Дисертації з теми "Fraility"
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Meehan, Conor J., M. G. I. Langille, and R. G. Beiko. "Frailty and the Microbiome." Karger, 2015. http://hdl.handle.net/10454/17257.
Повний текст джерелаFrom the moment of birth, the human body plays host to a rich diversity of microbes. Body sites such as the skin, the gut and the mouth support communities of microorganisms (collectively known as the microbiome) that are both numerous and diverse. As our understanding of the microbiome advances, it is evident that these microbial populations participate in a multitude of symbiotic associations with us. The disruption of these associations can lead to a range of diseases beyond mere pathogenesis as microbial nutrition, signaling, and immune defense break down. It is known that changes in microbial composition occur as the human host ages and that diet and living conditions influence the microbiome of older individuals. However, the link between the microbiome and frailty is as yet mostly unexplored. Although the microbiome is likely to influence health factors that contribute to frailty, further work is needed to determine whether overall microbial signatures of frailty exist and, if so, what the diagnostic and therapeutic utility of these signatures might be.
Wienke, Andreas. "Frailty models in survival analysis." [S.l.] : [s.n.], 2007. http://deposit.ddb.de/cgi-bin/dokserv?idn=985529598.
Повний текст джерелаPause, Cheryl A. "Frailty misspecification in survival data." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0027/NQ31107.pdf.
Повний текст джерелаBoneng, Yus T. "Weibull frailty for modelling heterogeneity." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ61968.pdf.
Повний текст джерелаAfilalo, Jonathan. "Frailty assessment before cardiac surgery." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=92222.
Повний текст джерелаMethods: After performing a systematic review of the literature, a multi-center prospective cohort of elderly patients undergoing cardiac surgery was assembled. Patients were evaluated with a questionnaire and timed 5-meter gait speed test, with frailty defined as a time taken to walk 5 meters ≥6 seconds. The composite endpoint was postoperative mortality or major morbidity.
Results: Based on nine previous studies, the prevalence of frailty was found to be 2-4 fold greater in patients with cardiovascular disease. Two studies suggested that frailty was a risk factor for mortality, although none specifically addressed frailty as a risk factor for adverse events in response to a cardiac surgery. Our cohort consisted of 131 patients undergoing cardiac surgery with a mean age of 75.8±4.4 years and 34% females. Thirty patients experienced the composite endpoint and frailty (slow gait speed) was an independent predictor (odds ratio 3.05, 95% confidence interval 1.23, 7.54). Addition of frailty to traditional risk assessment models resulted in notable improvements in model performance.
Conclusion: The prevalence of frailty is increased in patients with cardiovascular disease. Frailty, as measured by 5-meter gait speed, is a simple and effective test to identify a subset of vulnerable elders who have an incrementally higher risk of adverse events after cardiac surgery. Further studies are needed to validate the optimal cut-off for slow gait speed.
Objectif: La fragilité est un syndrome gériatrique qui signifie une diminution de la résistance au stress physiologique impliquée dans la pathogénèse et le pronostique des maladies cardiovasculaires. Notre objectif était de revoir de façon systématique le rôle de la fragilité dans les maladies cardiovasculaires et de déterminer la valeur incrémentielle de la fragilité (telle que mesurée par la vitesse de marche) pour prédire la mortalité et la morbidité chez les sujets âgés atteints de maladie cardiovasculaire subissant une chirurgie cardiaque.
Méthodes: Après avoir revu la littérature systématiquement, une cohorte multicentrique prospective de sujets âgés subissant une chirurgie cardiaque a été assemblée. Les sujets ont été évalués à l'aide d'un questionnaire et du test de vitesse de marche sur 5 mètres avec la fragilité définie comme étant un temps ≥6 secondes pour marcher 5 mètres. L'issue primaire étant un composé de la mortalité postopératoire et des complications majeures.
Résultats: Neuf études précédentes ont démontré que la prévalence de la fragilité était 2-4 fois plus élevée chez les patients avec une maladie cardiovasculaire. Deux études ont démontré que la fragilité était un facteur de risque pour la mortalité, cependant, aucune étude n'avait précisément adressé la fragilité comme facteur de risque après une chirurgie cardiaque. Notre cohorte incluait 131 sujets subissant une chirurgie cardiaque dont l'âge moyen était de 75.8±4.4 ans et 34% étaient des femmes. Trente patients ont développé l'issue primaire et la fragilité (faible vitesse de marche) était un prédicteur indépendant (odds ratio 3.05, 95% confidence interval 1.23, 7.54). L'inclusion de la fragilité au modèle de prédiction traditionnel a eu comme résultat une nette amélioration des performances du modèle.
