widespread acceptance of these principles throughout the medical profession, there has been resistance to adopt such an approach in the veterinary profession. To date, there are. few examples in the literature of the application of the principles of evidence-based medicine to either clinical or scientific research. The aim of this study was to design a series of investigations of equine diseases, and implement them at three private equine hospitals. A variety of study designs were used, providing different classes of evidence when using the classification system proposed by Yusuf et al. (1998). The main focus of this investigation was to ascertain whether it was possible to apply the ethos of EBM to the veterinary profession, and provide good quality research and evidence form private practice. It was found that 85.6% of horses (95% c.l. 81.3 to 89.3) treated for septic arthritis were successfully discharged from the hospital, with 65% of these horses (95% C.l. 57.9 to 71.6) able to return to their previous level of athletic function. When considering those horses treated for septic digital tenosynovitis, 87.8% survived to be discharged from the hospital. However, the prognosis for future soundness was poorer than that achieved following resolution of septic arthritis, with only 50% of horses treated for septic digital tenosynovitis able to return to their previous level of athletic function. Racing Thoroughbreds, both neonates and mature horses, were identified as an important subset of the population. It was found that the occurrence of septic arthritis in neonatal Thoroughbreds significantly reduced the likelihood of those foals going on to make at least one start on a racecourse, with those foals being 3.5 times less likely to start on a racecourse when compared to their siblings. In contrast, when considering mature Thoroughbred racehorses it was found that the occurrence of septic arthritis did not affect the likelihood that they would make at least one start on a racecourse when compared to their siblings, or be able to achieve an Official Rating awarded by the British Horseracing Board's handicappers equal to, or higher than, either the highest rating achieved prior to the onset of sepsis in cases in which horses had raced previously, or equal to the highest rating achieved by their siblings. In a controlled, randomised trial it was found that 31.6% (95% c.l. 17.5 to 48.7) of horses wearing a belly band following an exploratory laparotomy developed incisional complications, compared with 76.6% (95% c.I. 62.0 to 87.7) of horses where no belly band was used. If a belly band was used following an exploratory laparotomy, the risk of developing post-operative incisional complications was reduced by 45% compared to those cases where no belly band was used. Following a clinical audit of elective surgical procedures at three private equine hospitals, there was found to be a higher rate of post-operative complications, when compared to results reported in both the medical and small animal veterinary literature. It was concluded that it was possible to apply the ethos of EBM to the veterinary profession, and provide good quality research and evidence from research performed in private practice. However, in order to be able to achieve sufficient case numbers to provide answers that are directly relevant to practice-based clinical situations, multi-centre studies are likely to be the best way forward.
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Wigram, Anthony Lewis. "The effects of vibroacoustic therapy on clinical and non-clinical populations". Thesis, St George's, University of London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242997.
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Arocha, José F. (José Francisco). "Clinical case similarity and diagnostic reasoning in medicine". Thesis, McGill University, 1991. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=74638.
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This thesis describes a study of novice problem solving in the domain of medicine. The study attempts to answer questions pertaining to the diagnostic accuracy, the generation and change of diagnostic hypotheses, and the use of clinical findings in the course of solving clinical cases with similar presenting complaints. Two specific issues are addressed: (1) how does the initial case presentation suggesting a common disease schema affect the diagnostic problem solving process of novices and intermediate subjects? (2) what are the processes the subjects used in coordinating hypothesis and evidence during diagnostic problem solving?Medical trainees (students and a resident) were given four clinical cases to solve and think-aloud protocols were collected. The verbal protocols were analyzed using methods of protocol analysis. The results show that second year medical students interpreted clinical cases in terms of the more common disease schema, regardless of the initial presentation of the case. More advanced students, although unable to make a correct diagnosis in most instances, were less susceptible to such confusions. Only the resident was able to interpret the cases in terms of different disease schemata, reflecting knowledge of the underlying disease process. The semantic analysis of the protocols revealed that most students, especially at lower levels of training, misinterpreted or ignored the evidence that contradicted their initial hypotheses and made use of a mixture of forward and backward reasoning; a finding consistent with previous research. Implications for educational training and for a theory of novice problem solving in medicine are presented.
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Innes, David Findlay. "The value of the autopsy in clinical medicine". Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/26604.
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The main purpose of this study was to assess the value of the autopsy in clinical medicine today. This has been achieved by analysing several variables. Clinical diagnostic accuracy was determined by assessing the concordance/discrepancy of clinical and autopsy diagnoses. In addition, several variables were assessed, namely whether or not the size of the hospital, type of ward, autopsy rate, age of the patient, and degree of confidence with which the clinical diagnosis was made had any bearing on the accuracy of the diagnosis. The impact of the newer diagnostic tests on clinical diagnosis was also assessed to confirm or refute the widely held opinion amongst clinicians that diagnostic advances have indeed reduced the need for autopsies. The attitudes of pathology registrars and consultants towards the autopsy were analysed, using a questionnaire proposed by Stubbs et al.
