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1
Barnard, Irene Susan. "Exploring the older patient/physiotherapy clinician relationship". Thesis, University of Southampton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.401751.
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Saemrow, Matthew Ronald. "Does Gender Influence the Patient-Clinician Relationship?" Thesis, North Dakota State University, 2016. https://hdl.handle.net/10365/27979.
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Athletic trainers commonly work with athletes of the opposite gender yet it is not fully
understood if gender may influence these interactions. The purpose of this study was to
determine the extent that gender influences comfort, communication, and trust in the athlete and
athletic trainer relationship. A 26-item survey containing Likert based questions and open-ended
and a trust instrument were distributed in athletic training rooms to analyze comfort,
communication, and trust. Comfort, communication, and trust were significantly lower when
working with athletic trainers of the opposite gender. Athletes reported trust and communication
as the most valued aspect of the relationship with their athletic trainer. Despite lower perceived
scores, 150 out of 178 participants reported no preference for the gender of their athletic trainer.
Athletic trainers should understand that athletes may experience a decrease in comfort,
communication, and trust when working with athletic trainers of the opposite gender.
Key Words: Comfort, Trust, Communication, Athletic Trainer
3
Nieuwkamp, Garry Anthony Aloysius, i res cand@acu edu au. "The Theory of Informed Consent in Medicine: problems and prospects for improvement". Australian Catholic University. School of Philosophy, 2007. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp166.22072008.
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Practice and law around informed consent in healthcare have undergone a revolution for the better over recent decades. However the way we obtain informed consent remains problematic and is imbued with irreducible but not ineliminable uncertainty. The reasons for this uncertainty are varied. The uncertainty is partly due to the conceptual opacity of important core concepts. The complexity of communication in clinical encounters is another. The role of autonomy, and the changing nature of the clinician patient relationship, have also contributed to this uncertainty remaining. This thesis is not a panacea for these difficulties. However there have been two quite profound revolutions in healthcare over the last decade or so, namely, the introduction of evidence-based medicine into clinical decision making, and the institutionalization of clinical governance and the application of quality improvement philosophy. I have examined ways in which these two “movements” can help in reducing some of the uncertainty in the practice of informed consent.
4
Arrese, Loni C. "Assessment of the relationship between patient and clinician ratings of swallowing function in individuals with head and neck cancer". The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1429856045.
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Caruso, Myah. "The Patient-Physician Relationship from the Perspective of Economically Disadvantaged Patients". Antioch University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=antioch150362027045926.
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Rieck, Sue Boswell. "The relationship between the spiritual dimension of the nurse-patient relationship and patient well-being". Diss., The University of Arizona, 2000. http://hdl.handle.net/10150/289187.
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The purpose of this study was to examine if the spiritual dimension of the nurse-patient relationship (SDNPR) contributes to patient well-being. The research design was a nonexperimental, predictive, latent-variable model and two open-ended questions that asked participants to describe nurse characteristics and behaviors important to well-being. The model included age, significant life events, health, social support, and self-transcendence in addition to SDNPR as predictors of well-being. The sample consisted of hospitalized, postoperative adult patients (N = 98). The Spiritual Dimension Inventory (SDI), a 25 item, four dimensional scale was developed to measure SDNPR. Reliability coefficients for the SDI subscales (connection, empathy, commitment, and trust) and for the total scale were .84 and above. Construct validity was established through measurement model testing. Predictive validity was supported by regression analysis. Connection, commitment, and trust explained 53% of the variance of well-being. The predictive model was tested by confirmatory factor analysis and compared to five competing models. The results of the model testing did not support the hypothesized model of SDNPR predicting well-being. Four themes of nurse characteristics emerged from the content analysis of the responses to the open-ended questions: concern for the patient in time of need, being recognized as a person and feeling accepted, competence, and teaching and explaining.
7
Tat, Lien Thieu. "LASIK clinical results and their relationship to patient satisfaction /". University of Sydney. Faculty of Health Sciences, 2006. http://hdl.handle.net/2123/1607.
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Doctor of Philosophy (PhD) OrthopticsThe aim of this study was to evaluate the safety and efficacy of LASIK as a refractive surgical procedure, using a repeated measures design to assess satisfaction of patients who had LASIK and to correlate clinical outcomes with detailed measures of patient satisfaction to document long-term viability, monitor changes over time and patients’ functional abilities post-operatively. Method In the study 216 post-LASIK subjects were randomly selected from among patients who underwent simultaneous bilateral LASIK using the Chiron Technolas 217C plano-scan excimer laser with the Chiron ACS (Automated Corneal Shaper) and the Hansatome microkeratome. The subjects were recruited from within one centre, and the procedures were performed by any one of three surgeons. The study also included 100 non-LASIK subjects as a control group, to compare and differentiate ocular symptoms and visual difficulties between LASIK and non-LASIK patients. Clinical data documented included visual acuity, subjective refraction, record of glasses and/or contact lenses prescription, corneal topography with EyeSys and Orbscan, slit lamp examination, surgical details, and any pre-existing eye disease/conditions and previous surgery or injury that might prevent the subjects from achieving their desired visual outcome post-operatively. Subjective patient satisfaction evaluation of the treatment group was assessed by subjects completing a survey questionnaire at 3 months, 6 months, 12 months and 24 months post-operatively. The control group subjects completed a comparable questionnaire and were assessed at baseline and 3 months later. Because the control group subjects did not have any surgical alterations, it was unnecessary for them to have more than one follow-up. Results LASIK achieved relatively high patient satisfaction, with only a small number of dissatisfied patients. It was effective in correcting myopia, hyperopia and astigmatism. However, there was some persistent under-correction in myopic spherical and minus cylindrical refractive errors. Hyperopic spherical correction was less effective, as there were more under- as well as over-correction, and the plus cylindrical correction tended to be under-corrected. The LASIK subjects’ post-operative distance uncorrected visual acuity was not as good as their pre-operative best corrected visual acuity, but it did not significantly correlate with patient satisfaction. The findings were consistent with other studies and confirmed the concept that patient satisfaction is not unidimensional and is not related to outcome solely in terms of visual acuity and residual refractive errors. Other contributing factors included problems with glare, rating of unaided distance and near vision, ability to drive at night, change in ability to perform social/recreational, home and work activities, change in overall quality of life, amount of information given prior to surgery, rating of surgery success, and surgery outcome relative to pre-operative expectations. These variables demonstrated distinctive differences between subjects who were satisfied and dissatisfied. Conclusions The findings of this study are consistent with those of earlier studies. However, the repeated measures design and the comparisons between LASIK subjects and the control group revealed some new insights that were previously undocumented. LASIK achieved high patient satisfaction, and factors associated with satisfaction were predictable, but sources of dissatisfaction were more idiosyncratic and contributing factors were identified.
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Nimnuan, Chaichana. "Epidemiological study of functional somatic syndromes in general hospitals". Thesis, King's College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.314008.
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Ellis, Mairghread J. H. "Professionalism within the clinical context of the patient-podiatrist relationship". Thesis, University of Brighton, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486669.