Conclusion: La prévalence de fragilité est plus élevée chez les sujets âgés atteints de maladie cardiovasculaire. La vitesse de marche est un test simple et efficace pour identifier une sous-population de patients vulnérables ayant un risque plus élevé de mortalité et morbidité après une chirurgie cardiaque. D'autres études sont nécessaires pour valider la valeur seuil optimale de vitesse de marche.
Soong, John. "Frailty assessment in acute care." Thesis, Imperial College London, 2017. http://hdl.handle.net/10044/1/50158.
Повний текст джерелаBrunk, Jennifer M. "FRAILTY: MEANINGFUL CONCEPT OR CONCEPTUAL MUDDLE?" Oxford, Ohio : Miami University, 2007. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1183660563.
Повний текст джерелаGrenier, Amanda. "Diverse older women : narratives negotiating frailty." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82884.
Повний текст джерелаThe twelve older women's storied responses, illustrations and experiences challenge the various stories that are told about them. Their complex accounts both reflect and reject dominant notions, blur the boundary between the frail and non-frail classifications, expose frailty as contextual, temporal and relative, as well as illustrate the connections between medical and social needs. Their individual accounts highlight how they make meaning of their life events in relation to their diverse experiences and identities, as well as how these identities and interpretations are key to their negotiations of life and needs. The variations between the imposed stories about frailty and women's self-perceptions highlight the research, policy and practice relevance of a narrative approach focused on in-depth local accounts, raise questions about the current priorities within home care services, as well as the future of social work practice with older women considered frail.
Collins, Susan Kay Ransom Palmer Mary H. "Associations between frailty and sex and frailty and race in hospitalized chronic heart failure patients an exploratory study /." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2007. http://dc.lib.unc.edu/u?/etd,1226.
Повний текст джерелаTitle from electronic title page (viewed Mar. 26, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Nursing." Discipline: Nursing; Department/School: Nursing.
Pelagia, Ioanna. "Variable selection of fixed effects and frailties for Cox Proportional Hazard frailty models and competing risks frailty models." Thesis, University of Manchester, 2016. https://www.research.manchester.ac.uk/portal/en/theses/variable-selection-of-fixed-effects-and-frailties-for-cox-proportional-hazard-frailty-models-and-competing-risks-frailty-models(c75c6314-f43e-4d69-a2de-942bece6a404).html.
Повний текст джерелаBray, Nicholas Walter. "Exercise to reverse frailty in older females." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/62549.
Повний текст джерелаGraduate Studies, College of (Okanagan)
Graduate
O'Connell, Matthew. "Frailty and anabolic hormones in ageing men." Thesis, University of Manchester, 2011. https://www.research.manchester.ac.uk/portal/en/theses/frailty-and-anabolic-hormones-in-ageing-men(9c0e52d6-262e-4eca-85a2-167a805aa7a1).html.
Повний текст джерелаWilliams, Joan Elizabeth. "Characteristics of Frailty in Community-Dwelling Elders." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1281648130.
Повний текст джерелаSharron, Genevieve Rose. "Frailty and Health in a Slovenian Sample." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1397603702.
Повний текст джерелаLohman, Matthew. "Frailty and Depression: A Latent Trait Analysis." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3324.
Повний текст джерелаYen, Ming-Fang. "Frailty and mixture models in cancer screening evaluation." Thesis, University College London (University of London), 2004. http://discovery.ucl.ac.uk/1446761/.
Повний текст джерелаBlank, Nash Caryn. "Identifying frailty using the ICF: proof of concept." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=19258.
