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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
41

Comparison of Different Strategies for the Management of Febrile Neutropenia in Children - A Cost-utility Analysis

Teuffel, Marc Oliver 30 November 2011 (has links)
Introduction: There is uncertainty whether low-risk febrile neutropenia (FN) episodes in children with cancer are best managed in the inpatient or outpatient setting. Methods: A cost-utility model was created to compare four different treatment strategies for low-risk FN in pediatric cancer patients. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollar), and incremental cost-effectiveness ratios (ICER). Results: The most cost-effective strategy was outpatient treatment with intravenous antibiotics. It was cost saving ($2,732 versus $2,757) and more effective (0.66 QAFNE versus 0.55 QAFNE) as compared to outpatient treatment with oral antibiotics. An early discharge strategy after 48 hours in hospital was slightly more effective but significantly more expensive than outpatient treatment with intravenous antibiotics resulting in an unacceptably high ICER of more than $130,000 per QAFNE. Inpatient care was the least cost-effective strategy. Conclusions: Outpatient strategies for treatment of low-risk FN in children are more cost-effective than traditional inpatient care.
42

Changes in Social Inequality in Smoking-attributable Adult Male Mortality between 1986 and 2001 in Four Developed Countries

Singhal, Sonica 20 December 2011 (has links)
Social inequalities exist in smoking-attributable mortality rates of males. Change in these social inequalities in the past two decades in developed countries remains uncertain. This study was conducted in Canada, France, Poland, and Switzerland to quantify differences in smoking-attributable mortality rates, at ages 35-69 years, among different social strata in recent years and to examine the changes in social inequalities in these rates between 1986 and 2001. Analyses included 377,878 deaths from a total population of 13,482,210 males of these four countries. Smoking-attributable mortality rates reduced in all strata over the comparative time periods, in all countries, except France. This work specifically focuses to fill the gap in knowledge about whether tobacco control has reached the poor or lower social strata in developed countries. This study will enable follow up research including quantification of effects of the specific tobacco control policies in each country.
43

Optimizing the Tailored Treatment of Breast Cancer

Amir, Eitan 06 December 2012 (has links)
Background: Breast cancer is a diverse disease. Over the past 3 decades it has been increasingly appreciated that therapy should be targeted to specific patient and tumour characteristics. In recent years the evaluation of tailored therapy has been dominated by the development of new drug therapy which when successful has been marketed at a high price. There have been few successful attempts to optimize currently available therapies. This thesis explores the optimization of currently available therapies in three domains: efficacy, toxicity and supportive care. Methods: Three independent studies were undertaken. First, a prospective cohort study was conducted to assess the impact of re-biopsy of recurrent breast cancer on physician choice of therapy and on patient satisfaction. The second study comprised a systematic review and meta-analysis of randomized trials exploring toxicities associated with different endocrine therapy options for early breast cancer with the aim of identification of patients who may be harmed by certain drugs. Finally, a randomized feasibility study was conducted to evaluate de-escalated intravenous bisphosphonates in women with low-risk metastatic breast cancer to bone. Results: All studies met their objectives in showing that the tailored use of available therapies can be optimized. The prospective study of the impact of re-biopsy showed that treatment decisions were modified in 14% of women. Patient satisfaction with the process of re-biopsy was high. The meta-analysis of toxicities of endocrine therapy identified cardiovascular disease as a statistically significant toxicity of aromatase inhibitors, thereby suggesting that those with established cardiovascular disease or risk factors thereof should reduce their exposure to these drugs. Finally, the randomized feasibility study showed that it is possible to conduct randomized trials of de-escalated bisphosphonates in women with low-risk breast cancer and there was no signal that reducing the frequency of treatment was associated with untoward outcomes. Conclusions: It is possible to optimize the tailored therapy of breast cancer using currently available treatments. This may lead to improved patient outcome while using existing resources. Further studies assessing the optimization of other treatments are warranted.
44

The Role of Drinking Water as a Source of Transmission of Antimicrobial Resistant Escherichia coli

