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1
Cai, Yan. "Clinical and pre-clinical pharmacokinetics of green tea polyphenols". Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/280157.
Texto completo da fonteResumo:
Tea consumption has been suggested to have beneficial effects for human health, especially in cancer prevention. At present, epidemiological evidence of the protective effect of tea consumption against the development of human cancer is not conclusive. Interpretation of epidemiological data and extrapolation of rodent data to humans are generally hampered by inadequate information on the bioavailability and pharmacokinetics of tea constituents. We have performed studies to determine the pharmacokinetics of green tea in humans after single and multiple oral dose administration of tea polyphenols and the contribution of hepatic first-pass elimination to the low oral bioavailability of green tea catechins in animals. EGCG was present in the systemic blood in the unchanged form in humans after oral administration of two green tea polyphenol products, EGCG and Polyphenon E (a mixture of major green tea polyphenols). Oral administration of EGCG and Polyphenon E resulted in similar systemic exposure of EGCG. EGC and EC were present in glucuronic acid/sulfate conjugates in blood and urine samples after the Polyphenon E administration. Large inter-subject variations in the systemic levels of green tea catechins were observed following oral administration of green tea polyphenols. We found that it is safe for healthy human subjects to take green tea polyphenols for four weeks in amounts equivalent to those contained in 8 to 16 cups of green tea once a day or in divided doses twice a day. Systemic availability of EGCG increased more than 60% after chronic green tea polyphenol administration at high doses once a day. Oral administration of green tea polyphenols at the selected doses and dosing schedules did not elicit overall changes in the selected pharmacodynamic measurements. Oral bioavailability of green tea catechins was demonstrated to be low in animals and possibly in humans. Based on our pre-clinical study, we found that first-pass hepatic elimination of green tea catechins didn't play a significant role in the presystemic elimination of orally administered catechins. Factors within the gastrointestinal tract such as limited membrane permeability, transporter mediated intestinal secretion, or gut wall metabolism may contribute more significantly to the low oral bioavailability of green tea catechins.
2
Campanile, Loredana. "Effective clinical instruction : selection of behaviours by occupational therapy clinical supervisors". Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=56962.
Texto completo da fonteResumo:
The present study surveyed occupational therapy clinical supervisors working in a number of university affiliated hospitals in the Montreal area, via a mail questionnaire. Therapists were first asked to rate the importance of behaviours in facilitating student learning during clinical instruction. Then they were asked to report their attendance at continuing education courses on clinical instruction. The relationship between attendance at these courses, number of years of clinical experience and rating of behaviours was investigated. Therapists with few years of clinical experience had a low rate of attendance and rated behaviours as important more frequently. Therapists who attended a course rated behaviours as important less frequently. Behaviours rated as most important belonged to the area of communication, followed by the areas of teaching and interpersonal relationships. The results of this study demonstrated that a workshop on clinical instruction would benefit therapists by improving their clinical supervisory skills.
3
Doby, Cynthia Funnye. "Awareness of Clinical Laboratory Sciences and Shortage of Clinical Laboratory Scientists in the 21st Century". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3095.
Texto completo da fonteResumo:
Retiring baby boomers and the lack of interest and awareness among college students to enroll in an accredited Clinical Laboratory Science (CLS) program have created a shortage of CLS professionals in the 21st century. The U.S. Bureau of Labor Statistics predicts 18,000 CLS vacancies by 2018. However, only about 5,000 students graduate from accredited CLS programs each year. The purpose of this study was to explore students' perceptions of allied health professions and factors that influenced students and CLS professionals to select CLS as a profession. Bandura's social cognitive career theory served as the theoretical framework for this phenomenological study. Convenient purposeful sampling was used to select the 7 CLS professionals, 5 high school students, and 5 college students in the Chicago area. Participants took part in either a 30- to 60-minute group session or a 45- to 90-minute semi structured interview. Qualitative analysis included open axial coding to identify emerging patterns and themes from the transcripts. Findings revealed that the perceptions of both high school and college students' knew little about the CLS profession, and factors influencing CLS as a career choice included interests in science, health care, and family. CLS professionals indicated their interests in science and a high demand for CLS services in the workforce led them to pursue careers in the field. Implications for social change include improving professional-development programs for student awareness of allied health professions and mitigating the shortage of clinical laboratory scientists.
4
Mehrabi, Saeed. "Advanced natural language processing and temporal mining for clinical discovery". Thesis, Indiana University - Purdue University Indianapolis, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10032405.
Texto completo da fonteResumo:
There has been vast and growing amount of healthcare data especially with the rapid adoption of electronic health records (EHRs) as a result of the HITECH act of 2009. It is estimated that around 80% of the clinical information resides in the unstructured narrative of an EHR. Recently, natural language processing (NLP) techniques have offered opportunities to extract information from unstructured clinical texts needed for various clinical applications. A popular method for enabling secondary uses of EHRs is information or concept extraction, a subtask of NLP that seeks to locate and classify elements within text based on the context. Extraction of clinical concepts without considering the context has many complications, including inaccurate diagnosis of patients and contamination of study cohorts. Identifying the negation status and whether a clinical concept belongs to patients or his family members are two of the challenges faced in context detection. A negation algorithm called Dependency Parser Negation (DEEPEN) has been developed in this research study by taking into account the dependency relationship between negation words and concepts within a sentence using the Stanford Dependency Parser. The study results demonstrate that DEEPEN, can reduce the number of incorrect negation assignment for patients with positive findings, and therefore improve the identification of patients with the target clinical findings in EHRs. Additionally, an NLP system consisting of section segmentation and relation discovery was developed to identify patients’ family history. To assess the generalizability of the negation and family history algorithm, data from a different clinical institution was used in both algorithm evaluations. The temporal dimension of extracted information from clinical records representing the trajectory of disease progression in patients was also studied in this project. Clinical data of patients who lived in Olmsted County (Rochester, MN) during 1966 to 2010 was analyzed in this work. The patient records were modeled by diagnosis matrices with clinical events as rows and their temporal information as columns. Deep learning algorithm was used to find common temporal patterns within these diagnosis matrices.
5
Cao, Xinyuan. "Assessment of Clinical Engineering Departments in developing countries". Thesis, University of Ottawa (Canada), 2004. http://hdl.handle.net/10393/26594.
Texto completo da fonteResumo:
This study was to evaluate the development level of Clinical Engineering Departments (CEDs) in hospitals in developing countries. The method of data collection was a survey done by structured questionnaire sent by Email and Listserv. In total, 61 responses (9% response rate) were grouped into two regions: Latin America (27 from Venezuela, Mexico, Brazil) and Asia (34 from India, Bangladesh, P.R. China, Indonesia, Saudi Arabia, South Africa); The responses from those developing countries were compared with those from developed countries acquired in previous studies done by Frize and Glouhova. In this study, results indicate that CEDs that responded to the survey from developing countries have similar organizational structure as developed countries, but there are differences in personnel educational levels, responsibilities, and resources. We also identified differences in the level of development of CEDs in respondents from Asia and those from Latin America. The latter were more advanced overall than those in Asia, but CEDs in both regions need to improve their level of development. Future research should focus on collecting more data from CEDs of developing countries, and expand the quantitative analysis that will be possible with a larger sample.
6
Brown, Sarah E. "Electromyographical Analysis of Barefoot Squat: A Clinical Perspective". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/honors/58.
Texto completo da fonteResumo:
The purpose of this study was to compare muscle activation in eight superficial lower limb muscles during execution of barbell back squats while in barefoot and athletic shoe conditions. It was hypothesized that greater muscle activity would be seen when squats were performed in barefoot conditions. Six participants were included in the study (means: 21.33±1.53 years, 170.45±11.33cm height, 69.85±12.46kg mass, 3.4±1.40 years training). Each met specific inclusion criteria. Participants came in three separate days for data collection (Day 1 – 1 repetition maximum [1RM] was determined, Day 2 – maximum voluntary contraction tests were held, Day 3 – squat tests performed with two footwear conditions). Squat tests were performed at 60, 70, and 80% of participants’ 1RM for each footwear condition and EMG data was recorded for these tests. Paired-sample T-tests were used to see if any differences were present between footwear conditions during eccentric and concentric phases of the squat, regardless of intensity. To test for differences between eccentric and concentric phases of the squat by intensity, 2x3 repeated measure ANOVAs were performed. Results showed some statistical difference between footwear conditions for two muscles in eccentric phase and no statistical significance for difference in concentric phase when compared without regard to intensity. When comparing footwear conditions at each intensity, main effects, as well as statistical significance, were found between footwear conditions in the eccentric phase. Main effects, but no statistical significance, were found in the concentric phase. The results indicate that EMG activity is greater for certain lower extremity muscles during the eccentric portion of a squat when under barefoot conditions.
7
Rosenthal, Daniel Todd. "A clinician-mediated, longitudinal tracking system for the follow-up of clinical results". Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/33084.
Texto completo da fonteResumo:
Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2005.Includes bibliographical references (p. 36-37).
Failure to follow-up on abnormal tests is a common clinical concern comprising the quality of care. Although many clinicians track their patient follow-up by scheduling follow-up visits or by leaving physical reminders, most feel that automated, computerized systems to track abnormal test results would be useful. While existing clinical decision support systems and computerized clinical reminders focus on providing assistance with choosing the appropriate follow-up management, they fail by not tracking that follow-up effectively. We believe that clinicians do not want suggestions how to manage their patients, but instead want help tracking follow-up results once they have decided the management plan. We believe that a well-designed system can successfully track this follow-up and only require a small amount of information and time from the clinician. We have designed and implemented a complete tracking system including 1) an authoring tool to define tracking guidelines, 2) a query tool to search electronic medical records and identify patients without follow-up, and 3) a clinical tool to send reminders to clinicians and allow them to easily choose the follow-up management. Our tracking system has made improvements on previous reminder systems by 1) using our unique risk-management guideline model that more closely mirrors, yet does not attempt to replicate, the clinical decision process, 2) our use of massive population-based queries for tracking all patients simultaneously, and 3) our longitudinal approach that documents all steps in the patient follow-up cycle. With these developments, we are able to track 450 million pieces of clinical data for 1.8 million patients daily.
