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Gellerstedt, Martin. "Interpretation of diagnostic information given patient characteristics /". Göteborg : Institute of Biomedicine, The Sahlgrenska Academy at Göteborg University, 2006. http://hdl.handle.net/2077/720.
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Brez, Sharon. "Adult learners' perspectives on screening reading ability for patient teaching". Thesis, University of Ottawa (Canada), 1995. http://hdl.handle.net/10393/9879.
Texto completo da fonteResumo:
The expectation of greater individual responsibility for health promotion practices and decision making in hospitals is dependent upon knowledgeable consumers. The heavy reliance on printed material for both gathering and disseminating information in hospitals has led to recommendations that literacy screening tests be considered to enhance the efficacy of patient teaching interventions for the significant number of adults with low literacy skills. A qualitative case study design was used to investigate the response of adults with low literacy skills to literacy screening. Data were collected through in depth interviews including an experience using the Rapid Estimate of Adult Literacy in Medicine (REALM) word recognition tool. Analysis was achieved using a constant comparison technique. A conceptual model of response to screening was developed and compared to the Health Belief Model and Knox's Proficiency Theory of adult learning. While all participants supported the principle of screening in the context of the hospital, response to the REALM experience was variable. Factors found to influence responses to screening included perceived risks of illiteracy exposure, perceived risks of non-disclosure during hospitalization and the attribution of characteristics to the hospital leading to it's designation as a "special" place. Specific responses to the REALM were found to be further influenced by a set of individual historic factors. The results have lead to several recommendations for health care professionals considering utilization of literacy screening instruments.
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Santander, Mercado Alcides Ricardo. "Identification of Patient Recovery Patterns after Cardiovascular Surgery Based on Laboratory Tests Results". Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3332.
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In this dissertation is proposed a methodology to identify patient's recovery patterns after cardiovascular surgery based on laboratory tests results. The main purpose is to enhance the understanding of the manifestations of postsurgical complications in patients who underwent cardiovascular surgery. The analysis of patients' recovery process is based on the relationship between plasma calcium, ionized calcium and platelet count over time.
Laboratory results from the James A. Haley Veterans' Hospital databases, related to patients admitted to the Surgical Intensive Care Unit (SICU) after cardiac surgery (coronary artery bypass, aortic value replacement and mitral valve replacement), are used. These databases contain information regarding commonly ordered tests such as Complete Blood Count tests (CBC) and Basic Metabolic Panel (BMP) for a large group of patients over time. Physicians usually order these tests as a component of screening, routine evaluation, or serial assessment. These test results, contain a large amount of information used by most physicians during the diagnosis process and patient monitoring.
This study creates time series of some components of the aforementioned tests to analyze their behavior during the perioperative and postoperative period. Time series based clusters are developed to determine the similarities among tests results from four different types of patients: patients who had a satisfactory recovery process without any manifestation of complications, patients who experienced complications but survived,
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patients who experienced complications and then died during their recovery and patients who died during the perioperative period. As a conclusion, the time series based clustering techniques were able to identify whether a patient is likely to fully recover from the surgery, but it does not have the power to detect effectively results corresponding to a patient experiencing complications.
The development of this methodology provides statistical evidence of the differences among different patterns on patient recovery. It is clear that patients experiencing complications have a steeper drop of test results after surgery, and also a non-stable trend towards normal levels. The appropriate use of the proposed methodology could help to timely anticipate complications in patient condition, improve the comprehensiveness of the assessment of patient condition based on laboratory test results and enhance the utilization of laboratory results databases.
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Lee, Katherine JS. "Lowering the Number of False Positive Responses to Electric Pulp Tests by Qualifying Patient Response". VCU Scholars Compass, 2015. http://scholarscompass.vcu.edu/etd/3712.
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The electric pulp test (EPT) has been shown to be a valuable tool in assessing pulp vitality. One of its drawbacks, however, is its high number of false positives. The purpose of this study was to determine if qualifying the type of sensation elicited by the test could lower the percentage of false positive responses. A retrospective chart review of an eleven-month period was conducted, examining all patients with necrotic teeth tested with the EPT. Of 189 teeth, when the patient responded to EPT at first sensation 23.3% of teeth were incorrectly identified as vital. When the patient was asked to respond only if they felt an uncomfortable sensation, the false positive rate was lowered to 8.5%, a statistically significant difference. No association was found between the teeth reclassified as necrotic and age, gender, type of tooth, or number of canals.
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Garratt, Andrew M. "A comparison of four approaches to measuring health outcome". Thesis, University of Aberdeen, 1997. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU094377.
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Objectives. To compare four diverse approaches to measuring patient perceptions about health outcomes; the SF-36 Health Survey; clinically derived condition specific instruments; daily time trade-off (DTTO); patient generated index (PGI). The relationship between the instruments and their responsiveness to changes in Health Related Quality of Life (HRQL) was assessed. Results. The response rate exceeded 75% (1327 respondents). The SF-36 had Cronbach's Alpha values above the criterion of 0.7. Test-retest estimates were above 0.7 for al but the role-limitations scales which were above the criterion of 0.5. The specific instruments produced Alpha values and test-retest estimates above 0.7. The DTTO and PGI produced estimates of reliability above 0.5. Evidence for the construct validity of the SF-36 was demonstrated by the differences in scale scores between the general population and four condition-specific groups. Evidence for the construct validity of the specific instruments and PGI was demonstrated by the significant moderate levels of correlation with the SF-36. Evidence for the validity of all four approaches was demonstrated by patient scores behaving as predicted in relation to condition-specific and sociodemographic variables. Comparisons of the four approaches show that the relationship between them is condition dependent. Score changes for the SF-36, specific instruments and PGI were significantly related to self reported health transition. The SRMs for the specific instruments were significantly greater than those for the SF-36. Conclusions. These results demonstrate that the SF-36 has similar properties in United Kingdom patient populations as those in the United States and is satisfactory for comparisons of groups. The clinically derived approach is recommended for constructing instruments where no suitable condition-specific instrument exists. These two approaches are recommended for use as part of a package of instruments for assessing health outcomes.
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Bongard, Emily. "Uncomplicated urinary tract infection in primary care : evaluation of point of care tests and patient management". Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/85515/.
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Antibiotic resistance is an increasing global public health problem. Resistance is increasing sharply in gram-negative organisms, including Escherichia coli (E. coli), the main causative organism for community-acquired urinary tract infection (UTI). Antimicrobial stewardship strategies in primary care to help contain antibiotic resistance include supporting general practitioners (GPs) in deciding whether to prescribe an antibiotic for UTI and selecting the most appropriate antibiotic. In this thesis, I aim to describe the management of uncomplicated UTI in primary care and evaluate potential point of care tests (POCT) to assist the diagnosis and/or appropriate prescribing of antibiotics for uncomplicated UTI. The program of work includes: 1. Laboratory evaluation of a culture-based test that allows the quantification, identification and susceptibility profile of infecting bacteria from urine (FlexicultTM). 2. Evaluation of a novel chromatic sensing technique to identify bacterially infected urine compared to visual assessment of urine turbidity and urinalysis dipsticks. 3. Systematic review and analysis of data (descriptive and multi-level modelling) from an international primary care based observational study to describe UTI management. I identified unwarranted variation in clinical management of UTI between countries and between general practices within countries. Empirical antibiotic prescribing for UTI in Europe is high and treatment is generally prescribed for longer than guidelines recommend. FlexicultTM identifying bacterial UTI. The use of FlexicultTM in practice may support GPs in screening out negative samples reducing the proportion of patients that are prescribed antibiotics empirically. Chromatic sensing and visually assessing turbidity were equally useful at identifying negative urine samples and both improved the analytic performance of urinalysis dipsticks. The chromatic sensing system requires development prior to further evaluation.
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Righter, Emily Stewart. "Graphical and Bayesian Analysis of Unbalanced Patient Management Data". Diss., CLICK HERE for online access, 2007. http://contentdm.lib.byu.edu/ETD/image/etd1710.pdf.
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Isouard, Godfrey, of Western Sydney Macarthur University e Faculty of Health. "A total quality management approach to appropriate clinical laboratory test utilisation in acute myocardial infarction". THESIS_FH_XXX_Isourd_G.xml, 1996. http://handle.uws.edu.au:8081/1959.7/20.
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The first goal of this investigation was to undertake a non-equivalent quasi-experimental design to test the effect of a total Quality management (TQM) approach to improve the appropriateness of clinical laboratory test utilisation in the management of early acute myocardial infarction (AMI). The study was conducted at 2 public hospitals in Sydney over a 30 month period, and in 2 stages- pre and post TQM intervention. Using specifically a Continuous Quality Improvement (CQI) FOCUS-PDCA model, a multidisciplinary team was empowered to make appropriate changes in order to improve a variety of problem areas that affected the total pathology service. Improvement was directed at the total system of pathology testing, not just test ordering. It was observed that the introduction of a TQM environment had provided a more committed, integrated and motivated clinical care effort towards improving the appropriateness of test ordering. Such team efforts were accompanied by demonstrated customer satisfaction at various aspects of the laboratory service and further benefits to patient care. Patient care benefited greatly from the highly significant changes towards more appropriate timing of blood collections for cardiac enzyme testing. Other improvements included overall improvements to the turnaround time of test results, reductions in specimen delivery delays, more appropriate use of clinical laboratory tests, a streamlined distribution of printed reports and marked improvements in communication between staff involved in the process of test ordering. Of major importance was the finding that CQI strategies resulted in substantial savings of 23.0% of the overall cost of pathology services. Adoption of the TQM approach appears to be a strategy worthy of exploration by laboratory directors and health administrators interested in improving patient care while at the same time reducing expenditure.Doctor of Philosophy (PhD)
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Isouard, Godfrey, University of Western Sydney e Faculty of Health. "A total quality management approach to appropriate clinical laboratory test utilisation in acute myocardial infarction". THESIS_FH_XXX_Isouard_G.xml, 1996. http://handle.uws.edu.au:8081/1959.7/670.
Texto completo da fonteResumo:
The first goal of this investigation was to undertake a non-equivalent quasi-experimental design to test the effect of a total Quality management (TQM) approach to improve the appropriateness of clinical laboratory test utilisation in the management of early acute myocardial infarction (AMI). The study was conducted at 2 public hospitals in Sydney over a 30 month period, and in 2 stages- pre and post TQM intervention. Using specifically a Continuous Quality Improvement (CQI) FOCUS-PDCA model, a multidisciplinary team was empowered to make appropriate changes in order to improve a variety of problem areas that affected the total pathology service. Improvement was directed at the total system of pathology testing, not just test ordering. It was observed that the introduction of a TQM environment had provided a more committed, integrated and motivated clinical care effort towards improving the appropriateness of test ordering. Such team efforts were accompanied by demonstrated customer satisfaction at various aspects of the laboratory service and further benefits to patient care. Patient care benefited greatly from the highly significant changes towards more appropriate timing of blood collections for cardiac enzyme testing. Other improvements included overall improvements to the turnaround time of test results, reductions in specimen delivery delays, more appropriate use of clinical laboratory tests, a streamlined distribution of printed reports and marked improvements in communication between staff involved in the process of test ordering. Of major importance was the finding that CQI strategies resulted in substantial savings of 23.0% of the overall cost of pathology services. Adoption of the TQM approach appears to be a strategy worthy of exploration by laboratory directors and health administrators interested in improving patient care while at the same time reducing expenditure.Doctor of Philosophy (PhD)
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De, Beer Neal. "Development of a process chain for digital design and manufacture of patient-specific intervertebral disc implants with matching endplate geometries". Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6564.
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Thesis (PhD (Industrial Engineering))--University of Stellenbosch, 2011.ENGLISH ABSTRACT: Back pain is a common concern amongst a growing population of people across the world today, where in most cases the pain can become unbearable resulting in major lifestyle adjustments. Seventy to eighty percent of the population of the Western world experiences low-back pain at one time or another. Pain can be produced as a worn disc becomes thin, narrowing the space between the vertebrae. Pieces of the damaged disc may also break off and cause irritation to the nerves signalling back pain. Depending on the severity of a patient’s condition, and after conservative treatment options have been exhausted, a disc replacement surgery (arthroplasty) procedure may be prescribed to restore spacing between vertebrae and relieve the pinched nerve, while still maintaining normal biomechanical movement. Typical complications that are however still observed in some cases of disc implants include: anterior migration of the disc, subsidence (sinking of disc) and lateral subluxation (partial dislocation of a joint). Issues such as function, correct placement and orientation, as well as secure fixation of such a disc implant to the adjacent vertebrae are highly important in order to replicate natural biomechanical behaviour and minimise the occurrence of the complications mentioned. As various imaging and manufacturing technologies have developed, the option for individual, patientspecific implants is becoming more of a practical reality than it has been in the past. The combination of CT images and Rapid Manufacturing for example is already being used successfully in producing custom implants for maxilla/facial and cranial reconstructive surgeries. There exists a need to formalise a process chain for the design and manufacture of custom-made intervertebral disc implants and to address the issues involved during each step. Therefore this study has investigated the steps involved for such a process chain and the sensible flow of information as well as the use of state-of-the-art manufacturing technologies. Strong emphasis was placed on automation of some of the processes as well as the user-friendliness of software where engineers and surgeons often need to work together during this multi-disciplinary environment. One of the main benefits for customization was also investigated, namely a reduction in the risk and potential for implant subsidence. Stiffness values from pressure tests on vertebrae were compared between customized implants and implants with flat endplate designs. Results indicated a statistically significant improvement of customized, endplate matching implants as opposed to flat implant endplates. Therefore it may be concluded that the use of customized intervertebral disc implants with patient specific endplate geometry may decrease the risk and potential for the occurrence of subsidence.