Повний текст джерелаLa fragilité a émergé comme un concept de plus en plus important dans la compréhension et les soins des personnes âgées. En dépit de ceci, aucun consensus n'a été établi dans la littérature concernant un cadre théorique, une définition opérationnelle, ou des stratégies de mesure. La classification internationale de la fonction, de l'incapacité et de la santé, (CIF), fournit un cadre attrayant pour illustrer et consolider la littérature diverse sur la fragilité. La CIF est un système de classification développé par l'organisation mondiale de la santé (OMS) pour fournir un langage commun et un cadre conceptuel universel pour décrire la santé et les conditions de santé. L'objectif global de cette étude de preuve-de-concept est de déterminer jusqu'à quel point d'identification et de mesure de la fragilité sont compatibles avec le cadre de la CIF. Un total de 156 mots a été identifié par des professionnels de la santé à partir de deux articles qui se sont avérés influents dans la littérature. Par la suite, ces mots ont été liés à la CIF selon un protocole standardisé de recoupement. Les 202 codes qui ont été identifiés comportent un ensemble complet d'indicateurs d'états fonctionnels (IEFs), ou des caractéristiques qui décrivent l'entité clinique de la fragilité, d'une façon uniforme et standardisée. Un total de 21 de ces IEFs a été identifié à partir des questions des versions françaises et anglaises du Système de Mesure d'Autonomie Fonctionnelle (SMAF), une mesure spécifique pour quantifier la fonction chez les personnes âgées.
Sarker, Md Shah Jalal. "Tests for Weibull based proportional hazards frailty models." Thesis, University of Surrey, 2002. http://epubs.surrey.ac.uk/1046/.
Повний текст джерелаMasuadi, E. "Non-parametric competing risks with multivariate frailty models." Thesis, Oxford Brookes University, 2013. http://radar.brookes.ac.uk/radar/items/e828e4da-de08-2f34-37b0-8cc3bbaf7150/1.
Повний текст джерелаDolgin, Natasha H. "Frailty and Outcomes in Liver Transplantation: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsbs_diss/817.
Повний текст джерелаDolgin, Natasha H. "Frailty and Outcomes in Liver Transplantation: A Dissertation." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/817.
Повний текст джерелаGray, Roberta. "Constructions of frailty in a senior housing facility /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/8259.
Повний текст джерелаLundell, Jill F. "On the Model Selection in a Frailty Setting." DigitalCommons@USU, 1998. https://digitalcommons.usu.edu/etd/7110.
Повний текст джерелаWilson, Daisy. "Frailty, sarcopenia and immunesenescence : shared mechanisms and clinical insights." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8257/.
Повний текст джерелаLevett, Thomas. "Frailty prevalence and predictors in older adults with HIV." Thesis, University of Brighton, 2017. https://research.brighton.ac.uk/en/studentTheses/fdf0904b-7635-4bc7-a9ca-5997c075fe54.
Повний текст джерелаDing, Lili. "Bayesian Frailty Models for Correlated Interval-Censored Survival Data." University of Cincinnati / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1267454031.
Повний текст джерелаWang, Shan-Tair. "Estimation for the gamma and positive stable frailty models /." The Ohio State University, 1991. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487759436326687.
Повний текст джерелаLittle, Julianna. "“Frailty, thy name is woman”: Depictions of Female Madness." VCU Scholars Compass, 2015. http://scholarscompass.vcu.edu/etd/3709.
Повний текст джерелаKamaruzzaman, Shahrul Bahyah. "The assessment of frailty in community dwelling older people." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2010. http://researchonline.lshtm.ac.uk/4646532/.
Повний текст джерелаFalls, Candice. "FRAILTY IN PATIENTS UNDERGOING LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION." UKnowledge, 2019. https://uknowledge.uky.edu/nursing_etds/47.
Повний текст джерелаBottura, Camila. "Avaliação da fragilidade em indivíduos submetidos à cirurgia cardíaca." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17137/tde-06042018-095710/.