(cont.) Keyword follow-up tracking; reminder system; preventive medicine; computerized medical record system; practice guidelines; clinical decision support system
by Daniel Todd Rosenthal.
S.M.
8
Carberry, Helen. "Semiotic analysis of clinical chemistry: for "knowledge work" in the medical sciences". Thesis, Queensland University of Technology, 2003. https://eprints.qut.edu.au/15809/1/Helen_Carberry_Thesis.pdf.
Texto completo da fonteResumo:
In this thesis a socio-cultural perspective of medical science education is adopted to argue the position that undergraduate medical scientists must be enculturated into the profession as knowledge workers and symbolic analysts who can interact with computers in complex analytical procedures, quality assurance and quality management. The cue for this position is taken from the transformations
taking place in the pathology industry due to advances in automation, robotics and
informatics. The rise of Evidence-Based Laboratory Medicine (EBLM) is also noted
and the observation by higher education researchers, that knowledge systems are
transforming in such a way that disciplines can no longer act in isolation. They must
now collaborate with disparate fields in transdisciplinary knowledge systems such as
EBLM, for which new skills must be cultivated in undergraduate medical scientists.
This thesis aims to describe a theoretical basis for knowledge work by taking a semiotic perspective. This is because, semiotics, a theory of signs and representations, can be applied to the structure of transdisciplinary scientific knowledge, the logic of scientific practice and the rhetoric of scientific
communications. For this purpose, a semiotic framework is first derived from a wide
range of semiotic theories existent in the literature. Then the application of this
semiotic framework to clinical chemistry knowledge, context, logic, and rhetoric is
demonstrated. This is achieved by interpreting various clinical chemistry data
sources, for example, course materials, laboratory spatial arrangements, instruments,
printouts, and students' practical reports, collected from a teaching laboratory
situation.
The results of semiotic analysis indicate that the clinical chemist working in the computerised laboratory environment performs knowledge work, and the term is synonymous with symbolic analysis. It is shown that knowledge work entails the application of a systematic structure for clinical chemistry knowledge derived in terms of the validation procedures applied to laboratory, data, results and tests; the application of logic in the classification and selection of instruments, their rule governed-
use, and in troubleshooting errors; pragmatic decisions based on availability of space, services and budgets; discrimination among values in laboratory test evaluations in EBLM, for the cost-effectiveness and relevance of
pathology services; and the recognition of rhetorical strategies used to communicate
laboratory test information in graphs, charts, and statistics. The role of the laboratory
context is also explained through semiotics, in terms of its spatial arrangements and
designs of laboratory instruments, as a place that constrains the knowledge work
experience. This contextual analysis provides insights into the oppositional trend
brought to wide attention by analysts of computerised professional work, that more
skills are needed, but that there are fewer highly skilled positions available.
The curriculum implications of these findings are considered in terms of the need to cultivate knowledge workers for highly complex symbolic analysis in computerised laboratories; and also the need to prepare medical science graduates for
the transdisciplinary knowledge system of EBLM, and related venues of employment such as biomedical research and clinical medicine. In meeting the aims to define and demonstrate knowledge work from the semiotic perspective, this thesis makes an original contribution to knowledge by the application of semiotics to a field in which it has probably never been tested. It contributes to the scholarship of
teaching in higher education by formulating a structure for transdisciplinary medical
science knowledge, which integrates scientific with other forms of knowledge, and with real world practice.
9
Carberry, Helen. "Semiotic analysis of clinical chemistry: for " knowledge work " in the medical sciences". Queensland University of Technology, 2003. http://eprints.qut.edu.au/15809/.
Texto completo da fonteResumo:
Abstract In this thesis a socio-cultural perspective of medical science education is adopted to argue the position that undergraduate medical scientists must be enculturated into the profession as knowledge workers and symbolic analysts who can interact with computers in complex analytical procedures, quality assurance and quality management. The cue for this position is taken from the transformations taking place in the pathology industry due to advances in automation, robotics and informatics. The rise of Evidence-Based Laboratory Medicine (EBLM) is also noted and the observation by higher education researchers, that knowledge systems are transforming in such a way that disciplines can no longer act in isolation. They must now collaborate with disparate fields in transdisciplinary knowledge systems such as EBLM, for which new skills must be cultivated in undergraduate medical scientists. This thesis aims to describe a theoretical basis for knowledge work by taking a semiotic perspective. This is because, semiotics, a theory of signs and representations, can be applied to the structure of transdisciplinary scientific knowledge, the logic of scientific practice and the rhetoric of scientific communications. For this purpose, a semiotic framework is first derived from a wide range of semiotic theories existent in the literature. Then the application of this semiotic framework to clinical chemistry knowledge, context, logic, and rhetoric is demonstrated. This is achieved by interpreting various clinical chemistry data sources, for example, course materials, laboratory spatial arrangements, instruments, printouts, and students' practical reports, collected from a teaching laboratory situation. The results of semiotic analysis indicate that the clinical chemist working in the computerised laboratory environment performs knowledge work, and the term is synonymous with symbolic analysis. It is shown that knowledge work entails the application of a systematic structure for clinical chemistry knowledge derived in terms of the validation procedures applied to laboratory, data, results and tests; the application of logic in the classification and selection of instruments, their rulegoverned- use, and in troubleshooting errors; pragmatic decisions based on availability of space, services and budgets; discrimination among values in laboratory test evaluations in EBLM, for the cost-effectiveness and relevance of pathology services; and the recognition of rhetorical strategies used to communicate laboratory test information in graphs, charts, and statistics. The role of the laboratory context is also explained through semiotics, in terms of its spatial arrangements and designs of laboratory instruments, as a place that constrains the knowledge work experience. This contextual analysis provides insights into the oppositional trend brought to wide attention by analysts of computerised professional work, that more skills are needed, but that there are fewer highly skilled positions available. The curriculum implications of these findings are considered in terms of the need to cultivate knowledge workers for highly complex symbolic analysis in computerised laboratories; and also the need to prepare medical science graduates for the transdisciplinary knowledge system of EBLM, and related venues of employment such as biomedical research and clinical medicine. In meeting the aims to define and demonstrate knowledge work from the semiotic perspective, this thesis makes an original contribution to knowledge by the application of semiotics to a field in which it has probably never been tested. It contributes to the scholarship of teaching in higher education by formulating a structure for transdisciplinary medical science knowledge, which integrates scientific with other forms of knowledge, and with real world practice.
10
Morley, Michelle. "Simulation and baccalaureate nursing students' clinical competence". Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27893.
Texto completo da fonteResumo:
Health science students are faced with a reduction in acute care clinical placement opportunities, which are considered essential for developing clinical competence. Education methods using high-fidelity human patient simulation (HPS) may provide a way to ensure students are meeting minimal levels of competence. Using a quasi-experimental design pilot study, clinical competence among 19, third year baccalaureate nursing students was investigated. The experimental group (n = 10) received four days of HPS as part of their clinical practicum, while the control group (n = 9) participated in their regular clinical practicum. Clinical competence was measured using final grades from a medical-surgical theory course and an Objective Structured Clinical Examination (OSCE). There was no significant difference in clinical competence between the groups, as was evidenced by their final theory grades; t (17) = 1.090, p = .291 and OSCE scores (M = 60 for both groups). The results from this pilot study can guide future research using HPS in health care education. A randomized controlled study with a larger sample needs to be completed to provide more insight into the outcomes of HPS in health care curricula.
11
Rahman, Najib. "Clinical trials in pleural disease". Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:930991f1-3424-4b96-984e-06df7f6e9204.
Texto completo da fonteResumo:
The focus of this thesis is on practice changing clinical studies which impact upon the day to day treatment of patients with pleural infection, answering specific questions on several aspects of patient management. Specific areas of assessment in this thesis include: Assessment of the current evidence for optimal drain size choice in patients with pleural infection; Analysis and statistical modelling of a previous cohort of patients with pleural infection, in order to assess optimal drain size choice in pleural infection; The design, conduct and analysis of a 2 x 2 factorial multi-centre randomised, placebo controlled trial to assess the efficacy of two novel intrapleural agents (tPA and DNase) in aiding drainage in patients with pleural infection (The 2nd Multi-centre Intrapleural Sepsis Trial, referred to from here on as MIST2); Validation work informing the primary outcome measure of MIST2, assessing the relationship between chest radiograph imaging of infected pleural effusion and CT measured volume of pleural fluid using novel digital measurement strategies.
12
Smith, Laurie Ann Johnson. "Clinical decision making capacity among institutionalized elders". Thesis, The University of Arizona, 1993. http://hdl.handle.net/10150/278392.
Texto completo da fonteResumo:
A descriptive study was conducted to explore the relationship among three measures of decision making capacity: (1) clinicians' opinions, (2) Pfeiffer's (1975) SPMSQ, and (3) a developmental instrument by Fitten et al. (1990) designed to measure patient clinical decision making ability. Another purpose of the study was to replicate portions of the work by Fitten et al. (1990). A convenience sample of 41 patients, four physicians, and three nurse practitioners was studied. Quantitative research techniques were employed for data collection and analysis. Significant correlations were found among all measurements of decision making capacity indicating that the developmental instrument appears to be a valid method of determining decision making capacity according to results obtained for convergent validity. The findings of this study support those reported by Fitten et al. (1990).
13
Egermayer, Paul Charles. "The epidemiology and clinical pathophysiology of thromboembolic disease". Thesis, University of Auckland, 2001. http://wwwlib.umi.com/dissertations/fullcit/3085722.