AFRIKAANSE OPSOMMING: Rugpyn is ‘n algemene bekommernis vir ‘n groeiende populasie van mense in die wêreld vandag, waar in meeste gevalle die pyn ondraagbaar kan raak en groot leefstyl aanpassings vereis. Sewentig tot tagtig persent van die populasie in die Westerse wêreld ondervind lae rugpyn op een of ander stadium. Die pyn kan veroorsaak word deur ‘n intervertebrale skyf wat verweer en dunner word, en veroorsaak dat die spasie tussen die vertebrae vernou. Stukkies van die beskadigde skyf mag ook afbreek en irritasie aan die senuwees veroorsaak wat verdere pyn kan veroorsaak. Afhangende van die ernstigheid van ‘n pasiënt se geval, en nadat opsies vir konservatiewe behandeling uitgeput is, kan ‘n skyf vervangings-prosedure (artroskopie) voorgeskryf word om die spasie tussen die vertebrae te herstel en sodoende die geknypte senuwee te verlos. Die skyf vervanging herstel spasiëring tussen vertebrae terwyl die normale biomeganiese beweging ook behoue bly, in teenstelling met ‘n fusieprosedure wat die betrokke vertebrae aanmekaar vasheg en normale beweging belemmer. Tipiese komplikasies wat egter steeds na ‘n skyf vervanging in sommige gevalle waargeneem word sluit in: anterior migrasie van die inplantaat, insinking, sowel as laterale sublukasie (gedeeltelike dislokasie van ‘n gewrig). Faktore soos funksie, korrekte posisionering en orientasie, sowel as vashegting van so ‘n skyf inplantaat tot die aanliggende vertebrale bene is besonder belangrik om natuurlike biomeganiese beweging te herstel en sodoende bogenoemde komplikasies te verminder. Soos wat verskeie beeldings- en vervaardigingstegnologië verbeter het oor die laaste dekade, het die moontlikheid vir individuele, pasiënt-spesifieke inplantate al hoe meer ‘n praktiese realiteit begin word. Die kombinasie van Gerekenariseerde Tomografie (GT), tesame met Snel Vervaardiging word byvoorbeeld reeds suksesvol aangewend tydens die ontwerp en vervaardiging van pasiënt-spesifieke inplantate vir maksilla- en kraniale rekonstruktiewe chirurgie. Daar bestaan egter ‘n behoefte om ‘n formele prosesketting vir die ontwerp en vervaardiging van pasiënt-spesifieke intervertebrale skyf inplantate te ontwikkel en om belangrike faktore tydens elke stap noukeurig te beskryf. Hierdie studie het na die verskillende stappe in die prosesketting gekyk om ‘n sinvolle vloei van informasie en benutting van hoë gehalte vervaardigingstegnologië saam te snoer. Sterk klem was gelê op outomatisering van prosesse asook gebruikersvriendelikheid van sagteware waar ingenieurs en medici dikwels saam moet werk tydens hierdie kruisdissiplinêre omgewing. Een van die hoof verwagte voordele met die gebruik van pasklaar skyf inplantate, naamlik die vermindering van moontlike insinking van die inplantaat in die been, is ook ondersoek. Die ondersoek het druktoetse behels en die vergelyking van ooreenstemmende styfheid tussen inplantate wat die kontoer van die bene volg teenoor gewone plat eindplate. Die resultate was statisties beduidend in die guns van die pasklaar inplantate wat die beenkontoere gevolg het, en bewys dus dat die risiko vir insinking verminder is.
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Fischer, Shira H. "Factors Associated with Ordering and Completion of Laboratory Monitoring Tests for High-Risk Medications in the Ambulatory Setting: A Dissertation". eScholarship@UMMS, 2011. https://escholarship.umassmed.edu/gsbs_diss/543.
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Since the Institute of Medicine highlighted the devastating impact of medical errors in their seminal report, “To Err is Human” (2000), efforts have been underway to improve patient safety. A portion of medical errors are due to medication errors, and a large portion of these can be attributed to inadequate laboratory monitoring.
In this thesis, I attempt to address this small but important corner of this patient safety endeavor. Why are patients not getting their laboratory monitoring tests? Do they fail to complete them or do doctors not order the tests in the first place? Which prescribers and which patients are least likely to do what is needed for testing to happen and what interventions would be most promising?
To address these questions, I conducted a systematic review of existing interventions. I then proceeded with three aims: 1) To identify reasons that patients give for missing monitoring tests; 2) To identify patient and provider factors associated with monitoring test ordering; and 3) To identify patient and provider factors associated with completion of ordered testing.
To achieve these aims, I worked with patients and data at the Fallon Clinic. For aim 1, I conducted a qualitative analysis of their reasons for missing tests as well as reporting completion and ordering rates. For aims 2 and 3, I used electronic medical record data and conducted a regression with patient and provider characteristics as covariates to identify factors contributing to test ordering and completion.
Interviews revealed that patients had few barriers to completion, with forgetting being the most common reason for missing a test. The quantitative studies showed that: older patients with more interactions with the health care system were more likely to have tests ordered and were more likely to complete them; providers who more frequently prescribe a drug were more likely to order testing for it; and drug-test combinations that were particularly dangerous, indicated by a black box warning, were more likely to have appropriate ordering, though for these combinations, primary care providers were less likely to order tests appropriately, and patients were less likely to complete tests.
Taken together, my work can inform future interventions in laboratory monitoring and patient safety.
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Yoo, Julie Keunhee. "What makes personalized medicine work? : an empirical analysis of the role of product attributes, medical professional societies and patient groups in the diffusion of four breast cancer genetic tests". Thesis, Massachusetts Institute of Technology, 2009. http://hdl.handle.net/1721.1/54595.
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Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2009.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 69-73).
Personalized medicine is the science and practice of customizing medical screening and treatment plans for an individual based on his or her genomic profile. Breast cancer is one of the first disease areas to serve as an example of this approach, where most patients have experienced its benefits through the use of genetic tests that provide decision support for health care workers regarding the likely effectiveness of specific drugs and, more broadly, the urgency of particular treatment options (for example, chemoprevention versus prophylactic surgery). Little is known about the diffusion of such personalized approaches to medical practice, particularly the factors shaping the adoption of genetic tests. While numerous medical diffusion studies have been published over the past few decades, most were univariate analyses and did not consider the unique aspects of genetic testing versus drugs. Moreover, they mainly focused on the characteristics and behaviors of physicians, patients, product manufacturers, and social networks, and did not explore the role of potentially important third parties like professional medical societies and patient groups (e.g. disease foundations and patient advocacy organizations). The aim of this thesis was to analyze the relationship between seven attributes of four breast cancer genetic tests and clinical adoption to show that standard diffusion frameworks can be enhanced through previously unstudied dimensions when evaluating personalized medicine-related innovations.
(cont.) We identified four variables that correlated with clinical adoption: 1) regulatory status, 2) inclusion in practice guidelines by professional societies, 3) explicit endorsement by patient groups, and 4) implicit endorsement by patient groups. Our findings indicate that a key overlooked element in the current literature (and potentially overlooked by the firms creating these tests) is the role of patient groups in the diffusion of novel genetic tests, in addition to endorsement from medical professional societies. These findings may add value to strategic decisions made by company executives, investors, payers, health care providers, and patients as they are presented with novel products and development opportunities in the era of personalized medicine.
by Julie Keunhee Yoo.
S.M.
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Woerlé, Johanne. "L'information du patient en oncogénétique : l'annonce du résultat négatif issu du test de prédisposition BRCA chez le cas-index". Thesis, Grenoble, 2012. http://www.theses.fr/2012GRENH030.
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Au cours de ces dernières décennies, des progrès considérables ont été réalisés dans le domaine de l'oncogénétique, activité médicale basée sur les avancées scientifiques de la biologie moléculaire permettant de prédire le risque de survenue d'un cancer. Néanmoins, dans 80% des cas, les analyses génétiques initiales, réalisées auprès de patientes atteintes d'un cancer du sein et/ou de l'ovaire, ne permettent pas d'identifier une mutation délétère sur l'un des deux gènes BRCA. Dans ce cas, le résultat est dit « négatif », alors qu'il existe toujours un facteur génétique résiduel et le risque de développer un autre cancer justifiant la poursuite de la surveillance personnelle et familiale. En collaboration avec des médecins oncogénéticiens de la région Rhône-Alpes, nous avons interrogé les modalités de transmission de l'information dans ce contexte, en évaluant d'une part l'apport d'un document écrit remis aux patientes à l'issue de la consultation et d'autre part la nécessité du cadre de la consultation. Nous avons également tenté de mieux discerner la manière dont les informations orales sont perçues par les patientes. Pour ce faire, nous avons interviewé 88 patientes au cours d'un entretien clinique de recherche et 172 patientes ont répondu à un questionnaire. Les résultats obtenus ont montré : - l'utilité de délivrer un document écrit résumant les informations orales transmises par le médecin ; - le cadre indispensable de la consultation pour délivrer le résultat négatif ; - l'existence d'un message paradoxal, dans la mesure où le résultat « non concluant » est annoncé comme négatif, rendant la compréhension de l'information plus difficileOver the last decades, major progresses have been realized in oncogenetics. This medical activity based on scientific advances in molecular genetics predicts cancer risk. However, no deleterious mutation is detected by BRCA1/2 genetic testing for the majority (80 %) of women who suffer from either breast or ovarian cancer. Under this condition, the result is considered as “inconclusive” although there remains an increased risk for developing breast and/or ovarian cancer. The failure to identify a mutation in a diagnostic test does not rule out the existence of a predisposing factor. Surveillance should be pursued for both the patients and their families. In association with genetic counselors of the region Rhône-Alpes, we considered useful to address the question of information delivery in the context of an inconclusive result. We investigated on one hand the benefit from a written document delivered to patients upon the appointment, and on the other hand the usefulness of a disclosure session. We also investigated how patients experienced the oral information given during the counsel session. Therefore, we conducted semi-structured interviews with 88 women while 172 women answered a questionnaire. The observations demonstrate : - a written document, summarizing the oral information delivered by the oncologist, is useful for patients with an inconclusive result; - a disclosure session is absolutely necessary to announce the inconclusive result; - the presence of a “paradox” when the inconclusive result is delivered as a negative one, increasing the degree of comprehension of information more difficult
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Duconseil, Pauline. "Le décryptage omique de l'hétérogénéité de l'adénocarcinome pancréatique : de la paillasse au lit du patient". Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0108/document.
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L'hétérogénéité de l'adénocarcinome canalaire pancréatique (ADCP) est l'obstacle majeur au traitement efficace des patients. En effet, les caractéristiques cliniques et la sensibilité aux traitements sont associés à un phénotype donné et sont plutôt régis à un niveau transcriptomique. Nous avons donc analysé le transcriptome de xénogreffes provenant des patients (Patients Derived Xenografts : PDX) lors des biopsies de tumeurs ou de pièces chirurgicales. Après extraction d’ARN, nous avons trouvé une signature moléculaire capable de diviser les patients en deux groupes, en fonction de leur survie. Nous avons également montré que la réponse autraitement pouvait être prédite par l‘analyse transcriptomique. Nous avons ensuite analysé les tumeurs et leurs stromas, et mis en évidence deux soustypesde stromas et deux sous-types de tumeurs, définis par la transcriptomique basée sur l'ARN, ou la méthylation de l'ADN. Nous avons étudié la réponse aux traitements administrés seuls ou en combinaison avec des chimiothérapies de routine. Nous avons mis en évidence des sous-groupes de patients plus chimiosensibles à certains traitements. Tous ces résultats sont encourageants,mais pas encore applicables en pratique clinique. Nous développons maintenant les organoïdes, véritable représentation de la tumeur en 3dimensions. Contrairement aux PDX, les organoïdes nous permettent d'obtenir des résultats rapidement exploitables. Nous pensons que dans un avenir proche, le traitement des cancers du pancréas sera précédé d'une caractérisation moléculaire étendue afin de sélectionner les traitements les plus appropriés et de pouvoir enfin proposer une médecine personnaliséeHeterogeneity of Pancreatic Ductal AdenoCarcinoma (PDAC) has become the majorimpediment to the effective treatment of patients. Clinical outcome and sensitivity to treatments are associated with a given phenotype and associated at a transcriptomic level. Recent data indicate that studying the expressionof a selected gene set could inform selection of the most appropriate treatments.We areoptimizing this approach by analysing transcriptome of Patient-Derived Xenografts (PDX)from surgical as well as endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)biopsies of tumors, as a source of RNA. We have found a molecularsignature capable of dividing patients into two groups, function of theirsurvival.Independently, we have shown that treatment response pattern can also be foundat a transcriptomic level. We thenanalysed tumors and their stromas, and have found two sub-types of stromas and two sub-types of tumors. These wereindinstinctly defined by RNAseq-based transcriptomics, or DNA methylation. We also studied response to treatments administered alone or incombination to routine chemotherapies. All these results are encouraging, but not yetapplicable in clinical pratice. We are now developing the PDAC Biopsy DerivedPancreatic Cancer Organoids (BDPCO): BDPCO culture represents an excellent source of “exvivo” material. Unlike PDX, which take many months to grow, BDPCO allow us to obtainexploitable material rapidly useful for clinical application. We are convinced that in the near future, the treatment ofpancreatic cancers will be preceded by an extensive molecular characterization of cancercells in order to select the most appropriate treatments
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Lima, Rhanna Emanuela Fontenele. "Adaptação transcultural do Safety Attitudes Questionnaire para o Brasil - questionário de atitudes de segurança". Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-30112011-085601/.