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Samuelsson, Anders. "Effects of burns and vasoactive drugs on human skin : Clinical and Experimental studies using microdialysis". Doctoral thesis, Linköpings universitet, Anestesiologi med intensivvård, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-59519.
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Patients who require critical care, including those with burns, are affected by a systemic inflammatory reaction, which at times has consequences such as multiple organ dysfunction and failure. It has become increasingly evident that other factors important in the development of organ dysfunction are disturbances at the tissue level, in the microcirculation. Such disturbances activate cascade systems including stress hormones, all of which have local effects on organ function. Despite this knowledge, monitoring and treatment in critical illness today relies mainly on central haemodynamics and blood sampling. Microdialysis is a minimally invasive technique that enables us to study the chemical composition and changes in biochemistry in the extracellular, extravascular space in living tissues. Most of our current experience is from animal models, but the technique has also been used in humans and has become routine in many neurosurgical intensive care units to monitor brain biochemistry after severe injury. In skin, this experience is limited. During the first half of this thesis we studied the injured and uninjured skin of severely burned patients. The results show that there are severe local metabolic disturbances in both injured and uninjured skin. Most interesting is a sustained tissue acidosis, which is not detectable in systemic (blood) sampling. We also recorded considerable alterations in the glucose homeostasis locally in the skin, suggesting a cellular or mitochondrial dysfunction. In parallel, we noted increased tissue glycerol concentrations, which indicated appreciable traumainduced lipolysis. We also examined serotonin kinetics in the same group of patients, as serotonin has been claimed to be a key mediator of the vasoplegia and permeability disturbances found in patients with burns. We have shown, for the first time in humans to our knowledge, that concentrations of serotonin in skin are increased tenfold, whereas blood and urine concentrations are just above normal. The findings support the need for local monitoring of substances with rapid local reabsorption, or degradation, or both. The results also indicate that serotonin may be important for the systemic response that characterises burn injuries. In the second half of the thesis we evaluated the effects of microdosing in skin on metabolism and blood flow of vasoactive, mainly stress-response-related, drugs by the microdialysis system. The objectives were to isolate the local effects of the drugs to enable a better understanding of the complex relation between metabolic effects and effects induced by changes in local blood flow. In the first of these two studies we showed that by giving noradrenaline and nitroglycerine into the skin of healthy subjects we induced anticipated changes in skin metabolism and blood flow. The results suggest that the model may be used to examine vascular and metabolic effects induced locally by vasoactive compounds. Data from the last study indicate that conventional pharmacodynamic models (Emax) for time and dose response modelling may be successfully used to measure the vascular and metabolic response in this microdosing model. We conclude that the microdialysis technique can be successfully used to monitor skin metabolism and iso late a mediator (serotonin) of the local skin response in burned patients. It was also feasible to develop a vascular model in skin based on microdialysis to deliver vasoactive substances locally to the skin of healthy volunteers. This model provided a framework in which the metabolic effects of hypoperfusion and reperfusion in skin tissues could be examined further.
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Macdonald, Morag M. "Craft knowledge in medicine : an interpretation of teaching and learning in apprenticeship". N.p, 1997. http://ethos.bl.uk/.
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Clarke, Amanda. "Two professional issues in clinical psychology : reflective practice and clinical effectiveness". Thesis, University of Warwick, 2010. http://wrap.warwick.ac.uk/36732/.
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This thesis contributes knowledge to the areas of Reflective Practice and Clinical Effectiveness, both professional issues in clinical psychology, which have a direct link to patient care in the National Health Service (NHS). The literature review presented in Chapter 1 focuses on reflective practice. The review aimed to identify all published empirical research, which investigated the application and usefulness of reflective practice for staff qualified in healthcare professions, and working in health services specifically, including the NHS. The findings have clinical and professional implications for health care staff, their managers, and the broader organisations in which they work. The use of reflective practice has been linked in the literature to increased clinical effectiveness, which is the second professional issue. The empirical paper presented in Chapter 2 explored the measurement and demonstration of clinical effectiveness as experienced by clinical psychologists working within NHS using a qualitative methodology. Demonstrating clinical effectiveness was found to be particularly relevant given the current, changing financial climate of the NHS and a context in which clinical psychologists are expected to prove their professional worth. The review and empirical paper highlight the importance of practice-based evidence. Chapter 3 presents a reflective paper, which explores the impact of the review and research findings on the author who is approaching the end of her clinical psychology training. This paper may be of interest to more experienced clinicians who wish to understand the issues from a newly qualified perspective, or to readers interested in the transition from training to professional practice.
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van, Kralingen Josie Charlotte. "MicroRNAs and extracellular vesicles in pre-clinical and clinical stroke studies". Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/7937/.