Coleman, Brenda Lee 26 February 2009 (has links)
Antimicrobial resistance is a serious threat to the treatment of infectious diseases and a leading public health concern of the 21st century. Antimicrobial resistant E. coli has been detected in many places including domestic livestock, humans, food items, surface water, and drinking water. Although the use of antibiotics is a major contributor to the emergence of resistance, the ingestion of water contaminated with antimicrobial resistant bacteria may contribute to the prevalence of antimicrobial resistance in humans. Purpose: The objectives of the research were to determine the prevalence of human faecal carriage of antimicrobial resistant E. coli in people residing in southern Ontario who used private water sources and to determine whether the use of water contaminated with antimicrobial resistant E. coli was associated with human carriage of same. Method: The study population consisted of people living in Ontario households that submitted water samples from private water sources for bacteriological testing between May 2005 and September 2006. Respondents completed a questionnaire and submitted a self-collected rectal swab. Results: Antimicrobial resistant E. coli were detected in the swabs of 41% of the 699 respondents, with 28% resistant to ampicillin, 25% to tetracycline, and 24% to sulfisoxazole, and 29% that were multi-drug resistant. Subjects from households using untreated water contaminated with antimicrobial resistant E. coli were 40% more likely to carry antimicrobial resistant E. coli in their gastrointestinal system than people from households using uncontaminated water, even after adjusting for the effect of other variables. Implications: The association between the consumption of water contaminated with antimicrobial resistant E. coli and human carriage of resistant E. coli highlights the ongoing risks associated with water contamination and antimicrobial resistance in Ontario. The high rates of resistant E. coli in healthy non-institutional persons provides further rationale for public health programs to reduce antibiotic use in medicine and agriculture.
45

Family Matters: An Examination of the Association between Family Structure and Youth Injury

Scott, Helen M. 03 March 2010 (has links)
Injury is the leading cause of morbidity and mortality among Canadian youth. In order to develop successful prevention strategies for this major public health problem, it is necessary to determine injury risk factors. Despite reasons to believe that family structure (parents’ marital and living arrangements) may be associated with youth injury, this link has been largely overlooked in injury research. The objectives of this thesis were to determine whether family structure was associated with youth injury in a manner described by theory, after considering alternative explanations for the observed association and to explore how engaging in high risk behaviour mediated the impact of family structure on youth injury. The association was explored using cross-sectional and longitudinal data. This study was based on a representative, cross-sectional World Health Organization, Health Behaviour in School-aged Children (2006) survey of 9, 068 Canadian students, aged 11–15 years, from 186 schools. A sub-sample of 1, 885 Ontario students surveyed in 2006 and again in 2007 comprised the longitudinal sample. The associations were assessed using generalized estimating equations with classroom clusters and Poisson distribution, adjusting for identified potential confounders and examining mediation by high-risk behaviours. There were three main findings: 1) Family structure was associated with medically treated injury in females, after accounting for confounding. Results showed that females from non-intact families had slightly increased risk of any injury than those from intact families (PR=1.11; 95% CI: 1.04-1.19). However, they had a greater risk of non-sports (PR=1.30; 95% CI: 1.16-1.77) and severe, non-sports (PR=1.46; 95% CI: 1.12-1.91) injury. 2) Only a small portion of the association between family structure and injury was explained by engaging in high risk behaviour. 3) There was an inconsistent relationship between family structure and male non-sports injury (Canadian cross-sectional, PR=1.05; 95% CI: 0.94-1.16; Ontario longitudinal, PR=1.58; 95% CI: 1.20-2.07). The findings of this thesis call attention to the importance of non-intact family structures as a risk factor for youth injury. More research is needed to improve our understanding of the mechanisms through which family structure influences youths' risk of injury in order to guide policy development.
46

Methods for Exploring Heterogeneity in Systematic Reviews of Randomized Controlled Trials

Gagnier, Joel 12 August 2010 (has links)
This thesis consisted of three major components: 1. A sample of randomized controlled trials of herbal medicines was collected and assessed with a recently developed extension of the CONSORT statement for herbal medicine trials. 2. A methodological review of proposed methods of assessing clinical heterogeneity in meta-analyses of randomized controlled trials, 3. The application of permutation based resampling in meta-regression of multiple covariates. An analysis of 406 RCTs of herbal medicine interventions revealed that these trials are regularly under reporting important aspects of the intervention. Next, the second project showed that there are many resources providing suggestions for investigating clinical heterogeneity in systematic reviews of controlled clinical trials and though there is minimal consensus some recommendations are common across sources. Finally, the third project found that permutation tests result in more conservative, larger, p-values potentially reducing the rate of false positive findings when exploring multiple covariates.
47