Повний текст джерелаFrailty syndrome, defined as the reduction of energy reserve and resistance to stressors, associated with late indication of some surgical procedures, results in a higher occurrence of risk situations for the patients with heart disease, with a greater predisposition to the development of postoperative complications, which are related to an increase in cases of hospital readmission and high length of stay. In order to improve postoperative management and our assessment of severity, prevention and risk stratification, preoperative physiotherapy uses functional tests that translate the patient\'s actual physical and pulmonary condition, allowing the identification of potentially risk factors. As a way of evaluating the prevalence of frailty in population for cardiac surgery, the association of functional tests with frailty, and peri and postoperative morbidity and mortality, we evaluated the candidates for cardiac surgery according to five criteria proposed by Fried: loss of weight, depression, low handgrip strength, low level of physical activity and reduction of walking speed, as well as lung capacity (manovacuometry, ventilometry and peak flow), effort tolerance (6MWT) and cognitive function (MMSE). After surgery, information was collected regarding the surgical procedure and postoperative recovery and then, subjects were divided into two groups: fragile and nonfragile and subdivided according to the age group in the elderly and not elderly. We evaluated 100 individuals, being 59 valvopaths and 41 coronary disease; 13% were considered nonfragile, 70% pre-fragile and 17% fragile; the maximum inspiratory pressure was significantly lower in the fragile individuals (52 ± 21 vs 75 ± 33 in non-fragile, p = 0.044), as well as the handgrip strength (31 ± 11 vs. 22 ± 8, p = 0.007); 11 patients died after the procedure (7.2% non-fragile versus 29.4% fragile individuals; p = 0.019). From the results found, we can conclude that the prevalence of frailty in cardiac surgery patients was high, even among individuals not considered elderly, and, in addition, fragile individuals had lower handgrip strength, lower vital capacity and lower inspiratory pressures and expiratory rates than those observed in non-fragile patients, as well as higher in-hospital mortality.
Gallart, Palau Xavier Ramon. "Synaptic frailty and mitochondrial dysfunction in familial amyotrophic lateral sclerosis." Doctoral thesis, Universitat de Lleida, 2016. http://hdl.handle.net/10803/386410.
Повний текст джерелаLa Esclerosis Lateral Amiotrófica (ELA) es una enfermedad neurodegenerativa de la motoneurona. Todas las motoneuronas se ven afectadas desde la corteza motora primaria hasta la unión neuromuscular. En 1993 la descubierta de mutaciones en el gen SOD1 abrió nuevos límites experimentales con la creación de los primeros roedores transgénicos para esta enfermedad. Desde ese momento y hasta la actualidad, la mutación más estudiada en la ELA ha sido la mutación SOD1-G93A. Los modelos transgénicos de esta mutación han revelado mecanismos esenciales de la neurodegeneración en la ELA, incluyendo la excitotoxicidad, la disfunción proteica y la degeneración axosináptica entre otras. En este trabajo hemos explorado los cambios moleculares que tienen lugar en los terminales C, unos terminales altamente especializados de las α-motoneuronas, en un modelo murino de ELA con la mutación SOD1-G93A. Además, también hemos focalizado nuestra atención sobre la relación patológica que se establece en la ELA familiar (ELAF) entre la mutación SOD1-G93A y las mitocondrias. En relación a los terminales C durante la ELAF, hemos encontrado cambios asociados con la aparición de síntomas, como por ejemplo el incremento de la expresión del factor neurotrófico Neuregulina-1, localizado por primera vez en la cisterna subsináptica de los terminales C. La Neuregulina-1 en esas estructuras de retículo endoplasmático fue observada dentro de vesículas extracelulares (VEs), sugiriendo que el análisis de la Neuregulina-1 dentro de VEs en la ELA resulta especialmente prometedor como biomarcador potencial para esta enfermedad. Así, nosotros hemos desarrollado también un nuevo método para purificar VEs, dado que este es un paso esencial previo al estudio de las proteínas asociadas con estas estructuras. Nuestro método aplicado a la purificación de VEs de tejidos complejos fue capaz de facilitar la identificación de la Neuregulina en VEs provenientes de tejidos clínicos y fluidos biológicos. En relación a las implicaciones de la mitocondria en la ELA, hemos encontrado que la mutación SOD1-G93A estabiliza la proteína PINK1 en las mitocondrias activando el factor nuclear NFκB en neuronas. La interacción secuencial entre la SOD1 mutante y el NFκB crea una clara disfunción sobre la capacidad proteolítica del proteosoma, la cual a su vez promueve co-agregación de la SOD1 mutante y PINK1 en estas células. Estos resultados suman un sustancial conocimiento mecanístico sobre los roles de la mitocondria en eventos degenerativos clásicos de la ELA, como es la agregación de proteínas disfuncionales en motoneuronas. Siguiendo nuestro estudio de la afectación mitocondrial en la ELA, hemos creado y caracterizado un nuevo modelo de Drosophila que expresa la mutación humana SOD1-G93A en fibras musculares torácicas bajo el promotor 24B. Este modelo de Drosophila transgénica recapitula con éxito en fenotipo mitocondrial característico de la ELA presentando importantes ventajas para la elección de nuevos compuestos terapéuticos. En definitiva, los resultados generados en esta tesis proporcionan evidencia experimental, extensa comprensión molecular y insinúan nuevos horizontes terapéuticos acerca de los mecanismos moleculares y eventos neurodegenerativos asociados con la disfunción sináptica y la disfunción mitocondrial en la ELAF.