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Stroke is a leading cause of death and disability worldwide and remains a largely unmet clinical need. Despite decades of pre-clinical stroke research there are only two licensed interventions: intravenous delivery of thrombolytic recombinant tissue plasminogen activator (rt-PA) within 4.5 hours of stroke or mechanical thrombectomy. However, the number of patients eligible to receive either treatment is limited. An alternative intervention is needed, one which directly address specific aspects of stroke pathophysiology. Through their ability to alter the expression of multiple genes involved in stroke pathophysiology microRNAs (miRNA or miR) offer a novel therapeutic intervention. miRNA expression is altered both in experimental stroke and in patients with stroke. It was initially hypothesised that modulation of specific dysregulated miRNAs would be therapeutically beneficial in pre-clinical experimental ischaemic stroke. Recently, active transport of miRNAs in extracellular vesicles (EV), such as exosomes, has been demonstrated pre-clinically between cells in atherosclerosis and cardiac hypertrophy disease settings. It was therefore hypothesised that miRNAs packaged in exosomes would differ between patients with stroke and patients without stroke, raising the potential for novel exosomal miRNAs to be used as biomarkers or therapeutic agents for modulation. In Chapter 3, investigations were carried out to test the hypotheses that modulation of either miR-494 or miR-21 would be therapeutically beneficial in pre-clinical in vitro models of stroke. While miR-494 expression was unchanged in brain tissue of spontaneously hypertensive stroke prone rats (SHRSP) harvested at either 24 or 72 hours following transient middle cerebral artery occlusion (tMCAO) its expression was successfully up-regulated in B50 neuronal and GPNT cerebral endothelial cell lines following delivery of miR-494 mimic in combination with siPORT, a lipid based transfection reagent. mRNA expression of putative miR-494 target genes (PTEN, MMP2 and MMP9) was investigated post-miR-494 modulation but there was no obvious change in their expression. Modulation of miR-494 expression did not appear to be therapeutically beneficial (or detrimental) when assessed by a cell survival assay (MTS). As the balance of evidence did not indicate that miR-494 would be a suitable target for modulation in experimental stroke subsequent similar experiments investigated the therapeutic potential of miR-21. Its expression was significantly increased in SHRSP brain tissue at 72 hours following ischaemic stroke. miR-21 expression was successfully increased in cerebral endothelial cells following delivery of miR-21 mimics (with siPORT). mRNA expression of putative target genes (PDCD4 and PTEN) was unchanged following miR-21 modulation and cell survival (assessed by MTS assay) was unaffected. Subsequent experiments looked at vessel reactivity of aortae taken from miR-21+/- and miR-21-/- mice in comparison to wild type (WT) mice. Treatment of vessels with L-NAME to block endogenous nitric oxide (NO) bioavailability resulted in unopposed contraction to U46619 in WT mice while there was no change in contraction in miR-21-/- mice aortae, consistent with reduced basal NO bioavailability, and a detrimental phenotype associated with the loss of miR-21 expression. As the data generated in this study were primarily neutral and gave no indication that either miR-494 or miR-21 would be therapeutically beneficial in the setting of ischaemic stroke, subsequent studies focussed on investigating exosomal miRNA in ischaemic stroke. In Chapter 4, exosomal miRNA expression was profiled in blood samples from stroke patients and subsequently in pre-clinical rodent stroke models. Patients with suspected stroke were recruited and a blood sample taken at 48 hours post-stroke. All participants gave full informed consent and the study was approved by the Scotland A Research Ethics Committee. Exosomes were isolated from 200 μL serum before RNA was extracted. A miRNA microarray was performed (OpenArray™ platform) on samples from 39 patients. Validation of results was performed by real-time quantitative polymerase chain reaction using samples from 173 patients to determine the expression levels of specific miRNAs. Microarray experiments identified 26 exosomal miRNAs that were significantly dysregulated between stroke and non-stroke patients or between specific TOAST subtypes and non-stroke controls. Of these, changes in 13 miRNAs were validated in the larger cohort and levels of 9 miRNAs (-27b, -93, -20b, -17, -199a, -30a, let-7e, -218 and -223) were found to be significantly increased in definitively diagnosed stroke patients as compared to non-stroke patients. Differences in exosomal miRNA expression were observed between TOAST subtypes with small vessel disease patients consistently having the highest levels of these miRNAs. miRNA expression did not correlate with baseline or day 7 NIHSS score, although there was a trend towards patients with better functional outcome post-stroke (as assessed by modified Rankin Score at 1 month) having a higher level of some exosomal miRNAs. Subsequently total and exosomal miR-17 family (miRNAs -17, -93 and -20b) expression was investigated in pre-clinical models of hypertension and stroke. Total circulating miR-17 expression was unchanged between the serum of normotensive WKY and hypertensive SHRSP rats, whilst exosomal miR-17 expression was significantly increased in SHRSP vs. WKY. miR-17 family expression was unchanged in peri-infarct brain tissue of SHRSP at both 24 and 72 hours post-tMCAO. Experiments profiling total and exosomal circulating miR-17 family expression in serum of SHRSP post tMCAO or permanent MCAO revealed that expression was variable and changes observed were not significant. Cellular expression of miR-17 family miRNAs was unchanged following hypoxic challenge in neuronal, glial and cerebral endothelial cell lines and exosomal miRNA expression was highly variable, with no changes detected as significant. This study both identified and validated (for the first time) changes in exosome packaged miRNA expression in patients with stroke across differing stroke subtypes. The pre-clinical experimental findings corroborate the human data and support a functional role for these findings. In Chapter 5 exosomal packaged miR-17 family miRNAs were delivered in pre-clinical models of ischaemic stroke (both in vivo and in vitro) to test the hypothesis that they would be therapeutically beneficial following in vitro hypoxic challenge or in vivo experimental stroke. Bioinformatics analysis highlighted a number of important target genes implicated in stroke pathophysiology for each miRNA including genes involved in the regulation of the cellular response to stress, apoptosis and angiogenesis. miRNAs were artificially loaded (by electroporation) into EVs harvested from SHRSP brain. While miRNA loaded EVs did not successfully modulate miRNA expression either in vivo or in vitro it is believed that this is a result of technical issues with the loading of the miRNAs into the EVs. This study should be repeated when miRNAs have been successfully loaded into EVs, as these experiments remain of interest. In summary, the findings presented in this thesis confirm that packaging of miRNAs into exosomes is significantly dysregulated in stroke patients and that as a result the circulating exosomal miRNA profile is altered. This will direct future studies looking into paracrine signalling in the setting of stroke and the modulation of specific miRNAs as a novel therapy in the setting of experimental stroke.