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Background: Podiatry aims and professes to undertake patient centred practice. However no podiatric literature was sourced which examines or discusses that most central component of our practice - the nature of our relationship with our patients, nor has any published research specifically focussed on this area. Aim This study aimed to explore the nature of the patient podiatrist relationship from the perspective of both private and National Health Service practitioners. Methodological approach: A phenomenological approach, with a hermeneutic focus was utilised to construct meaning and understanding from the data of semi structured interviews with eight participants. The researcher acknowledges herself as situated within the research; and a reflexive approach is demonstrated throughout. Iterative thematic analysis was undertaken to enable development of meaning and understanding. Findings: Findings were developed into six categories - relationship, engagement, role, image, reward, and personal development; coming together in one overarching theme, that of Professionalism Discussion and application: Professionalism is considered through theories of dramaturgy, Iiminality and the concept of macro- and microprofessionalism. The patient-podiatrist relationship can be a lens through which to consider aspects of micro professionalism. Dramaturgical theory positions the podiatrist on the healthcare stage, as . 'actor' performing for the patient as 'audience'. Uniform, as costume, and names and titles as forms of address are also explored within this theory. Liminality - the concept of being 'betwixt and between', is used to position both the participants' perceptions of practice, and their relationships with patients within current models of healthcare practice. It may explain participants' sometimes ambiguous feelings around their role and status. Findings suggest that while macro aspects of professionalism are explicit to practitioners, micro aspects such as relationship, communication and connection are developed through experiential learning and may be tacit in nature. Within both NHS and private practice, the personal connection between podiatrist and patient is seen as an essential element of an effective therapeutic relationship, and not, as may have been previously considered, an unprofessional over involvement. Thus the core message of this thesis is that professionalism be redefined from an explicit and public corporate concept, to its demonstration at an individual level - accepting that it is indeed professional to 'care', both for and about the patient; and that caring is beneficial to both patient and practitioner. Caring is truly the bedrock of the patient-podiatrist relationship, and of professionalism.
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Gill, Elaine Elizabeth. "Why don't we ask people what they need? : teaching and learning communication in healthcare". Thesis, Queen Mary, University of London, 2003. http://qmro.qmul.ac.uk/xmlui/handle/123456789/28571.
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There are numerous empirically described problems of communication in healthcare. The doctor/patient relationship is fundamental to many such problems. The changing nature of healthcare and the doctor/patient relationship is explored in this thesis. An increasing evidence base demonstrates that patient outcomes in healthcarea re directly relatedt o clinical communication. However, more fundamental than patient outcomes is the very nature of personhood and the effects illness has on individual autonomy. A theory of human need provides the foundation for discussion. Autonomy in healthcare is discussed in these terms and is argued as a basic human need. Moreover, human communication is argued as a basic human need using the same theoretic approach. It therefore follows logically that health professionals have the same duties and responsibilities to meet basic human communication needs on the same terms as those for autonomy. The relationship between autonomy and communication is shown to be a reflexive one. A theory of democratic communication is drawn on to describe the type of communication that will meet autonomy and communication needs. This is set in the context of healthcare. Consent in healthcare is used to show how far we have come in meeting communication and autonomy needs. Given the arguments o far it is reasonable to expect medical education to respond to the changing and recognised needs of the users of healthcare. The role of effective communication in medical education programmes is explored. Finally, a strategic approach to organising and delivering a communication curriculum is proffered which tries to meet both the philosophically and democratically argued basic needs. The resulting communication curriculum combines theoretic foundations with a pragmatic approach to the problems of clinical practice. If the approaches in this thesis are followed then communication can no longer be perceived as something doctors do after they have completed other medical tasks. Effective doctors have to be effective communicators in order to meet patients' needs.
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McPheters, Justin Kade. "The role of MS patient and partner reports of couple relationship quality and depression in the physical functioning of MS patients". Related electronic resource: Current Research at SU : database of SU dissertations, recent titles available, full text:, 2008. http://wwwlib.umi.com/cr/syr/main.
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Duggan, Annmarie. "Serum transthyretin in hemodialysis patients : relationship to nutritional status". FIU Digital Commons, 1997. http://digitalcommons.fiu.edu/etd/3094.
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The validity of serum transthyretin as a nutrition assessment parameter in hemodialysis patients was investigated. Fifty-one subjects (39% male and 61 % female; 53% black, 28% white, 12% Hispanic, 7% Other) receiving hemodialysis for 30 24 months (mean SD) and a total of 36 26 months of renal replacement therapy were followed for six months. Serum transthyretin, albumin, BUN, creatinine, cholesterol, normalized protein catabolic rate (nPCR), KT/V, weight and 24 hour urine analysis were determined monthly. Etiologies of end stage renal disease were diabetic nephropathy (37%), hypertensive nephrosclerosis (37%). glomerulonephritis (12%), polycystic kidney disease (4%), lupus nephritis (4%), other causes (6%). A significant correlation was found between transthyretin and creatinine, albumin and loss of dry weight (p<0.05). Transthyretin levels <30 mg/dl were found to correlate with urine outputs > 240 cc/24 hours, predialysis BUN < 50 mg/dl and nPCR
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Stephens, Jacqueline G. "Relationships Between Interprofessional Teamwork and Clinical Management of". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4565.
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Diabetes mellitus (DM) is a highly prevalent chronic disease that affects 29 million people in the United States including over 2 million veterans who receive care through the Veterans Administration. Patient-aligned care teams (PACTs) are an interprofessional teamwork system designed to improve outcomes of chronic illness, but empirical explorations of the efficacy of the PACTs have been insufficient. Utilizing the chronic care model, the purpose of this retrospective study was to determine if PACTs have been efficient in the diabetic management of veterans receiving care through a Southeastern VA. Medical records for 114 veterans with type 2 DM were randomly selected. A 1-way ANOVA was used to analyze outcomes for 5 evidence-based standards (SBP, DBP, BGL, A1C, & LDL) among 6 outpatient clinics. A repeated measures ANOVA was used for the same 5 evidence-based standards for the clinics to assess if there were any changes from FY2014 to FY2016. Results revealed that blood pressure readings and LDL levels met evidence-based standards, while A1C and BGL levels did not. No significant differences over the 3-year period were noted nor were there significant differences in patterns of performance between the clinics. The findings provide an essential basis for initiating a discussion on the potential of PACTs for the delivery of quality healthcare to U.S. veterans with diabetes and other chronic diseases. Positive social change can result from improving the delivery of healthcare using the PACT model to decrease morbidity, improve clinical outcomes, and increase the quality of life of U.S. veterans with type 2 DM. Future research that examines perceptions of clinical team members, team stability, and the delivery of shared care is warranted.
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Boudourakis, Leon. "Evolution of the Surgeon Volume / Patient Outcome Relationship". Yale University, 2009. http://ymtdl.med.yale.edu/theses/available/etd-11212008-111421/.
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Adams et al. was the first to demonstrate an association between improved outcomes and provider experience in a 1973 study examining complication rates from coronary arteriograms.[1] In this study, a questionnaire was mailed to the directors of coronary arteriography laboratories throughout the US. They found that mortality was eight times higher in institutions performing fewer than 200 examinations per two-year period compared to institutions performing more than 800 examinations per two-year period. It was not until 1979, however, that efforts to systematically study outcomes in surgery were made by Luft and colleagues.[2] They demonstrated lower mortality rates at high-volume centers compared with low-volume centers for several high risk procedures, such as coronary artery bypass graft surgery (CABG) and vascular surgery. This landmark study set the stage for outcomes research in surgery. Over the past decade, additional studies have continued to show higher surgeon or hospital volumes to be associated with improved patient outcomes. [3-13] To what degree surgeon versus hospital volume each contribute to outcomes is controversial and depends on the procedure examined. Nevertheless, formal recommendations encouraging certain high-risk procedures be performed at high-volume hospitals began as early as 2000 by the Leapfrog group and other policy initiatives.[14, 15] Formal recommendations for surgeon volume, on the other hand, have been lacking. There has been mounting evidence, particularly in the last decade, that surgeon volume is associated with improved patient outcomes, independent of hospital volume. To what measure these data have influenced referral patterns from low- to high-volume surgeons is unknown.
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Parry, Catherine J. "Understanding patient aggression : an experimental study of psychiatric nurses' attributions for patient aggression and their relationship to staff well-being". Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/2234.
