A research report submitted to the School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Dentistry in the branch of Prosthodontics Johannesburg, 2017 / Purpose: To perform a comparative analysis of the accuracy of intra-oral and extra-oral digital scanners when used for the milling of a long-span implant supported superstructure framework. Method: Three intra-oral and three extra-oral scanners were used to measure a master model containing five implant analogues. The three-dimension positions of the implant analogues were measured with a coordinate measuring machine. The digital data from the scanners were used to mill the implant positions in aluminium blanks from a single milling device. These implant positions were measured at the same points as the master model. The three-dimensional differences were calculated to provide a measure of the most accurate frameworks. Results: For the intra-oral scanners, the further the measurement between points, the greater the standard deviation (the poorer the precision) and the poorer the mean accuracy. However, these were clinically acceptable over short distances. For the extra-oral scanners, there was no correlation between the length of the measured distances and the accuracy of the produced framework. All the extra-oral scanners were clinically acceptable for complete-arch prostheses. Conclusions: Noting the limitations of this study and the use of a milling centre to mill the frameworks, for the intra-oral scanners, the 3Shape Trios® (3Shape, Copenhagen, Denmark) can be used for measurements up to 21,5mm and the Sirona CEREC OmniCam (Sirona Dental Systems, Inc., Bensheim, Germany) can be used for measurements up to 34mm. The extra-oral scanners used in this study can be used for complete-arch implant prosthetics. The accuracy of these is relative to the model or impression created. Steps should therefore be made to ensure the accuracy of the model such as the use of a verification jig / MT2017

Hospital readmission rates are considered to be an important indicator of quality of care because they may be a consequence of actions of commission or omission made during the initial hospitalization of the patient, or as a consequence of poorly managed transition of the patient back into the community. The negative impact on patient quality of life and huge burden on healthcare system have made reducing hospital readmissions a central goal of healthcare delivery and payment reform efforts. In this project, we will focus on COPD (Chronic Obstructive Pulmonary Disease) which is one of the leading causes of disability and mortality worldwide. This project will design and develop a prognostic COPD healthcare management system which is a sustainable clinical decision-support system to reduce the number of readmissions by identifying those patients who need preventive interventions to reduce the probability of being readmitted. Based on patient’s clinical records and discharge summary, our system would be able to determine the readmission risk profile of patients treated for COPD. Suitable interventions could then be initiated with the objective of providing quality and timely care that helps prevent avoidable readmission. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