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Gusmão, Carolina Ramalho Rosado. "Wild animals clinical medicine and surgery - Botulism in gulls". Master's thesis, Universidade de Évora, 2019. http://hdl.handle.net/10174/26153.
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This report was developed in the context of the Integrated Master's Degree in Veterinary Medicine carried out by the author and was based in her curricular externship at two wildlife hospitals/rehabilitation centres, one located in Spain and the other in the United Kingdom.
There are two main parts to this report. The first one includes a description of the activities performed by the author during the externship and data about the animals admitted at both centres. The second part includes a monograph about Botulism in Gulls and a case report of a Lesser Black-backed Gull (Larus fuscus) with botulism. Botulism is one of the most important diseases in wild birds worldwide. Outbreaks of this disease can have high mortality rates and a large impact on wildlife populations; Resumo:
Clínica e Cirurgia de Animais Selvagens - Botulismo em Gaivotas
Este relatório foi desenvolvido no âmbito do Mestrado Integrado em Medicina Veterinária e foi baseado no estágio curricular realizado pela autora em dois hospitais/centros de recuperação de animais selvagens, um localizado em Espanha e o outro no Reino Unido.
Este relatório está dividido em duas partes principais. A primeira inclui uma descrição das atividades desenvolvidas pela autora durante o seu estágio e dados sobre os animais admitidos nos dois centros. A segunda parte inclui uma monografia sobre Botulismo em Gaivotas e um caso clínico de uma Gaivota-d ’asa-escura (Larus fuscus) com botulismo. O botulismo é uma das doenças mais importantes do mundo em aves selvagens. Surtos desta doença podem ter elevadas taxas de mortalidade e um grande impacto nas populações de animais selvagens.
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Flores, Sepulveda Luis Jose. "Clinical judgement in the era of evidence based medicine". Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/clinical-judgement-in-the-era-of-evidence-based-medicine(d05f12b7-05fd-45a2-b1ff-78060d1d8520).html.
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“Evidence Based Medicine” (EBM) urges that medical recommendations be based on the best research evidence, rather than on clinical judgement. While I strongly endorse attention to relevant research evidence, I argue that the related downplaying of clinical judgement is a step backwards. This is because actual models of EBM encourage physicians to focus exclusively on research probabilities and so to neglect relevant information about patients. I call this feature of EBM the “Problem of Extra Information” (PEI), and contend that it leads to predictions and prescriptions based on the wrong probabilities. The PEI has been largely neglected by EBM, which has construed the challenge of clinical care as a matter of developing better research evidence, and of reminding physicians to attend to patients’ preferences and values. And although meritorious attempts have been made to connect research with individuals through sophisticated methodological improvements, these only address the PEI partially, and do not eliminate the need for clinical discretion. In this dissertation I contend that, in response to the PEI, clinical medicine requires a more Discretionary Approach (DA). This approach recognizes that the objective probabilities that matter for clinical recommendations are those in the reference class defined by everything the physician knows about the patient, and argues that the central role for judgment in clinical practice is to estimate these probabilities. So understood, the DA has two main advantages over the EBM approach: prudential adequacy and evidential flexibility. My defence of the DA consists of addressing criticisms of the role ascribed to judgment and clinical experience within this approach. The final two chapters of this doctoral dissertation complement my arguments with two meta-analytical empirical studies: one which compares “therapeutic guidelines based on evidence” with “usual care” with respect to patients’ outcomes, and another which examines the relative predictive performance of statistical models and physicians’ judgment in the context of diagnosis and prognosis. These studies refute previous evidence cited against judgment and vindicate the plausibility of the Discretionary Approach to clinical care.