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Purpose of Study: Research on psychiatric nurses’ attributions about patient aggression has so far focussed on attributions made at one point in time in response to one stimulus (vignette or real account of patient aggression). To date, no research has been conducted on how new information influences attributions made; on investigating differences in attributions in different settings; and there is inconsistent evidence regarding the impact of previous exposure to aggression. This research therefore seeks to rectify some of these gaps. This study will examine the impact of new information; the effect of incident setting; and previous exposure to aggression upon attributions made by psychiatric nurses about patient aggression. Investigation is also made into further examining the relationships between attributions, previous exposure to aggression, general health, and burnout; and how these relate to nurses’ acceptance or avoidance of their distressing experiences. Methodology: A mixed design was employed. A repeated measures design tested the effect of new information (history of aggression, diagnosis of schizophrenia, and substance misuse) upon attributions of locus, control, and stability, measured on a seven-point scale. The experimental stimulus was a vignette. Each participant was randomly assigned one vignette depicting an incident of aggression set either in a work or non-work setting (independent samples design). Five questionnaires were also completed: the General Health Questionnaire, the Acceptance and Action Questionnaire, the Maslach Burnout Inventory, the Exposure to Aggression and Violence Scale, and the Impact of Patient Aggression upon Carers Scale. Attributions were correlated with these measures. Results: A significant effect of new information about history of aggression and diagnosis of schizophrenia was found for attributions of control, but not locus or stability. Locus and stability attributions were affected by the incident setting. No effect of previous exposure to aggression was found on attributions. Several significant correlations were detected. The measure of nurses’ acceptance or avoidance of distressing experiences correlated more frequently with the other measures in comparison to attribution ratings. Conclusions: The impact of new information was not as large as expected. This may be related to methodological issues but consideration is given to other explanations. Calls for nurse training to include consideration of environmental and personal influences (including attitudes and self-awareness) are outlined.
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Dearden, Richard Simon. "Exploring patient-neurosurgical team inter-relationships throughout the perioperative period of awake craniotomy". Thesis, University of Hull, 2015. http://hydra.hull.ac.uk/resources/hull:13068.
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The portfolio thesis is divided into three parts: a systematic literature review, an empirical study, and appendices. Part one is a systematic literature review exploring definitions, measures and influencers of health-related quality of life (HRQofL) in brain tumour (BT) populations. The review was undertaken as no BT-specific HRQofL definition currently exists, literature remains unclear regarding the existence of reliable and valid BT-specific measures, and little is known about factors associated with HRQofL that may be amenable to change. A systematic search of four databases identified 13 relevant studies. No accepted HRQofL definition emerged. Only two validated BT-specific HRQofL measures were reported and numerous variables influencing HRQofL were identified within themes of ‘patient’, ‘tumour’, and ‘social support’ factors. Findings provided recommendations for future research and useful insights for refining clinical practice. Part two is an empirical study exploring how both patients and neurosurgical team members experience awake craniotomy (AC) and make sense of their perioperative interactions. The qualitative study aimed to enhance knowledge surrounding efficacious approaches to build positive patient-practitioner relationships with the potential to improve overall AC experience. A patient and neurosurgical team group, each comprising eight participants, were interviewed and the data was analysed using Interpretative Phenomenological Analysis (IPA). Four superordinate and six subordinate themes, and three superordinate and seven subordinate themes emerged within patient and neurosurgical team groups respectively. Themes are discussed within the context of wider healthcare literature, identifying relevant clinical implications. Part three consists of appendices supporting the systematic literature review and the empirical study. It also includes a reflective statement of the ‘research experience’.
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Forde, E. J. "Do patients' perceptions of the quality of their relationships with clinicians mediate relationships between attachment style and distress in ocular melanoma patients?" Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3004171/.
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Relationships between attachment style, distress and clinical relationships in oncology settings: A systematic narrative literature review Abstract Cancer diagnosis, treatment and prognosis is challenging to patients. Coping with stress is in part an interpersonal process, and patients’ capacities to form relationships with clinicians can influence their well-being. This systematic narrative review aims to understand how patient attachment style might predict dissatisfaction with clinical relationships and distress in cancer patients, and factors that mediate or moderate the effects of attachment style on these relationships. Four databases were systematically searched for relevant empirical papers published between 1969 and 2015, yielding nine studies which were quality assessed and reviewed. A narrative approach was used to synthesise the findings. The majority of studies employed cross-sectional or prospective survey designs, and focussed on several conceptualisations of attachment and clinical relationships. Mostly cross-sectional links were identified between attachment style and poorer patient perceptions of clinical relationships and distress, but these do not allow cause to be tested. Some evidence suggested that lower trust mediated relationships between insecure attachment and distress, but stronger evidence was found that trust moderated relationships between attachment style and perceptions of clinical relationships and distress. Further research using prospective designs and testing mediation will explain the relationships between attachment style and distress and their mechanisms. Do patients’ perceptions of the quality of their relationships with clinicians mediate relationships between attachment style and distress in ocular melanoma patients? Abstract Ocular melanoma (OM) patients experience emotional and practical challenges related to diagnosis, treatment and prognostication. Relationships with medical staff are important to patients living with cancer diagnoses and patients’ perceptions of the quality of relationships with clinicians might reduce their experiences of distress. Patients’ attachment styles predict lower distress, and may influence distress because attachment may help them to achieve subjectively good relationships with clinicians. The objective of this project was to test whether links between attachment and lower distress are mediated by patients’ perceptions of the quality of their relationships with consultants and nurses. A quantitative cross-sectional study of recently diagnosed OM patients using self-report questionnaires was used to examine attachment style, perceived quality of clinical relationships, anxiety, depression and potential covariates, including coping, social support and religious beliefs. Correlational analysis showed secure attachment was negatively related to anxiety and depression and positively related to patients’ perceptions of relationship quality. Mediational analysis showed no evidence that perceptions of professional relationships was a mediator. Secure attachment and perceived quality of relationships with medical staff independently predicted anxiety and depression. Further research is warranted to understand why perceptions of relationships with medical staff are important after diagnosis and how these might be improved.
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Tallarico, Serena. "Quand les esprits troublent les esprits : patients et cliniciens à la rencontre du monde invisible". Thesis, Sorbonne Paris Cité, 2019. http://www.theses.fr/2019USPCD010.
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Dans la pratique clinique, ainsi que bien que dans la littérature scientifique, on relève un vaste répertorie des erreurs diagnostiques, notamment lorsque les patients migrants expriment une symptomatologie en lien avec les esprits, les djinns et tous « les êtres de la nuit » et qui se disent (ou qui sont dits) possédés, habités, ou visités par le monde invisible. L'objectif de cet étude est d'analyser, expliquer et prévenir la grande incidence de troubles psychiatriques aigus, principalement psychotiques, parmi les migrants. Nous avons collecté et analysé les discours des patients, des cliniciens, des patients et leurs familles et nous avons restitué un photogramme du suivi psycho-médical. Nous avons fait l'hypothèse que la maladie des esprits serait pour le patient à la fois l'expression d'une souffrance, ainsi que le pivot du processus de guérison qui passe à travers une quête de sens, une négociation qui interroge l'ici et l'ailleurs, le temps présent et le temps passé, l'individu et le groupe, la famille, le lieu de provenance et celui d'accueil, l'ordinaire et l'extraordinaire, et tous les êtres, et les personnes qui en font partie. Nous sommes arrivés à la conclusion que les esprits ont souvent une fonction «réparatrice» dans le psychisme des patients analysés. L'apparition, ou la possession par l'invisible, peut être également une source de jouissance et de ressourcement narcissique dans le vécu du patient, bien que ce soit une expérience terrifiante. Ce travail souligne la nécessité de construire le cadre et la relation thérapeutique, à partir de la manière dont le patient raconte son histoireIn the clinical practice, as well as in the scientific literature, there is a vast repertory of diagnostic errors, especially when migrant patients express symptomatology related to spirits, djinns and ali "the night's beings" and/or they say (or who are said) possessed, inhabited, or visited by the invisible world. The purpose of this study is to analyze, explain and prevent the high incidence of acute psychiatrie disorders, mainly psychotic, among migrants. We collected and analyzed the speeches of patients, clinicians, patients and their families and we reproduced a photogram of psycho-medical follow-up. We hypothesized that the spirits's illness would be for the patient the expression of suffering, as well as the pivot of the healing process that passes through a quest for meaning, a negotiation between the present and the past, the individual and the group, the origin country and the new world, the ordinary and the extraordinary, and between all the beings, and the persans who are part of. We have corne to the conclusion that spirits often have a "restorative" function in the psyche of the patients analyzed. The appearance, or possession by the invisible, can also be a source of desire satisfaction and narcissistic healing in the patient's experience, although it is a terrifying experience. This work highlights the need to build the framework and the therapeutic relationship, from the way the patient tells his story
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Gates, Madison Lamar. "THE NATURE AND MEANING OF CULTURE IN PRIMARY CARE MEDICINE: IMPLICATIONS FOR EDUCATION, CLINICAL PRACTICE, AND STEREOTYPES". Lexington, Ky. : [University of Kentucky Libraries], 2009. http://hdl.handle.net/10225/1174.