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Em 2004, a Organização Mundial de Saúde (OMS) definiu como prioridade o desenvolvimento de pesquisas baseadas em evidências científicas com melhores práticas voltadas para a segurança do paciente. Desde então, vários estudos surgiram com o objetivo de avaliar a cultura de segurança nas instituições de saúde, por meio de instrumentos de mensuração do clima de segurança. Dessa forma, o objetivo desse estudo foi realizar a adaptação transcultural do Safety Attitudes Questionnaire (SAQ) - Short Form 2006 para a língua portuguesa. O instrumento foi aplicado em seis hospitais de três regiões do Brasil, Nordeste, Sudeste e Centro- Oeste. Para a tradução e adaptação cultural do instrumento seguiu-se a proposta metodológica de Beaton et al (2002). A validade de conteúdo e face foi realizada pela análise dos juízes e pelo pré-teste. A validade de construto foi realizada pelas análises fatorial exploratória e confirmatória e comparação entre grupos. A análise da confiabilidade do instrumento foi realizada por meio da análise da consistência interna dos itens, através do coeficiente alfa de Cronbach. A amostra do estudo foi composta por 1301 profissionais das enfermarias clínicas e cirúrgicas dos seis hospitais. A aplicação do instrumento ocorreu nos meses de julho a outubro de 2010. O estudo foi aprovado pelos comitês de Ética em Pesquisa das seis instituições. A versão adaptada para a língua portuguesa do SAQ apresentou alfa de Cronbach total de 0,89. As correlações item-total entre os domínios foram consideradas de moderada a forte, com exceção do domínio Percepção do Estresse. A análise confirmatória mostrou que o ajuste do modelo final dos 41 itens foi considerado satisfatório. Na análise fatorial exploratória o item 14, que não pertence a nenhum domínio na escala original, foi alocado no domínio Percepção da Gerência e os itens 33, 34 e 35 foram alocados em um único domínio. Quanto ao método de comparação de grupos identificou-se diferença de médias estatisticamente significativa entre hospitais e tempo de atuação. Conclui-se, portanto que a versão adaptada do Safety Attitudes Questionnaire para o Português é considerada válida e confiável em nossa amostra.In 2004, the World Health Organization (WHO) has defined as priority the development of evidence-based research with best practices for patient safety. Since then, several studies have begun to evaluate the safety culture in healthcare institutions, by means of instruments measuring the safety climate. Thus, the objective of this study was the cultural adaptation of the Safety Attitudes Questionnaire (SAQ) - Short Form 2006 for the Portuguese language. The instrument was applied in six hospitals in three regions of Brazil: Northeast, Southeast and Midwest. For the translation and cultural adaptation of the instrument followed the methodological approach of Beaton et al (2002). The face and content validity analysis was performed by judges and the pre-test. Construct validity was performed by exploratory and confirmatory factor analysis and method of comparison groups. Analysis of instrument reliability was performed by analyzing the internal consistency of items through the Cronbach coefficient. The study sample was comprised of 1,301 professionals in clinics and surgical wards of six hospitals. The application of the instrument occurred from July to October 2010. The study was approved by the Research Ethics Committee of six institutions. A version adapted to Portuguese SAQ showed Cronbach\'s alpha of 0.89. The item-total correlations between the domains were considered moderate to strong, except for domain Stress Recognition. The confirmatory analysis showed that the model fitting end of the 41 items was satisfactory. The exploratory factor analysis the item 14, which has no domain in the original scale, was allocated in the domain Perception of Management and items 33, 34 and 35 were allocated in a single component. The method of comparison groups were identified statistically significant average difference between hospitals and years specialty. We conclude that the SAQ Portuguese version was considered valid and reliable in our sample.
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Bourgoin, Pénélope. "Recherche de nouveaux tests rapides en cytométrie en flux pour l’établissement de diagnostics « aux lits des patients » : application à la discrimination des infections bactériennes et/ou virales en vue de réduire l’usage inutile des antibiotiques". Thesis, Aix-Marseille, 2020. http://theses.univ-amu.fr.lama.univ-amu.fr/200213_BOURGOIN_959uvzsse391uijk154knph339nyhkrq_TH.pdf.
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Les maladies infectieuses sont des pathologies dont le diagnostic étiologique est souvent complexe. Le clinicien doit baser son diagnostic sur ses observations cliniques et les relier aux mesures biologiques du patient. Plusieurs groupes recherchent activement de nouveaux marqueurs biologiques pour préciser ce diagnostic. C’est dans cette optique que la cytométrie en flux a été utilisée et optimisée pour comparer l’expression de nouveaux biomarqueurs sur les cellules du sang des patients infectés ou des sujets sains. La caractérisation des mécanismes d’expression des marqueurs montre que l’expression du CD64 sur les neutrophiles est amplifiée chez les patients infectés par une bactérie via l’interféron γ, alors que l’expression du CD169 sur les monocytes est amplifiée chez les patients infectés par un virus via la famille des interférons de type I (α, β, ω). De plus, l’expression de l’HLA-DR sur les monocytes semble aider à l’identification étiologique de l’infection. Les travaux suggèrent que le dosage de ces trois biomarqueurs par la technique de cytométrie en flux optimisée pourrait être un candidat intéressant dans les études sur le diagnostic des infections bactériennes et viralesInfectious diseases are pathologies whose etiological diagnosis is often complex. The clinician must base his diagnosis on his clinical observations and link them to the patient's biological measurements. Several groups are actively seeking new biomarkers to clarify this diagnosis. It is for this purpose that flow cytometry has been used and optimized to compare the expression of new biomarkers on blood cells of infected patients or healthy subjects. Characterization of the expression mechanisms of the markers shows that the expression of CD64 on neutrophils is amplified in patients infected by a bacterium via interferon γ, whereas the expression of CD169 on monocytes is amplified in patients infected with a virus via the type I interferon family (α, β, ω). In addition, the expression of HLA-DR on monocytes seems to help the etiological identification of the infection. The work suggests that the assay of these three biomarkers combined into an optimized flow cytometry technique could be an interesting candidate in studies on the diagnosis of bacterial and viral infections
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Neumark, Thomas. "Treatment of Respiratory Tract Infections in Primary Care with special emphasis on Acute Otitis Media". Doctoral thesis, Linköpings universitet, Allmänmedicin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-54832.
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Background and aims: Most respiratory tract infections (RTI) are self-limiting. Despite this, they are associated with high antibiotic prescription rates in general practice in Sweden. The aim of this thesis was to evaluate the management of respiratory tract infections (RTIs) with particular emphasis on acute otitis media (AOM). Methods: Paper I: A prospective, open, randomized study of 179 children presenting with AOM and performed in primary care. Paper II & III: Study of 6 years data from primary care in Kalmar County on visits for RTI, retrieved from electronic patient records. Paper IV: Observational, clinical study of 71 children presenting with AOM complicated by perforation, without initial use of antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.
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Pasquier, Laurent. "Enjeux sociétaux et de l'organisation des soins liés à la généralisation de l'accès aux tests génétiques en France : analyse des évolutions en cours et évaluation qualitative des pratiques auprès de médecins non-généticiens". Thesis, Normandie, 2020. http://www.theses.fr/2020NORMC418.
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Il est acquis que l’utilisation des tests génétiques fait partie des pratiques courantes de nombreuses spécialités médicales. Pourtant la réalisation d’un test génétique soulève des problématiques spécifiques qui impactent la trajectoire de vie des personnes, à court terme, mais aussi à long terme, en bousculant les notions de prévention, de prédiction, de santé, de maladie, tant pour le patient et que pour sa famille. Ces tests génétiques soulèvent des questions centrales pour les choix que doivent faire les individus et la société lors de leur mise en œuvre (respect des droits fondamentaux, gestion des résultats et de l’incertitude, équilibre entre le secret médical et le droit des tiers…). Il convient de se demander comment accompagner le développement rapide d’une médecine génomique, pour laquelle la plupart des médecins n’ont pas été spécifiquement formés. Analyser la façon dont ces professionnels intègrent ces tests génétiques à la relation soignante est essentiel pour préparer à un meilleur usage de la génomique par tous.Par le biais d’une approche multidisciplinaire alliant des médecins généticiens, des juristes, sociologues, spécialistes d’éthique, et associations de patients, nous avons mené une réflexion sur les enjeux médicaux, éthiques, sociologiques et juridiques dans le cadre de la réalisation des tests génétiques à l’échelle d’une population. Nous avons également mené une étude qualitative composée d’une série d’entretiens semi-structurés en focus groups auprès de 21 médecins spécialistes en neurologie et endocrinologie, autour de leurs pratiques en génétique.Sur les bases de ces réflexions et de cette étude qualitative, nous suggérons de mettre en œuvre une certaine forme de régulation avec la promotion d’une véritable politique d’accompagnement des pratiques médicales autour des tests génétiques en :1. Promouvant la recherche autour de l’utilité médicale des tests génétiques pour le patient et sa famille au regard des incertitudes liées au résultat notamment lorsqu’il s’agira de proposer des tests génétiques en population générale.2. Orientant les pratiques vers une approche systémique de nature pluridisciplinaire par équipe ou en réseau (incluant des spécialistes d’organes et des spécialistes généticiens cliniciens et biologistes) comme une arène de ressources efficace pour faire face aux incertitudes dans l’interprétation d’un résultat, aux situations limites du côté technique ou clinique et permettre, si besoin, la réalisation de consultations en binômes.3. Accumulant des éléments quantitatifs supplémentaires autour de ces pratiques, des éléments juridiques, économiques et de confrontations avec les professionnels de santé impliqués dans la médecine génomique pour faire évoluer le cadre réglementaire, qui n’apparait aujourd’hui que partiellement adapté à la réalisation de tests génétiques en population et aux pratiques médicales. Ce travail de fond parait indispensable afin d’éclairer le législateur avant toutes modifications lors d’une prochaine révision de loi relative à la Bioéthique.2. Favorisant une réelle autonomie des patients en évitant d’inclure la proposition de ce test génétique dans une procédure automatisée de soins. La seule réalisation d’un consentement écrit ne peut pas être de nature à justifier cette banalisation du test génétique compte tenu des enjeux associés aux résultats. Cette autonomie pourrait être accrue par une sensibilisation des médecins prescripteurs lors des sessions de formation médicale continue et par une meilleure acculturation de la génétique par le grand public.Au total ce dialogue entre les disciplines médico-techniques génétiques et les sciences humaines et sociales apparait pertinent dans la mesure où les enjeux sociétaux apparaissent particulièrement nombreux et sensibles. Cela serait de nature à proposer un accompagnement adéquat pour chaque personne et sa famille en génétique médicaleGenetic testing is widely accepted to be a common practice in many medical specialties. Nonetheless, it raises specific issues that impact the trajectory of people’s lives, not only in the short term, but in the long term as well, and shakes up notions of prevention, prediction, health and illness for patients and their families. These genetic tests raise questions central to the choices individuals and society must make when using them, such as respecting basic rights, handling results and uncertainty and balancing concerns for medical confidentiality with the rights of third parties. We need to consider how to help physicians deal with the rapid development of genomic medicine, for which most of them are not specifically trained. Analysing how these professionals integrate genetic testing into the patient-provider relationship is essential to paving the way for a better use of genomics by all.We used a multidisciplinary approach that brings together medical geneticists, legal experts, sociologists, ethicists and patient associations to conduct a discussion on the medical, ethical, sociological and legal stakes of widespread genetic testing. We also conducted a qualitative study made up of a series of semi-structured interviews in focus groups with 21 neurologists and endocrinologists about their genetic testing practices.Based on these discussions and the qualitative study, we recommend implementing regulations that promote a true policy supporting medical practices surrounding genetic testing by:1. Promoting research about the medical usefulness of genetic testing for patients and their families in face of the uncertainties related to test results, especially when it involves offering genetic testing to the general population.2. Orienting practices toward a systemic approach using a multidisciplinary team or network (including organ specialists and clinical and biologist geneticists) to provide resources for dealing with uncertainties in interpreting results or situations that require additional technical or clinical skills and, if necessary, to allow for joint consultations with both a geneticist and a non-geneticist medical specialist.3. Collecting additional quantitative data about these practices, including legal and economic data, and meeting with health professionals involved in genomic medicine to effect changes in the regulatory framework, which currently seems to be only partially suited to widespread genetic testing and medical practices. This groundwork seems essential to educating legislators before any changes are made during an upcoming revision of the French Bioethics Act.4. Promoting real patient autonomy and avoiding the recommendation of genetic testing in automated care management procedures. The simple fact of having a written consent cannot justify making genetic testing commonplace given the stakes associated with the results. Autonomy could be increased by providing prescribing physicians with continuing medical education sessions to make them aware of the issues and increasing public’s level of genetic literacy.All in all, this dialog between genetic medical/technical disciplines and human and social sciences seems relevant considering the many difficult social challenges. Such a dialog is likely to recommend appropriate support for each patient and family with regard to medical genetics
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Hamidzadeh, Mahnaz. "Reliability of patient self-measure physical performance test among mixed cancer patients (stage I-IV)". Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=96761.