Amyotrophic Lateral Sclerosis (ALS) is an orphan age-associated neurodegenerative disease. All motoneurones in ALS are affected by degenerative flow from the primary motor cortex to the neuromuscular junction. In 1993, mutations of the gene SOD1 opened new research avenues allowing for the generation of familial ALS experimental models in rodents. Since then, the FALS mutation SOD1-G93A has been extensively studied worldwide in ALS to date. Transgenic models for this SOD1 mutation have revealed essential mechanisms of neurodegeneration including excitotoxicity, proteinopathy and axosynaptic degeneration among others. In this dissertation, we explored the molecular changes that occur in C-terminals, a very specialised synapse type from α-motoneurones of SOD1-G93A rodents. Also, we focused on the pathological relationship between the FALS mutant SOD1-G93A and mitochondria in motoneurones. With regard to C-terminals in FALS motoneurones, we found changes that were symptomatically associated with the up-regulated expression of the neurotrophic factor Neuregulin-1 located for the first time in the subsurface system of C-boutons juxtaposed to α-motoneurones. Furthermore, Neuregulin-1 in these endoplasmic reticulum structures was observed inside extracellular vesicles, suggesting that analysis of Neuregulin-1 from extracellular vesicles in ALS holds promise as a potential reliable biomarker for that neurodegenerative disease. We therefore have developed a new method for isolation of extracellular vesicles, as this remains as an essential step for the study of molecules associated with these structures. Our method applied to purify extracellular vesicles from complex biological tissues was able to facilitate the identification of Neuregulin-1 in extracellular vessicles from clinical tissues and biological fluids. Regarding implications of mitochondria in ALS, we have found that the FALS mutant hSOD1-G93A stabilises PINK1 in mitochondria and subsequently activates NFκB in neuronal cells. Sequential interaction between hSOD1 and NFκB impairs the proteosome proteolitic function promoting co-aggregation of SOD1 and PINK1 in these cells. These results add substantial mechanistic insight on the roles of mitochondria in classical ALS-associated neurodegenerative events, including aggregation of dysfuntional proteins in motoneurones. Following our study of mitochondria affectation in ALS, we have created and characterised a novel Drosophila model that expresses human SOD1-G93A in thoracic muscles under the genetic muscular promoter 24B. Flies expressing human SOD1-G93A in thoracic muscles successfully recapitulate FALS mitochondrial phenotype with several advantages in front of the current available rodent models for this FALS mutation. Taken together, the results generated in this thesis provide experimental evidence, further molecular comprehension and promise novel therapeutic approaches to the molecular mechanisms and neurodegenerative events associated with synaptic frailty and mitochondrial disfunction in FALS.
Atsu, Francis. "Essays on failure risk of firms using multivariate frailty models." Thesis, Brunel University, 2016. http://bura.brunel.ac.uk/handle/2438/12994.
Повний текст джерелаFernandes, Gomes da Silva Alexandre Miguel. "Methods for the analysis of multivariate lifetime data with frailty." Thesis, University of Reading, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.408331.
Повний текст джерелаDörfler, Juliane [Verfasser]. "Periphere Cholinesterasen als Prädiktoren der postoperativen Frailty-Verschlechterung / Juliane Dörfler." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2021. http://d-nb.info/1241538484/34.
Повний текст джерелаTang, Andrew. "FRAILTY IN THORACIC SURGERY: ONE SIZE DOES NOT FIT ALL." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1559835403469765.
Повний текст джерелаKUZUYA, MASAFUMI. "PROCESS OF PHYSICAL DISABILITY AMONG OLDER ADULTS : CONTRIBUTION OF FRAILTY IN THE SUPER-AGED SOCIETY." Nagoya University School of Medicine, 2012. http://hdl.handle.net/2237/16020.