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Thesis (Ph. D.)--University of Kentucky, 2009.Title from document title page (viewed on June 2, 2010). Document formatted into pages; contains: ix, 193 p. : ill. (some col.). Includes abstract and vita. Includes bibliographical references (p. 172-189).
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Chandler, Michelle G. "The Effects of eICU Technology on Clinical Outcomes of ICU Patients: Analysis of the Relationship of Patient, Hospital, and Unit Characteristics to Proximal and Distal Outcomes". Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3694.
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ABSTRACT Each year approximately five million people are treated in the nation's intensive care units making intensive care one of the most expensive components of the U.S. healthcare system. Of these patients, 400,000-500,000 will die annually giving the ICU the distinction of having the highest rate of mortality and complications in the hospital setting. Studies have demonstrated that one in ten patients who die each day in ICUs might survive if intensivists were present to manage clinical care and direct treatment plans (Randolph & Pronovost, 2002; Dimick, Pronovost, Heitmiller & Lipsett, 2001; Pronovost et al., 2002). The utilization of supplemental remote telemedicine has been investigated as a means of compensating for the limited resource of intensivists (Breslow et al., 2004; Rosenfeld et al., 2000). One specific use of this technology, the electronic intensive care unit or eICU®, has previously demonstrated the potential to improve physiological and economic outcomes in ICU patients through the use of integrated decision-support and patient data systems. The present study focuses on the eICU® as a 21st century technology capable of improving the quality of patient care and identifies those factors most likely to impact the success of this clinical intervention. This research utilizes a non-experimental pre-and post-intervention study design and examines patient data collected on all admissions to five ICUs managed by two regional tertiary care hospitals during a 36-month time period. Each ICU is equipped with eICU® software systems that allow intensivist surveillance of patients from a remote facility. The data is analyzed using both structural equation modeling and decision tree regression modeling to statistically evaluate the effects of patient, hospital and unit characteristics on proximal and distal outcomes in ICU patients. As the development of clinical complications subsequently affects patient length of stay, cost of stay, and mortality, it becomes increasingly imperative to seek interventions capable of reducing the risk of unfavorable patient outcomes. This study closely examines one such intervention, the eICU®.Ph.D.
Department of Public Administration
Health and Public Affairs
Public Affairs PhD
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Kim, Youngmee. "Relationship between illness perceptions, treatment adherence and clinical outcomes in maintenance hemodialysis patients". Diss., Restricted to subscribing institutions, 2009. http://proquest.umi.com/pqdweb?did=1876282361&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Orr, Barry. "Psychological factors in social relationships and home functioning of patients with chronic fatigue syndrome". Thesis, University of Hull, 2008. http://hydra.hull.ac.uk/resources/hull:1679.
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Background: Emotional expressivity has received recent research attention in studying behavioural outcomes, in non-clinical samples and clinical samples alike. However, it has not been tested with chronic fatigue syndrome patients, to see if positive expressivity predicts better social relationships. Secondly, dysfunctional attitudes concerning attainment and achievement, and poor everyday routine, have been associated with poorer functioning in different clinical conditions, such as cancer and diabetes. These have not been examined in chronic fatigue syndrome, for whether they predict worse patient functioning in their home duties. This study primarily aims to explore these relationships. The relationship between attainment/achievement attitudes and routine in this patient group was also explored. Method: This explorative, cross sectional study measured 57 patients' levels of positive expressive behaviour, attainment and achievement attitudes, routine, and levels of social relationship functioning and home functioning via self-report measures. Levels of CFS symptoms and depressive symptoms were also controlled for in each question. Results: Hierarchical regressions indicated positive expressivity did not significantly predict worse or better relationships with friends. Increased positive expressivity did predict worse relationships with family members. Attainment and achievement attitudes did not predict better home functioning, but better routine did. No relationship was found between attitudes and routine. Depressive symptoms predicted greater variance than CFS symptoms in the regressions. Conclusions: Depression appears to be of importance in relationship and home functioning difficulties. Positive expressivity also appears to have a special role for CFS patients, reducing quality of family relationships. Increased routine may help patients to manage their home duties better, but attainment and achievement attitudes appear to make little difference. Such attitudes do not appear to influence routine. Implications of findings for present theory and clinical treatment for patients are discussed, with further research following these findings suggested.
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Duval, Christian 1963. "The clinical relationship between tremor and voluntary motor behavior in patients with Parkinson's disease /". Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82862.
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Parkinson's disease (PD) is a neurodegenerative disease characterized by progressive loss of dopaminergic neurons of the substantia nigra pars compacta. Symptoms usually include akinesia, bradykinesia, muscle rigidity, postural imbalance and tremor. Despite numerous studies on the physiology and pathophysiology of tremor, its influence on voluntary motor behavior remains unclear. Accordingly, the main objectives of the present thesis were to (a) determine if a clinical relationship existed between tremor and performance of voluntary movements, and (b) characterize the impact of ventrolateral (VL) thalamotomy on tremor and voluntary motor behavior. Results indicate that age-related change of the supraspinal component of normal physiological tremor (NPT) has no influence on the performance of healthy elderly subjects making rapid alternating movements (RAM). Our results also show that subsets of patients presenting different tremor amplitudes and/or tremor power characteristics had similar RAM performance, hence negating any direct relationship between the supraspinal oscillator(s) generating tremor and RAM performance. Our results demonstrate that tremor can be detected during manual-tracking movements performed by patients with early PD, but this tremor has little consequence on the accuracy of these patients.As for the impact of VL thalamotomy on tremor, our results show that the thalamic lesion eliminates selectively PD tremor oscillations, in addition to preventing a resurgence of the supraspinal component of physiological tremor. The surgical procedure did not however improve or worsen RAM performance, suggesting that tremor probably plays little role in bradykinesia. Accuracy during the manual-tracking task is nonetheless greatly improved post-surgery, hence confirming the anticipated clinical benefits of the surgical procedure. In conclusion, despite previous evidence that tremor and RAM may share common neural networks and that tremor may be pathophysiologically linked with bradykinesia, the aforementioned results suggest that there is little clinical relationship between tremor and bradykinesia observed in patients with PD making RAM.
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Schlichting, Douglas E. "Research Nurse Coordinators’ Perception of Relationship with Patients Enrolled in a Clinical Research Study". Thesis, Boston College, 2016. http://hdl.handle.net/2345/bc-ir:107235.