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Physical performance is a useful and complementary method of monitoring cancer and its impact. Patient self measurement of physical performance would be very useful. This study evaluated the reliability of self-measured Simmonds Physical Performance Task Battery (SPPT) among mixed cancer patients (stage I-IV). Eighty six adults participated. Performance on the SPPT was measured simultaneously by the patient and the practitioner. The procedure was repeated one week later. Intra-Class Correlation (ICC) coefficients showed that test-retest reliability and inter-rater reliability of self-measured performance for the seven SPPT tasks was good to excellent (ICC1, 1= 0.87-0.963 and ICC1, 2= 0.93-0.97, respectively). Except for the six minute walk, mean performance scores were systematically higher for patient compared to practitioner measures (p<.0005). Self measurement is reliable and patients should be instructed to measure and monitor their physical performance as an indicator of disease state. Patient and practitioner methods of measurement can not be used interchangeably.La performance physique constitue une méthode utile et complémentaire pour le suivi du cancer et de son impact. Dans ce contexte, l'auto-évaluation de la performance physique par le patient serait très utile. L'étude a évalué la fiabilité de la batterie de tests de Simmonds pour l'auto-évaluation de la performance physique (SPPT) chez un groupe mixte de patients cancéreux (stade I–IV). Quatre-vingt-six patients adultes y ont pris part. La performance selon la batterie SPPT a été mesurée simultanément par le patient et le praticien. La procédure a ensuite été répétée une semaine plus tard. Les coefficients de corrélation intraclasse (ICC) ont démontré que la fiabilité test-retest et inter-examinateur de la performance auto-évaluée à l'égard des sept tâches de la batterie SPPT était de bonne à excellente (ICC1,1= 0,87– 0,963 et ICC1,2= 0,93–0,97, respectivement). Sauf pour la marche de six minutes, les scores moyens de performance se sont révélés systématiquement plus élevés chez les patients comparativement aux mesures du praticien (p<,0005). L'auto-évaluation est donc fiable et on devrait donner comme consigne aux patients de mesurer et de suivre leur performance physique en tant qu'indicateur de l'état pathologique. Toutefois, les méthodes de mesure – celle du patient et celle du praticien – ne peuvent être utilisées de manière interchangeable.
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Barks, Lee. "Wheelchair positioning and pulmonary function in children with cerebral palsy". [Tampa, Fla.] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0002107.
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Pupulim, Jussara Simone Lenzi. "Satisfação do paciente hospitalizado com sua privacidade física: construção e validação de um instrumento de medida". Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-01042009-112211/.
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Estudo do tipo metodológico com abordagem psicométrica que lida com a teoria e desenvolvimento de instrumentos de medição. O percurso metodológico norteou-se nos procedimentos teóricos, empíricos e analíticos para a elaboração de instrumento psicométrico (PASQUALI, 1998), e fundamentou-se em duas teorias da privacidade (WESTIN, 1970; ALTMAN, 1975), na teoria da territorialidade (ARDREY, 1966) e na teoria proxêmica (HALL, 1986). Os procedimentos teóricos compreenderam a definição do construto privacidade física no contexto hospitalar, em especial a exposição e manipulação corporal, o qual delineou-se a partir do referencial teórico adotado, da literatura pertinente e de estudo junto a 34 pacientes internados nos hospitais de Maringá-PR, com abordagem qualitativa, utilizando-se a análise de conteúdo (BARDIN, 2000). Esse estudo permitiu descrever a percepção do paciente hospitalizado sobre a privacidade em geral e sobre a privacidade física, identificando-se três categorias empíricas referentes à privacidade em geral, a saber, dignidade e respeito, espaço pessoal e territorial e autonomia, e com relação à privacidade física extraíram-se iguais categorias, acrescentando-se às anteriores a categoria intimidade e toque. Tais categorias compuseram os quatro domínios do instrumento em construção. O instrumento foi submetido à análise semântica e conceitual por um painel de juízes composto por sete peritos, e na seqüência a um pré-teste junto à população-alvo, resultando em um instrumento com 22 itens, tendo o domínio dignidade e respeito 8 itens, intimidade e toque e espaço pessoal e territorial 5 itens cada, e o domínio autonomia 4 itens. Os procedimentos empíricos englobaram a aplicação do instrumento construído, Escala de Satisfação do Paciente Hospitalizado com sua Privacidade Física (ESPH-PF), a uma amostra de 254 pacientes internados na rede hospitalar de Maringá- PR, entre novembro de 2007 e fevereiro de 2008. Os procedimentos analíticos englobaram a análise da consistência interna ( de Cronbach total de 0,68 e variação entre 0,35 e 0,60 nos domínios) e a validade de construto por meio da análise fatorial, extraindo-se seis fatores (57,6% da variância total) e optando-se por manter os quatro pré-estabelecidos (47,7% da variância explicada). A validade convergente do construto utilizando-se a correlação produtomomento de Pearson (p < 0,01) e aplicação da Escala do Sentimento frente à Invasão do Espaço Territorial e do Espaço Pessoal do Paciente Hospitalizado (EMS-FIETEP), contemplou o domínio espaço pessoal e territorial da ESPH-PF e confirmou o poder discriminativo de todos os 22 itens do instrumento. A validade discriminante do construto empregando o teste t de student (p < 0,05) não encontrou diferença estatística significante, exceto nos grupos extremos relativos à escolaridade. A análise psicométrica demonstra que a ESPH-PF pode ser aplicada para medir a satisfação do paciente com sua privacidade física no contexto hospitalar, sobretudo no que diz respeito à exposição e manipulação corporal. Os resultados obtidos junto a essa população não podem ser generalizados, porém comprovam a importância de se avaliar a satisfação do paciente com sua privacidade física, visto que o nível de satisfação revela, implicitamente, as preferências e necessidades dele por privacidade, e indiretamente também reflete o desempenho dos profissionais de saúde relativo à proteção e manutenção da privacidade no hospital.The study is of a methodological type using the psychometric approach which deals with the theory of the development of measurement instruments. The methodological apparatus is based on empirical and analytical theoretical proceedings, to the development of a psychometric instrument (PASQUALI, 1998), and is grounded in two privacy theories (WESTIN, 1970; ALTMAN, 1975), on the territoriality theory (ARDREY, 1966) and on the proxemic theory (HALL, 1986). The theoretical proceedings entailed the definition of the physical privacy construct in hospital context, especially the exposure and body manipulation, drawing on the theoretical apparatus used, the related literature and a study with thirty-four patients admitted in hospitals in Maringá-PR, with qualitative approach, using the content analysis (BARDIN, 2000). This study allowed to describe the perception of the hospitalized patient as regards general privacy and physical privacy, identifying three empirical categories concerning general privacy, namely dignity and respect, personal and territorial space and autonomy, and as regards physical privacy the same categories were extracted, adding to the previous ones the category of intimacy and touch. Such categories composed the four domains of the instrument under construction. The instrument was subjected to semantic and conceptual analyses by a panel of judges composed by seven connoisseur, followed by a pretest with the target population, resulting in an instrument with 22 items, in which the domain dignity and respect had eight items, intimacy and touch and personal and territorial space had five items each, and the domain autonomy had four items. The empirical proceedings entailed the application of the constructed instrument, Satisfaction Scale of the Hospitalized Patient with his/her Physical Privacy (ESPH-PF), to a sample of 254 patients admitted in the hospital chain of Maringá-PR between November 2007 and February 2008. The analytical proceedings entailed the internal consistency analysis (-Cronbach total of 0,68 variation between 0,35 and 0,60 in the domains) and the construct validity by means of factorial analysis, extracting six factors (57,6% of total variation) and opting to maintain the four preestablished ones (47,7% of explained variation). The convergent validity of the construct utilizing the correlation product-moment of Pearson (p < 0,01) and the application of Feeling Scale before the Invasion of Territorial and Personal Space of the Hospitalized Patient (EMSFIETEP) contemplated the domain personal and territorial space of ESPH-PF and confirmed the discriminating power of all 22 items of the instrument. The discriminating validity of the construct employing the test t of student (p < 5005) did not find significant statistical difference, except for extreme groups regarding education. The psychometric analysis shows that the ESPH-PF can be applied to measure the patients satisfaction with his/her physical privacy, once the level of satisfaction implicitly reveals his/her privacy preferences and necessities, and also indirectly reflects the performance of health professionals as regards protection and maintenance of hospital privacy.
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Manton, Jesse West. "Medical Emergency Management in the Dental Office: A Simulation-Based Training Curriculum for Dental Residents". The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1565360422025093.
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Camart, Nathalie. "Approche dimensionnelle de la personnalité de patients phobiques sociaux : étude psychométrique et projective". Paris 10, 2005. http://www.theses.fr/2005PA100070.
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L'objectif de cette recherche est d'étudier la personnalité de patients phobiques sociaux dans une approche dimensionnelle, basée sur le modèle en cinq facteurs et complétée par une méthode projective. Dans ce but, 100 patients phobiques sociaux ont passé l'inventaire de personnalité NEO PI-R et 50 le test de Rorschach et ont été comparés à des patients dépressifs. Les données obtenues au NEO PI-R montrent l'existence de traits de personnalité propres aux phobiques sociaux. Un indice de dépistage a pu être établi. Ces résultats sont discutés à la lumière de l'apport de l'approche dimensionnelle pour le diagnostic et la définition de la phobie sociale et des nombreuses perspectives théoriques et pratiques qui en découlent. Les résultats obtenus au Rorschach montrent des particularités intéressantes mais qui ne ressortent pas à grande échelle. Ils sont discutés dans le cadre d'une réflexion sur la nature des réalités psychologiques mesurées par ce testThe object of this study is the evaluation of social phobic patients' personality in a dimensional approach, based on the five-factor model and completed by a projective method. 100 social phobic patients have been assessed the personality inventory NEO PI-R, and 50 the Rorschach test and then have been compared to depressed patients. The findings of the NEO- PI-R reveal specific personality traits of social phobic patients. An detection index of this disorder have been identified. The findings are discussed in the light of the dimensional approach for the diagnosis and definition of social phobia, the theoretical and practical perspectives resulting from it. The Rorschach's results show interesting particularities but they do not appear on a large scale. They are discussed considering the nature of psychological realities measured by this test
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Romijn, François. "S’exposer en inquiétude. Le sujet fait et défait avec les médiations nouvelles sur sa santé". Thesis, Paris Sciences et Lettres (ComUE), 2018. http://www.theses.fr/2018PSLEH038.