Texto completo da fonteResumo:
Thrombosis is a vascular pathological process which frequently affects the veins of the lower limbs, and embolisation of thrombotic material is common. Thromboembolic disease is a common cause of death in Western societies, predominantly affecting the elderly. Numerous risk factors and co-morbidities have been identified. Safe and effective means of prophylaxis are available but are underutilised. Anticoagulant drugs are very effective in preventing thromboembolic disease, but their effects on the evolution of the thrombotic process remain poorly documented. These drugs are difficult to use, and treatment errors and treatment failures are common. The factors which determine the embolisation of deep vein thrombosis are poorly understood. When such embolisation occurs it is usually asymptomatic. Symptomatic pulmonary embolism presents in 3 general ways-pleuritic pain, shortness of breath, or collapse. Tachypnea is the commonest sign. Tests which are available to assist in the diagnosis of thromboembolic disease include the ventilation perfusion lung scan, ultrasound of the lower limbs, pulmonary angiography and echocardiography. The commonest investigation requested in this context is the lung scan. Although the results are often inconclusive, this is frequently the only specific investigation which is performed. The accurate interpretation of lung scans requires consideration of the pretest probability of pulmonary embolism. The D-dimer assay is another test which may be useful. The finding of a normal D-dimer level substantially reduces the probability of thromboembolic disease and may render a lung scan unnecessary.Subscription resource available via Digital Dissertations only.
14
Louie, Tiffany M. "Clinical assessment of early demineralization using PS-OCT". Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1465486.
Texto completo da fonte
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Rodella, Stefania. "Exploring reliability in epidemiology and clinical research". Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23421.
Texto completo da fonteResumo:
Quality of measurement is a fundamental issue in medical research and clinical practice, of relevance for any inference or decision-making process. Reliability, as an estimate of the variability in the domain of repeated measurements, is an important component of the quality of measurements.Reliability indices are frequently used and presented in the medical literature and a considerable amount of methodological research has been conducted on this topic in the last decades. However, the debate is still open on some theoretical and operational aspects. Available knowledge concerning reliability, particularly for categorical data, is not easily accessible since it is often confined to specialized journals and almost disregarded by statistical textbooks. Therefore, a thorough understanding is difficult to achieve for a researcher potentially involved in reliability studies.
My main objective was to pursue a conceptual and global understanding of the role of reliability in the domain of categorical data. In order to achieve this goal I reviewed and synthesized the literature according to some specific objectives: (a) to provide an overview on the founding concepts and methods in the measurement of reliability for categorical variables, also contrasting them with what has been done in the domain of continuous variables; (b) to present and discuss the main limitations of traditional indices, particularly the kappa statistic; (c) to briefly introduce some possible alternative methods and areas for future development; (d) to emphasize the implications of reliability for epidemiological and clinical research.
Finally, in order to illustrate the application of some of the methods discussed, I used a real set of data, concerning 209 slides of lymphomas tissue samples, reviewed by a panel of four pathologists, according to a standard classification based on 10 categories.
16
Ostrovska, Alexsandra. "Vestibular evoked myogenic potentials in clinical applications". Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=80345.
Texto completo da fonteResumo:
It is uncertain whether clinically useful information of otolith function can be well characterized by vestibular-evoked-myogenic-potentials (VEMPs), i.e., electromyogenic activity recorded from sternomastoid muscles in response to brief loud auditory clicks. We aimed to assess the utility of VEMP testing in the differential diagnosis of dizziness (81 dizzy patients, 12 normals). We found that: (1) VEMP was reliably elicited from all controls and from 96% of patients without loss of vestibular function; (2) in patients with documented unilateral peripheral vestibular disorders, VEMP could reveal loss of otolith function that usefully facilitated diagnoses; and (3) such otolith function loss was independent of canal function loss revealed by caloric testing. We conclude that the VEMP-test is clinically useful to assess vestibular (otolith and/or inferior vestibular nerve) function, providing information complementary to that obtained from caloric testing (horizontal semicircular canal and/or superior vestibular nerve function).
17
Horowitz, Roberta S. "Idea Analysis for the Development of Clinical Trial Strategies". NSUWorks, 1995. http://nsuworks.nova.edu/gscis_etd/589.
Texto completo da fonteResumo:
Idea Analysis was investigated to determine its ability to organize scientific information and explain the results of specialists' deliberations in designing new clinical trials. Ideas have long been recognized as the engine of creativity. By focusing on the capture of ideas from the scientific literature, idea analysis procedures enable the arrangement of the information into forms consistent with those developed by subject specialists. The most obvious example is the concept structure. Ideas containing a common frequently occurring term/phrase can be depicted as a primary node in the concept network. Related terms will appear as elements associated with that node. Ideas containing couplets of primary nodal terms/phrases can be used to link nodes, thus, completing the paths in the network. Using this methodology, information specialists can build and maintain knowledge structures for use by students, subject specialists and interested others. In contrast with expert systems, idea analysis does not attempt to duplicate thought processes performed by experts in a subject. Instead, it focuses on the management of ideas and the arrangement of those ideas using organizational models. The application of these techniques to the scientific literature dealing with brain tumors and to clinical trial protocols developed by subject specialists is illustrative. This study showed that, in the brain tumor literature and clinical trial protocols, the idea analysis approach was effective in accomplishing the two tasks required: 1. Organization of complex material into succinct and understandable descriptions--tabular and graphic; 2. provision of explanations of expert-derived research strategies and/or plans. This methodology enhanced identification, extraction, computerization and incorporation of ideas into knowledge structures in an efficient and effective manner.
18
Yee, Daphne. "Clinical epidemiology of mono-pyrazinamide-resistant Mycobacterium tuberculosis in Quebec". Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=101809.
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Rationale. In Quebec, 6.2% of all Mycobacterium tuberculosis (TB) isolates from Canadian-born patients are resistant to pyrazinamide alone (mono-PZA-R). Over 90% of mono-PZA-R isolates in Quebec have been characterized by a specific and unique mutation in the pncA gene. The unusually high prevalence of mono-PZA-R disease and its associated mutational profile in Quebec provided an exceptional opportunity to study the epidemiologic and clinical significance of mono-PZA-resistance in patients with active TB. Methods. 67 patients with mono-PZA-R TB diagnosed between 1 Jan 1990 and 31 Dec 2000 were compared to 211 randomly selected patients with pan-sensitive (Pan-S) isolates diagnosed within the same time period. Demographic, laboratory, and clinical information pertaining to patients diagnosed with TB from the provincial database of Maladies a declarations obligatoires (MADO) were linked to drug resistance profiles derived from the provincial laboratory. Data from MADO were supplemented by other clinical information abstracted from chart review, the provincial drug insurance database, and the provincial registry for Bacillus Calmette Guerin vaccination. Results. There were no statistically significant differences in demographics or clinical characteristics between patients infected with mono-PZA-R compared to Pan-S strains. Among patients with mono-PZA-R TB, 51 (76%) were cured, 3 (4%) relapsed, and 13 (19%) died within 6 months of diagnosis. In comparison, for subjects with Pan-S TB, 181 (86%) were cured, 2 (1%) relapsed, 2 (1%) failed treatment, and 26 (12%) died within 6 months of diagnosis. In multivariate logistic regression analysis, mono-PZA-R was associated with decreased odds of successful clinical outcomes compared with Pan-S TB (OR=0.38, 95% CI = 0.18-0.81). Conclusion. PZA-resistance had a clinically significant impact on outcome of TB disease.
19
Wang, Chenchen 1958. "Clinical and health status of patients with Systemic Lupus Erythematosus : the impact of disease activity, damage and other clinical measures". Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=29928.
Texto completo da fonteResumo:
The prognosis of Systemic Lupus Erythematosus (SLE) has improved markedly over recent decades, however, little research has focused on the improvement of SLE patient's quality of life. The main objective of this cross-sectional study was to evaluate the relationship between disease activity, cumulative damage and self-reported quality of life in 54 patients with SLE.Disease activity was measured by the SLE Disease Activity Index (SLEDAI), Systemic Lupus Activity Measure (SLAM-2) and cumulative damage by the Systemic Lupus International Cooperating Clinics/ACR damage index (DI). Quality of life was assessed by the Medical Outcome Survey Short Form 36 (SF-36) and the Euroqol (EQ-5D) self-report questionnaires. Multiple linear regression was used to identify significant predictors of patients' self reported health status. Cumulative damage was found to be associated with physical function, physical health and social functioning (SF-36); disease activity was found to have a significant association with general health (SF-36) and a weaker association on overall health status as evaluated through the 'thermometer' rating scale of the EQ-5D. Patients' ratings of ability with usual activities was strongly related to overall physical health (SF-36) as well as the physical functioning and general health subscales of the SF-36. In addition, patients' ratings of anxiety and depression were strongly related to overall mental health status (SF-36).
In conclusion, physical health of SLE patients was associated with disease activity, disease damage, capacity for usual activity, and mobility.
20
Grady, Jesse Glennan. "BIOMECHANICAL AND MOLECULAR CHARACTERISTICS OF 'HYPERELASTOSIS CUTIS' IN QUARTER HORSES". MSSTATE, 2008. http://sun.library.msstate.edu/ETD-db/theses/available/etd-11052007-102632/.
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The biomechanical and molecular characteristics of equine hyperelastosis cutis (HC) are not fully known. This study sought to better characterize HC by analysis of ultimate tensile strength, modulus of elasticity, toughness, and thickness of skin from 23 affected and unaffected horses. In addition total soluble collagen and glycosaminoglycan concentrations of skin were analyzed from 26 affected and unaffected horses. Affected horses' skin proved to be significantly weaker at five of seven sample locations (p<=0.05). The modulus of elasticity proved to be significantly different at three of seven sample locations and toughness at two of seven locations (p<=0.05). No significant difference was proven to exist between HC affected and unaffected horses for skin thickness or total soluble collagen and GAG concentrations. Collectively this data demonstrates that HC animals' reduced skin tensile strength is not due to a deficit of either collagen or GAG, but likely a result of altered collagen micro-architecture.
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Doran, Pamela. "Clinical severity and familial risk in mood disorders". Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110606.