Повний текст джерелаBarnes, Nicola Jane. "An exploration of older case management patients' physical health, function and strength, and the feasibility of measures of muscle strength as an aid to monitoring." Thesis, University of Southampton, 2015. https://eprints.soton.ac.uk/378384/.
Повний текст джерелаSeidenz, Ericha. "Frailty Status and Rehabilitation Outcomes Among Older Adults: A Systematic Review." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42575.
Повний текст джерелаWynne, Hilary A. "What are the effects of ageing and frailty upon drug metabolism." Thesis, University of Newcastle Upon Tyne, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241342.
Повний текст джерелаKameda, Masahiro. "Frailty markers comprise blood metabolites involved in antioxidation, cognition, and mobility." Kyoto University, 2020. http://hdl.handle.net/2433/259000.
Повний текст джерелаRudden, Amy Ranalli. "PREDICTING FRAILTY AMONG COMMUNITY DWELLING OLDER ADULTS IN THE NHANES III." Miami University / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=miami1131593051.
Повний текст джерелаWarmoth, Krystal. "Understanding frailty in older adults and its relationship with ageing perceptions." Thesis, University of Exeter, 2015. http://hdl.handle.net/10871/17903.
Повний текст джерелаToosizadeh, Nima, Christopher Wendel, Chiu-Hsieh Hsu, Edward Zamrini, and Jane Mohler. "Frailty assessment in older adults using upper-extremity function: index development." BIOMED CENTRAL LTD, 2017. http://hdl.handle.net/10150/624654.
Повний текст джерелаMauguen, Audrey. "Prognosis of cancer patients : input of standard and joint frailty models." Thesis, Bordeaux, 2014. http://www.theses.fr/2014BORD0240/document.
Повний текст джерелаResearch on cancer treatment has been evolving for last years in one main direction: personalised medicine. Thetreatment choice must be done according to the patients’ and tumours’ characteristics. This goal requires somebiostatistical developments, in order to assess prognostic models and eventually propose the best one. In a firstpart, we consider the problem of assessing a prognostic score when multicentre data are used. We extended twoconcordance measures to clustered data in the context of shared frailty model. Both the between-cluster andthe within-cluster levels are studied, and the impact of the cluster number and size on the performance of themeasures is investigated. In a second part, we propose to improve the prediction of the risk of death accountingfor the previous observed relapses. For that, we develop predictions from a joint model for a recurrent event anda terminal event. The proposed individual prediction is dynamic, both the time and the horizon of predictioncan evolve, so that the prediction can be updated at each new event time. The prediction is developed ona French hospital series, and externally validated on population-based data from English and Dutch cancerregistries. Its performances are compared to those of a landmarking approach. In a third part, we explore theuse of the proposed prediction to reduce the clinical trial duration. The non-observed death times of the lastincluded patients are imputed using the information of the patients with longer follow-up. We compared threemethods to impute the data: a survival mean time, a time sampled from the parametric distribution and atime sampled from a non-parametric distribution of the survival times. The comparison is made in terms ofparameters estimation (coefficient and standard-error), type-I error and power
Summerbell, Joanna. "Plasma aspirin esterase and associated plasma esterases in old age and frailty." Thesis, University of Newcastle Upon Tyne, 1992. http://hdl.handle.net/10443/658.
Повний текст джерелаMatos, Berta Hespanha Garcia de. "Intrahospital frailty screening." Master's thesis, 2017. http://hdl.handle.net/10316/81945.