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L’être humain est de plus en plus souvent inscrit dans des contextes où lui est accessible un savoir nouveau sur sa vie biologique (e.g., gènes, épigénome, neurones, microbiote). À portées de mains ou de clics, des médiations toujours plus nombreuses (e.g. tests génétiques prédictifs en matière de santé ; « récréatifs », relatifs à l’« ancestralité biogéographique », microbiote intestinal ou à l’« âge épigénétique » ; applications dites de « self-tracking ») mettent l’usager en relation avec des formats d’information de plus en plus diversifiés (e.g., SNP’s, diagnostics, probabilités exprimées sous forme de pourcentages de développer des maladies ou d’autres conditions : réponses de l’organisme à certains pathogènes et molécules, résistance à certaines pathologie, et d’autres propriétés qui seraient influencées par la génétique, comme la longévité ou les facultés cognitives). La découverte de ces données biologiques éprouve la personne et la confronte à de nouvelles inquiétudes qu’elle doit traverser.Menée sur base de trois terrains situés dans le champ de la santé (consultation médicale, usage du web en matière de santé, et usage d’auto-tests tests génétiques), cette recherche contribue à la compréhension de ce phénomène de société. Elle s’applique en particulier à préciser la variété des façons dont la personne intègre ces données nouvelles qui s’accompagnent d’une prétention à un réalisme fort. Dans certains cas, ces technologies fournissent à l’individu une image objectivante de son « identité ». L’approche préconisée s’articule à un questionnement anthropologique singulier : Comment la personne s’arrange-t-elle de situations dans lesquelles elle est mise en relation non plus seulement avec d’autres humains mais au premier titre avec des données objectivantes relatives à son intériorité biologique ? Cette question anthropologique invite à porter au moins autant d’attention à ce qui nous relie à autrui et à notre environnement (deux questions classiquement situées au cœur du projet de la sociologie), qu’aux façons dont l’humain assure une continuité avec lui- même dans des situations où le vivant pose question. Cette recherche démontre que la conduite effectivement adoptée par les usagers des trois médiations examinées est irréductible à l’attente d’autonomie souvent promue comme prise en charge de sa santé relevant d’un plan d’action orienté vers un but à atteindre. Soutenue par des outils sociologiques qui sous-tendent une conception plurielle du sujet et de l’action, cette recherche attire l’attention sur des dynamiques peu traitées dans les sciences sociales de la santé. L’examen attentif du maintien du sujet mis à l’épreuve de ces nouveaux savoirs jette une lumière nouvelle sur l’habileté de l’humain à évoluer entre une pluralité de positions, de définitions de ce qu’il se passe et/ou de qui il est afin de s’arranger de ces découvertes qui insécurisent son état de sujet. Plutôt que de considérer le caractère ambivalent, équivoque et parfois carrément ambigu de la conduite de l’usager comme un échec de l’analyse, ce travail contribue à une approche de la composition dans le rapport à soi et à autruiMore than ever before humans have access to new knowledge about their biological life (e.g., genes, biochemical marks influencing phenotypes, neurons, microbiota). This knowledge is progressively transfered out of laboratories and into commercial markets. Then, by means of an ever-increasing number of readily available mediations (e.g. direct-to-consumer (epi)genomic tests (DTC GT), health-related uses of the Internet, direct-to-consumer genomic tests, self-tracking applications on smartphones) layusers are connected to an increasingly diverse array of data (e.g., online diagnostics, genomic predispositions, probabilities, SNP’s). My doctoral thesis develops an investigation of the practices whereby individuals ensure continuity with others/themselves when confronted to new knowledge related to their biology. Knowing the so-called “real” or potential biological endowment of oneself but also of others has tremendous social, political and ethical consequences. These new reflexive technologies grant individuals with an objectifying image of their “identity”. These new objectifying data related to the biological self puts the subject to test. They confront them to inquietudes they have to cope with.Built on three fieldworks located in the field of health (the classic medical examination, health-related information on the Internet, health-related direct-to-consumer genomic tests), this research fosters a better understanding of this social phenomenon. My investigation specifically seeks to clarify the variety of ways that allow individuals to integrate these new data marked with a strong degree of realism. The approach set forth in this research revolves on a specific anthropological question: how human beings find arrangements with situations in which they are not only confronted to others but also with objectifying data related to their biological life? This anthropological problematic invites us to bring at least as much attention to what connects us with others than to the specific ways individuals ensure continuity with themselves in contexts where the “living” raises question. My research demonstrates that the conduct actually adopted by users of the three mediations studied is irreducible to the expected liberal autonomy often promoted in the literature as “management of one’s health”. A careful analysis of the subject’s consistence facing this new knowledge highlights social dynamics that have received little attention in the field of social sciences of health. The fieldworks carried out provide new insights on the human ability to bring together different positions or definitions of what is happening and/or who you are in order to arrange with these discoveries that challenge their subject consistency. Rather than considering the equivocal features and sometimes the outright ambiguity of the conducts as a failure of the analysis, this research effort contributes achieving a better understanding of the pervasiveness of composition in our relationship to our self and the others in social contexts related to biology
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Michou, Georges. "Etude du test a la metyrapone, et comparaison aux tests a la dexamethasone et au trh, chez 43 patients deprimes". Université Louis Pasteur (Strasbourg) (1971-2008), 1986. http://www.theses.fr/1986STR1M155.
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Henophy, Sara Catherine 1983. "Test-re-test reproducibility of constant rate step and shuttle walking tests for the assessment of exertional dyspnea in patients with chronic obstructive pulmonary disease (COPD)". Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=116085.
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Purpose: Exercise testing modalities to assess the effects of a given intervention should prove to be reliable and reproducible. This study reports on test-retest reproducibility of the 3-min shuttle walking and step testing exercise protocols to assess exertional dyspnea and exercise physiology in COPD patients.Methods: Stable COPD patients (N=43; 65 +/- 6.5 years; FEV1 = 49 +/- 16% pred.) equipped with a portable Jaeger Oxycon MobileRTM metabolic system repeated the walking or stepping tests on two occasions separated by 7 to 14 days. At each visit, participants performed, in a randomized order, four externally paced 3-min bouts of shuttle walking at speeds of 1.5, 2.5, 4.0 and 6.0 km·h-1 or of stepping at a constant rate of 18, 22, 26 and 32 steps·min-1, respectively. Each exercise bout was separated by a 10-min rest period. Ventilation, heart rate, gas exchange parameters and Borg dyspnea score were obtained for each bout during the last 30-seconds of exercise.
Results: The majority of patients completed stepping or walking at the slowest cadence but only 33% completed walking at 6.0 km·h -1 and 40% completed stepping at 32 steps·min-1. Test-retest Pearson correlation coefficients for ventilation, heart rate, gas exchange parameters and dyspnea scores over the four exercise bouts, all exceeded 0.80 with the highest coefficient found for ventilation (r≥.95). Intra-class correlation coefficients were similar to Pearson. Bland & Altman representation showed that a similar proportion of dyspnea data points (92 vs. 96%) lied within 2 SD of the mean difference between test-retest values for dyspnea Borg scores during walking and stepping.
Conclusion: Results show very good reproducibility for both 3-min shuttle walking and stepping exercise protocols in patients with COPD.
This study was supported by an unrestricted grant from Boehringer-Ingelheim/Pfizer.
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Magalhães, Ana Tereza de Matos. "Contribuição do avanço tecnológico do processador de fala para usuários de implante coclear Nucleus 22®". Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5143/tde-03012014-123922/.
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Objetivo: Identificar as contribuições tecnológicas do processador de fala Freedom® para pacientes implantados com Nucleus 22® e a satisfação dos usuários com a nova tecnologia. Entre os novos recursos disponíveis, foram analisados o efeito da tabela de alocação de frequências, o T-SPL e C-SPL e o ajuste de pré-processamento do som (ADRO®). Material: Este estudo foi prospectivo e exploratório. Foram incluídos adolescentes e adultos implantados com Nucleus 22® no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, usuários efetivos do processador de fala Spectra®, com alguma percepção de frases em contexto fechado e sem experiência anterior com a nova tecnologia. Foram selecionados 17 pacientes, entre as idades de 15 e 82 anos, e implantados há mais de oito anos. Para determinar a contribuição do Freedom®, os limiares auditivos e os testes de percepção de fala foram realizados com o último mapa utilizado com o Spectra® e comparados os mapas criados com o Freedom®. Para identificar o efeito da tabela de alocação de frequências, ambos os mapas convertidos (mesma tabela) e atualizados (tabela nova) foram programados. A tabela escolhida foi mantida, e foram realizados três mapas com diferentes parâmetros: o programa 1 (P1) com T-SPL de 30 dB e do C-SPL de 70 dB, programa 2 (P2) com T-SPL de 25 dB e do C-SPL de 65 dB, e o programa 3 (P3) com ADRO®. A ordem de apresentação dos mapas e dos testes foi randomizada. Para avaliar a satisfação com seus dispositivos auditivos foram utilizados os questionários SADL e APHAB após um mês e um ano de uso do Freedom®. Resultados: A contribuição do processador de fala Freedom® para pacientes usuários do Nucleus 22® foi estatisticamente superior em comparação com o Spectra® em todos os testes de percepção da fala e em todos os limiares audiométricos, tanto individualmente quanto em média, com exceção de 8000 Hz. Em relação à escolha da tabela de frequência, 64,7% dos pacientes (n=11) mantiveram o mapa com a tabela de frequências do Spectra®. Comparando os mapas com diferentes T-SPL e C-SPL, houve diferença estatística tanto nos limiares audiométricos de 500, 1000, 1500 e 2000 Hz quanto na média. Não houve diferença estatística entre os testes de fala com ou sem o uso do ADRO®. Os questionários de satisfação mostraram uma melhora estatisticamente significativa, apenas na subescala que avalia o desempenho em ambiente ruidoso e uso do telefone. Conclusão: A tecnologia contribuiu no desempenho de percepção de fala e nos limiares audiométricos dos pacientes usuários de Nucleus22®. A maioria manteve a tabela de frequência original. As mudanças nos parâmetros de T-SPL e C-SPL mostraram uma melhora dos limiares audiométricos nas frequências principais da fala. As diferenças significantes foram sutis nos questionários de satisfação, demonstrando que os pacientes já estavam adaptados e satisfeitos com o implante coclearObjective: To identify the technological contributions of the Freedom® speech processor to the patients implanted with Nucleus 22® and the satisfaction of users of the new technology. Among the new features available, we focused on the effect of the frequency allocation table, the T-SPL and C-SPL and the pre-processing gain adjustments (ADRO®). Methods: This study was prospective and exploratory. It included teenage and adult patients implanted with Nucleus 22® who effectively used the implant with no previous experience with the new technology and had at least some speech recognition on a closed set with the Spectra® processor. Seventeen patients met the inclusion criteria, ranging in age from 15 to 82 years and deployed for over 8 years. To determine the contribution of the Freedom®, thresholds and speech perception tests were performed with the last map used with the Spectra® and the maps created for Freedom®. To identify the effect of the frequency allocation table, both converted (same table) and upgraded (new table) maps were programmed. The table selected is maintained, and maps were performed with three different parameters: the first program (P1) was programmed with 30 dB T-SPL and 70 dB C-SPL; the second program (P2) with was programmed with 25 dB T-SPL and 65 dB C-SPL; and the program 3 (P3) with ADRO®. The order of presentation of the maps and the testing was randomized. To assess satisfaction were used SADL and APHAB after one moth and one year of using the Freedom®. Results: The contribution of the Freedom® speech processor to patients with the Nucleus 22® was statistically superior compared to the Spectra® in all tests of speech perception and in all audiometric thresholds, both individually and on average, except for 8000 Hz. Regarding the choice of a frequency allocation table, 64.7% of patients (n=11) maintained the same map that had been used with the Spectra® processor. The sound field threshold was statistically significant at 500, 1000, 1500 and 2000 Hz with 25 dB T-SPL/ 65 dB C-SPL. The patients\' satisfaction there was a statistically significant improvement, only in the sub-scale of speech in noise abilities and telephone use. Conclusions: The Freedom® technology improved the performance of patients with the Nucleus 22®. Most of the patients retained the original frequency table. The changes in the parameters of T-SPL and C-SPL showed an improvement in the audiometric thresholds for the main frequencies of speech. Significant differences were subtle in questionnaires of satisfaction, demonstrating that patients were already adapted and satisfied with the cochlear implant
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Fadele, Florence. "Increasing Providers’ Adherence to Ordering Urine Microalbumin Tests". NSUWorks, 2017. https://nsuworks.nova.edu/hpd_con_stuetd/47.
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Currently, a microalbumin urine test is an annual test for diabetic patients recommended by the American Diabetes Association, but primary care providers are not ordering the tests. This may be, in part, attributable to the fact that there are no guidelines for ordering microalbumin urine tests. The purpose of this capstone project was to assess providers' compliance in identifying the need for the microalbumin urine test for patients with diabetes, to develop evidence-based guidelines for monitoring and ordering microalbumin urine tests, and to evaluate providers' compliance. Rogers's theory of the diffusion of innovation provided the framework for this capstone project. A quantitative, descriptive design using a non-parametric paired t-test was used. Data was collected pre- and post-evidence based practice guidelines implementation in electronic health records. The mean monthly percentage of diabetic patients given microalbumin urine tests pre-implementation was 66.86 (SD = 4.25; 95% CI = (64.17, 69.56). The mean monthly percentage of diabetic patients given microalbumin urine tests post-implementation was 73.53 (SD = 2.58; 95% CI = (70.32, 76.73). SPSS version 23 (IBM Corp., Armonk, NY). The two sample t-test was statistically significant, t (15) = -3.232, p = 0.006). The introduction of evidence-based practice guidelines for ordering microalbumin urine tests improved provider compliance.
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Morice, Pierre-Marie. "Evaluation de la déficience de la recombinaison homologue et de la réponse des tumeurs ovariennes aux inhibiteurs de PARP grâce à l'utilisation de modèles de culture 3D en vue du développement d'un test prédictif Identifying eligible patients to PARP inhibitors: from NGS-based tests to promising 3D functional assays Automated scoring for assessment of RAD51-mediated homologous recombination in patient-derived tumor organoids of ovarian cancers Risk of myelodysplastic syndrome and acute myeloid leukemia related to PARP inhibitors: a combined approach using a safety meta-analysis of placebo randomized controlled trials and the World Health Organization's pharmacovigilance database The long non-coding RNA ‘UCA1’ modulates the response to chemotherapy of ovarian cancer through direct binding to miR-27a-5p and control of UBE2N levels". Thesis, Normandie, 2020. http://www.theses.fr/2020NORMC414.