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Background: Major depressive disorder (MDD) and bipolar disorder (BP) are highly prevalent illnesses that cause substantial burden in the affected individual, their families, and society at large. These consequences underline the importance of etiological research in order to develop superior measures of both prevention and treatment. Although family history is the most consistently replicated risk factor for mood disorders, minimal efforts have been made to outline differences in sociodemographic and clinical characteristics between patients with familial and non-familial forms of these disorders. Moreover, despite the lack of conclusive findings in genome-wide association and linkage studies regarding the particular genes involved in mood disorder etiology, investigators have not yet examined the significance of familial exposure to psychiatrically ill relatives in influencing their onset and course. Methods: Subjects were 378 outpatients with a current DSM-IV diagnosis of MDD (N=139) or BP (N=239). Retrospective chart reviews were conducted in order to examine differences in sociodemographic and clinical characteristics between subjects with and without physician-reported family history. Patient-reported family history was used to compare subjects on a number of self-reported familial exposure variables. Associations between these variables and clinical characteristics were also examined. Results: Mood disorder subjects with physician-reported family history were primarily Canadian born and English speaking, and subjects without such a history were mostly unemployed. In terms of clinical characteristics, BP subjects with physician-reported family history sought psychiatric assistance at a younger age and MDD subjects without such a history were hospitalized more often. Consistent with prior research, BP subjects demonstrated more familial loading of both BP and schizophrenia/psychosis compared to MDD subjects. Furthermore, a family history of schizophrenia/psychosis and drug problems were associated with more frequent hospitalizations. Finally, a family history of drug and alcohol problems as well as living with two or more acutely ill family members, were associated with more lifetime suicide attempts. Conclusions: Family history undeniably plays an instrumental role in both the onset and clinical presentation of mood disorders. Our results particularly emphasize the significance of familial exposures and their ability to operate as risk factors, combined with underlying genetic susceptibility, to produce more severe and impairing cases of these disorders. Clinicians should carefully examine each patient's family history status since it may add value to risk assessments for outcomes like suicide attempts and hospitalizations.Contexte: Le trouble dépressif majeur (TDM) et le trouble bipolaire (TB) sont des maladies très répandues qui causent le fardeau substantiel dans la personne touchée, leurs familles, et dans la société en général. Ces conséquences soulignent l'importance de la recherche étiologique dans le but d'élaborer des mesures supérieures à la fois de prévention et de traitement. Bien que les antécédents familiaux est le facteur de risque le plus constamment répliqué pour les troubles de l'humeur, des efforts minimes ont été apporté à décrire les différences dans les caractéristiques sociodémographiques et cliniques entre les patients avec des formes familiales et non familiales de ces troubles. Par ailleurs, malgré l'absence de résultats convaincant dans les études d'association pangénomique et les études de liaison concernant les gènes impliqués dans l'étiologie des troubles de l'humeur, les enquêteurs n'ont pas encore examiné l'importance de l'exposition aux membres de la famille souffrant d'une maladie mentale en influençant l'apparition et l'évolution des troubles de l'humeur. Méthodes: Les sujets inclus 378 patients à l'externe avec un diagnostic DSM-IV de la TDM (N=139) ou TB (N=239). Examens rétrospectifs des dossiers ont été menées afin d'examiner les différences dans les caractéristiques sociodémographiques et cliniques entre les sujets avec et sans des antécédents familiaux rapportés par un médecin. Les antécédents familiaux rapportés par le patient ont été utilisés pour comparer des sujets sur plusieurs variables auto-déclarées sur l'exposition aux membres de la famille touchée. Les associations entre ces variables et les caractéristiques cliniques ont également été examinées.Résultats: Les sujets avec un trouble de l'humeur ayant des antécédents familiaux rapportés par un médecin étaient principalement anglais et née au Canada, et les sujets sans une telle histoire étaient pour la plupart au chômage. En termes de caractéristiques cliniques, les sujets avec des antécédents familiaux de TB rapportés par un médecin a demandé l'assistance psychiatrique à un plus jeune âge et les sujets avec un TDM sans une telle histoire ont été hospitalisés plus souvent. En ligne avec la recherche précédente, les sujets avec un TB ont démontré plus de membres de la famille touchée avec soit un TB ou bien de la schizophrénie/psychose par rapport aux sujets de TDM. De plus, des antécédents familiaux de schizophrénie/psychose et de problèmes de drogue ont été associés à des hospitalisations plus fréquentes. Enfin, des antécédents familiaux de problèmes de drogue et d'alcool ainsi que de vivre avec deux ou plusieurs membres de la famille gravement malades, ont été associés à plus de tentatives de suicide à vie. Conclusions: Les antécédents familiaux jouent indéniablement un rôle instrumental dans l'apparition et à la présentation clinique des troubles de l'humeur. Nos résultats met un accent particulier sur l'importance de l'exposition aux antécédents familiaux et leur capacité à fonctionner comme facteurs de risque, en combinaison d'une sous-jacente susceptibilité génétique, pour produire des cas plus graves et débilitantes de ces troubles. Les cliniciens devraient examiner soigneusement les antécédents familiaux de chaque patient, car cela peut ajouter de la valeur aux évaluations de risque pour les tentatives de suicide et les hospitalisations.
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Polaha, Jodi, McKenzie Highsmith, William Lusenhop, Deepu George e Adrian Sandoval. "Clinical Evaluators Take Your Mark". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6881.
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Discuss two implementation outcomes (adoption and reach) and explain why they are important for clinicians to measure and report, with application to own work Name sources of data that are accessible to clinicians in health care settings, with consideration of own setting. Describe a range of dissemination strategies used to create impact, including new ideas for dissemination of own work.
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McKerrell, Rosemary. "Labrador retriever myopathy : clinical and pathological investigation". Thesis, University of Cambridge, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.306555.
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Carlson, Robin. "Clinical Significance of Response Shift in a Spine Interventional Clinical Trial". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/231.
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The effectiveness of treatments for degenerative spine conditions, where the primary symptom is back pain, is typically determined using patient-reported quality of life (QoL) measures. However, patients may adjust their internal standards when scoring QoL based on factors other than their health. This response shift phenomenon could confound the interpretation of study data and impact effectiveness conclusions. In the current study, response shift was examined using structural equation modeling (SEM) and previously collected clinical trial data comparing 2 minimally invasive medical devices in lumbar spinal stenosis patients through 1 year postintervention. In subject QoL results, reprioritization shift between 3 months and 12 months that could confound standard analysis was identified. Treatment group did not influence response shift identified at 12 months. SEM provided an effective and practical tool for clinical investigators to assess response shift in available clinical study data. As response shift could lead to invalid conclusions when QoL measures are analyzed, clinical investigators should include response shift assessment in the design of clinical trials. This research into how response shift phenomenon can impact clinical trial results improves the ability of clinical investigators to interpret clinical trial data, potentially preventing erroneous conclusions. This research may also assist researchers and government regulators in the identification and reimbursement of beneficial, cost-effective medical treatments for patients worldwide. For clinical research designers, this study demonstrates a practical application of response shift assessment.
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Thiers, Fabio Albuquerque. "The globalization of clinical drug development". Thesis, Massachusetts Institute of Technology, 2006. http://hdl.handle.net/1721.1/35556.
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Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2006.Includes bibliographical references (p. 54-58).
Industry-sponsored clinical research of investigational drugs (also called clinical development) has traditionally been carried out in relatively developed countries in the North American, Western European, and Pacific regions. However, lately it has been widely reported that clinical trials starting now are becoming increasingly diffused globally, with significant growth of activity in so-called emerging economies in Eastern Europe, Latin America, and Southeast Asia. This change in location of clinical development activities has numerous implications for patients, health care providers, pharmaceutical companies, regulatory agencies and governments around the globe. Even though there is much debate about the topic, a public systematic quantitative assessment of the current status of the globalization of clinical drug development phenomenon is lacking. The objective of this thesis research is to provide such objective quantification while addressing some issues that are currently in active discussion. This thesis documents that the participation of emerging countries is still relatively small (13%) and they most commonly participate in very large (involving more than five countries) phase Ilb or III trials.
(cont.) Albeit perceived as small, this participation is growing at a rapid pace (23% average annual growth rate) and the number of clinical sites of global clinical trials located in all emerging countries (11,038) is comparable with the sum of Germany, France, U.K., and Italy (11,061). Eastern European and Latin American countries have the greatest participation in clinical trials among emerging countries, but Southeast Asia is the region that is experiencing fastest growth. Meanwhile, Western Europe has experienced negative average annual growth of -8%, and North America has seemingly been stable. This thesis discusses findings and key drivers behind the globalization process. I also consider the argument that the sustainability of this model will depend on stringent protection of patients in these emerging countries and continued development of these nations, with eventual creation of an attractive market for pharmaceutical products. The extension of this process of globalization of clinical trials, if coupled with substantial improvements in health care delivery and research capacity in these emerging economies, has the potential of revolutionizing medical product development within the next two decades.
by Fabio Albuquerque Thiers.
S.M.
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Abdi, Yasin. "The appropriateness of clinical microbiology laboratory investigations : a retrospective study of the cost and clinical relevance of specimen management and processing". Thesis, University of Portsmouth, 2011. https://researchportal.port.ac.uk/portal/en/theses/the-appropriateness-of-clinical-microbiology-laboratory-investigations(b1f5faea-580b-4dad-b033-8ecc2407ff97).html.