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Thesis advisor: Dorothy JonesBackground/Purpose: The growth of clinical research trials to improve patient outcomes has significantly affected nursing and the implementation of the nurse research coordinator role. The purpose of this study was to explore how the research nurse coordinator (RNC) perceives this role and associated responsibilities for patients enrolled in a clinical research study and associated problems and ethical tensions that emerge during the delivery of a clinical research protocol. The research questions were 1) How does the RNC perceive his or her role responsibility for patients enrolled in a clinical trial? 2) Does the nurse experience ethical tension during the implementation of the RNC role? Methods: A qualitative descriptive study was used to answer the questions. RNCs from a large Northeastern teaching hospital participated in 1:1 interviews with the investigator. Data were analyzed for this study according to the methods described in Lincoln and Guba (1985) for qualitative research and presented as themes. Results: Eleven RNC participated in the study. Data from the interviews were distilled into five final themes: 1) The RNC develops intentional and mutual relationships with patients and their families that fosters trust; 2) In coming to know the patient the RNC as a clinical expert is able to advocate for the unique needs of patients enrolled in clinical trials; 3) The RNC is respected by the team for his or her skills and as a result is able to practice autonomously; 4) In reflecting on past experiences, RNCs identify with medical science philosophy of cure as opposed to nursing’s one of caring/healing and; 5) In reflecting on some aspects of clinical trials, RNCs recognize ethical tensions and as such are able to influence protocol implementation and future studies. Knowledge gained from this study provides insights about the RNC role perception and highlighted multiple dimensions of care delivery faced by nurses who practice as an RNC. The study participants described practicing in the RNC role with clarity about the role and described practicing with autonomy and independence
Thesis (PhD) — Boston College, 2016
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Perumal, Rubeshan. "The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33928.
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Background Incorrect inhaler use is associated with poorer health outcomes, reduced quality of life, and higher healthcare utilisation in patients with asthma and COPD. Method We performed an observational study of pressurized metered-dose inhaler technique in patients with asthma or COPD. Patients were assessed using a six-point inhaler checklist to identify common critical inhaler technique errors. An inadequate inhaler technique was defined as the presence of one or more critical errors. A multivariate logistic regression model was used to determine the odds of an inadequate inhaler technique. Results During the 14-month study period, 357 patients were enrolled. At least one critical error was executed by 66.7% of participants, and 24.9% made four or more critical errors. The most common errors were: failure to exhale completely prior to pMDI activation and inhalation (49.6%), failure to perform a slow, deep inhalation following device activation (48.7%), and failure to perform a breathhold at the end of inspiration (47.3%). The risk of a critical error was higher in COPD patients (aOR 2.25, 95%CI 1.13 – 4.47). Prior training reduced error risk specifically when trained by a doctor (aOR 0.08, 95% CI 0.1 – 0.57) or a pharmacist (aOR 0.02, 95% CI 0.01 – 0.26) compared to those with no training. Previous clinical trial participation significantly reduced error risk and rate:< 3 trials (aOR 0.35, 95% CI 0.19 – 0.66) and ≥3 trials (aOR 0.17, 95% CI 0.07 – 0.42). The rate of critical errors was not significantly associated with age, sex, or prior pMDI experience. Conclusion This study found a high rate of critical inhaler technique errors in a mixed population of asthma and COPD patients; however, prior training and in particular, multiple previous clinical trial participation significantly reduced the risk of errors.
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Savage, Colleen. "The relationship between patient reported symptoms and health care personnel reported symptoms in a cancer clinical trial". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ63361.pdf.
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Robinson, Erin Linn. "Older adults and HIV prevention : exploring the relationship between patient-provider communication and condom use intentions". Diss., University of Iowa, 2016. https://ir.uiowa.edu/etd/2138.
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Older adults account for 20% of new HIV infections in the U.S and 50% of people living with the disease. In part, this is due to people living longer with HIV, greater sexual activity in later life, a lack of condom use, and little understanding about HIV/AIDS. Evidence suggests that healthcare providers can play a key role in the dissemination of information about HIV/AIDS to older adults. The purpose of this study was to examine the impact of patient-provider communication of HIV/AIDS on older adults’ intentions to use condoms. The mediating relationships of knowledge of HIV/AIDS, perceived threat, subjective norms, and self-efficacy were also examined. This study utilized a cross-sectional, web-based survey, administered to adults aged 50 years and older (N=427). Forty-one percent of participants reported no communication with the healthcare provider about HIV/AIDS, yet 87% reported future intentions to use a condom with a new sexual partner. Participants demonstrated high knowledge of HIV/AIDS (M=14.7 out of 18), believed their sexual partner would be agreeable to using condoms (M=24 out of 36), and 91% believed they had the ability to properly use a condom. However, participants did not believe HIV/AIDS posed a threat to their health (M=8 out of 36). Mediation analysis yielded non-significant results. Healthcare providers can provide tailored prevention recommendations to higher risk older adults in order to curb the number of new infections. Additional research is needed with older adults who identify as LGBT, MSM, and older adults of color.
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Vera, Naima. "The relationship between uncertainty in illness and anxiety in patients with cancer". [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0003002.
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Pavelka, Sarah. "The Relationship Between Hospital Leadership Activities and Clinical Quality Outcomes in Iowa". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2996.
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The Centers for Medicare and Medicaid Services have been working with hospital networks across the United States to improve health care through education and training on clinical best practices and leadership frameworks. Some organizations have failed to reach the high-quality standards of care expected and have adverse patient care outcomes. The purpose of the study was to determine the relationship between leadership actions, funding type, and clinical care outcomes in participating Partners for Patients hospital programs in Iowa. The secondary variable data were provided from a Partnership for Patients contractor, through the Centers for Medicare and Medicaid Services Organizational Assessment Tool. Multiple linear regression analyses were used to determine the relationship between the leadership actions, funding type, and the clinical quality outcomes of catheter-associated urinary tract infections, central line associated bloodstream infections, falls with injury, and venous thromboembolism. The findings demonstrated no statistically significant relationships between leadership actions, such as completing a leadership checklist, incident dashboard, and board involvement in decision making, and the specified clinical care outcomes. There was a statistically significant relationship between leadership actions of completing a root cause analysis for incidents, federal funding type, and the clinical quality outcomes of falls with injury and venous thromboembolism. The results of this study will be shared with Partnership for Patients program leadership to positively impact patient care. The results may be useful as organizations continue to implement best practices to reduce medical errors, save cost, and increase patient safety.
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Dehestani, Fatemeh. "The relationship between dispositional optimism and quality of life in upper aerodigestive tract cancer patients /". Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31220.
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The aim of this study was to investigate the hypothesis that pre-therapeutic "dispositional optimism" is associated with post-therapeutic "quality of life (QOL)" in a sample of patients with upper aerodigestive tract (UADT) cancer. A sample of 101 subjects with UADT cancer was enrolled in this cohort study. QOL was evaluated through the EORTC QLQ-H&N35 and the global domain of the EORTC QLQ C-30. Dispositional optimism was measured using the Life Orientation Test (LOT). Subjects completed these self-administered questionnaires prior to treatment and one week to one month after their treatment. Other data were gathered by interview and medical chart review.Prior to treatment, an association between dispositional optimism and QOL was observed for the global, pain, swallowing, senses and feeling ill domains. However, no such associations were observed following treatment.
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Al-Jabari, Rawya M. "Therapist (Dis)Continuity, Therapeutic Relationship, and (Premature) Termination in a Psychology Training Clinic". Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc804891/.