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Chaque année, plus de 150 000 décès sont associés aux cancers épithéliaux de l’ovaire dans le monde, notamment en raison du développement d’une résistance à la chimiothérapie. Environ la moitié de ces cancers présentent des altérations moléculaires provoquant une déficience de la réparation de l’ADN par recombinaison homologue (HRD) qui les sensibilise à l’action des inhibiteurs de la protéine PARP (PARPi). A ce jour, il n’existe pas de test capable d’appréhender le phénotype HRD dans sa globalité, limitant ainsi l’accès à ces traitements. Dans ce contexte, nous avons entrepris de mettre au point des tests fonctionnels basés sur l’utilisation d’explants tumoraux tranchés puis sur l’utilisation d’organoïdes tumoraux dérivés de tumeurs ovariennes de patientes chimio-naïves ou antérieurement traitées. La culture d’explants s’est révélée inappropriée pour la réalisation de ces tests et nous avons alors focalisé nos travaux sur les organoïdes tumoraux. Ces derniers ont été exposés au carboplatine (traitement de 1e ligne) et à deux inhibiteurs de PARP (l’olaparib et le niraparib) utilisés en traitement d’entretien. En parallèle, nous avons collecté les données cliniques des patientes (survie, intervalle sans platine, RECIST, traitements) afin d’évaluer le potentiel prédictif de ces modèles. Les organoïdes tumoraux établis ont répondu de façon hétérogène aux différents médicaments testés, et nos résultats montrent que les tests réalisés sur les organoïdes sont capables d’identifier des patientes présentant un niveau de résistance élevé au carboplatine, suggérant que ce test fonctionnel pourrait présenter un intérêt prédictif vis-à-vis de ce médicament. Concernant le potentiel prédictif des organoïdes vis-à-vis des PARPi, des profils de sensibilité variés ont été identifiés, mais la corrélation avec la réponse clinique reste à établir par des études menées sur des échantillons de tumeurs issus de patientes traitées par ces médicamentsWorldwide each year, more than 150 000 women die from epithelial ovarian cancer largely due to emergence of resistance to chemotherapy. Approximately half of these cancers display molecular alterations that cause deficiency of DNA repair via homologous recombination (HRD), which confer sensitivity to PARP protein inhibitors (PARPi). To date, there is no test capable of fully identifying the HRD phenotype, thus limiting access to these treatments. In this context, we are developing functional assays based on the use of tumor explant slices and then, on the use of tumor organoids derived from ovarian tumors of chemotherapy-naive or previously treated patients. The culture of explants was unsuitable for this application and we then focused our work on tumor organoids. Tumor organoids were exposed to carboplatin (first-line treatment) and two PARP inhibitors (olaparib and niraparib) used for maintenance therapy. In parallel, we collected clinical data from patients (survival, platinum-free interval, RECIST, treatments) to evaluate the predictive potential of these models. The established tumor organoids responded heterogeneously to different drugs, and our results show that the organoid-based assay is capable of identifying patients highly resistant to carboplatin, suggesting that this functional assay could have a predictive value for patients treated with carboplatin. Regarding the potential of organoids in predicting PARPi response, multiple sensitivity profiles have been identified, but the correlation with clinical response has yet to be determined by studies conducted on tumor samples from patients treated with these drugs
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Costa, Nathalia Almeida. "Desenvolvimento de uma metodologia de calibração e testes de medidores de produto Kerma-Área". Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/85/85131/tde-14082013-144903/.
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A grandeza produto kerma-área (PKA) é importante para estabelecer níveis de referência em exames de radiologia diagnóstica. Essa grandeza pode ser obtida por meio de medidores do PKA. O uso desses medidores é fundamental para avaliar a dose de radiação em procedimentos radiológicos, além de ser um bom indicador para que os limites de dose na pele do paciente não sejam excedidos. Algumas vezes, esses medidores vêm acoplados a equipamentos de radiação X, o que dificulta sua calibração. Neste trabalho foi desenvolvida uma metodologia de calibração de medidores do PKA. O instrumento utilizado para este fim foi o Patient Dose Calibrator (PDC). Ele foi desenvolvido para ser utilizado como referência na verificação da calibração de medidores do PKA e kerma no ar usados na dosimetria de pacientes e para verificação da consistência e do comportamento de sistemas de controle de exposição automáticos. Por se tratar de um equipamento novo, que, no Brasil, ainda não é utilizado como equipamento de referência para calibração, foi realizado, também o controle de qualidade deste equipamento, com testes de caracterização, a calibração e a avaliação da dependência energética. Após os testes, ficou provado que o PDC pode ser utilizado como instrumento de referência para a calibração a ser realizada in situ, de forma que as características de cada equipamento de radiação X onde os medidores do PKA são utilizados sejam consideradas. A calibração foi, então, realizada com medidores do PKA portáteis e em um equipamento de radiologia intervencionista que possui um medidor do PKA acoplado. Os resultados foram bons e ficou provada a necessidade de calibração desses medidores e a importância da calibração in situ com um medidor de referência.The quantity kerma area product (PKA) is important to establish reference levels in diagnostic radiology exams. This quantity can be obtained using a PKA meter. The use of such meters is essential to evaluate the radiation dose in radiological procedures and is a good indicator to make sure that the dose limit to the patient\'s skin doesnt exceed. Sometimes, these meters come fixed to X radiation equipment, which makes its calibration difficult. In this work, it was developed a methodology for calibration of PKA meters. The instrument used for this purpose was the Patient Dose Calibrator (PDC). It was developed to be used as a reference to check the calibration of PKA and air kerma meters that are used for dosimetry in patients and to verify the consistency and behavior of systems of automatic exposure control. Because it is a new equipment, which, in Brazil, is not yet used as reference equipment for calibration, it was also performed the quality control of this equipment with characterization tests, the calibration and an evaluation of the energy dependence. After the tests, it was proved that the PDC can be used as a reference instrument and that the calibration must be performed in situ, so that the characteristics of each X-ray equipment, where the PKA meters are used, are considered. The calibration was then performed with portable PKA meters and in an interventional radiology equipment that has a PKA meter fixed. The results were good and it was proved the need for calibration of these meters and the importance of in situ calibration with a reference meter.
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Coble, Helen Marie. "Therapists' attachment, interpersonal functioning, and countertransference : a test of a mediational model /". view abstract or download file of text, 2001. http://wwwlib.umi.com/cr/uoregon/fullcit?p3003992.
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Thesis (Ph. D.)--University of Oregon, 2001.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 137-152). Also available for download via the World Wide Web; free to University of Oregon users.
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Rudolph, Laura. "Validity and reliability study of the diabetes information test given to patients at the International Diabetes Center". Online version, 1998. http://www.uwstout.edu/lib/thesis/1998/1998rudolphl.pdf.
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Hilborn, Robert Scott. "Psychological characteristics contributing to performance on neuropsychological tests and effort testing". Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9093/.
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The issue of effortful patient performance has been an area of clinical interest in individuals with minor traumatic brain injury (mTBI). Clinical attention to this area has increased largely because of an increase in the number of worker's compensation claims, injury-related lawsuits and/or insanity defense pleas. As patients are presented with the opportunity for secondary gain, the issue of optimum performance on neuropsychological measures becomes salient. In addition to neurocognitive deficits, there are psychological characteristics associated with mTBI including depression, emotional disturbance, personality changes, and other psychopathology. This study utilized the MSVT, a set of standard neuropsychological instruments, and the Minnesota Multiphasic Inventory-2 (MMPI-2) to investigate the relationships between effort, psychological characteristics, and neuropsychological functioning in individuals with minor traumatic brain injuries. The first objective of this study was to determine which psychological factors were related to effort in mTBI. The second objective was to determine if there were differences between groups that performed poorly on effort testing and groups that performed adequately on effort testing, based on relevant psychological characteristics. The results of the analyses supported the first hypothesis. Hysteria was inversely related to effort, and Mania was positively related to effort on one of five measures of effort. The second hypothesis was not supported.
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Valentin, Livia Stocco Sanches. "Avaliação dos efeitos da dexametasona sobre a incidência de disfunção cognitiva pós-operatória em idosos submetidos à anestesia geral". Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-16032015-152134/.
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Introdução: Disfunção cognitiva pós-operatória (POCD) é um evento adverso multifatorial mais frequente em pessoas com idade superior a 60 anos ou doenças neurológicas e psiquiátricas. Este estudo avaliou o efeito da dexametasona sobre a incidência de POCD em idosos após cirurgia não cardíaca sob anestesia geral. Métodos: Cento e quarenta pacientes (ASA I-II, idade 60-87 anos) participaram deste estudo prospectivo, randomizado, envolvendo a administração ou não de 8 mg de dexametasona IV antes da indução anestésica para anestesia geral profunda ou superficial de acordo com o índice bispectral. Os testes neuropsicológicos foram aplicados no pré-operatório e em 3, 7, 21, 90 e 180 dias após a cirurgia e comparados com os dados normativos. Enolase específica do neurônio e S100beta foram avaliados antes e 12 horas após a indução da anestesia. A regressão linear com inferência baseada no método de equações de estimação generalizadas (GEE) foi aplicado, seguido pelo teste post-hoc de Bonferroni, considerando P <0,05 como significativo. Resultados: No terceiro dia pós-operatório, POCD foi diagnosticada em 25,2% dos pacientes que receberam a dose de dexametasona e anestesia profunda, 15,3% nos pacientes que receberam a dose da dexametasona e anestesia superficial, 68,2% do grupo de anestesia profunda e 27,2% do grupo de anestesia superficial (p < 0,0001). Os testes neuropsicológicos demonstraram que a anestesia superficial e a dose de dexametasona antes da indução anestésica diminuiu a incidência de POCD, especialmente para as funções memória e atenção e para a função executiva. A administração de dexametasona preveniu o aumento nos níveis séricos de S100beta no pós-operatório (p < 0,002) bem como está relacionado com uma diminuição significativa nos níveis séricos de enolase específica de neurônio (NSE) (p < 0,001). A memória imediata apresentou diferença entre pacientes com e sem alelo APOe4 (p = 0,025) independente do momento de avaliação. A memória de longo prazo apresentou alteração ao longo dos momentos de avaliação em pacientes com e sem a presença do APOe4 (p = 0,006 e p = 0,017 respectivamente). Pacientes com o alelo APOe4 apresentaram maior percentual de disfunção para memória imediata que os pacientes sem o alelo (p = 0,003). Os pacientes sem o alelo APOe4 apresentaram redução de disfunção para o processo de flexibilidade mental após 180 dias quando comparado aos demais momentos (p < 0,05) e os pacientes com a presença do alelo não apresentaram qualquer alteração estatisticamente significativa (p > 0,999), sendo que após 180 dias os pacientes com o alelo APOe4 apresentaram alteração na função executiva para a flexibilidade mental quando comparados aos pacientes sem o alelo (p < 0,001). Conclusão: A dexametasona pode minimizar a incidência de POCD em pacientes idosos submetidos a cirurgia não cardíaca, especialmente quando associada à anestesia superficial. Efeito da dexametasona sobre os níveis séricos S100beta e NSE pode estar relacionado com algum grau de neuroproteçãoBackground: Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients or people aged over 60 years, neurological and psychiatric diseases. This study evaluated the effect of dexamethasone on POCD incidence after non-cardiac surgery and general anesthesia. Methods: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective randomized study involving the administration or not of 8 mg of IV dexamethasone before deep or superficial anesthesia according to bispectral index. Neuropsychological tests were applied preoperatively and at 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. Neuron specific enolase and S100beta were evaluated before and 12 hours after induction of anesthesia. Linear regression with inference based on the generalized estimating equations (GEE) method was applied, followed by the post-hoc Bonferroni test considering P < 0.05 as significant. Results: On the 3rd postoperative day, POCD was diagnosed in 25.2% of patients receiving dexamethasone plus deep anesthesia, 15.3% of the dexamethasone plus superficial anesthesia group, 68.2% of the deep anesthesia group and 27.2% of the superficial anesthesia group (p < 0.0001). Neuropsychological tests showed that dexamethasone plus superficial anesthesia decreased the incidence of POCD, especially memory, attention and executive function. The administration of dexamethasone prevented the postoperative increase in S100? serum levels (p < 0.002) and it is also related with a significant decrease in serum levels of neuron specific enolase (p < 0.001). Immediate memory was different between patients with and without APOe4 allele (p = 0.025) independent of the moment of assessment. The Long-term memory was impaired over the evaluation periods in patients with and without the presence of APOe4 allele (p = 0.006 and p = 0.017 respectively). Patients with the APOe4 allele had higher percentage of dysfunction for Immediate memory (p = 0.003). Patients without the APOe4 allele showed a reduction of dysfunction for the process of Mental flexibility after 180 days compared to the other assessment phases (p < 0.05) and patients with APO?4 allele showed no statistically significant change (p > 0.999), and after 180 days the patients with the APOe4 allele had alterations in Executive function for mental flexibility when compared to patients without the allele (p < 0.001). Conclusion: Dexamethasone can minimize the incidence of POCD in elderly patients undergoing non-cardiac surgery, especially when associated with superficial anesthesia. The effect of dexamethasone on S100beta e NSE serum levels might be related with some degree of neuroprotection
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Houston, Wes S. "PRESIDENTS TEST PERFORMANCE OF PATIENTS WITH FOCAL EPILEPSY". University of Cincinnati / OhioLINK, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=ucin991166083.