Osteossarcoma é o tumor ósseo maligno primário mais comum, com uma taxa de incidência nos adolescentes de 8 a 11 casos/milhão entre 15 e 19 anos. No Brasil, estima-se 350 casos/ano até 20 anos. A sobrevida é de até 70% em cinco anos para os não metastáticos e 80% de sobrevida global. Quando recaem, essa sobrevida atinge 20% em um ano. Pacientes com Osteossarcoma devem ser acompanhados frequentemente com estudos radiológicos para investigação de metástases, por pelo menos 5 anos após término do tratamento , sendo mais intensivo nos dois primeiros anos, onde ocorrem a maioria das recaídas. Objetivo: Avaliar o acompanhamento do pós tratamento nos pacientes portadores de osteossarcoma. Casuística e Métodos: Estudo retrospectivo realizado na Fundação Pio XII Hospital de Câncer de Barretos, com 52 pacientes tratados de Osteossarcoma pelo Departamento de Pediatria, no período de janeiro de 2000 a julho de 2006. Os dados foram coletados através de uma ficha clínica, que constava registros sócios demográficos e clínicos. Foi realizada a análise descritiva dos dados. Para a associação das variáveis independentes ao comparecimento à consulta, utilizou-se o teste qui-quadrado. Resultados: Dos 52 pacientes analisados, 61,5 % eram do sexo masculino, com mediana de idade de 15 anos e 48,1% procedentes do Estado de São Paulo. Em relação às variáveis clínicas, 59,6% recidivaram e desses recidivados, 58% foram pulmonar. Desses com recidiva pulmonar, 44,4% no momento da recaída apresentavam queixa e não adiantaram a consulta. Não houve associação estatisticamente significativa entre as características demográficas com o comparecimento adiantado à consulta, sendo que os residentes a menos de duas horas do hospital representaram 33,3% e os que residiam há mais de 21horas de viagem 30,8% (p=0,073). Nas consultas em que ocorreram atrasos, 54,5% dos pacientes estavam hospedados em alojamento (p=0, 010). Entre os pacientes, 81,3% dos que adiantaram a consulta apresentavam queixas quando comparados com os que não adiantaram (p=0,005). Dos pacientes que recidivaram, 12,9% compareceram atrasados em alguma consulta, enquanto que os não recidivados,47,6% atrasaram em alguma consulta (p=0,006).Nas consultas em que houve atrasos, 54,5% estavam hospedados em alojamento(p=0,010). Conclusão: Em nossa experiência podemos inferir que a distância não foi fator preponderante para o comparecimento atrasado às consultas e que a maioria dos pacientes que compareceram atrasados à consulta dependiam do alojamento para hospedagem. Verificou-se que os pacientes que adiantaram a consulta apresentavam mais queixas, e estas estavam associadas ao resultado positivo dos exames realizados. Além disso, nos pacientes que recidivaram, aqueles que adiantaram a consulta não apresentaram diferença estatisticamente significativa na sobrevida livre de recidiva / Osteosarcoma, the most common malignant primary bone tumor, with incidence rates, for adolescents between 15 to 19 years old, of 8-11 cases/ million. In Brazil, it is estimated 350 cases/ year until 20 years of age. It has a survival of up to 70% in five years for the non-metastatic ones and a global survival of up to 80%. When they relapse, this survival reaches 20% in one year, and it might reach 40 % in five years. Osteosarcoma patients should be followed up, frequently, with radiologic studies to investigate metastases, for at least five years after the end of treatment, which should be more intensive in the two first years, where most of the relapses occur. Aim: To evaluate the post-treatment follow-up in osteosarcoma patients. Material and methods: A retrospective study carried out at Fundação PioXII Hospital de Câncer de Barretos evaluated 52 osteosarcoma patients who were treated by the Pediatrics Department, between January, 2000 and June, 2006. Data were collected using a clinical file which comprised socio-demographic and clinical data. Results: 52 patients were analyzed, 61,5% were male, the mean age was 15 years old, and 48,1% were from São Paulo State. In regard to the clinical variables, 59,6% of patients relapsed, and from those, 58% have lung relapses. 44,4%of the patients who had lung relapses, presented some kind of complain and did not move up their visits. There was no statistically significant difference between the demographic features and the early attendance to visits, and people who lived less than a two-hour-trip from the hospital represented 33,3% of patients whereas people who lived more than a 21-hour-trip, represented 30,8% (p=0,073). The relapse showed association with late attendance to visit, because 12,9% of relapse patients were late (p=0,006). Among the late patients, 54,5% of them were in housing(p=0,005). Conclusion: In our study, we could infer that distance was not an important factor to late attendance to visits, and most late patients depended on housing to have a place to stay. During follow-up, it was verified that early patients presented more complaints, and those were related to the positive results of the exams. Besides, in relapse patients, those who have moved up their visits, did not present statistically significant difference in the relapse-free survival

