Thesis (M.Ost.)--Unitec New Zealand, 2008. / Includes bibliographical references (leaves 75-83).

Thesis (M.Ost.)--Unitec New Zealand, 2009. / Includes bibliographical references (leaves 88-92).

Thesis (M.Ost.)--Unitec New Zealand, 2008. / Coda (electronic version) title-page has 2009 date. Includes bibliographical references (leaves 38-47).

BACKGROUND: Bariatric surgery is an effective weight loss treatment modality for people with morbid obesity, however, there may be a negative impact on postoperative bone health. This review summarizes changes of different bone mineral density dual-energy x-ray absorptiometry measurements, with specific attention to the laparoscopic sleeve gastrectomy and the roux-en-y gastric bypass. METHODS: PubMed and the Cochrane Library searches yielded 156 articles published before November 2017. The articles were evaluated based on the following inclusion criteria: focus on laparoscopic sleeve gastrectomy or roux-en-y gastric bypass and bone health, written in English, full-length article, studied participants for one-to-two years, and included statistical measurements. RESULTS: Of the 156 studies that were initially screened, 16 full-length articles were included in the final analysis. The articles described a lower loss of bone density at the lumbar spine, femoral neck, forearm, and total hip after laparoscopic sleeve gastrectomy when compared to roux-en-y gastric bypass, however, these studies lack statistical power due to the small sample sizes of less than 10 participants. CONCLUSION: The number of bariatric surgeries continues to increase worldwide, however, the literature provides limited studies that evaluate the effects of bariatric surgery on bone health, more than two-years postoperative. Further study is necessary to determine the mechanisms of bone loss after bariatric surgery, with great attention to differences in bone health between sexes.