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CROW, RICHARD S., JAMES C. DAHL, ERNST SIMONSON e KAZUNOBU YAMAUCHI. "Sex Differences in Submaximal Exercise Tests Correlation with Coronary Cineangiography in 133 Patients". Nagoya University School of Medicine, 1985. http://hdl.handle.net/2237/17479.
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Longridge, N. S. "Evaluation of the dynamic illegible 'E' test in the dizzy patient". Thesis, University of Newcastle Upon Tyne, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.376324.
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Holm, Löv Marita. "Effektivare resursanvändning vid återbesök inom psykiatrisk öppenvård : Utveckling, test och erfarenheter av digitala vårdmöten". Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-41113.
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Bakgrund Hög andel sena återbud och uteblivna besök, är ett problem vid psykiatriska kliniker och orsakar effektivitetsbrister då tillgängliga resurser inte används optimalt. Fysiska besök och telefonkontakter behöver kompletteras med fler mötesformer för att bättre möta patientens behov och öka tillgängligheten. Syfte Syfte och övergripande mål med förbättringsarbetet var att öka tillgängligheten till psykiatrisk öppenvård genom att erbjuda digitala vårdmöten. Syftet med studien av förbättringsarbetet var att identifiera erfarenheter från förbättringsarbetet som kan användas som lärdomar i fortsatt verksamhetsutveckling. Metod Nolans förbättringsmodell har används i förbättringsarbetet. Studien är en fallstudie, inspirerad av interaktiv ansats med kvalitativ metod. Resultat Genom utveckling och genomförande av 20 digitala vårdmöten är lärdomarna att digitala vårdmöten är ett komplement till besök på mottagning och att digital teknik stödjer arbetsprocessen. Studiens resultat visar att ledningen, strukturer och medarbetares delaktighet är centrala vid kvalitetsförbättringar. Slutsatser Inställning till patientens kapacitet och digital teknik är central för att erbjuda mötesformen. Tekniska lösningar måste vara lättillgängliga. För att dela kunskap, öka tryggheten i det nya sättet att mötas och undanröja hinder som uppstår är arbetsmöten viktiga. Ledningen utgör en central roll för att påverka förbättringskulturen och de värderingar och mönster som finns i verksamheten.
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Baylor, Krissa A. "The Effects of Spouse Presence During Graded Exercise Testing on Psychological and Physiological Parameters in Cardiac Patients and Healthy Adults". Thesis, North Texas State University, 1987. https://digital.library.unt.edu/ark:/67531/metadc330947/.
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The direct effect of spouse presence during graded exercise testing on anxiety and performance has not been previously delineated. Therefore, the purposes of this study were to (a) ascertain if spouse presence during graded exercise testing affects state anxiety or physiological performance variables, and (b) determine differences in psychological status between cardiac patients and healthy adults.
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Saraf, Smriti. "Assessment of thrombotic and thrombolytic status in patients with coronary artery disease and its relation to clinical outcomes". Thesis, University of Hertfordshire, 2014. http://hdl.handle.net/2299/15000.
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Background: Platelets provide the initial haemostatic plug at sites of vascular injury. They also participate in pathological thrombosis that leads to myocardial infarction, stroke and peripheral vascular disease. The outcome of an acute myocardial infarction depends not only on the formation and stability of an occlusive thrombus, but also on the efficacy of the endogenous thrombolytic process, which allows reperfusion of the infarct related artery and prevents recurrent ischaemic episodes. Various platelet function tests are available to measure the thrombogenic potential of an individual, but the sensitivity of these tests remain questionable as most of these tests use citrated blood and measure response to a particular agonist. Endogenous thrombolysis has been a neglected entity, and its beneficial effects on cardiovascular outcomes has not been studied in depth in the past, possibly as until recently there has been no available technique to measure spontaneous thrombolytic activity in native blood. The Global Thrombosis Test (GTT) is a new point of care tests that allows us to measure time to thrombus formation (Occlusion time: OT) using native blood, avoiding the use of agonists and making the test results more physiological. The GTT also measures the time to lyse this formed thrombi without use of any lytic agents (Lysis time: LT), allowing us to measure the patient’s endogenous thrombolytic potential. Aim: Our aim in this study was to detect patients who are at risk of future thrombotic events despite dual antiplatelet therapy, either due to prothrombotic tendency or due to impaired endogenous thrombolysis, and to determine if these two parameters were correlated. Methods: GTT was used to assess the thrombotic and thrombolytic activity in healthy volunteers, and in different patient populations. 100 healthy volunteers were tested using the GTT, and a normal range was established. 300 patients admitted to hospital with a diagnosis of acute coronary syndrome (ACS) were included in the study, and tested using the GTT after they had been stabilized on dual antiplatelet therapy (Aspirin and Clopidogrel). All these patients were followed up for a year, to determine if their baseline GTT results were a predictor of recurrent cardiac events. The primary endpoint of the study was major adverse cardiovascular events (MACE), which was a composite of cardiovascular death, nonfatal myocardial infarction, or stroke at 12 months. Results: All results were analysed using statistical package SPSS version 16.0 (SPSS Inc., Chicago, Illinois). The 100 healthy volunteers were all non-smokers, and were not taking any medications. There were 55 males and 45 females, and mean age was 38±11 years (range 22-76, IQR 11). OT was normally distributed with mean OT 377.80s, and using mean ± 2SD, we derived a normal range of 185-569s (200-550s). LT demonstrated a skewed distribution with values ranging between 457 – 2934s. Using log transformation, a normal range of 592 – 1923 (600- 2000s) was established for LT. OT and LT were both prolonged in ACS patients compared to normal volunteers (p< 0.001). No association was observed between OT and risk of major adverse cardiovascular events. LT was noted to be a significant and independent predictor of MACE in a multivariate model adjusted for cardiovascular risk factors. LT ≥ 3000 s was the optimal cutoff value for predicting 6 month MACE [hazard ratio (HR): 2.48, 95% CI: 1.2-4.8, P= 0.008] and cardiovascular death [HR: 4.04, 95% CI : 1.3-12.0, P= 0.012 ] and 12 month MACE [HR:1.9, 95% CI: 1.04- 3.5,P= 0.03] and cardiovascular death [HR: 3.9,95% CI: 1.34-11.9, P= 0.013 ]. LT ≥ 3000 s was observed in 23% of ACS patients. Conclusions: Our study suggests that endogenous thrombolytic activity based on lysis of platelet rich thrombi can be assessed by the point of care GTT assay, which can help in identification of ACS patients at high risk of future cardiac events. Prolongation of OT may be explained by the antiplatelet effects of Aspirin and Clopidogrel, as both these drugs prolong time to thrombus formation and hence increase OT. Further large studies are required to study factors which can reduce thrombogenic potential, and improve endogenous thrombolytic activity, which can be monitored using the GTT to improve cardiovascular outcomes.
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Souza, Ana Paula Leme de. "Tratamento dos transtornos alimentares: perfil da não adesão e dos fatores associados". Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-06012016-151027/.
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Os transtornos alimentares (TA) são doenças psiquiátricas graves que apresentam quadro complexo e de mau prognóstico. Acometem principalmente adultos jovens que não raramente abandonam o tratamento. O objetivo deste trabalho foi traçar o perfil da não adesão do tratamento de pacientes com TA de um serviço especializado e investigar os fatores associados. Trata-se de estudo transversal de caráter descritivo exploratório com delineamento do tipo caso-controle e quali-quantitativo, cuja coleta de dados se deu em duas etapas. Na primeira, os prontuários de todos os pacientes atendidos pelo serviço foram revisados para coletar dados sociodemográficos, clínicos e desfecho do tratamento. Na segunda etapa, seis participantes do sexo feminino que abandonaram o tratamento foram entrevistadas para coleta de dados antropométricos, alimentares (EAT-26), de imagem corporal (Escala de Figuras de Silhuetas) e investigar os motivos da não adesão. Os dados foram analisados pelo programa SPSS e foram utilizados os testes qui-quadrado, teste exato de Fisher, teste não paramétrico de Mann-Whitney e análise de regressão logística, além da análise de conteúdo temático. Como resultados, 156 (66,7%) pacientes abandonaram o tratamento (Grupo Abandono-GA) e 78 (33,3%) tiveram outros desfechos (Grupo Não Abandono-GNA): alta (n=55; 70,5%), óbito (n=02; 2,6%) ou estavam em seguimento no momento da coleta de dados (n=21; 26,9%). No GA, a maioria era do sexo feminino (n=140; 89,7%), de Ribeirão Preto e região (n=120; 76,9%), estudantes (n=86; 55,1%), solteiros (n=122; 78,2%) com escolaridade mínima do nível fundamental (n=45; 28,8%) e proporcionalmente com diagnóstico de bulimia nervosa (n=41; 80,4%). Foi encontrada diferença significativa entre os grupos na Hipótese Diagnóstica, Comorbidades Psiquiátricas, Depressão, Transtornos de Personalidade, Comorbidades Clínicas e Osteopenia. No GA, o primeiro (n=85; 54,5%) e o último atendimento (n=89; 57,05%) foram nos anos 2000, o estado nutricional foi de eutrofia tanto no primeiro (n=85; 54,5%) quanto no último atendimento (n=104; 66,7%) e ausência de amenorreia no momento inicial e final do seguimento. O estado nutricional apresentou significância estatística em relação ao desfecho do tratamento e a presença de comorbidade clínica atuou como fator protetor para o abandono. No momento atual, a maioria das participantes apresenta atitudes alimentares típicas dos TA, inacurácia da percepção corporal e insatisfação com a autoimagem. Os motivos para o abandono do tratamento foram multifatoriais envolvendo aspectos relacionados à equipe, ao protocolo de tratamento e à própria paciente. Como conclusão, a taxa de abandono do serviço é alta e a presença de comorbidade clínica atuou como fator protetor para o abandono. Pacientes com estado nutricional adequado e sem complicações clínicas são mais vulneráveis ao abandono e podem, a longo prazo, permanecer com os sintomas típicos dos TA. Pelo fato do abandono envolver questões multifatoriais, sugere-se capacitação dos profissionais da equipe, revisão e aprimoramento de protocolos de atendimento para melhor acolhimento, adesão e identificação prévia dos grupos de risco. Estudos prospectivos e baseados em evidências poderão contribuir para as pesquisas dirigidas especificamente à resistência ao tratamento e consequente não adesão de pacientes com TA, buscando uma melhor compreensão desses transtornos e seu tratamentoEating Disorders (ED) are serious psychiatric illness which present a complex set of symptoms and signs and bad prognosis. ED affect mainly young adults who not infrequently dropout of treatment. This paper aims at outlining the profile of non-adherent patients from a specialized service suffering from ED and investigating associated factors. This is a cross- sectional study, of exploratory descriptive nature, with case-control and quali-quantitative approach, whose data collection occurred in two stages. In the first stage, medical records of all patients being treated by the service have been reviewed in order to collect social and demographic data, as well as clinical data and data related to the outcome of the treatment. In the second stage, six female participants who have dropped out of treatment have been interviewed for the purposes of collecting anthropometric, eating (EAT-26), body image (Silhouettes Scales) data and investigating the reason for their non-adherence. Data has been analyzed by SPSS program and the following tests have been used: chi-square, Fisher\'s exact test, Mann-Whitney U test and logistic regression analysis, besides theme-based content analysis. As a result, 156 (66.7%) patients dropped out of treatment (Dropout Group-DG) and 78 (33.3%) had different outcomes (Persisters Group-PG): medical discharge (n=55; 70.5%), death (n=02; 2.6%) or were still under treatment at the time of data collection (n=21; 26.9%). Among DG, most were female (n=140; 89.7%), from Ribeirão Preto and surroundings (n=120; 76.9%), students (n=86; 55.1%), single (n=122; 78.2%) at least with Junior and Elementary High School (n=45; 28.8%) and proportionally with a diagnosis of bulimia nervosa (n=41; 80.4%). A significant difference was found between the groups in terms of Diagnostic Hypothesis, Psychiatric Comorbidities, Depression, Personality Disorder, Clinical Comorbidities and Osteopenia. Among DG, the first (n=85; 54.5%) and last visits (n=89; 57.05%) were paid in the 2000\'s, nutritional status was eutrophia both in the first (n=85; 54.5%) and last visits (n=104; 66.7%) and absence of amenorrhea on the first and final moments of their treatment. Nutritional status has proved to be statistically significant regarding the outcome of the treatment and existence of clinical comorbidity has worked as a protective factor to prevent dropout. Currently, most participants assume eating attitudes typical of ED: inaccurate body perception and dissatisfaction with their self-image. Reasons for their dropping out treatment were due to many factors, involving aspects related to the team, to the treatment protocol and to patients themselves. As a conclusion, the dropping out rate of service is high and the existence of clinical comorbidity has worked as a protective factor to prevent dropout. Patients with an appropriate nutritional status and without clinical complications are more likely to dropout of treatment and may, on a long term, remain with symptoms typical of ED. As dropouts occur for multiple reasons, it is suggested: to qualify and train the team of professionals, review and improve service protocols in order to enhance receptiveness, adhesion and prior identification of risk groups. Prospective evidence-based studies could contribute to researches specifically driven to treatment resistance and consequent non-adherence of patients with ED, which could seek a better understanding of these disorders and their treatment
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Ferron, Parayre Audrey. "Le dépistage du conflit décisionnel chez les patients en soins primaires : Validation du test SURE". Thesis, Université Laval, 2013. http://www.theses.ulaval.ca/2013/29542/29542.pdf.