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Each year, NHS clinical laboratories carry out more than 700 million laboratory tests, of which 50 million are microbiology investigations. Several studies have shown that between 25% and 40% of all tests sent to the laboratory are unnecessary, and up to 46% of ordered microbiology tests are inappropriate. In light of these accounts, the present study was undertaken to evaluate the process of microbiology specimen management in order to assess microbiology test utilisation and the appropriateness of the test ordering processes. The study focussed on respiratory tract specimens using sputum microbiology as a model for the microbiology service inappropriate test utilisation. The overall main aim of this study was to determine the appropriateness of clinical microbiology test utilisation, its clinical relevance and cost-effectiveness, hence recommend better utilisation strategies. A total of 15,941 respiratory tract samples from Barts and The London NHS Trust were randomly selected from the years 2004/05 and analysed retrospectively. Seven hundred microbiology laboratory request forms from patients for whom respiratory tract cultures were requested over a three month period were examined in detail. These requests were derived from 511 sputum specimens, 100 throat swabs, 63 ear swabs and 76 samples from other respiratory tract sites. 641 (91%) of microbiology test requisition forms were completed, provided all requested details by the service users and were therefore considered as appropriate microbiology test requisitions. 660 (94%) of those examined stated the patient’s clinical diagnosis and only in 65 (13%) of these patients was the stated diagnosis as respiratory tract infection. Sixty percent of sputum specimens examined were considered as poor quality. Forty percent of respiratory specimens were reported as culture positive, based on the local hospital criteria of microbiology test reporting. In sputum culture, 39% was reported as culture positive; however, less than 18% were positive with recognised respiratory pathogens, whilst 27% of throat swabs were reported as culture positive, of which 67% had throat pathogens. From the beginning of this study and before, there were no microbiology test comments and interpretation of test results provided with the test result reporting. The test turnaround time of respiratory microbiology results reported within three days in 2004/2005 was only 20%. The total inappropriate respiratory specimens processed locally were 9,575. Extrapolating from our results, this suggests that 2,153,977 nationally were inappropriate in NHS hospitals in 2004/2005. The total cost of inappropriate respiratory microbiology test use was approximately £152,000 in local NHS hospitals. Extrapolating from our results, this suggests that £23,900, 000 nationally was the total cost of inappropriate tests in the NHS hospitals. Following implementation of this study, follow up studies in 2006 and onwards indicated that there has been an improvement in the quality of the microbiology service. The number of good quality sputum specimens was 69% compared to 40% in 2004/2005. While the total microbiology test turnaround time that was reported within three days in 2009/2010 was more than 94%. From mid 2006 onwards, test interpretation comments have been used in all microbiology test result reporting. The total workload of respiratory tract microbiology activity decreased from 18,915/year to 16,651/year over the years 2004/2005 to 2007/2008, which is down nearly 8%. Analysis of the findings showed that the usefulness of culture results was limited by the collection of inappropriate specimens, and lack of clinical information on the microbiology request form. The crucial importance of the role of clinical and nursing staff is stressed if the clinical relevance of sputum culture is to be maximised. The increasing introduction of electronic pathology test requests gives new opportunities to restrict the collection of inappropriate specimens and make substantial savings in resources, both in the ward and the laboratory. This type of study and audit can give invaluable information about the rationale behind testing, and the appropriateness of sampling and transport time. Appropriate measures for corrective actions can be identified.
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Mac, Donald Tanya. "Standardized functional capacity outcome measures in post-operative cardiac surgery: A survey of current clinical practice and development of a clinical practice guideline (CPG)". Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28369.
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The objectives of the thesis were to determine the prevalence of functional capacity outcome measure use among physiotherapists working with post-operative cardiac surgery clients and to develop evidence-based recommendations regarding their use in clinical practice. The thesis consisted of a systematic review of the literature; a survey of outcome measure use in clinical practice; and the development of a clinical practice guideline. Thirty-one functional capacity outcome measures were included in the review. Only 2.6% of survey respondents reported almost always using outcome measures in their clinical practice. The Six Minute Walk Test, the modified Borg Rating Scale of Perceived Exertion and vital signs were recommended for routine use in clinical practice. A variety of outcome measures are available for use in clinical practice however their use in clinical practice continues to be less than optimal. There is a need for continued training in outcome measure use in clinical practice.
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Ghanbari, Hedieh. "Predictors of temporomandibular disorders : clinical variables and patient characteristics". Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=101127.
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This case control study was designed to investigate the contributing factors for the occurrence of temporomandibular disorder (TMD) and its subgroups: myofascial pain (MFP) and disc displacement (DD). 178 patients with TMD were selected from the dental clinics of the Jewish General and Montreal General Hospitals, Montreal, Canada, and 100 concurrent controls selected only at the first clinic, participated in this study. The association with TMD, MFP and DD was evaluated for bruxism, trauma, psychological factors, and sociodemographic status using a logistic regression. Migraine, depression, and clenching were associated with the occurrence of TMD. Among the MFP patients, clenching, clenching-grinding, anxiety, female, depression, and somatization were associated with disease occurrence.In addition, adjusted analysis among the DD patients showed an association with clenching-grinding, orthodontic treatment, and anxiety. Our results identify possible risk factors that are associated with TMD, MFP, and DD occurrence. Further research needs to be conducted to look at these associations in depth.
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Taylor, Demetra T. "Investigation of a Clinical Suicide Risk Assessment". The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1408981316.
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McAllister, Lindy. "The experience of being a clinical educator". Connect to full text, 2001. http://hdl.handle.net/2123/4017.
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Thesis (Ph. D.)--University of Sydney, 2001.Title from title screen (viewed Jan. 22, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Physiotherapy, Faculty of Health Sciences. Includes bibliography. Also available in print form.
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Coleman-Ferreira, Kimberly W. "Achieving Competence: Clinical Instructors' Perspective". Diss., NSUWorks, 2015. https://nsuworks.nova.edu/hpd_pt_stuetd/1.
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Purpose: The profession of physical therapy uses physical therapist clinical instructors to educate students in the clinical education portion of the curriculum. The requirements to become a clinical instructor are minimal and non- specific regarding formal training and development. A variety of educational opportunities is available to clinical instructors, but the evidence in the physical therapy literature is conflicting regarding the effectiveness of these programs. Additionally, no previous research regarding the meaning of competence, nor the pathway to achieving competence as a clinical instructor was found. Therefore, the purpose of this study was to describe the experience of achieving competence as perceived by clinical instructors who have chosen different paths toward becoming effective CIs. Methods: This study utilized phenomenological methodology to explore the meaning of clinical instructor competence and the experience of achieving competence from the perspectives of the clinical instructors themselves. Data was collected through the use of focus groups, semi-structured interviews and written statements. Data was analyzed for themes using thematic analysis. Participants: A purposive sample of twenty-nine physical therapist clinical instructors was recruited to participate in five focus groups, each group consisted of 5-7 participants. Results: An overarching theme of “Empowerment” emerged from the data analysis of the transcriptions and field notes. This overarching theme was supported by eight themes which resonated across the five focus groups. These themes were 1: The meaning of competence, 2: “My first student”, 3: Finding the way, 4: Feeling supported, 5: A fork in the road, 6: Barriers to achieving competence, 7: The “ah-ha” moment, 8: “Ongoing road”. Conclusion: The results of this study provide a description and interpretation of the meaning of clinical instructor competence and the journey of achieving competence. These findings can inform and empower clinical instructors on their own journey to competence. CCCEs may also find a deeper awareness of the meaning of competence and the importance of providing support for CIs. The physical therapy education community and it’s professional bodies can also be informed by these findings in establishing a definition of clinical instructor competence. As well as give direction to future efforts and programs designed to prepare clinicians to effectively educate students in the clinic setting.
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Liu, Yun Ph D. Massachusetts Institute of Technology. "Applying domain knowledge to clinical predictive models". Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104469.
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Thesis: Ph. D. in Medical Engineering, Harvard-MIT Program in Health Sciences and Technology, 2016.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 115-124).
Clinical predictive models are useful in predicting a patient's risk of developing adverse outcomes and in guiding patient therapy. In this thesis, we explored two different ways to apply domain knowledge to improve clinical predictive models. We first applied knowledge about the heart to engineer better frequency-domain features from electrocardiograms (ECG). The standard frequency domain (in Hz) quantifies events that repeat with respect to time. However, this may be misleading because patients have different heart rates. We hypothesized that quantifying frequency with respective to heartbeats may adjust for these heart rate differences. We applied this beat-frequency to improve two existing ECG predictive models, one based on ECG morphology, and the other based on instantaneous heart rate. We then used machine learning to find predictive frequency bands. When evaluated on thousands of patients after an acute coronary syndrome, our method significantly improved prediction performance (e.g., area under curve, AUC, from 0.70 to 0.75). In addition, the same bands were found to be predictive in different patients for beat-frequency, but not for the standard frequency domain. Next, we developed a method to transfer knowledge from published biomedical articles to improve predictive models when training data are scarce. We used this knowledge to estimate the relevance of features to a given outcome, and used these estimates to improve feature selection. We applied our method to predict the onset of several cardiovascular diseases, using training data that contained only 50 adverse outcomes. Relative to a standard approach (which does not transfer knowledge), our method significantly improved the AUC from 0.66 to 0.70. In addition, our method selected 60% fewer features, improving interpretability of the model by experts, which is a key requirement for models to see real-world use.
by Yun Liu.
Ph. D. in Medical Engineering
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Bennett, David M. "Effectiveness of clinical practice guidelines for treating asthma in the Department of Defense: A comparison of clinical and economic outcomes between the Army, Air Force, and Navy". Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/280138.
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The purpose of this research was to evaluate the strategy of the military health service (MHS) to improve asthma outcomes through the use of clinical practice guidelines (CPGs). Outcomes were evaluated at the patient level and included inpatient/outpatient visits, prescriptions dispensed, number of exacerbations, number of beddays and direct cost of therapy. In addition, provider compliance to CPG recommendations was evaluated by measuring the proportion of subjects dispensed long-acting controller medications. A nonrandomized control-group before-after design with retrospective matched-pair DoD data was used for this research. The intervention used in this research was the formal asthma CPG-use process implemented by the Army in September of 2000. Compared to baseline measures, all outcomes improved significantly (p < 0.05) in the after period for both the subjects exposed, and not exposed, to the CPG-use process. Other than the improvement noted in the number of asthma exacerbations, which was greater in the exposed group than the non-exposed group (p < 0.001), there was no other difference between groups in the amount that outcomes improved. The proportion of subjects prescribed long-term controller medications increased significantly for subjects exposed to the CPG-use process (0.30 to 0.66, p < 0.001), and for those not exposed to the CPG-use process (0.30 to 0.66, p < 0.001). Although the findings of this research suggested that a formal CPG-use process to standardize asthma therapy was associated with decreased costs, this was not supported by results regarding the clinical outcomes. To further evaluate the effect of asthma CPGs on economic and clinical outcomes, additional research is needed.
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Choucair, Khalil. "The clinical implications of the survival pathway in prostate cancer". Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110572.