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Premature termination is a substantial problem with significant adverse effects for clients, therapists, and treatment organizations. Unfortunately, it is also a relatively common phenomenon within mental healthcare settings. Across varied mental healthcare settings, rates of premature termination have reportedly ranged from 19.7 % to 40 %. Perhaps not surprisingly, the rate of premature termination in training clinics is substantially higher than in community mental health settings and private practice, with 75 to 80 % of clients ending treatment services prematurely. The purpose of this study was to explore the combined effect of intake therapist continuity or discontinuity, and quality of the therapeutic relationship on premature termination. Intake therapist continuity, measures of working alliance, and termination outcome from 524 clients at the University of North Texas Psychology Clinic were utilized for adults receiving individual therapy services between August 2008 and August 2013. Results of the study suggest intake therapist continuity did not predict subjective termination status (X2(2, n = 524) = 1.61, p = 0.45), nor did it predict change in symptomology status (X2(3, n = 453) = 1.14, p = 0.77). Additionally, working alliance predicted subjective termination status (X2(6, n = 212) = 21.17, p < 0.01), but not change in symptomology status (X2(9, n = 208) = 6.27, p = 0.71). The findings of the current study are discussed, as well as suggestions for further research related to client, therapist, treatment, and procedural variables and their impact on premature termination.
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Fröhner, Michael, Rainer Litz, Andreas Manseck, Oliver W. Hakenberg, Steffen Leike, D. Michael Albrecht i Manfred P. Wirth. "Relationship of Comorbidity, Age and Perioperative Complications in Patients Undergoing Radical Prostatectomy". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133867.
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Objectives: To investigate the prevalence and distribution of comorbidity and its association with perioperative complications in patients undergoing radical prostatectomy (RPE). Methods: In 431 unselected RPE patients, the American Society of Anesthesiologists Physical Status classification (ASA-PS), the New York Heart Association classification of cardiac insufficiency (NYHA), the classification of angina pectoris of the Canadian Cardiovascular Society (CCS), height, weight, the body mass index (BMI), and the number of concomitant diseases (NCD) were assessed and related to perioperative cardiovascular complications. Results: In RPE patients less than 70 years old, comorbidity rose nearly continuously with increasing age. However, after reaching an age of 70 years, the proportion of NYHA-0 patients increased (60–64 years, 86%; 65–69 years, 85%; ≥70 years, 87%). Furthermore, the severe comorbidities decreased in patients selected for RPE aged 70 or more years. There was a nonsignificant trend towards higher comorbidity in patients with perioperative cardiovascular complications. Conclusions: These data suggest that documentation of the distribution of ASA-PS, CCS, NYHA and of concomitant diseases might be helpful to characterize the general health status and the degree of selection of prostate cancer treatment populations especially in series with a high portion of patients aged 70 or more years. Concerning perioperative complications, the individual predictive value of comorbidity seems to be poor in the radical prostatectomy settingDieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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Ruzicka, Amelia. "Considering the influences of the physician-patient relationship on the patient's quality of life| An interpretive phenomenological analysis of the experience of being dismissed by one's physician among women with autoimmune diseases". Thesis, Institute of Transpersonal Psychology, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3589680.
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This study used Interpretive Phenomenological Analysis to explore the lived experiences of women with autoimmune diseases who felt dismissed by their physicians when seeking diagnosis of their symptoms. Six women with medically diagnosed autoimmune diseases were each interviewed twice in a semi-structured format. Participants reported lasting harm from negative emotional and psychological states that resulted from disruptions in intrapsychic processes, including challenges to embodied material reality and self-concept due to physicians' dismissive attitudes. A description of a unique phenomenon, named here as physician dismissiveness, emerged from the data. Participants also reported that experiencing physician dismissiveness made coping with symptoms more difficult during the quest for accurate diagnosis. These findings raise important questions regarding mind-body awareness, the nature of embodiment, authority over the body, and the role of expert others in holistic functioning. Background of the study includes elements of healing theory put forth by Rogers, as well as theory of the body as described by Merleau-Ponty.
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Fröhner, Michael, Rainer Litz, Andreas Manseck, Oliver W. Hakenberg, Steffen Leike, D. Michael Albrecht i Manfred P. Wirth. "Relationship of Comorbidity, Age and Perioperative Complications in Patients Undergoing Radical Prostatectomy". Karger, 2001. https://tud.qucosa.de/id/qucosa%3A27543.
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Objectives: To investigate the prevalence and distribution of comorbidity and its association with perioperative complications in patients undergoing radical prostatectomy (RPE).
Methods: In 431 unselected RPE patients, the American Society of Anesthesiologists Physical Status classification (ASA-PS), the New York Heart Association classification of cardiac insufficiency (NYHA), the classification of angina pectoris of the Canadian Cardiovascular Society (CCS), height, weight, the body mass index (BMI), and the number of concomitant diseases (NCD) were assessed and related to perioperative cardiovascular complications.
Results: In RPE patients less than 70 years old, comorbidity rose nearly continuously with increasing age. However, after reaching an age of 70 years, the proportion of NYHA-0 patients increased (60–64 years, 86%; 65–69 years, 85%; ≥70 years, 87%). Furthermore, the severe comorbidities decreased in patients selected for RPE aged 70 or more years. There was a nonsignificant trend towards higher comorbidity in patients with perioperative cardiovascular complications.
Conclusions: These data suggest that documentation of the distribution of ASA-PS, CCS, NYHA and of concomitant diseases might be helpful to characterize the general health status and the degree of selection of prostate cancer treatment populations especially in series with a high portion of patients aged 70 or more years. Concerning perioperative complications, the individual predictive value of comorbidity seems to be poor in the radical prostatectomy setting.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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Chetwynd-Talbot, Jo. "Surrender to the drama the enacted process in the psychotherapeutic relationship : a systematic literature review with clinicial illustrations : this dissertation [thesis] is submitted by Jo Chetwynd-Talbot ... to Auckland University of Technology in partial fulfilment of the degree of Master of Health Science, 2004". Full thesis. Abstract, 2004.
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Mårtensson, Gunilla. "The Insider and Outsider Perspective : Clinical importance of agreement between patients and nurses in cancer care concerning patients’ emotional distress, coping resources and quality of life". Doctoral thesis, Uppsala universitet, Vårdvetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-101337.
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Background: It is a well-known phenomenon that nurses and other oncology staff have a tendency to ascribe patients with cancer more problems and suffering than the patients themselves report. Aim: The overall aim of the present thesis was therefore to gain increased knowledge and understanding of dis/agreement between patients with cancer and nurses regarding their perception of patients’ situation and of the importance of patient-nurse dis/agreement in clinical practice. Methods: A prospective comparative design was used. Data were collected from a sample of 90 consecutively recruited patient-nurse pairs. Each pair consisted of a patient with cancer, newly admitted to a ward, and a nurse responsible for that patient’s care. Data were collected from the pairs with corresponding self-administrated questionnaires on two occasions: directly after the admission interview and on the patient’s third day on the ward. Results: At the group level, a distinct pattern was shown in which nurses ascribed the patients more emotional distress, less coping resources and a lower quality of life than the patients themselves reported. In short, the results revealed the following clinical importance of patient-nurse dis/agreement. With respect to how nurses act in relation to their perceptions of patients’ emotional distress, patient-nurse dis/agreement did not seem to be important; with few exceptions, nurses’ implemented care did not differ when it was directed at more as compared to less distressed patients. Further, nurses’ general tendency to overestimate cancer patients’ problems and suffering had no influence on patients’ satisfaction with received care and nurses’ satisfaction with provided care. However, patients cared for by nurses who underestimated their level of depression were less satisfied with those nurses’ care. In addition, the more frequently the nurse had implemented care characterized by a trusting relationship, the higher patients’ and nurses’ satisfaction with received/provided care. Conclusions: Initial patient-nurse dis/agreement concerning patients’ situation appears to be of little significance to nurses’ caring behaviour and to patients’ and nurses’ subsequent evaluation of received and provided care.