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Cette étude a évalué les propriétés psychométriques d’un outil de dépistage du conflit décisionnel cliniquement significatif, le test SURE, auprès de patients présentant une infection aigüe des voies respiratoires et devant prendre une décision quant à la prise ou non d’antibiotiques. Au moyen d’un questionnaire auto-administré qui leur était fourni immédiatement après la consultation médicale, les 712 patients recrutés dans neuf unités de médecine familiale rattachées à l’Université Laval devaient répondre aux questions du test SURE et par la suite à celles de l’Échelle de Conflit Décisionnel (ÉCD), la mesure de référence du conflit décisionnel. Le coefficient de fidélité Kuder-Richardson 20 du SURE a été de 0,7, et les mesures d’association et de corrélation entre les résultats continus de l’ÉCD et ceux du SURE se sont avérées significatives (P<0,0001). La sensibilité et la spécificité ont été respectivement de 94,3% (79,4-99,0) et 85,2% (82,2-87,8). Cette étude suggère que le test SURE est adéquat pour dépister le conflit décisionnel en soins primaires. La validité du test dans différents contextes décisionnels devra être évaluée.This study validated the psychometric properties of a screening tool assessing decisional conflict, the SURE test, in patients with acute respiratory infection who had to make a decision about taking antibiotics or not. Using a self-administered questionnaire which was provided immediately after the medical encounter, 712 patients recruited in nine family practice teaching units related to Laval University were asked to respond to SURE and Decisional Conflict Scale (DCS) questions, the gold-standard measure of decisional conflict. The internal consistency using Kuder-Richardson 20 coefficient was 0.7, and there was a significant correlation between DCS and SURE scores (P<0.0001). Sensitivity and specificity were 94.3% (79.4-99.0) and 85.2% (82.2-87.8, respectively. This study suggests that the SURE test is appropriate to screen for decisional conflict in primary care. The validity of the test in different decisional contexts should be evaluated.
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Maki, Brian Edward. "A posture control model and balance test for the prediction of relative postural stability, with special consideration to the problem of falling in the elderly". Thesis, University of Strathclyde, 1987. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=21488.
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A balance testing methodology was developed, based on a posture control model which defines relative stability by the degree to which a transient postural perturbation would cause the centre-of-pressure on the feet to approach the limits of the base-of-support. To minimize anticipatory adaptations and to ensure subject safety, the balance test used a small-amplitude continuous random or pseudorandom perturbation. The data were used to identify an input-output model, which was then used to predict large-amplitude transient response. The test perturbation was an anterior-posterior acceleration of a platform on which the subject stood. Pilot experiments were performed to determine appropriate perturbation parameters. Testing of sixty-four normal subjects demonstrated highly significant ageing-related decreases in predicted stability. No significant sex-related differences were found. Predicted stability increased when the subjects were blindfolded. In using the balance test to identify balance-impaired individuals, the blindfolded results and the eyes-open/blindfolded ratio provided higher success rates than the eyes-open results. Depending on the modelling method used, the balance test was able to identify up to three of five vestibular patients and five of five elderly fallers, at a false positive rate of 25% in the normal subjects. Correlations between the balance test results and measures of spontaneous postural sway were weak, except in the normal young adult subjects. Comparison with transient tests showed the balance test to yield reasonably accurate predictions of small-amplitude transient response, but to overestimate the large-amplitude response; however, the transient test results may have been confounded by adaptive effects. It was concluded that the balance test provides a sensitive functional measure of the changes in postural control that are known to occur in ageing. Although it shows promise as a tool for identifying balance impairments, larger numbers of balance-impaired subjects must be tested.
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Jacq, Hugues Probst Vincent. "Suivi à long terme de 190 patients après Tilt-test". [S.l.] : [s.n.], 2005. http://theses.univ-nantes.fr/thesemed/SPEjacq.pdf.
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Sun, Luning. "Using the Ekman 60 faces test to detect emotion recognition deficit in brain injury patients". Thesis, University of Cambridge, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708553.
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Nicolau, Ioana. "Evaluation of urine-based rapid tests for smoking and isoniazid treatment monitoring in adult patients". Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=106335.
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Background: Globally, tuberculosis (TB) affects 9.4 million people every year, with an estimated 2 million deaths. Effective treatment of latent TB infection with isoniazid (INH) as a TB control strategy has been hampered by poor adherence to therapy. Research has shown that smoking is a risk factor for TB and that adherence to TB therapy may be lower among smoking individuals. Rapid tests are now available to detect smoking status as well as isoniazid treatment adherence in a clinic setting. Objective: The objective was to validate IsoScreen and SmokeScreen, two new point-of-care urine-based tests for INH metabolites and cotinine metabolites. The results from each of the two tests were compared with the corresponding reference standard algorithm developed in this study for measuring INH intake and smoking status. Methods: The main outcomes measured were accuracy and reliability of IsoScreen and SmokeScreen. Accuracy was measured using sensitivity and specificity values for each test against the corresponding reference standard: INH Intake Reference Standard Scale and the Smoking Status Reference Standard. Reliability was measured using kappa statistic for inter-rater and intra-rater agreement. Results: In this study, we recruited 200 adult outpatients attending the tuberculosis clinic and/or the smoking cessation clinic at the Montreal Chest Institute. The patients recruited were a combination of patients on or not on INH medication and smokers or non-smokers. IsoScreen had a sensitivity of 93.2% (95% confidence intervals [CI] 80.3, 98.2) and specificity of 98.7% (94.8, 99.8). IsoScreen had intra-rater agreement of 0.75 (0.48, 0.94) and inter-rater agreement of 0.61 (0.27, 0.90). SmokeScreen had a sensitivity of 69.2% (56.4, 79.8) and specificity of 81.6% (73.0, 88.0). SmokeScreen had intra-rater agreement of 0.77 (0.56, 0.94) and inter-rater agreement of 0.66 (0.42, 0.88).Conclusion: IsoScreen had high accuracy and reliability, whereas SmokeScreen had modest accuracy and modest reliability in tuberculosis and smoking cessation clinic settings. Further research should be conducted in various clinic settings with a focus on the impact of the tests on patient management.Contexte: Globalement, la tuberculose (TB) affecte 9,4 millions de personnes chaque année, avec environ 2 millions de décès. L'efficacité de l'INH, lorsqu'utilisé dans une stratégie de contrôle et de traitement de la TB latente, est limitée parce que les patients ne le prennent pas comme prescrit. La recherche a démontré que le tabac était un facteur de risque pour la tuberculose, et que les fumeurs auraient plus de difficulté à maintenir leur adhésion au traitement contre la tuberculose. Il existe maintenant de nouveaux tests rapides capables de détecter les fumeurs ainsi que l'adhésion au traitement à l'isoniazide, et ces tests d'urine peuvent facilement être utilisés en clinique. Objectif: L'objectif de l'étude était de valider IsoScreen et SmokeScreen, deux nouveaux tests d'urine utilisés en clinique pour détecter les métabolites INH et les métabolites de cotinine. Les résultats de chaque test ont été comparés aux algorithmes des standards de référence développés pour chaque test pour déterminer si le patient prend la pilule INH et son statut de fumeur. Méthodes: Les principaux résultats mesurés étaient la précision et la fiabilité des tests IsoScreen et SmokeScreen. La précision a été mesurée en comparant les valeurs de sensibilité et de spécificité de chaque test à leurs standards de référence: le Standard de référence pour le statut de l'INH et le Standard de référence pour le statut de fumeur. La fiabilité a été mesurée avec statistique kappa pour déterminer l'accord intra-évaluateur et inter-évaluateurs. Résultats: Dans cette étude, nous avons recruté 200 patients externes adultes de la clinique de tuberculose et/ou de la clinique de cessation tabagique à l'Institut thoracique de Montréal. Les patients recrutés étaient des patients qui prenaient ou non des médicaments INH et des fumeurs ou des non-fumeurs. IsoScreen avait une sensibilité de 93.2% (intervalle de confiance à 95% [IC] à 80.3, 98.2) et une spécificité de 98.7% (94.8, 99.8). L'accord intra-évaluateur pour IsoScreen était de 0.75 (0.48, 0.94) et l'accord inter-évaluateurs était de 0.61 (0.27, 0.90). SmokeScreen avait une sensibilité de 69.2% (56.4, 79.8) et une spécificité de 81.6% (73.0, 88.0). L'accord intra-évaluateur pour le test SmokeScreen était de 0.77 (0.56, 0.94) et l'accord inter-évaluateurs était 0.66 (0.42, 0.88).Conclusion: Le test IsoScreen avait une grande précision et une grande fiabilité, alors que SmokeScreen avait une précision et une fiabilité modestes. D'autres recherches devraient être menées dans des contextes cliniques différents, en mettant l'accent sur l'impact de l'utilisation de ces tests sur la gestion des patients.
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Lyons, Beth (Beth A. ). "Adherence/Compliance to Exercise Prescription: A Test of the Self-Efficacy Model". Thesis, North Texas State University, 1985. https://digital.library.unt.edu/ark:/67531/metadc331015/.
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It has been well-documented in the literature that there are many physical and psychological benefits to be derived from regular aerobic exercise. It has also been noted that adherence/compliance to aerobic exercise regimens tends to be quite low. Investigators have found that a number of factors tend to correlate with adherence, but it has been difficult thus far to determine a mechanism which underlies a tendency to adhere versus a tendency to drop-out. This study examined the problem of non-adherence from the perspective of Self-Efficacy Theory (Bandura, 1977). Subjects for this investigation included all patients seen during a four week period in the Cooper Clinic at the Aerobics Center in Dallas, Texas. Patients at the clinic receive a complete physical examination and health prescriptions based upon the results of their examination. During this four week period, half were administered a Self-Efficacy Questionnaire. Approximately three months later all patients seen during this four week period received a followup (adherence questionnaire in the mail). It was hypothesized that there would be a positive relationship between responses on the Self-Efficacy Questionnaire and responses on the Adherence Questionnaire. A second hypothesis stated that there would be a positive relationship between items which specifically pertained to exercise on each of the questionnaires. In addition, it was expected that there would be no difference in adherence rates between those who made self-efficacy judgments and those who did not. Results of a t-test conducted between the group which made self-efficacy judgments and the group that was not asked to make such an evaluation demonstrated no significant difference in adherence rates. A correlational analysis revealed that there was not a statistically significant relationship between total self-efficacy scores and total adherence scores. There was, however, a statistically significant relationship between levels of exercise self-efficacy and levels of exercise adherence. In addition to these main variables of interest, correlations between other variables (sex, age, percent bodyfat, etc.) were examined and discussed.
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Covert, Julie Hart. "Neurocognitive Variables Underlying Group Performance on a Measure of Effort: The Medical Symptom Validity Test (MSVT)". Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9787/.
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This study utilized the Medical Symptom Validity Test (MSVT) and a set of standard neuropsychological instruments to determine the underlying construct of the MSVT that accounts for effort in mild traumatic brain injury (mTBI) patients by comparing/contrasting mTBI with dementia and an analog simulation. The results indicate that a common underlying neurocognitive construct (memory) exists between mTBI and dementia patients, which may account for poor effort as measured by the MSVT. Other underlying factors emerged for both groups, though they did not point to a common construct. This finding suggests that the overall effect of brain injury in neurologically impaired groups also impacts effort performance as measured by the MSVT. Similarly impaired performance patterns also emerged between mTBI and dementia groups in sub-groups that failed effort measures. Thus, failed effort tests may be a function of more pronounced deficits in these groups, rather than a function of effort. Finally, although similar effort profiles were noted between mTBI and analog simulators, the analog group was unable to mimic the neurocognitive effects of mTBI.
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Andersson, Christin. "Predictors of cognitive decline in memory clinic patients /". Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-232-3/.
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Wing, Edgar H. "The relationship between therapist empathy, the working alliance, and therapy outcome a test of a partial mediation model /". Ohio : Ohio University, 2010. http://www.ohiolink.edu/etd/view.cgi?ohiou1262266810.
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