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Prostate Cancer (PCa) is the second leading cause of cancer death in North Americanmen. The heterogeneity of the disease, along with the imperfection of the current prognostic determinants is a challenge to physicians who are unable to discriminate indolent cancers from those that will become life-threatening. Previous work has identified 3 molecular subtypes of PCa that correlated with clinical behaviour, and found the PI/AKT pathway genes to be up-regulated in metastatic samples compared to primary ones. Copy number alteration analysis on this group of patients showed frequent 16p13(PDPK1) genomic amplification and the 10q23 (PTEN) deletion. PDK1 activates thePI/AKT survival pathway, while PTEN inhibits it. In this study, we report for the first time the detection of the 16p13.3 (PDPK1) genomic gain in lymph node metastasis and their matched primary samples, in castration- resistant prostate cancer, and in unmatched primary prostate cancer samples. This localized gain was enriched in advanced disease compared to primary prostate cancer, and associated with high Gleason grade and high preoperative PSA levels, pointing its potential prognostic value. In vitro, we characterized a role for PDK1 in PCa cells motility, a crucial process in metastasis. This finding supports the idea of a role for the 16p13.3 (PDPK1) gain in PCa progression towards a more aggressive disease, and makes PDK1 a potential therapeutic target in patients with aggressive PCaLe cancer de la prostate (CaP) est la deuxième cause de décès par cancer chez les hommes nord-américains. L'hétérogénéité de la maladie, ainsi que l'imperfection des déterminants pronostiques actuels, constitue un défi pour les médecins qui sont incapables de distinguer les cancers indolents de ceux qui progresseront pour devenir mortels. Une étude antérieure a identifié 3 sous-types moléculaires de cancer de la prostate qui corrèlent avec le comportement clinique, et a rapporté une augmentation dans l'expression des gènes de la voie de signalisation PI/AKT dans les échantillons métastatiques, comparé aux cancers primaires. L'analyse des altérations génomiques dans ce groupe de patients a montré que l'amplification génomique 16p13 (PDPK1)et la délétion 10q23 (PTEN) sont fréquentes. PDK1 active la voie de survie PI /AKT, tandis que PTEN l'inhibe. Dans cette étude, nous rapportons pour la première fois la détection du gain génomique 16p13.3 (PDPK1) dans les métastases et de leurs échantillons appariés primaires, dans des spécimens de cancer de la prostate résistants à la castration, et dans des tumeurs primaire non-métastatiques. Le niveau de gain augmente dans les échantillons de stade avancé, soulignant ainsi une possible valeur pronostique. In vitro, nous avons caractérisé le rôle de PDK1 dans la motilité des cellules du cancer de la prostate, un processus essentiel à la métastase. Cette constatation appuie l'idée d'un rôle joué par le gain génomique 16p13 (PDPK1) dans la progression du cancer de la prostate vers une maladie létale, et rend PDK1 une cible thérapeutique potentielle chez les patients avec un cancer agressif.
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Federico, Carole. "The characterization of preclinical evidence for agents entering clinical development". Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=117175.
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The translation of basic biological discoveries into clinical applications that improve human health remains a slow, expensive, and failure-prone endeavor despite tremendous advances in genetics and molecular biology. Drug development failures have immense costs, including the burden of subjecting patient-volunteers to needless harms and the squandering of scarce resources that could be applied to more promising areas of research. To better understand why so many drugs that appear promising in preclinical studies perform so poorly in later trials, this thesis first developed a search method to capture a cohort of 371 novel agents entering clinical translation between 2000-2003 and then sought to determine the accessibility of preclinical in vivo efficacy evidence for these interventions. In general, there was a large volume of animal evidence available in the published literature (n=2735; 55/agent). However, the number of studies published prior to the first published account of human testing was modest (7/agent). This was especially true for agents that went on to receive regulatory approval; licensed drugs had, on average, half as many animal studies published prior to initial clinical trial publication (per agent) than unlicensed drugs. Furthermore, 16% of our sample of novel interventions had no antecedent animal data available whatsoever. This suggests that data withholding might take place earlier in development – perhaps especially where clinical promise is greatest. However, our ability to obtain a large volume of preclinical studies suggests the feasibility of synthesizing preclinical evidence to better understand why some drugs fail in clinical development.La traduction des découvertes biologiques fondamentales en applications cliniques améliorant la santé humaine reste une entreprise lente, coûteuse et encline à l'échec, malgré les importants progrès de la génétique et de la biologie moléculaire. Les échecs dans le processus de développement des médicaments ont des coûts énormes, dont ceux de causer préjudice à des patients-volontaires et de gaspiller des ressources rares qui pourraient servir à d'autres sphères de recherche plus prometteuses. Afin de comprendre pourquoi tant de médicaments en apparence prometteurs au stade des études précliniques obtiennent de si mauvais résultats lors d'essais cliniques postérieurs, cette thèse élabore une méthode de recherche visant dans un premier temps, à isoler une cohorte de 371 nouveaux agents entrant dans le processus de traduction clinique entre 2000 et 2003, et par la suite, à déterminer l'efficacité pour ces interventions, d'avoir eu accès à des études précliniques effectuées in vivo. De manière générale, on retrouve un important nombre d'études animales publiées dans le domaine (n=2735; 55/agent). Toutefois, le nombre de ces études publiées avant que celles des premières études effectuées sur les humains ne le soient, reste modeste (7/agent). Ceci est particulièrement vrai dans le cas des agents ayant obtenu par la suite, les approbations réglementaires afférentes. Pour les médicaments homologués, on répertoriait en moyenne par agent, la moitié moins d'études animales publiées avant la publication initiale d'essai clinique, que les médicaments non homologués. De plus, 16% des interventions de notre échantillon original n'étaient basées sur aucune donnée animale antérieure que ce soit. Ceci nous laisse croire à une retenue des données tôt dans le processus de développement – surtout peut-être lorsque les espoirs de réussites cliniques sont plus grands. Toutefois, le fait que nous puissions obtenir un grand nombre d'études précliniques laisse supposer qu'il est possible d'effectuer la synthèse des données précliniques afin d'être en mesure de mieux comprendre l'échec de certains médicaments au stade du développement clinique.
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Ernest, II Charles. "Benefits of Non-Linear Mixed Effect Modeling and Optimal Design : Pre-Clinical and Clinical Study Applications". Doctoral thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-209247.
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Despite the growing promise of pharmaceutical research, inferior experimentation or interpretation of data can inhibit breakthrough molecules from finding their way out of research institutions and reaching patients. This thesis provides evidence that better characterization of pre-clinical and clinical data can be accomplished using non-linear mixed effect modeling (NLMEM) and more effective experiments can be conducted using optimal design (OD). To demonstrate applicability of NLMEM and OD in pre-clinical applications, in vitro ligand binding studies were examined. NLMEMs were used to evaluate precision and accuracy of ligand binding parameter estimation from different ligand binding experiments using sequential (NLR) and simultaneous non-linear regression (SNLR). SNLR provided superior resolution of parameter estimation in both precision and accuracy compared to NLR. OD of these ligand binding experiments for one and two binding site systems including commonly encountered experimental errors was performed. OD was employed using D- and ED-optimality. OD demonstrated that reducing the number of samples, measurement times, and separate ligand concentrations provides robust parameter estimation and more efficient and cost effective experimentation. To demonstrate applicability of NLMEM and OD in clinical applications, a phase advanced sleep study formed the basis of this investigation. A mixed-effect Markov-chain model based on transition probabilities as multinomial logistic functions using polysomnography data in phase advanced subjects was developed and compared the sleep architecture between this population and insomniac patients. The NLMEM was sufficiently robust for describing the data characteristics in phase advanced subjects, and in contrast to aggregated clinical endpoints, which provide an overall assessment of sleep behavior over the night, described the dynamic behavior of the sleep process. OD of a dichotomous, non-homogeneous, Markov-chain phase advanced sleep NLMEM was performed using D-optimality by computing the Fisher Information Matrix for each Markov component. The D-optimal designs improved the precision of parameter estimates leading to more efficient designs by optimizing the doses and the number of subjects in each dose group. This thesis provides examples how studies in drug development can be optimized using NLMEM and OD. This provides a tool than can lower the cost and increase the overall efficiency of drug development.My name should be listed as "Charles Steven Ernest II" on cover.
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George, Joyce S. M. Massachusetts Institute of Technology. "An ontology model for clinical documentation templates". Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/33845.
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Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2005.Includes bibliographical references (leaves 46-47).
There are various kinds of clinical documents used in a hospital or clinic setting. With the emergence of Electronic Medical Records, efforts are being made to computerize these documents in a structured fashion in order to enable decision support. With structured data entry, because each fact about the patient is stored discretely and can be retrieved separately, information can be organized and presented in different ways, depending on the needs of the user. A typical structured clinical document contains a range of findings recorded by a physician, nurse or other care. These findings can be thought of as discrete pieces of information, called observations. These observations can be grouped together to form observation sets that can be placed under relevant headers within the document. When building information systems that support structured clinical documentation, these observations and sets are created and stored in catalogs. My thesis addresses the issue of building an ontology model for clinical documentation that supports the creation and management of an observations catalog, observation sets catalog and a clinical document catalog. The ontology can be used as an organizational tool for efficient maintenance of these catalogs. By tagging observations and observation sets with relevant attributes, it is possible to generate intelligent displays of data that are more flexible and dynamic.
by Joyce George.
S.M.
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Clokie, Cameron M. L. (Cameron Malcolm Lang). "The titanium-bone interface : a clinical and morphological analysis of osseointegration". Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=39399.
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Clinical and morphological investigations were carried out concerning the osseointegration of dental implants. A clinical evaluation of 1087 implants placed over a seven year time span revealed an osseointegration success rate of 96%. Studies indicated that, on average 8.7 months lapsed between implant insertion and prosthesis delivery. A technique was developed to evaluate the process of osseointegration with the light microscope (LM) and transmission electron microscope (TEM). A rat model was used and threaded implants were fabricated from solid commercially pure titanium. LM demonstrated osseointegration and a preservation of implant surface topography utilizing this technique. TEM analysis revealed an electron dense lamina-limitans like layer covered by an amorphous substance adjacent to the surface of the implant. $ sp3$H-proline was used to label seams of bone formation in order to evaluate the distribution and rate of formation of the new bone next to the metal implant. Bone appeared to grow from the old presurgical bone towards the implant with no apparent direct influence of the metal. A quail embryo model was developed to evaluate the effects of vascular occlusion on the formation of bone and to label epithelial blood vessels with iodinated transforming growth factor-beta 1 applied to the chorioallantoic membrane. These preliminary experiments demonstrated that surgical manipulation of the quail embryo was possible for the purposes of studying the process of osseointegration.