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McMillan, Meg. "Who needs who? Therapist dependency and its impact on the therapeutic relationship : a modified systematic review with clinical illustrations : this dissertation [thesis] is submitted by Meg McMillan to Auckland University of Technology in partial fulfilment of the degree of Master of Health Science, 2005". Full thesis. Abstract, 2005.
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Thesis (MHSc--Health Science) -- Auckland University of Technology, 2005.Appendices not included in e-thesis. Also held in print (v, 44 leaves, 30 cm.) in Akoranga Theses Collection. (T 616.8914 MCM)
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Bonner, Alice F. "Certified Nursing Assistants’ Perceptions of Nursing Home Patient Safety Culture: Is There a Relationship to Clinical or Workforce Outcomes?: A Dissertation". eScholarship@UMMS, 2008. https://escholarship.umassmed.edu/gsn_diss/10.
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Patient safety culture (PSC) is a critical factor in creating high reliability healthcare organizations. However, few studies to date have correlated PSC measures with actual safety outcomes. In particular, nursing home studies have only recently appeared in the literature. Nursing homes differ from hospitals in that the vast majority of direct care is provided by certified nursing assistants (CNAs), not licensed nurses. Thus nursing home PSC could differ in important ways from PSC in acute care institutions.
This dissertation was a secondary data analysis that examined whether CNAs’ perceptions of patient safety culture were correlated with clinical outcomes in a random sample of 74 nursing homes in five randomly selected states. This study matched CNA PSC survey data using the Hospital Survey of Patient Safety Culture (HSOPSC) with Minimum Data Set (MDS), Area Resource File (ARF) and Online Survey Certification and Reporting (OSCAR) data from those same homes during the first two quarters of 2005. In the original study, 1579 nurse aides out of 2872 completed the survey, for a 55% response rate.
In addition to clinical outcomes, this study examined the relationship between CNA PSC scores and staff turnover. The relationship between certain demographic variables, such as level of education, tenure as a CNA, and PSC scores was evaluated. The relationship between certain facility characteristics, such as profit status and bed occupancy was also assessed. An exploratory factor analysis of the original HSOPSC instrument was re-run for this nursing home CNA sample.
Data were analyzed using Poisson regression and multilevel techniques; descriptive statistics were compiled for demographic data. Major findings from the regression analyses and combined GEE models suggest that certain factors, such as CNA turnover and LPN staffing may predict CNA PSC scores. CNA PSC scores were associated with rates of falls and restraint use, but were not associated with differences in pressure ulcer rates in this sample. Few associations for CNA PSC with individual subscales were identified. The exploratory factor analysis revealed some potential differences in how items and subscales factored in this nursing home CNA population.
This dissertation represents an important step in the evaluation of CNA PSC in nursing homes and the relationship of PSC to safety outcomes. Future work on nursing home PSC and clinical and workforce outcomes is described.
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Edalati, Esmaeilzadeh Hanie. "Exploring the relationship between perceived neglect and violence and problematic alcohol use in adolescents, undergraduate students, and clinical patients". Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/52319.
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The present dissertation aimed to understand how perceived maltreatment including neglect and violence places individuals at risk for problematic alcohol use through the development of a framework of vulnerability. We tested the role of dual process pathways including system 1 (alcohol automatic memory associations) and system 2 (future orientation, and alcohol outcome expectancies) processes, risky personality traits, and current perceived stress as the underlying structure between perceived maltreatment and alcohol use and problematic drinking in three groups of participants : adolescents (n = 145), undergraduate students (n = 510), and clinical patients under treatment for substance use disorders (n=100). In all three groups, perceived maltreatment was associated with higher current perceived stress, development of risky personality traits, and lower future orientation and positive or coping alcohol expectancies. Only maltreated undergraduate students indicated more alcohol-related coping memory associations. In adolescents, more alcohol feeling good expectancy, higher sensation seeking and impulsivity mediated the relationship between violence and recency of alcohol use. In undergraduate students, more alcohol-related coping memory associations, lower future orientation, and higher sensation seeking mediated the relationship between higher frequency of alcohol use and problematic drinking. Higher impulsivity also mediated the relationship between violence and problematic alcohol use in this group. The best dual processes pathway that connected violence to problematic alcohol use was via alcohol coping association and future orientation in undergraduate students, in that those with higher levels of violence showed impaired future orientation, and were more likely to shape alcohol-related coping memory associations, and that this cognitive pathway resulted in higher rates of problematic alcohol use. In general, neglected males and females exposed to violence indicated a pattern similar to internalizing problems. In contrast, a pattern of externalizing problems were increased in neglected females and males exposed to violence by adding sex to the analysis. Our findings suggest that intervention programs for problematic drinking should consider screening for experiences of violence. Maltreated individuals with alcohol problems would benefit from interventions that improve rational thinking and behavioural inhibition, and learning how to cope effectively with the stress and the experience of maltreatment.Graduate Studies, College of (Okanagan)
Graduate
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Kitatani, Ryosuke. "Descending neural drives to ankle muscles during gait and their relationships with clinical functions in patients after stroke". 京都大学 (Kyoto University), 2016. http://hdl.handle.net/2433/215466.
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Torii, Shizuka. "The wounded healer in psychotherapy a systematic literature review concerning an issue related to the psychotherapeutic relationship interspersed with illustrations from clinical practice: a dissertation [thesis] submitted to the Auckland University of Technology in partial fulfilment of the degree of Master of Health Science, 2005". Full thesis. Abstract, 2005.
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Doherty, Michael Mary. "The relationship between abnormal involuntary movements, clinical symptoms and measures of organic brain structure and function in patients with schizophrenia". Thesis, Queen's University Belfast, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322643.
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Bond, Kirsten. "A brief psychoeducation intervention for patients with bipolar disorder : effect on attitudes and beliefs and their relationship to clinical outcomes". Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/a-brief-psychoeducation-intervention-for-patients-with-bipolar-disorder-effect-on-attitudes-and-beliefs-and-their-relationship-to-clinical-outcomes(a2b7f420-b1f8-443d-a8ba-970e81bae01f).html.
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Bipolar disorder (BPD) is associated with negative health outcomes and high relapse rates and group psychoeducation (PE) is recognised as an effective intervention when used in conjunction with pharmacological treatment. Unhealthy beliefs and attitudes have not been measured or related to outcomes in group PE and the mechanism for how PE exerts its effect are unidentified. Aims: (a). An adapted group psychoeducation intervention will change (improve) unhealthy personal beliefs about illness and attitudes towards medication when compared to a treatment as usual group. (b). Changes in unhealthy personal beliefs and attitudes will be maintained overtime (a 12 month follow up period). (c). People who subsequently relapse compared to those who do not relapse, will have less improvement in their unhealthy personal beliefs about illness and attitudes towards medication from PE. (d). An evaluation of the efficacy of psychoeducation in a systematic review for bipolar disorder in preventing relapse and other outcomes will identify factors that relate to clinical outcomes. Methods: A 10 session PE intervention was adapted and 38 participants with bipolar disorder I or II (using DSM-IV criteria) were recruited from a Specialist Affective Disorders Service. A waiting list assessment time was used as a parallel group control and a longitudinal study took place over a 12 month follow up period in all participants once they had received the intervention. A mirror image study reviewed case notes to identify relapse 12 month pre versus post intervention. Assessments measuring, beliefs and attitudes, mood symptoms and satisfaction where carried out, 8 weeks prior to intervention (waiting list), pre intervention, and 6 and 12 months post intervention. Results Summary: The waiting list control comparison showed significant improvement in attitudes measured by the Personal Beliefs about Illness Questionnaire (PBIQ) and Drug attitude Inventory (DAI) and symptoms and functioning. Beliefs on all domains of the PBIQ improved significantly (p<0.001) as did attitudes toward medication (p<0.001) there were also small but significant improvements in mood symptoms. In all participants (n=38) improvements were maintained over the 12 month follow up period. Nine people relapsed in the 12 months after the intervention compared with 22 before (p<0.002) and relapsers improved significantly less than non-relapsers following PE on the PBIQ (p=0.012) and the DAI (p=0.046). Conclusions: A group PE intervention reduced unhealthy personal beliefs and attitudes, both manic and depressive relapse and improved functioning. Improvements are maintained over time except adherence which remained unchanged. The amount of improvement in the PBIQ and DAI is related to relapse with non relapsers improving more than relapsers. The systematic review provides reasonable evidence that psychoeducation is at least modestly effective in preventing relapse in bipolar disorder, with the strongest evidence for reducing overall and manic relapse.