Introdução - As práticas obstétricas têm sido determinadas pela noção de risco, resultando em altas taxas de intervenções intraparto e de cesarianas no país. As indicações desta cirurgia não têm seguido um critério clínico-obstétrico fundamentado nos diferentes cenários de assistência, reduzindo o seu potencial protetor. Objetivos - Identificar e comparar as indicações de cesarianas intraparto em mulheres de baixo risco, a partir da assistência e das intercorrências que antecederam o nascimento, em dois modelos de assistência (Centro de Parto Normal e Centro Obstétrico); e caracterizar os locais de estudo quanto à equipe de saúde, às práticas protocolares e à estrutura física para assistência à mulher e ao bebê. Métodos - Estudo transversal, realizado por coleta de dados secundários, em dois hospitais públicos de São Paulo. Foram incluídas no estudo 158 parturientes de baixo risco submetidas à cesariana intraparto, em 2010. Para análise dos dados, estimou-se a Odds Ratio. Resultados - Os achados foram discutidos à luz da Medicina Baseada em Evidências. Os melhores resultados estiveram associados ao Hospital que dispõe de Centro de Parto Normal, com significância estatística na internação oportuna da parturiente, na presença de um acompanhante, no uso de partograma e nos métodos não farmacológicos para alívio das dores. Constataram-se alguns registros de práticas obstétricas realizadas de modo questionável em ambas as instituições, como uso de ocitocina e de amniotomia. Quanto às intercorrências, as mais frequentes foram: sofrimento fetal, presença de mecônio, distocia funcional e desproporção céfalo-pélvica, embora parte dessas indicações tenha divergido dos achados registrados no decorrer do trabalho de parto. Considerações finais: Fragilidades nas práticas obstétricas estiveram presentes em ambas as instituições, embora o Hospital com Centro de Parto Normal tenha demonstrado assistência menos restritiva e mais personalizada às mulheres. Evidenciou-se a presença de intervenções desnecessárias, com vistas à aceleração do trabalho de parto, o que demonstra resistência dos profissionais e das instituições às evidências científicas, bem como às recomendações e diretrizes do Ministério da Saúde e da Organização Mundial da Saúde / Background - The obstetrical practices have been determined by the notion of risk, resulting in high rates of intrapartum interventions and cesarean sections in the country. The recommendations of this surgery have not followed a wellfounded clinical and obstetric criterion in different assistance scenarios, reducing its protective potential. Objectives Identify and compare the recommendations for intrapartum caesarean sections in women with low-risk pregnancies from the assistance and the events that preceded the birth, in two models of care (Center for Childbirth and Obstetric Center); and characterize the study sites regarding the health team, protocol practices and the structure to assist the woman and the baby. Methods - A cross sectional study carried out by secondary data collection in two public hospitals in São Paulo. The study included 158 pregnant women with low-risk pregnancies, submitted to intrapartum cesarean section in 2010. For data analysis, we estimated the Odds Ratio. Results The findings were discussed from the Evidence-Based Medicine. The best results were associated with a hospital that has a Childbirth Center, with statistical significance in the timely admission of the mother, in the presence of a companion, the use of partogram and non-pharmacological methods for pain relief. There were records of obstetrical practices in a way questionable in both institutions, such as use of oxytocin and amniotomy. As for complications, the most frequent were: fetal distress, meconium, functional dystocia and cephalopelvic disproportion, although part of these records have diverged from findings reported in the course of labor. Conclusion: Weaknesses in obstetric practices were present in both institutions, although the Hospital Childbirth Center has demonstrated a more personalized and less restrictive care to women. It was noted the presence of unnecessary interventions, aiming at the acceleration of labor, which shows resistance of professionals and institutions to the evidence-based medicine, and also to the recommendations and guidelines of the Ministry of Health and World Health Organization