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Copeland, Aquanetta D. "A qualitative study of clinical oncology nurses' perceptions of work-life balance". Thesis, University of Phoenix, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3583280.
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The purpose of the hermeneutic phenomenological study was to explore the perceptions and lived-experience of work-life balance of oncology nurses living the Houston Metropolitan area. The two theories used to advance the study were work-family conflict and role stress theory. A single research question guided the study: How do oncology nurses perceive and describe the lived-experience of work-life balance? Twelve oncology nurses were interviewed to identify perceptions of work-life balance, understand from the nurses’ perspectives of the contribution of oncology work environment to work-life balance, to describe the experience of work-life balance, and to identify personal strategies that help the nurses achieve work-life balance. The study revealed nine major themes: (a) work-life balance is described as managing time between work and home; (b) time management and emotional demand are challenges oncology nurses face in achieving work-life balance; (c) the oncology work-environment creates challenges for nurses achieving work-life balance; (d) work-life imbalance creates negative effects for the nurse, the workplace, and the patient; (e) nurses had considered leaving oncology or the current nursing workplace because of work-life balance issues; (f) successful work-life balance has positive outcomes for employees and the workplace employer; (g) A nurses’ lifestyle and demographic factors contributes to successful work-life balance; (h) an organization’s benefits and resources contribute to successful work-life balance; and (i) self-care is a strategy nurses find useful for obtaining and maintaining work-life balance and self-care is important to psychosocial health. Recommendations include providing more staff recognition opportunities, providing more work-life balance resources, performing work-life balance nursing needs assessment, developing work-life balance programs, developing work-life balance champions, developing nurse caregiver programs, and improving marketing and communication regarding work-life benefits and programs. Education recommendations include educating staff about available work-life balance and self-care programs, increasing the amount of and access to oncology related educational opportunities, incorporating work-life balance and self-care in nursing educational programs, and providing time management learning opportunities designed specifically to address managing critically ill patients and high acuity. Finally, a recommendation for nursing practice is developing strategies that include flexible work schedules and self-scheduling.
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Tietjen, Joan Marie. "Loneliness in adults with schizophrenia, affective disorders or without clinical diagnosis". The Ohio State University, 1992. http://rave.ohiolink.edu/etdc/view?acc_num=osu1346957443.
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Perez, Leon Andres Alfredo. "A Smartphone-based System for Clinical Gait Assessment". Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6350.
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Patients with lower limbs problems are an increasing population in the US and many of them require surgery and its subsequent post-op Physical Therapy (PT). For all these patients, tracking their progress and evolution towards full recovery is very important. To assess the patients and track their progress, patients are usually required to perform very specific tests administered by a physical therapist. These tests either require very expensive equipment or rather require the subjective experience of the physical therapist who administer them. One of these tests is the Functional Gait Assessment (FGA) test, perhaps the most widely adopted one for gait assessment.
This thesis presents a system for Clinical Gait Assessment using exclusively the sensors embedded in today’s smartphones. The system processes the raw sensor data to perform the FGA test and calculate additional metrics, capable of identifying problems in the human gait. The system is therefore objective, as it is based on measurements; cheap, as it only requires a smartphone; mobile, as it can be used pretty much anywhere; and self-care, as it does not need the presence of a physical therapist.
The system was designed and tested on the Android OS with the phone attached to the back of the user using a belt or elastic band. It includes a new step detection algorithm with a mean absolute error of ±1 and algorithms to detect the deviation from a straight path with an accuracy of 90%, 80%, 35%, and 30% for each of the required deviation levels of the FGA test. Additionally, the system includes autocorrelation and DTW metrics, which provide additional information to detect different impediments of the user gait.
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Hamilton, Allison R. "A Clinical Documentation Practice Improvement to Increase Insurance Reimbursement". NSUWorks, 2019. https://nsuworks.nova.edu/hpd_con_stuetd/58.
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Background: The National Institute Mental Health (2015) estimated there were about 44.7 million people diagnosed with a serious mental illness and 62.9% of those diagnosed were without mental health services. The loss of services was due to unemployment, reoccurring hospitalization, inabilities to care for themselves, and lack of participation in societal norms (World Health Organization [WHO], 2014). According to Insel (2011/2015), the U.S. cost of mental healthcare was an estimated $57.5 billion in 2006. This cost was not due to actual care but associated with the economic burden of job loss and the excessive use of community resources. The Affordable Care Act (ACA) and the Mental Health Equality and Parity Act (MHEPA) has positively influenced access to mental healthcare, but healthcare coverage continues to be deficient. Insufficient clinical documentation practices decrease insurance reimbursement potential.
Purpose: The purpose of this quality improvement project was to enhance the current clinical documentation practices and policies and increase insurance reimbursement in an adult psychiatric inpatient unit in a private, non-profit mental and behavioral health organization.
Theoretical Framework: The Kurt Lewin’s 3 Step Change Management Theory
Methods: A quantitative design guided this project utilized an investigator-developed tool modeled from the CMS Inpatient Unit Worksheet as a data collection tool from the clinical chart documentation reviews.
Results: Fisher’s Exact and Chi square tests measured the cross tabulation of pre and post comparison sample frequency of staff’s integration of an evidence-based descriptive documentation method into practice. The results presented with statistical significance of the progress narrative notes. The declined chart claims a p <0.001, and the numbers related to case scenario utilization of the documentation method was p = 1.00.
Conclusion: The relationship between descriptive clinical documentation and insurance reimbursement was evident in the usage of the Data, Assessment/Action, Response, and Plan (DARP) method in the clinical documentation progress narratives notes. There was a 24% improvement in insurance reimbursement claims and a 17% decrease in charts declined for the study period.
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Kisat, Mehreen Teizoon, e Mehreen Teizoon Kisat. "Circulating Mitochondrial and Bacterial DNA as Biomarkers of Sepsis". Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/621839.
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Introduction: Sepsis is a leading cause of death in critically ill patients. Conventional methods of diagnostics in patients with suspected sepsis have limited sensitivity and long turnaround times. These factors contribute to indiscriminate use of broad-spectrum antibiotics and antimicrobial resistance. Our goal was to investigate where direct molecular analysis of circulating cell-free DNA in plasma could identify the microbial etiology of sepsis and improve assessment of prognosis. Methods: We conducted a prospective study of 30 consecutive patients suspected of sepsis in the Surgical Trauma ICU and compared with 22 healthy volunteer controls. Longitudinal plasma samples were collected at the time of workup for sepsis (day 0) and on days 7 and 14. Blood samples were collected in Streck Cell-Free DNA tubes and processed within 24 hours. DNA was extracted using QIAamp Circulating Nucleic Acid Kit. We measured mtDNA levels in plasma using real-time quantitative PCR targeting the mitochondrial NADH1 gene. Absolute mtDNA copies were calculated by comparing with known standards, pre-quantified using droplet digital PCR. Whole genome sequencing of cell-free DNA from plasma samples of three patients with positive blood cultures and 1 healthy volunteer control were performed to detect pathogen DNA. Results: We analyzed 72 serial plasma samples from 30 patients with suspected sepsis. Median mtDNA levels in controls were 602 ± 636 copies/µL of plasma (median ± IQR). In comparison, median mtDNA levels at day 0 in patients with SIRS were 3318 ± 1960 copies/µL (p<10⁻⁸, area under the ROC curve: 0.939). mtDNA levels were correlated with peripheral WBC count and respiratory rate (p=0.026 and 0.013 respectively) but not with temperature, heart rate or systolic BP. 3/30 patients died within the same hospital stay and last recorded mtDNA levels were higher as compared to survivors (p=0.028). Three out of thirty patients with a diagnosis of sepsis had positive blood cultures. Concordant results were found between conventional microbiology and next-generation sequencing of cell-free plasma DNA in 1 patient. Conclusions: Circulating mtDNA levels in patients with suspected sepsis are five-fold higher than healthy controls. Longitudinal changes in mtDNA are correlated with conventional markers of systemic inflammatory response and can be a biomarker for outcomes. Sequencing of cell-free DNA in plasma of sepsis patients can enable identification of bacteria and viral pathogens, although additional optimization of laboratory and informatics protocols is needed.
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Vandayar, Yuvika. "A retrospective investigation of sudden unexpected death in the young investigated at Salt River Mortuary, Cape Town". Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/33965.
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Sudden unexpected death in the young (SUDY) is the tragic fatality of seemingly healthy individuals aged between one and 40 years. Little is known about the demographics and risk factors of these cases at Salt River Mortuary (SRM), Cape Town. Therefore, this project aimed to retrospectively investigate the burden and profile of SUDY cases admitted to SRM, between 1 January 2016 and 31 December 2018. Of the total 11 588 cases admitted over this period, 833 (7.2 %) were SUDY cases, wherein males comprised the majority (64.3 %). Individuals were a median age of 31 ± 10.3 years at death, and the main location of death was ‘residential' (43.5 %). There were also significantly more males than females in the age category of 31 - 40 years who were found outdoors compared to all other locations (p < 0.001). Risk factors included physical activity, substance abuse, and co-morbidities with concomitant use of chronic medication. More than a third of individuals experienced breathlessness prior to death (45.0 %). Of cases with a confirmed natural cause of death, the main organ systems involved were pulmonary, cardiovascular, central nervous system and gastrointestinal, which parallels international trends. Akin to local studies, in analogous amounts, TB and pneumonia were the leading causes of death. Additionally, 21.1 % of cases were identified as candidates for genetic testing which may resolve undetermined cases or elucidate underlying predisposing factors to sudden death. Fortunately, 81.8 % had biological samples available for these retrospective analyses. Cases often had missing documentation which advocates for training to ensure compliance to standardised procedures. This study shows that males aged 31 ± 10.3 years with pulmonary and cardiac-related co-morbidities are the most vulnerable for SUDY whilst sleeping. Awareness interventions targeted at this population are thus needed in an attempt to reduce these tragic fatalities.