Osteopathic physician (D.O.) residency programs that do not achieve accreditation under the new Single Accreditation System (SAS) standards by June 30, 2020 will lose access to their share of more than $9,000,000,000 of public tax dollars. This U.S. Centers for Medicare & Medicaid Services (CMS) funding helps sponsoring institutions cover direct and indirect resident physician training expenses. A significant financial burden would then be shifted to marginal costs of the residency program’s sponsoring institution in the absence of CMS funding. The sponsoring institution’s ability or willingness to bare these costs occurs during a time when hospital operating margins are at historic lows (Advisory.com /Daily Briefing /May 18, 2017 | The Daily Briefing / Hospital profit margins declined from 2015 to 2016, Moody's finds). Loss of access to CMS funding may result in potentially cataclysmic reductions in the production and availability of primary care physicians for rural and urban underserved populations. Which osteopathic residency programs will be able to survive the new accreditation requirement changes by the 2020 deadline? What are some of the defining attributes of those programs that already have achieved “initial accreditation” under the new SAS requirements? How can the osteopathic programs in the process of seeking the new accreditation more effectively “pivot” by learning from those programs that have succeeded? What are the potential implications of SAS to both access and quality of health care to millions of Americans? This report is based upon a study that examined and measured how osteopathic physician residency programs in the U.S. are accommodating the substantive structural, financial, political and clinical requirements approximately half way through a five-year adaptation period. In 2014, US Graduate Medical Education (GME) physician program accreditation systems formally agreed to operate under a single accreditation system for all osteopathic (D.O) and allopathic (M.D.) programs in the U.S. Since July 1, 2015, the American Osteopathic Association (AOA) accredited training programs have been eligible to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation. This agreement to create a Single Accreditation System (SAS) was consummated among the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM) and ACGME with a memorandum of understanding. As this research is published, the ACGME is transitioning to be the single accreditor for all US GME programs by June 30, 2020. At that time, the AOA would fully relinquish all its GME program accreditation responsibilities. The new SAS operates under published ACGME guidelines and governance. Business policy and health care resource allocation question motivated this research. Failure of osteopathic programs to “pivot” to the new standards could result in fewer licensed physicians being produced in the high demand primary care field. Potential workforce shortage areas include urban and especially rural populations (CRS Report 7-5700 R44376 Feb 12, 2016). Large physician shortages already have been projected to care for a rapidly aging US population without considering the impact of the GME accreditation changes currently underway (Association of American Medical Colleges 2017 Key Findings report www.aamc.org/2017projections). The goal of this research is to provide osteopathic GME programs practical insights into characteristics of a sample of osteopathic GME programs that have successfully made the “pivot” into SAS requirements and been accredited by ACGME and those that have not. The study seeks to better understand the experiences, decisions, challenges and expectations directly from osteopathic programs directors as they strive to meet the realities of the new SAS requirements. Do programs that are already accredited differ significantly from those that have not? How do characteristics such as program size, geographic locations, clinical program components, program sponsor structure, number and experience of faculty and administration, cost planning and perceived benefits of the movement to SAS factor into successfully meeting the new requirements before the 2020 closing date? A cross-sectional research survey was designed, tested and deployed to a national sample of currently serving osteopathic GME program directors. The survey elicited data about each program’s “pivot” from AOA GME accreditation practices and guidelines to the new Single Accreditation System (SAS). The survey instrument was designed to obtain information about patterns in osteopathic GME program curricula, administrative support functions, faculty training, compliance requirements and program director characteristics shared by those programs that have been granted “initial accreditation” by the Accreditation Council for Graduate Medical Education (ACGME) who administer SAS. Thirty five (35) osteopathic GME program directors responded to the 26 question survey in June 2017. Descriptive statistics were applied and central tendency measures determined. The majority of survey respondents were Doctors of Osteopathic Medicine (D.O.s) from specialty residency programs sponsoring an average of 16 residents. Respondents were mostly non-profit, urban, multi-facility health system locations with an existing affiliation with a research college or university. About half of the programs had completed some form of fiscal due diligence related to the potential cost impact of SAS. None of those surveyed reported utilizing outside consultants to assist in the SAS “pivot” process. Most programs plan to keep the same number of residents while others expressed an interest in expanding or contracting. None of the respondents planned to close their program. The dichotomous dependent variable (DV) was whether or not the Osteopathic GME program had “achieved or not yet achieved initial SAS accreditation” at the time of the survey. A cross tabulation analysis of the DV with potential predictive variables (IV) was conducted and Chi-square and various exact significance tests were applied to gage goodness of fit. Results were grouped into categories that aligned with the five research questions and hypotheses. Several characteristics were shared by those programs that achieved SAS. GME sponsor institutions that currently have dually accredited programs by the AOA and ACGME seemed to be at a distinct advantage. Although they represented a smaller number of total survey respondents (20%), all primary care program participants reported SAS achievement. Directors reported an average of six (6) full-time paid faculty members teaching in their programs and twice that number of preceptor volunteers in the total sample. Realization of any operational cost savings or efficiencies as a result of moving to a single accreditation system was a principle concern for the majority (86%) of GME program director respondents, regardless of current accreditation status, although most felt SAS would result in offering medical student graduates access to all accredited US GME residency and fellowships programs.

Thesis (M.Ost.)--Unitec New Zealand, 2008. / Includes bibliographical references (leaves 92-99).