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Crafoord, Kristina. "Genital prolapse surgery : A study of methods, clinical outcome and impact of pelvic floor muscle function". Doctoral thesis, Linköpings universitet, Obstetrik och gynekologi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17417.
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Objective: To evaluate whether a shift in the extent of genital prolapse surgery occurred between 1983 and 1993. If such a shift occurred, the need for subsequent prolapse surgery; the prevalence of symptoms of pelvic floor dysfunction (PFD) in women six years after vaginal prolapse surgery. And also to analyze predictive factors and the subjective and objective outcomes of prolapse surgery at long term follow up. To evaluate whether neurophysiologic findings of the pelvic floor muscles and anorectal manometry measurements respectively are associated with pre- and postoperative symptoms and the extent of prolapse. Methods/material: A retrospective study of 542 consecutive patients, operated on for genital prolapse, with primary surgery during 1983 and 1993 in three Swedish hospitals was conducted. Data were obtained from the patient records and were analyzed with emphasis on demographic, clinical and surgical data. A postal questionnaire with validated questions concerning symptoms of PFD was in 1999 sent to women operated in 1993 for primary POP and no subsequent POP surgery. A prospective study of 42 women with genital prolapse, stage 2-3, scheduled for vaginal prolapse surgery was carried out. Preoperatively the women were examined with anorectal manometry, pudendal nerve neurography and concentric needle electromyography of the pubococcygeus muscles and the external anal sphincter muscle. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated six years postoperatively. Results: A shift from complete to selective repairs was seen between the two time periods, and posterior repair was often omitted in the latter period. The prevalence of subsequent prolapse surgery increased in the 1990s and the increase was more common in women with a selective repair than in those with complete repair. At long term, PFD-symptoms commonly occurred and were found to be associated with the extent of the prolapse surgery. Symptoms of prolapse and bowel emptying improved significantly after POP surgery in the prospective study. The cure rates of rectocele and apical descent were high, but low concerning cystocele. The results of the neurophysiologic investigations and anal sphincter pressures showed associations with the symptoms and the extent of the prolapse; the individual characteristics showed no discriminatory values. Conclusion: The extent of the surgical prolapse procedures changed between the two study periods and the extent of subsequent surgery also was greater in the second period. Symptoms of PFD and recurrence of prolapse, especially of the anterior compartment, were frequently seen. Prolapse and bowel symptoms were associated with the function of pelvic floor muscles but neither the results of the neurophysiologic nor the anorectal manometry measurements of the pelvic floor muscles were found to predict anatomical or subjective outcomes of POP surgery. More knowledge is needed of the pathophysiology of PFD in order to develop better means of prevention and to optimize treatment of POP. Development of new methods for identifying all defects of the pelvic floor and surgical techniques for restitution is also warranted for improving outcome of surgical treatment of genital prolapse.
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Jarlmo-Måård, Hannes. "Datortomografisk koronarangiografi hos patienter med låg till måttlig risk för akut kranskärlssjukdom". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50529.
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Lindskog, Linda, i Nakhshin Abdelzadeh. "Ultraljud eller datortomografiundersökning vid djup ventrombos : Litteraturstudie". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50530.
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Rasak, Alma, i Saleh Zahraa Bassem. "Röntgensjuksköterskans tillämpning av basala hygienrutinerna vid datortomografiundersökning". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50531.
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Mohammad, Razhan, i Peyam Eizuldeen. "Radiologiska undersökningsmetoder vid diagnostisering av Stabil Angina Pectoris : En litteraturstudie". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50532.
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Nylin, Matilda, i Emma Hårsmar. "Hjälpmedel för barn som ska genomgå magnetkameraundersökning utan anestesi eller sedering : En litteraturstudie". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50533.
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Bolin, Isabelle, i Mavaneh Mina Jahangiri. "Bilddiagnostisk modalitet för att utvärdera aktiviteten av sakroilit vid ankyloserande spondylit : En litteraturstudie". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50534.
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Olofsson, Beatrice, i Erika Lind. "Patientstrålskydd vid konventionella ländryggsundersökningar på en röntgenklinik : En observationsstudie". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50536.
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Lindqvist, Karin, i Emelie Grankvist. "RADIOLOGISK DIAGNOSTICERING AV MULTIPELT MYELOM : EN LITTERATURSTUDIE". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50537.
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Kasim, Ihsan. "CK5/6 och CEA uttryck i skivepitelcancer i lunga: en retrospektiv studie". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50633.
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Lintonsson, Ruth. "Quantification of Canine muscle volume with Computed Tomography for diagnostic and scientific purpose". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50799.
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Nasr, Abir. "The prevalence of COPD among patients suspected for pulmonary embolism using V/P SPECT". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50802.
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Tworek, Luiza. "Development of a liquid chromatography - high resolution mass spectrometry method for multi-component screening of synthetic cannabinoids in blood". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50803.