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Vorster, Nina. "Investigating the views and expectations of pregnant women who undergo genetic counselling for age-related risk of aneuploidy". Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/33968.
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Background: Pregnancy at advanced maternal age (AMA) is associated with an increased risk of aneuploidy. In the Western Cape's public health sector maternal age alone is widely used to screen women for high risk of pregnancies affected by aneuploidy. The weekly pregnancy counselling clinic (PCC) at Groote Schuur Hospital (GSH) offers genetic counselling (GC) for women who are of AMA to inform them about their age-related aneuploidy risk, offer invasive diagnostic testing (IDT) and discuss the option of voluntary termination of an affected pregnancy. A recent audit at GSH showed that the uptake of IDT was low and other literature reports that South Africans tend to have a conservative view regarding termination of pregnancy (TOP). This study sought to understand what women expect from the GC service at PCC as well as what their experiences are of the service. Methods: This qualitative phenomenological study used a pragmatic approach and participants were recruited through purposive sampling. Semi-structured, in-person interviews were conducted after women had completed their GC sessions at PCC. Thematic analysis was used to analyse the data. Results: The results of this study suggest that participants (n=7) received very little information about their GC appointments at referring clinics, and that they generally did not have prior knowledge about age-related aneuploidy risks. Finding out about the age-related risk of aneuploidy was an emotional experience for the participants, but other factors, including normal ultrasound results, provided relief. The participants' choices regarding IDT and attitudes towards TOP reflected that of available literature as the uptake was low and most participants reported that they would not consider a TOP. The women reported that they would use the knowledge they gained during GC to educate other women in their communities about the pregnancy risks associated with increased maternal age. Generally, the participants believed that GC was useful and appreciated the opportunity. Conclusion: The participants in this study had limited health literacy and knowledge regarding AMA risks and GC. As a result, participants had no expectations of GC. However, the participants felt that GC was useful in helping them prepare for the possibility of a child with DS, and generally viewed the service in a positive light. Additionally, this study's results suggests that there is a need to educate women in local communities regarding AMA pregnancy risks.
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Silva, Gustavo Marísio Bacelar da. "Exploring clinical guidelines and the representation of their clinical statments using openEHR". Dissertação, 2012. https://repositorio-aberto.up.pt/handle/10216/72960.
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Silva, Gustavo Marísio Bacelar da. "Exploring clinical guidelines and the representation of their clinical statments using openEHR". Master's thesis, 2012. https://repositorio-aberto.up.pt/handle/10216/72960.
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Hernandez, Maria-Elena. "Visualization for seeking and comparing clinical trials". Thesis, 2009. http://hdl.handle.net/1828/2006.
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The sheer quantity of information available on the Internet poses a challenge to users who need an efficient way of finding the information most relevant to their needs. One of the most frequent information-seeking activities of Internet users is the search for health and medical information. In this research, I focus on the user process of seeking information on clinical trials which are the only evidence-based source of information in the medical domain. Through my work, I show that improvements for seeking clinical-trial information could be made to enhance the effectiveness of seeking and gathering results from clinical trials. Unfortunately, little work has been reported on alternative methods and on visualization systems in particular for these enhancements. I suggest that this omission may be due to a lack of understanding of the particular information needs of users of clinical-trial data. Understanding the users' needs is the first step towards providing more effective interfaces to support them in the information seeking process.
In this dissertation, I investigate 1) how information is accessed in the medical domain; more specifically, how users seek clinical-trial information on the Internet and 2) how to improve current Web-seeking interfaces for clinical-trial users. I discuss my findings from three exploratory studies: moderated discussion with professional researchers of clinical trials, an online questionnaire with health professionals and patients who search the clinical trial domain, and a qualitative query log analysis of a popular medical search engine.
The results of this research indicate that most of the time users are successful in finding the information they require. However, the process of seeking clinical-trial information is tedious, frustrating and time consuming, because current search interfaces do not sufficiently support users seeking this kind of information. Based on the findings from my studies, I propose a set of design principles to design better seeking interfaces. I validate my findings and the set of design principles with two visualization tools that support users in performing information-seeking tasks in the clinical-trial domain. Finally, I provide initial evidence that my proposed designs are indeed helpful with finding, summarizing and comparing information in this complex medical domain.
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Basílio, Francisco José Andrade. "Clinical and Forensic Aspects of Pharmacobezoars". Master's thesis, 2020. https://hdl.handle.net/10216/128929.
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Introdução: Farmacobezoares são um tipo específico de bezoar que se forma quando medicamentos, como comprimidos, suspensões e/ou sistemas de libertação de fármacos se agregam, e podem causar a morte através da oclusão das vias aéreas com material tenaz ou através da eluição dos fármacos resultando em concentrações sanguíneas letais ou tóxicas.
Objetivo: Este trabalho pretende fazer uma revisão completa do estado da arte em relação à patofisiologia, diagnóstico, tratamento e outros aspetos relevantes clínicos e forenses dos farmacobezoares.
Resultados: Pacientes de várias idades e de ambos os sexos apresentam-se com sinais e sintomas de intoxicação, ou mais comummente com obstruções gastrointestinais. O exato mecanismo da formação dos farmacobezoares é desconhecido, mas possivelmente é multifatorial. O diagnóstico e tratamento dependem do segmento gastrointestinal afetado e devem ser personalizados para o fármaco e fator subjacente. História clínica completa, exame físico, testes de imagem, endoscopia alta e cirurgia por laparotomia do trato gastrointestinal inferior são úteis para o diagnóstico e tratamento.
Conclusão: Farmacobezoares são raramente vistos na prática clínica e forense. Estão relacionados com formulações de libertação controlada ou imediata, substâncias líquidas ou não digeríveis, em tratos gastrointestinais normais ou com alterações da motilidade/anatomia, e em overdoses ou doses terapêuticas, e devem ser suspeitados na presença de fatores de risco ou em pacientes que tomam medicamentos que podem formar farmacobezoares.Background: Pharmacobezoars are specific types of bezoars formed when medicines, such as tablets, suspensions, and/or drug delivery systems, aggregate and may cause death by occluding airways with tenacious material or by eluting drugs resulting in toxic or lethal blood concentrations. Objective: This work aims to fully review the state-of-the-art regarding pathophysiology, diagnosis, treatment and other relevant clinical and forensic features of pharmacobezoars. Results: Patients of a wide range of ages and in both sexes present with signs and symptoms of intoxications or more commonly gastrointestinal obstructions. The exact mechanisms of pharmacobezoar formation are unknown but is likely multifactorial. The diagnosis and treatment depend on the gastrointestinal segment affected and should be personalized to the medication and the underlying factor. A good and complete history, physical examination, image tests, upper endoscopy and surgery through laparotomy of the lower tract are useful for diagnosis and treatment. Conclusion: Pharmacobezoars are rarely seen in clinical and forensic practice. They are related to controlled or immediate-release formulations, liquid or non-digestible substances, in normal or altered digestive motility/anatomy tract, and in overdoses or therapeutic doses, and should be suspected in the presence of risk factors or patients taking drugs which may form pharmacobezoars.
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Basílio, Francisco José Andrade. "Clinical and Forensic Aspects of Pharmacobezoars". Dissertação, 2020. https://hdl.handle.net/10216/128929.
Texto completo da fonteResumo:
Introdução: Farmacobezoares são um tipo específico de bezoar que se forma quando medicamentos, como comprimidos, suspensões e/ou sistemas de libertação de fármacos se agregam, e podem causar a morte através da oclusão das vias aéreas com material tenaz ou através da eluição dos fármacos resultando em concentrações sanguíneas letais ou tóxicas.
Objetivo: Este trabalho pretende fazer uma revisão completa do estado da arte em relação à patofisiologia, diagnóstico, tratamento e outros aspetos relevantes clínicos e forenses dos farmacobezoares.
Resultados: Pacientes de várias idades e de ambos os sexos apresentam-se com sinais e sintomas de intoxicação, ou mais comummente com obstruções gastrointestinais. O exato mecanismo da formação dos farmacobezoares é desconhecido, mas possivelmente é multifatorial. O diagnóstico e tratamento dependem do segmento gastrointestinal afetado e devem ser personalizados para o fármaco e fator subjacente. História clínica completa, exame físico, testes de imagem, endoscopia alta e cirurgia por laparotomia do trato gastrointestinal inferior são úteis para o diagnóstico e tratamento.
Conclusão: Farmacobezoares são raramente vistos na prática clínica e forense. Estão relacionados com formulações de libertação controlada ou imediata, substâncias líquidas ou não digeríveis, em tratos gastrointestinais normais ou com alterações da motilidade/anatomia, e em overdoses ou doses terapêuticas, e devem ser suspeitados na presença de fatores de risco ou em pacientes que tomam medicamentos que podem formar farmacobezoares.Background: Pharmacobezoars are specific types of bezoars formed when medicines, such as tablets, suspensions, and/or drug delivery systems, aggregate and may cause death by occluding airways with tenacious material or by eluting drugs resulting in toxic or lethal blood concentrations. Objective: This work aims to fully review the state-of-the-art regarding pathophysiology, diagnosis, treatment and other relevant clinical and forensic features of pharmacobezoars. Results: Patients of a wide range of ages and in both sexes present with signs and symptoms of intoxications or more commonly gastrointestinal obstructions. The exact mechanisms of pharmacobezoar formation are unknown but is likely multifactorial. The diagnosis and treatment depend on the gastrointestinal segment affected and should be personalized to the medication and the underlying factor. A good and complete history, physical examination, image tests, upper endoscopy and surgery through laparotomy of the lower tract are useful for diagnosis and treatment. Conclusion: Pharmacobezoars are rarely seen in clinical and forensic practice. They are related to controlled or immediate-release formulations, liquid or non-digestible substances, in normal or altered digestive motility/anatomy tract, and in overdoses or therapeutic doses, and should be suspected in the presence of risk factors or patients taking drugs which may form pharmacobezoars.