Повний текст джерелаBackground: Frailty defines a state of vulnerability facing a stressor event. Frail admitted patients represent a high-risk group for adverse health outcomes that benefit from a Comprehensive Geriatric Assessment (CGA). Screening instruments are crucial for identifying such patients; however, their potential has never been explored in Portuguese hospitals. The objective of this study is to evaluate the population of Internal Medicine inpatients at risk of frailty.Methods: Prospective study based on FRAIL scale (FS), PRISMA-7 (P7) (cut-off of 5) and medical records, conducted in a tertiary university hospital in Coimbra, Portugal, involving patients aged 65 and older admitted to Internal Medicine Service. We compared the demographic and clinical characteristics of patients with readmission and mortality within 30 and 90 days after discharge, as well as, the relationship between these outcomes and hospital admission length of stay and inhospital mortality with the state of frailty (defined by FS and P7).Results: Frailty was assessed in 100 patients. Of these, 69% and 47% were considered frail, through FS and P7, respectively. Independently of the scale, frailty was associated with greater hospital lengths of stay and the only inhospital death was of a frail patient. The patients who died within 90 days of discharge had statistically significant higher P7 score (4.9±1.6 versus 3.4±1.7, p= 0.0144) which translated into a risk of death during this period 5.5 times superior (RR 5.53, CI 95% 1.28 - 23.86, p= 0.0118) compared with the one of the not-frail patients defined by the same scale. No other risk relations, namely with FS, were concluded.Conclusions: FS and P7 are simple tools that can be used early in clinical admission to select patients to undergo CGA and improve health outcomes. Our study identified a significant percentage of patients that may have frailty. Frailty was associated with longer lengths of stay and presumably higher costs. FS and P7 application in the Portuguese population should be regarded with reservations as both demonstrated little association with readmission and mortality (except for 90 days' mortality with P7). Additional investigation is still required to further clarify this concept.
Introdução: Fragilidade define o estado de vulnerabilidade aumentado face a fatores extrínsecos de stress. Doentes frágeis internados representam um grupo de elevado risco de efeitos adversos que beneficiam de uma Avaliação Geriátrica Global (AGG). Ferramentas de rastreio de fragilidade são cruciais na identificação destes doentes; no entanto, o seu potencial nunca foi devidamente explorado em meio hospitalar português. O objetivo deste estudo é estudar a síndrome de fragilidade no doente agudo idoso internado no serviço de Medicina Interna.Métodos: Este estudo prospetivo, baseado na escala FRAIL (FS), PRISMA-7 (P7) (cut-off de 5) e em registos médicos, ocorreu num hospital universitário terciário em Coimbra, Portugal, e envolveu doentes com idade igual ou superior a 65 anos internados no Serviço de Medicina Interna. Comparámos as características clinicas e demográficas dos pacientes com a readmissão e mortalidade nos 30 e 90 dias após alta, assim como a relação destes outcomes, da duração do internamento e da mortalidade intra-hospitalar com o estado de fragilidade do doente (definido pela FS e P7).Resultados: Fragilidade foi pesquisada em 100 pacientes. Destes, 69% e 47% foram considerados frágeis, usando a FS e P7, respetivamente. Independentemente da escala utilizada, fragilidade associou-se com internamentos mais longos e a única morte intra-hospitalar registada foi de um doente considerado frágil. Os doentes que morreram nos 90 dias após alta tinham scores de P7 estatisticamente superiores (4.9±1.6 versus 3.4±1.7, p= 0.0144) o que se traduziu num risco de morte durante esse período 5.5 vezes superior (RR 5.53, CI 95% 1.28 - 23.86, p= 0.0118) quando comparado com o de doentes considerados não frágeis pela mesma escala. Não foram obtidas outras relações de risco, nomeadamente com FS.Conclusão: FS e P7 constituem instrumentos de rastreio simples de seleção de doentes à admissão para serem sujeitos a AGG com impacto clínico positivo. O nosso estudo identificou uma percentagem significativa de pacientes no serviço de Medicina Interna que poderão ser frágeis. A presença de fragilidade associou-se a internamentos mais longos e presumivelmente com maiores custos. A aplicação destas escalas na população portuguesa deve ser considerada com reserva, ambas demonstraram estar pouco associadas com readmissão e mortalidade (exceto a mortalidade a 90 dias e P7). Investigação adicional continua a ser necessária visando o esclarecimento mais aprofundado deste conceito.
Tung, Jou-Min, and 同柔敏. "Frailty Status and Functional Performance among Community-Dwelling Elderly - A Comparative Study Using two Frailty Criteria." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/74888409763702222419.