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Al-atia, Mohassad. "Can oral contrast enhance image quality at MRCP? A literature review". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50927.
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Ekholm, Ulla-Britt. "Premenstrual syndrome : a study of change in cyclicity, severity and sexuality". Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 1991. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-141050.
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82 women seeking help for the Premenstrual syndrome (PMS) were successively recruited into a research project on PMS. All of them performed daily self-ratings during one menstrual cycle and 54 of them during two cycles. Including the patients with two rated cycles the change between cycles in cyclicity and preovulatory symptoms was studied. They were diagnosed and subgrouped as having ”Pure PMS” with significant cyclicity and only premenstrual symptoms, ”PM aggravation” with significant cyclicity but with additional preovulatory symptoms or ”Non-PMS” without cyclicity. 78% showed the same cyclical pattern in both cycles and 65% were allocated to the same subgroup. The presence or absence of preovulatory symptoms was a more stable factor than the occurence of cyclicity. The cycle more resembling an ”ideal PMS pattern” better separated groups of patients regarding neurotic personality and psychiatric history. When all 54 patients were investigated together there was no change in severity between the two cycles when the whole cycles were compared, and using the premenstrual phase only difference in one symptom. When divided into subgroups it was found that the ”Pure PMS” group felt worse during the first rated cycle while the ”PM aggravation” group felt better during the first cycle. A method for estimating the severity of PMS was developed and tried. A severity-score was calculated and ± 1 SD was used to subdivide the patients into severity-groups giving 20% classified as having mild PMS, 61% as moderate and 19% as severe. The symptoms with the highest correlation to the severity-score were anxiety, tension and irritability. The validity of the severity-score was studied by comparing it with other ways of estimating severity of PMS. There was very good agreement between the severity-score and the prospective rating of influence on family, work and social life, fairly good between the result of a Moos Menstrual Distress Questionaire (MDQ) and the severity-score and also between the retrospective rating of influence and the severity-score. There was good agreement when the severity-score from two rated cycles was compared. Sexual parameters and the relationship to androgen levels and SHBG were studied. All sexual parameters showed cyclical change except the parameter ”unpleasant sexual thoughts” in the group with high levels of androstenedione, testosterone and SHBG when using combined p-value. The patients with a low level of androstenedione had more days with maximum ratings of the parameters ”sexual feelings” and ”pleasant sexual thoughts”. Patients with ”Pure PMS” had a lower level of testosterone compared with the ”PM aggravation” group. Four different methods for diagnosis of PMS, a nonparametric test, effect size, run test and 30% change were compared. Results showed high agreement except for the method of using 30% of the scale as condition for cyclicity, which resulted in fewer patients with cyclicity than the other methods used.digitalisering@umu.se
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Von, Ehr Michelle. "Optimization of the Two-Tailed RT qPCR method with synthetic miR-16 and miR-210 in human plasma for future diagnostics of sepsis". Thesis, Högskolan i Skövde, Institutionen för biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-18844.
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Every year, around 6 million people lose the fight against sepsis. Sepsis is a dysregulated response from the host to an infection, leading to life-threatening organ dysfunction. The gold-standard diagnostics of sepsis to date is blood culturing and the results take up to three days to be validated Therefore, it is important to focus on biomarkers like MicroRNA [miRNA] to develop faster diagnostics tools as they have previously shown to be potential minimally-invasive biomarkers for many diseases of different origin. RT-qPCR is known to amplify DNA, while a new primer, called the two-tailed primer, was developed by TATAA Biocenter to specialize on miRNA amplification. The aim of this study is to perform the two-tailed RT-qPCR method manually with two synthetic miRNAs, miR-210 and miR-16, reduce the amount of plasma to a minimum of 100 μl and optimize this method for the use in conventional labs. Whole blood was drawn, centrifuged and the resulting plasma underwent RNA extraction. Synthetic miRNAs were used for spiking and the two-tailed RT-qPCR method was performed and both melt curve analysis, standard curve analysis and absolute quantification were performed. Amplification was detected in all samples, allowing to conclude that the two-tailed primers work. The amplification efficiencies and the linearity for both synthetic miRNAs were determined at 77% and 0.99, respectively. Absolute quantification showed promising quantification for all spiked samples while it needs to be taken into account that the amplification efficiencies were rather low and the standard curves used for absolute quantification should be diluted with care.
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Lindeberg, Victoria. "Evaluation of Manual and QIAcube miRNA Extraction from Plasma with the miRNeasy Advanced Kit from Qiagen". Thesis, Högskolan i Skövde, Institutionen för biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-18848.