Ce travail de thèse porte sur des études de la cinématique 3D de la colonne cervicale in vivo chez des sujets asymptomatiques (N=30); il se divise en quatre parties. La colonne cervicale de tous les sujets est reconstruite en 3D à partir des images de tomodensitométrie dans différentes positions :position neutre, rotation axiale gauche et droite et lors du positionnement pré-manipulatif de la tête.<p>La première partie de ce travail a comme objectif fondamental de déterminer la cinématique 3D inter-segmentaire de la colonne cervicale, lors de la rotation axiale maximale de la tête. Les valeurs déterminées pour tous les paramètres cinématiques 3D vont nous servir comme base de données de référence.<p>Dans la deuxième partie, nous souhaitons contribuer à une meilleure compréhension du rôle des ligaments alaires lors de la rotation axiale. Pour cela, nous avons déterminé la cinématique 3D de l’os occipital par rapport à l’axis. Même s’il est inhabituel d’ignorer l’atlas, il nous a semblé plus juste de considérer les segments osseux qui livrent les principales insertions des ligaments alaires. La biomécanique de ces ligaments dépend des mouvements de l’os occipital par rapport à l’axis.<p>La troisième partie est orientée vers l’objectif principal de la thèse qui vise à déterminer les amplitudes articulaires inter-segmentaires lors de la position pré-manipulative de la colonne cervicale. Cette étude va nous permettre de comparer les amplitudes atteintes lors de la mise en position pré-manipulative avec celles des mouvements physiologiques.<p>La dernière partie a pour objectif principal de déterminer la longueur du trajet de l’artère vertébrale en position neutre, et ensuite de comparer la variation de longueur du trajet de l’artère vertébrale entre la position en rotation axiale maximale de la tête d’une part, et la position pré-manipulative d’autre part, donc lors de l’application d’une technique manipulative à composantes multiples telle qu’utilisée régulièrement en ostéopathie.<p>En comparant la position pré-manipulative à la rotation physiologique, les résultats les plus importants de ce travail sont :(1) les amplitudes segmentaires sont inférieures pour la position pré-manipulative et (2) l’artère vertébrale est moins allongée lors de cette mise en position que lors de la rotation physiologique. Ces deux faits, jusque-là inédits, sont importants en clinique ostéopathique courante et montrent l’importance d’un choix judicieux de la technique manipulative et de son exécution.<p> / Doctorat en Sciences de la motricité / info:eu-repo/semantics/nonPublished

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La thèse retrace l'histoire de la médecine ostéopathique aux Etats-Unis, en Grande-bretagne en France et en Belgique. Partant de sa création par Andrew Taylor Still au XIXe siècle dans le middle-west, on suit d'abord son évolution conceptuelle et académique avant de s'intéresser à son institutionnalisation. Les fondements métaphysiques et transcendantaux de cette médecine manuelle sont mis en perspectives par rapport aux connaissances de l'époque tant aux Etats-Unis qu'en Europe. Nous suivons ensuite son passage sur le vieux continent via l'Angleterre et la France avant d'aborder son développement en Belgique ainsi que son entrée à l'Institut des Sciences de la Motricité de l'U.L.B.<p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p><p> / Doctorat en Philosophie / info:eu-repo/semantics/nonPublished