Повний текст джерела國立體育大學
運動保健學系碩士班
100
BACKGROUND: Frailty is associated with reduced age-related functional reserve and dysregulation of multiple systems, leading to vulnerability status or adverse health condition. It is therefore important to know how frailty affects heath of old people in the globally aging world. Frailty phenotype of Cardiovascular Health Study (CHS) by Fried and Clinical Frailty Scale of Canadian Study of Health and Aging (CFS) by Rockwood were used to investigate the prevalence of frailty in Taiwan using a large sample size. Results from the aforesaid instruments both indicated mobility was an important aspect for frailty evaluation. However, the relationship between other functional performances and frailty has yet to be clarified. PURPOSE: The aim of this study was to compare the percentages in levels of frailty, and its different effect on functional performances among levels of frailty using CHS and CFS in the community-dwelling elderly. METHODS: Subjects were over the age of 65 resided near Linkou, New Taipei City and Gueishan, Taoyuan areas. They were implemented CFS, CHS, and functional performance tests, including BMI, one-leg standing with eyes-open and eyes-closed, functional forward reach (FFR), back scratch, chair sit-and-reach, grip strength, 30-s chair stand (CS), 2-minute step test (ST), 6-minute walk, 8-ft up-and-go (TUG), and 5-meter walk with usual (UW) and fast pace (FW). One-way analysis of covariance (ANCOVA) was used for analysis. Significant level was set at p<.05. RESULTS:122 subjects (58 men; 64 women, meanage = 75.92) were recruited in the study. Percentages of non-frailty (NF), pre-frailty (PF) and frailty levels were 65.6%, 30.3%, 4.1% in CHS and 48.3%, 49.1%, 2.5% in CFS respectively. Significant differences were both found in CHS and CFS across levels of frailty in FFR (p=.000 vs. p=.038), CS (p=.043 vs. p=.012), ST (p=.003 vs. p=.000), TUG (p=.001 vs. p=.000), and UW (p=.001 vs. p=.006) and FW (p=.034 vs. p=.002) with abovementioned performances in NF superior to those in PF. CONCLUSION: The common results from both CHS and CFS showed statistically significant differences in balance, low extremity strength, cardiovascular fitness, and mobility between NF and PF groups. It is crucial to incorporate components of these functional performances as a basis in physical frailty prevention and intervention for the older population dwelled in the community.
Jhan, Yi-Zong, and 詹益宗. "Physical activity and frailty analysis system." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/43509492848078764317.
Повний текст джерела中原大學
生物醫學工程研究所
100
The occurring of physical frailty often causes the loss of body function and generates adverse disease. The process of frailty is subtle and slow, so without a long term record, to have the diagnosis by a single meeting is quite difficult. Traditionally, the diagnosis of doctors depends on their own experience, but it is too subjective and difficult to compare during varied periods. Although there are existing instruments can precisely assist in the diagnosis, these devices are still too expensive and complicated, and the measurement and data interpretation are also difficult. Therefore, an expert is needed during operation. Due to above reasons, these devices and methods are difficult to be used commonly. This research is going to present an analysis system of physical frailty, including the front-end hardware measurement devices and back-end data analysis and storage interface. By this system, the doctors can avoid high cost of equipment and have a simpler measurement process; on the other hand, it can help doctors to establish a data set of long-term changes in physical activity that can notice the occurring of limb degradation easily. The analysis system using a three-axis acceleration sensor as a front-end physical activity signal capture device, and hardware devices can have different measurement modes by different setting from the interface. With different mode, this system can measure varied parameters of gait and data of physical activity. On the back-end part, the programs are separated into two sets, the hospital end and the home end. The software for hospital can record the gait parameters, and data can be sent to the computer and displayed in real-time by Bluetooth devices in a wireless way. The software for home use is to collect the long-term data of activity. User wears the device on the waist and it can record the activity status daily. Before bedtime, the user can remove the device, and charge by USB port of computer and receive data form device. At last, the two sets of programs can upload data to the server and have unified management and storage. The doctor can use the interface of data analysis to recall the data of patients, so the differences of patients’ physical activities in varied time can be recheck, as an important factor of diagnosis. In this study, a lightweight and portable device has been successfully developed, and all the measurement of different physical activities can be evaluated by using the same set of hardware. It can avoid the inconvenient and complicated use of equipment and significantly decrease the cost. By the integrating of data from hospital end and the home end, the doctor can understand the long-term data of gait parameters of patients. By quantification of physical activity data, this system can help doctors have an objective and easy diagnosis of the frailty in the clinical.
Visvanathan, Renuka. "Nutritional frailty : prevalence, screening and management." Thesis, 2005. http://hdl.handle.net/2440/119778.
Повний текст джерелаThesis (Ph.D.) -- University of Adelaide, Dept. of Medicine, 2005