There is a robust body of research regarding outcomes following pediatric acquired brain injury (ABI). However, these studies generally explore medium-term outcomes (i.e., 3 to 12-months postinjury), whereas functioning during acute stages following ABI is poorly understood. In particular, there is limited knowledge regarding caregiver functioning during a child’s hospitalization immediately after ABI. This study sought to identify and model caregiver and child predictors of ‘caregiver confidence’ in caring for their hospitalized child. Caregivers of 45 children with diverse types of new-onset acquired brain injuries completed self-report measures of their own psychological functioning, stress, and confidence levels, as well as their perceptions of their child’s stress and coping. Results showed that caregiver psychological functioning was negatively associated with caregiver confidence, and caregiver perceptions of child coping were positively associated with caregiver confidence. Child functional status did not serve as a significant mediator in this relationship as per the hypothesized model.

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There is a robust body of research regarding outcomes following pediatric acquired brain injury (ABI). However, these studies generally explore medium-term outcomes (i.e., 3 to 12-months postinjury), whereas functioning during acute stages following ABI is poorly understood. In particular, there is limited knowledge regarding caregiver functioning during a child’s hospitalization immediately after ABI. This study sought to identify and model caregiver and child predictors of ‘caregiver confidence’ in caring for their hospitalized child. Caregivers of 45 children with diverse types of new-onset acquired brain injuries completed self-report measures of their own psychological functioning, stress, and confidence levels, as well as their perceptions of their child’s stress and coping. Results showed that caregiver psychological functioning was negatively associated with caregiver confidence, and caregiver perceptions of child coping were positively associated with caregiver confidence. Child functional status did not serve as a significant mediator in this relationship as per the hypothesized model.

Physicians’ understanding of bio-signals, measured using medical instruments, becomes the foundation of their decisions and diagnoses of patients, as they rely strongly on what the instruments show. Thus, it is critical and very important to ensure that the instruments’ readings exactly reflect what is happening in the patient’s body so that the detected signal is the real one or at least as close to the real in-body signal as possible and carries all of the appropriate information. This is such an important issue that sometimes physicians use invasive measurements in order to obtain the real bio-signal. Generating an in-body signal from what a measurement device shows is called “signal purification” or “reconstruction,” and can be done only when we have adequate information about the interface between the body and the monitoring device. In this research, first, we present a device that we developed for electrocardiogram (ECG) acquisition and transfer to PC. In order to evaluate the performance of the device, we use it to measure ECG and apply conductive textile as our ECG electrode. Then, we evaluate ECG signals captured by different electrodes, specifically traditional gel Ag/AgCl and dry golden plate electrodes, and compare the results. Next, we propose a method to reconstruct the ECG signal from the signal we detected with our device with respect to the interface characteristics and their relation to the detected ECG. The interface in this study is the skin-electrode interface for conductive textiles. In the last stage of this work, we explore the effects of pressure on skin-electrode interface impedance and its parametrical variation.

The aim of this thesis was to examine the use of modelling techniques in the economic evaluation of selective decontamination of the digestive tract (SDD), used to prevent intensive care unit (ICU) acquired pneumonia. The need for evidence for the effectiveness and cost effectiveness of technologies used in intensive care was highlighted through an examination of the literature. The clinical and economic issues pertinent to ICU-acquired pneumonia and SDD were described. It was suggested that an economic evaluation of SDD was required. An evaluation using modelling techniques was proposed. A secondary economic evaluation of SDD was carried out, utilising a decision-analytic model and published clinical and economic evidence to derive cost/outcome ratios. This analysis showed that SDD could be a dominant therapy, but improved economic and long term outcome evidence was required to increase the robustness of conclusions. This thesis concentrated on improving the economic evidence. A national survey of SDD use provided information on clinical practice. A prospective observational study was carried out at two British ICUs to obtain evidence on the economic impact of ICU-acquired pneumonia. The impact of infection and confounding factors on resource use was handled quantitatively, using regression techniques. It was found that ICU-acquired pneumonia significantly increased length of ICU stay. These two sets of empirical data were used in a revised economic evaluation of SDD. SDD was found to be a dominant therapy at both centres. Uncertainty around cost/outcome ratios was considered to be decreased, or at least quantified, by this primary economic evidence. This thesis concludes that modelling has a place in economic evaluation in intensive care, if rigorous methods are used. It has also demonstrated that current, reliable and applicable economic evidence is a prerequisite to any economic evaluation, if it is to be included in the decision-making process.

Acquired brain injury (ABI) during adolescence presents even greater challenges to youth already facing complex issues in this transitory period. Studies have demonstrated that youth with ABI suffer from social and community withdrawal as a result of their injuries. However, a lack of research focusing on interventions designed to promote community integration has left the effectiveness of these programs difficult to assess. The current study aimed to collect pilot data about the effectiveness of an expressive arts-based therapeutic program in helping to improve community integration of these youth, as these therapies have been shown to be useful for individuals with similar cognitive and behavioural issues. Results over 2 stages of testing suggest that expressive arts therapy is a promising intervention strategy to help promote social and community integration skills. The findings also suggest that more research is needed to develop improved measures of community integration for adolescents with ABI.

Acquired brain injury (ABI) during adolescence presents even greater challenges to youth already facing complex issues in this transitory period. Studies have demonstrated that youth with ABI suffer from social and community withdrawal as a result of their injuries. However, a lack of research focusing on interventions designed to promote community integration has left the effectiveness of these programs difficult to assess. The current study aimed to collect pilot data about the effectiveness of an expressive arts-based therapeutic program in helping to improve community integration of these youth, as these therapies have been shown to be useful for individuals with similar cognitive and behavioural issues. Results over 2 stages of testing suggest that expressive arts therapy is a promising intervention strategy to help promote social and community integration skills. The findings also suggest that more research is needed to develop improved measures of community integration for adolescents with ABI.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.

Diss. Stockholm : Karol. inst.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.