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Gillespie, Ulrika. "Effects of Clinical Pharmacists' Interventions : on Drug-Related Hospitalisation and Appropriateness of Prescribing in Elderly Patients". Doctoral thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-167343.
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The overall aim of this thesis was to evaluate clinical pharmacist interventions with the focus on methods aiming to improve the quality of drug therapy and increase patient safety. Adverse drug events caused by medication errors, suboptimal dosages and inappropriate prescribing are common causes of drug-related morbidity and mortality. Clinical pharmacists integrated in multi-professional health-care teams are increasingly addressing these issues. A randomised controlled trial (RCT) was conducted to investigate the effectiveness of clinical pharmacists’ interventions in reducing morbidity and use of hospital care for patients 80 years or older. The results showed that the intervention group had fewer visits to hospital and that the intervention was cost-effective. In a subsequent study based on the population in the RCT, the appropriateness of prescribing was assessed using three validated tools. The results indicated improved appropriateness of prescribing for the intervention group as a result of the intervention. The tools and the number of drugs at discharge were then tested for validity in terms of causal links between the scores at discharge and hospitalisation. No clear correlations between high scores for the tools or a high number of drugs and increased risk of hospitalisation could be detected. During the inclusion period of the RCT a survey based study was conducted where the perceived value of ward-based clinical pharmacists, from the perspective of hospital-based physicians and nurses as well as from general practitioners (GPs) was evaluated. The respondents were positive to the new collaboration to a high degree and stated increased patient safety and improvements in patients’ drug therapy as the main advantages. In the last study the frequency and severity of prescription and transcription errors, when patients enrolled in the multidose-dispensed medications (MDD) system are discharged from hospital, was investigated. The results showed that errors frequently occur when MDD patients are hospitalised.
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Parrott, Elisabeth Anne. "A Self-Psychological Exploration of Multiple Sclerosis in its Biopsychosocial Context". Antioch University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1311007392.
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Miroglotta, Marissa L. "A Cross-Sectional Comparison of Psychosocial Adjustment among Spousal Caregivers for Hematopoietic Stem Cell Transplant Patients". Xavier University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1556140118018044.
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Tully, Carrie. "Development and Preliminary Validation of the Youth Therapist Observational Cultural Competence Scale". VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3682.
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The increasing diversity of the United States creates a pressing public health need to investigate methods to increase the engagement, retention, and efficacy of mental health services for racial/ethnic minority (REM) youth. Evidence from the adult psychotherapy treatment literature suggests that enhancing therapist cultural competence leads to increases in client satisfaction, alliance, and retention (Constantine, 2002; Sodowsky, Kuo-Jackson, Richardson, & Corey, 1998; Worthington, Soth-McNett, & Moreno, 2007). However, this relationship has not been adequately explored in youth mental health services, due in part, to a lack of valid and reliable measurement. This research project included measure development and initial validation of the Youth Therapist Observational Cultural Competence Scale (YTOCCS) with the aim of creating an observer-rated measure of youth therapist cultural competence. The measure was developed from a review of the theoretical and empirical literature and integrated the surveyed opinions of practicing child therapists, caregivers of REM children involved in the mental health system, and experts in therapist cultural competence. The study used an extreme group design based on child-therapist alliance selecting 32 recordings of 8 unique child-therapist dyads. Three coders were trained using a standardized manual and independently double coded early treatment sessions from an effectiveness trial for individual child cognitive-behavioral therapy conducted in community clinics. The measure demonstrated good reliability as measured by intraclass correlation coefficient, adequate internal consistency, and evidence supported initial validity through demonstrated significant between-group differences. Future studies are warranted to refine the measure and to explore the factor structure of the measure.
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Williams, Brittany V. "Emotion Regulation and Eating: An Evaluation of the Relationship Between Difficulties in Emotion Regulation and Eating Patterns in Obese Patients Seeking Bariatric Surgery". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etd/3274.
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Obesity is a major health epidemic, impacting many people worldwide. Bariatric surgery is a common treatment for severe obesity and generally leads to improved overall health, remission of comorbid disease, and improved quality of life. Despite positive postsurgical results, many patients regain some to most of their weight following the procedure. Guidelines for presurgical psychological assessments have been developed to assist healthcare professionals in predicting outcomes for patients. Previous studies have focused on the impact of psychological illness on surgical outcomes, with mixed results. The current study aimed to assess the influence that difficulties in emotion regulation has on eating patterns in bariatric surgery patients. A total of 144 patients seeking bariatric surgery were included in the study. Results indicated no difference in severity of eating patterns among restricted, emotional, and external eating; though difficulties in emotion regulation was only significantly related to emotional (r = .427, p < .001) and external (r = .275, p < .001) eating patterns. Regression analyses indicated significant models for the impact of difficulties in emotion regulation on emotional (R2 = .254 F(5, 135) = 9.180, p < .001) and external (R2 = .094, F(5, 135) = 2.811, p = .019) eating. Specific predictors of emotional eating were discussed. Outcomes of this study highlight the importance of considering difficulties in emotion regulation in bariatric surgery patients due to the impact emotional dysregulation may have on eating patterns.
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Mayhew, Laura Lynn. "The Role of Microvascular Complications in the Relationship between Glycemic Control and Depressive Symptomatology in Patients with Type 1 Diabetes: A Mediational Study". Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3238.
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People with diabetes are at double the risk of developing depression. Depression is associated with increased morbidity and mortality in people with diabetes. Levels of A1c have been linked to microvascular complications (e.g., retinopathy, nephropathy, and neuropathy) as well as depression. The interrelationship between A1c, microvascular complications, and depression has not previously been investigated in a comprehensive model, and a better understanding of the nature of these associations is needed. Preliminary analyses test the assumption that A1c mediates the relationship between group assignment in the Diabetes Control and Complications Trial (DCCT) and microvascular complications. The primary purpose of the study is to examine multiple mediation models, which hypothesize that the severity of microvascular complications mediates the relationship between A1c and depressive symptomatology levels. Participants were people with type 1 diabetes (N = 1441) enrolled in the DCCT, a longitudinal randomized controlled trial investigating intensive insulin treatment and diabetes complications, and divided into primary (e.g., no retinopathy) and secondary (e.g., mild retinopathy) cohorts. Biological markers were used to measure A1c and microvascular complications. Depressive symptomatology was measured by the depression subscale of the Symptom Checklist-90-Revised. Simple and multiple mediation analyses were used to test proposed models. A1c mediates the relationship between DCCT group assignment and microvascular complications. Microvascular complications partially mediate the relationship between A1c and depression for the full sample and secondary cohort. Results support the hypothesis that the severity of microvascular complications, in part, accounts for the association between A1c and depressive symptomatology in people with type 1 diabetes.
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Klingenstein, Joanna. "Mobilizing Motifs: An Installation Articulating and Visualizing Relationships between the U.S. Healthcare System, the Chronically Ill Patient, and the Healthcare Chaplain". Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1620742386332207.
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