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Sepsis is a syndrome causing millions of deaths every year. The diagnosis today uses several parameters one of which is blood culture. It can take up to 48 hours to get results. Sepsis can lead to major organ dysfunction in a span of four hours; therefore time is of the essence. Diagnosis of sepsis using multiple biomarkers a “multi marker panel” is currently being studied. One parameter suggested to be included is miRNA. There is need for an efficient extraction method to get the miRNA from the patients’ blood. This can be done by using a kit either manually or in a machine such as the QIAcube. The miRNeasy Serum/Plasma Advanced Kit (Qiagen) was used in both a manual and a QIAcube miRNA extraction with two volumes of plasma (200 μl and 100 μl) from self-assessed healthy individuals. There were 10 extractions made with each method and volume, in total 40 extractions was performed. The miRNA concentration was measure with a Qubit and purity was measured with a nanodrop. The miRNA concentration was statistically significantly higher using the QIAcube 100 μl compared to the other volume and the manual extractions. The turn-around time was shorter with the manual extraction while the hands-on time was shorter in the QIAcube methods. In conclusionthere is still research to be done on both miRNA and miRNA extraction before it can be included in a multi marker panel for sepsis. However the QIAcube does show potential to be used in a clinical laboratory.
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Aldosaky, Khatoon Salim Eshaq. "MANUAL VS MACHINERY SMALL RNA EXTRACTION BY USING A QIACUBE® MACHINE : Two methods. Two volumes". Thesis, Högskolan i Skövde, Institutionen för biovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-18854.
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Sepsis is a serious condition caused by a dysregulated immune response of the host triggered by an infection that can potentially lead to malfunction of various organs or even death in severe cases. Some studies have shown that the use of biomarkers could aid in early diagnosis as well as early treatment of sepsis patients. Furthermore, various studies have investigated the idea of using extracellular microRNAs as biomarkers for sepsis diagnosis. This study aimed to see if there were any differences in the quantity and purity of small RNA -which includes microRNA- by performing two different RNA extraction methods (manual and machinery by using a QIAcube) as well as two different volumes by using the ExoRNeasy Serum/Plasma Midi Kit. Blood samples were collected solely from the same self-assessed healthy donor. The plasma samples were frozen and then thawed before the RNA extraction, whether manually or machinery by the QIAcube. The extracted small RNA was then measured for quantity and purity. The quantitative results were analysed by ANOVA followed by post-hoc Tukey test to show the statistically significant difference in the concentration of small RNA. The QIAcube showed higher concentration values compared to the manual method as well as larger initial plasma volume in comparison to the lower initial plasma volume. Meanwhile, the Kruskal-Wallis test showed no statistically significant difference in the purity values among the different methods and volumes. In conclusion, based on this study, the QIAcube could do what human hands do.
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Yousif, Nisreen. "En jämförelse av två ekokardiografiska metoder vid mätning av sinus valsalvas diameter". Thesis, Jönköping University, HHJ, Avd. för naturvetenskap och biomedicin, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-53364.
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Söderquist, Fanny. "Melatonin and its receptors in the normal human gastrointestinal tract, pancreas and in small intestinal neuroendocrine tumours". Licentiate thesis, Uppsala universitet, Psykiatri, Akademiska sjukhuset, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-319920.
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Melatonin, “the hormone of darkness” is well known to regulate sleep and circadian rhythm. However, melatonin is also present in numerous peripheral tissues and the number of actions assigned to this neurohormone is growing steadily. Based on animal studies, it has been proposed that gastrointestinal melatonin is produced in enterochromaffin cells. The aims were to characterise the expression of melatonin and its receptors MT1 and MT2 in normal human gastrointestinal tract and pancreas as well as in tumours derived from enterochromaffin cells, small intestinal neuroendocrine tumours (SI-NET), using immunohistochemistry. Melatonin and receptor expression was furthermore compared to clinical symptoms, tumour prognostic factors and treatment response. In enterochromaffin cells from normal gastrointestinal tissue and in SI-NETs a strong immunoreactivity (IR) for melatonin and MT2 was found, while MT1 IR was low or absent. Melatonin, MT1 and MT2 IR was also seen in the large intestinal epithelium of normal gastrointestinal tract and in pancreatic islets, although the expression of MT1 in pancreatic tissue varied. Analyses of mRNA data confirmed the expression of the enzymes needed for melatonin synthesis as well as MT1 and MT2 in small intestine and pancreas. The intensity of melatonin IR in SI-NETs correlated to lower proliferation index and less symptoms of diarrhoea, which is well in line with the proposed actions of melatonin described in nimal studies. The intensity of MT2 IR was generally lower in metastases than in primary tumours. Plasma levels of melatonin in patients with SI-NETs and disease stabilisation/remission were reduced after treatment and higher levels were associated with nausea. In conclusion, melatonin and its receptors are present in the normal human gastrointestinal tract, pancreas and in SI-NETs. Melatonin IR intensity in tumours correlated significantly to less diarrhoea and to lower proliferation index. Plasma levels of melatonin in patients with SI-NETs were reduced with treatment response, indicating a possible tumour-derived origin of circulating melatonin levels. These results are in agreement with the suggested actions of melatonin on gastrointestinal motility and tumour growth.