The Ontario Structures of Care in Colorectal Cancer Surger Study (OSCRC): Assessing Hospital Level Variation and Impact on Short Term Patient Outcomes

Nenshi, Rahima N. 15 February 2010 (has links)
Introduction: Surgical treatment is the cornerstone of the management of colorectal cancer (CRC). This study described the structures of care at Ontario hospitals performing CRC surgery. Methods: Patients diagnosed with CRC undergoing surgery were identified from 2003-2007. Data linkage identified all institutions performing CRC surgery. Multiple hospital level structures were measured. For the final year of our study, the impact of these structures on 30-day mortality was evaluated. Results: 20,784 patients underwent CRC surgery. Each year, between 106 and 109 institutions performed at least one CRC operation. There was variation in hospital level structures of care. After adjustment for patient characteristics, no hospital level structures were independently associated with 30d mortality. Conclusions: Although variation in surgical care and patient outcomes is likely related to variation in processes and structures of care, after adjusting for covariates, our study did not show any significant relationship between hospital level structures and 30-day mortality.
48

The Ontario Structures of Care in Colorectal Cancer Surger Study (OSCRC): Assessing Hospital Level Variation and Impact on Short Term Patient Outcomes

Nenshi, Rahima N. 15 February 2010 (has links)
Introduction: Surgical treatment is the cornerstone of the management of colorectal cancer (CRC). This study described the structures of care at Ontario hospitals performing CRC surgery. Methods: Patients diagnosed with CRC undergoing surgery were identified from 2003-2007. Data linkage identified all institutions performing CRC surgery. Multiple hospital level structures were measured. For the final year of our study, the impact of these structures on 30-day mortality was evaluated. Results: 20,784 patients underwent CRC surgery. Each year, between 106 and 109 institutions performed at least one CRC operation. There was variation in hospital level structures of care. After adjustment for patient characteristics, no hospital level structures were independently associated with 30d mortality. Conclusions: Although variation in surgical care and patient outcomes is likely related to variation in processes and structures of care, after adjusting for covariates, our study did not show any significant relationship between hospital level structures and 30-day mortality.
49

The Impact of Pregnancy on Breast Cancer Survival in Women who Carry a BRCA1 or BRCA2 Mutation

Rodriguez de Valentini, Adriana Alicia 10 December 2013 (has links)
Background: Young BRCA mutation carries with a history of breast cancer often inquire about the impact of pregnancy upon their risks of cancer recurrence and survival. Methods: We identified 128 BRCA carriers who were diagnosed with breast cancer while pregnant or who became pregnant after breast cancer diagnosis. Women were matched to 269 controls. Women were followed from the date of breast cancer diagnosis until the date of death. The Kaplan-Meier method and a left-truncated Cox proportional hazard model were used to estimate 15-year survival rates. Results: The adjusted hazard ratio associated with 15-year survival for women diagnosed with breast cancer who were or became pregnant after breast cancer diagnosis, compared to women who did not become pregnant was 0.76 (95% CI 0.31 to 1.91 p = 0.56). Conclusion: Pregnancy concurrent with or after a diagnosis of breast cancer does not appear to adversely affect survival among BRCA1/2 mutation carriers.
50

The Impact of Pregnancy on Breast Cancer Survival in Women who Carry a BRCA1 or BRCA2 Mutation

Rodriguez de Valentini, Adriana Alicia 10 December 2013 (has links)
Background: Young BRCA mutation carries with a history of breast cancer often inquire about the impact of pregnancy upon their risks of cancer recurrence and survival. Methods: We identified 128 BRCA carriers who were diagnosed with breast cancer while pregnant or who became pregnant after breast cancer diagnosis. Women were matched to 269 controls. Women were followed from the date of breast cancer diagnosis until the date of death. The Kaplan-Meier method and a left-truncated Cox proportional hazard model were used to estimate 15-year survival rates. Results: The adjusted hazard ratio associated with 15-year survival for women diagnosed with breast cancer who were or became pregnant after breast cancer diagnosis, compared to women who did not become pregnant was 0.76 (95% CI 0.31 to 1.91 p = 0.56). Conclusion: Pregnancy concurrent with or after a diagnosis of breast cancer does not appear to adversely affect survival among BRCA1/2 mutation carriers.

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