Trata-se de um estudo teórico sobre vulnerabilidade que se desdobra numa contribuição prática. Concebe-se a vulnerabilidade como um contínuo a fim de se destacar sua relação com os diversos sentidos de realidade ao longo do amadurecimento humano. A partir disso, vinculamos as relações inter-humanas aos contextos sociais, partindo e retornando às relações de cuidado, já inseridas em contextos históricos e culturais (de respostas sociais e de re-avaliações responsivas intersubjetivas). O objetivo do projeto é discutir a relação entre cuidado e criatividade no contínuo da vulnerabilidade tendo como horizonte o fortalecimento das ações de cuidado no atendimento de saúde e mostrar a importância da criatividade como manifestação primária do homem, quando ele sente e significa seu estar no mundo. A partir de saberes filosóficos (fenomenológicos e hermenêuticos) e psicanalíticos (winnicottiano), defendemos que o cuidar é sustentar para a manifestação criativa. A seguir, revisamos o conceito de cuidado com a finalidade de produzir um roteiro para organização de sínteses dos encontros clínicos. Esse roteiro é inserido em uma prática que procura características pessoais a partir de experiências de vida. O roteiro tem uma lógica ou uma produtividade inerente (preocupada com a temporalização do existir humano) que sustenta a postura de escuta e que pode precipitar respostas aos desafios do contínuo da vulnerabilidade. O roteiro facilita a aproximação dos profissionais de saúde a diferentes modos de pensar as necessidades de saúde. É um convite a ir ao encontro do outro como um existente via um processo intuitivo, imediatamente aplicado e potencialmente aberto para revisões sobre a qualidade de nosso trabalho e interação com pacientes, equipes, instituições, comunidades e sociedades. / This is a theoretical study on the concept of vulnerability aiming at practical contributions. Vulnerability is taken here as a continuum, in order to highlight its relations with the diverse senses of reality that emerges from the processes of human maturing. Based on this, approach human relationships and care are examined within a to and fro analysis, contextualizing agency and social responses in their historical and cultural roots. The project\'s goal is to discuss the role of creativity in care practices in the horizon of the continuum of vulnerability and, by doing so, to demonstrate the importance of creativity as a primary manifestation of the human being, as long as creation express how he/she feel and mean his/her \"being in the world\". Based on a philosophical (phenomenology and hermeneutics) and psichoanalitical (Winnicott) knowledge, it is argued that care is the holding for creative expression. Then, the current concept of health care is revisited and a script for the organization of clinical summaries for the clinical meetings is suggested. This script seeks to aprehend personal features by means of life experiences. It has an inherent logic, or productivity (concerned about the temporality of human existence), that maintains an actitude of listening which can stimulate creative responses to the challenges brought about by the diverse needs configured on the vulnerability continuum. The script is therefore thought to facilitate health professionals to approach health care needs by new ways. It is a call to meet the other as an \"existent\" by means of an intuitive process, immediately applied and potentially open to revisions on the quality of our work and interaction with patients, others professionals, institutions, communities and societies.

The comprehensive measurement of efficiency and performance in the Health Service in the UK has become one of the most important managerial developments of recent years. The reasons for this development were examined, particularly in relation to the difficulties involved with performance assessment in such a context. The most widely utilised techniques were evaluated from the perspective of the Health Care Manager and a number of serious limitations were identified. In response to these limitations, the technique of Data Envelopment Analysis was evaluated as an alternative. It has been proposed as an appropriate and useful tool for the assessment of efficiency, although the literature on DEA showed limited practical application to public sector services in the UK. The many facets of the technique were investigated and literature on its application to hospital data was reviewed. A two-stage application procedure for the DEA technique was developed in response to this evaluation, to be used in the measurement hospital efficiency. The procedure was based on a deep theoretical understanding of the DEA methodology. The most important elements of the process were related to selection of the initial sample, the identification of the variables to be included in the DEA model and the definition of the weight restrictions to be incorporated. Input from Health Care Managers was used to guide the application and data from a sample of acute hospitals in Scotland was utilised in the analysis. The application procedure showed how the practicalities of the DEA technique could be enhanced, in particular through the inclusion of weight restrictions. This led to the development of efficiency strategies for the inefficient hospitals, which could be related to the policy objectives or managerial structure of the hospitals in the sample. It was concluded that there were many potential benefits of the DEA approach to efficiency assessment and the two-stage application procedure defined here, which could be seen to fulfil many of the requirements of the Health Care Manager. It was determined that combining theoretical and practical issues can enhance the applicability of the DEA methodology.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2006. / Title from first page of PDF file (viewed Feb. 14, 2008). Includes bibliographical references (p. 97-100).

Thesis (M.S.)--University of Missouri-Columbia, 2007. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. "May 2007" Includes bibliographical references.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed Feb. 17, 2009). Includes bibliographical references (p. 140-158).

Thesis (M.P.H.M.)--Mahidol University, 2000.