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Chrifi-Alaoui, Karim. "The mechanism of action and efficiency of Fingolimod in the treatment of relapsing-remitting multiple sclerosis : A systematic literature review". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58729.
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Larsson, Anna, i Axel Fowelin. "Hur efterföljs rutiner gällande kompression vid två röntgenkliniker i Sverige? : En observationsstudie". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58712.
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Montero, Carmen, i Gisele Niyigena. "Bildkvalitet och stråldos vid användning av lågdos-respektive normaldos-DTLA vid lungembolifrågeställning". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58714.
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Akimana, Clarisse, i Finan Weldegiorgis. "Kommunikation mellan röntgensjuksköterska och patient i samband med radiologiska undersökningar". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58715.
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Lauri, Kerstine, i Elin Bornström. "Patienten i fokus på röntgenavdelningen". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58716.
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Persson, Emma, i Jessica Strandberg. "Barnröntgen : Anpassad miljö och material vid konventionell röntgen och datortomografiundersökningar på barn". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58717.
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Karlsson, Malin, i Susanne Isaksson. "Tuberkulospatienten på röntgen – Vilka rutiner gäller?" Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58718.
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Thornholdz, Linda, i Sandra Vilhelmsson. "Röntgensjuksköterskans ansvar vid möten med barn som misstänks fara illa - Vilka rutiner och riktlinjer finns det på röntgenkliniker i Sverige?" Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58723.
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Ljung, Petter, i Sigfrids Victoria Söderblom. "Har du koll på läget? : En jämförande enkätstudie om informationen patienter får inför, under och efter datortomografiundersökning av buk med intravenöst kontrastmedel". Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58727.
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Murphy, Jeremy James. "Clinical trials in cerebrovascular disease". Thesis, University of Nottingham, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.293328.
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Salas-Vega, Sebastian. "Cancer medicines : clinical impact, economics, and value". Thesis, London School of Economics and Political Science (University of London), 2017. http://etheses.lse.ac.uk/3647/.
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Background and Importance: There has been much debate recently over rapidly growing drug expenditures. Cancer medicines, in particular, have driven new brand spending over recent years, and US oncological expenditures have risen faster than for many other disease areas, in part because of rapidly growing drug prices, as well as increased rates of use. Objective: In the face of ongoing debates on how to reasonably control growth in pharmaceutical spending, while also providing patients with the best possible care, this thesis sets out to help address the question of whether growing pharmaceutical expenditures are providing value-for-money to patients and society. Novelty and Empirical Contributions: This thesis is based in part on a systematic review with narrative synthesis of English-language HTA appraisals of the comparative clinical risks and benefits of new cancer medicines, as well as on the novel use of methods to generate comparative evidence on their use and cost. Adapting established methods, these data are then used to examine existing questions over whether growing expenditures are worth the cost to patients and society. This thesis makes five major contributions to the literature on value-based spending on cancer medicines: 1) approximately one in three newly licensed cancer medicines provide no known overall survival benefit, while one in five provide no known overall survival, quality of life, or safety benefit; 2) novel use of methodologies to model treatment course and duration reveals that cancer drug use and costs vary greatly between individual medicines, and across Australia, France, the UK, and the US; 3) the monetized value of survival gains attributable to cancer drug innovation, net of growth in cancer drug spending, varies across individual medicines, and, at a country-level, remains unambiguously positive in Australia, France, and the UK, but negative in the US; 4) spending on new cancer medicines is often only weakly associated with their clinical benefits; and 5) the strength of this association nevertheless varies across countries, with the UK demonstrating the strongest evidence of value-based spending on new cancer medicines. Clinical and Policy Implications: Findings from this thesis provide a resource for valuebased clinical decision-making by patients and physicians. Moreover, growing expenditures on cancer medicines may only weakly be associated with meaningful clinical benefits, though the extent to which this is true differs across countries. These findings highlight the important role that health policy can have in encouraging valuebased cancer drug spending. In particular, it is argued that managed access schemes promoting access and evidence development, as well as the use of value-based spending policies, can help expedite access to new treatments, incentivize the development of clinically meaningful medicines, and rationalize growing cancer drug expenditures. Future Research Directions: The comparative clinical risks and benefits from new cancer medicines using real-world data, and how they compare with trial-based results; how evidence on the comparative impact from new treatments is measured, weighted, and rewarded in decision-making by regulators and payers; and how it is effectively linked through policy and regulation to cancer drug spending.
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Michael, Gary E. "Performance Improvement in the Clinical Setting". Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/6429.
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Hudson, Michael B. "Mentoring effectiveness on clinical supervisors as perceived by athletic training students in the intercollegiate athletics clinical education experience /". free to MU campus, to others for purchase, 2002. http://wwwlib.umi.com/cr/mo/fullcit?p3052181.
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Cahill, Mary Rose. "Platelet activation : measurement of clinical significance". Thesis, Queen Mary, University of London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261799.
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Tubman, Thomas Richard John. "Clinical studies of surfactant replacement therapy". Thesis, Queen's University Belfast, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.333793.
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