Estudos revelam uma prevalência do refluxo gastroesofágico (RGE) em bebês no Brasil entorno de 11,5% a 18,2%, semelhante aos dados internacionais, trazendo sintomas que podem se perpetuar até a infância e adolescência. Os protocolos de tratamento atuais são em resumo medicamentosos. Poucos estudos referem evidências sobre terapias complementares no tratamento do refluxo. A osteopatia poderia ser utilizada neste contexto para tratar as causas do refluxo, porém, estudos que determinem Protocolos Osteopáticos de Tratamento (POT) são limitados e não são específicos para este diagnóstico. Assim, o objetivo deste estudo foi avaliar a aplicação de um POT desenvolvido para bebês de zero a um ano através de um método quantitativo. Foi realizado um estudo descritivo longitudinal com 59 bebês com idade entre zero e um ano de idade diagnosticados com refluxo e em tratamento medicamentoso. Inicialmente todos foram avaliados com o questionário I-GERQ-R. Trinta e três crianças foram selecionadas para o grupo A, que foi submetido ao POT em paralelo ao tratamento farmacológico, ou durante dois meses ou até atingir um score mínimo no questionário, o que ocorresse primeiro. O grupo B foi acompanhado pelo mesmo período, sendo reavaliado após dois meses. Foram analisados os dados coletados do questionário e os sintomas associados de cólica e tosse. No grupo A, a média inicial do score I-GERQ-R foi de 14,57 ±3,65 e a final 1,39 ±2,09 pontos (p=0,001). No grupo B estes valores foram respectivamente 17,23 ±4,78 e 8,46 ±7,41, caracterizando uma permanência do grupo B no diagnóstico de refluxo (escore>7) apesar da melhora com significância estatística (p=0,043). No grupo A 13 indivíduos chegaram ao escore final zero (“0”), enquanto que no grupo B nenhum indivíduo atingiu este escore. A redução da prevalência no uso de medicação ao final do estudo no grupo A foi de 75,76% enquanto que no grupo B esta redução foi de 11,54%. A melhora no grupo A ocorreu em um tempo médio de 28,76 ± 11,43 dias, independente da idade, onde o número médio de sessões foi 3,91 ±0,80. O sintoma de vômito apresentou melhora significativa no grupo A (p=0,001) mas não no grupo B (p=0,063). O sintoma de azia apresentou uma melhora significativa em ambos os grupos A e B (p=0,001 e p=0,002 respectivamente), bem como o soluço (p=0,001 e p=0,001 respectivamente). O sintoma de choro apresentou melhora significativa para o grupo A (p=0,001), porém não para o grupo B (P=0,123). Da mesma forma, os episódios de engasgos apresentaram redução estatisticamente significativa no grupo A (p=0,001) e não no grupo B (p=0,105). A tosse no grupo A foi reduzida em 94,45% (p=0,001) e a cólica em 75% (p=0,001). No grupo B a tosse permaneceu com a mesma incidência (14 casos) (p=1,000) e o sintoma de cólica aumentou 88,89% (de nove para 17 casos) (p=0,008). Conclui-se, portanto, que o POT proposto se mostrou eficaz na redução dos sintomas do refluxo em bebês e sintomas de tosse e cólica associados, em um tempo aproximado de 29 dias a níveis próximos à zero, tempo inferior ao descrito na literatura. Entende-se que o protocolo tenha atingido os mecanismos de causa do RGE, e, portanto a associação do POT com o tratamento medicação pode ser sugerido na abordagem do RGE em bebês de zero a um ano de idade. / The prevalence of gastroesophageal reflux disease (GERD) in infants in Brazil is about 11.5% to 18,2%, similar to international data, bringing symptoms that can be perpetuated into childhood and adolescence. Current treatment protocols are medicated summary, and few studies have reported evidence for complementary therapies in the treatment of reflux. Osteopathy could be used in this context to treat the causes of reflux, however, studies evaluating Osteopathic Protocols Treatments (OPT) are limited and are not specific for this diagnosis. The objective of this study was to develop and evaluate the application of a OPT developed for infants less than one year through a quantitative method. A longitudinal descriptive study of 59 babies aged under one year of age diagnosed with reflux and in a drug treatment was performed. Initially all were evaluated with I-GERQ-R questionnaire. Thirty- three children were selected for group A, which was submitted to OPT parallel to pharmacological treatment for two months or until it reaches a minimum score on the questionnaire, whichever came first. Group B was accompanied by the same period of two months and after that being re-evaluated. Data collected from the questionnaire and the associated symptoms of colic and cough were analyzed. In group A, the initial average score I-GERQ-R was 14.57 ±3.65 and 1.39 ±2.09 points at the end (p = 0.001). In group B these values were 17.23 ±4.78 and 8.46 ±7.41 points, featuring a stay of group B in the diagnosis of reflux (score>7) despite improvement with statistical significance (p = 0.043). In group A, 13 subjects reached the final score zero ("0"), while in group B no individual reached this score. Reduced use of medication in group A was 75.76% while in group B this reduction was only 11.54%. The improvement in group A occurred at a mean time of 28.76 ±11.43 days, regardless of age, where the average number of sessions was 3.91 ±0.80. The symptom of vomiting improved significantly in group A (p = 0.001) but not in group B (p = 0.063). The symptom of heartburn showed a significant improvement in both groups A and B (p = 0.001 and p = 0.002 respectively), as well as hiccup (p = 0.001 and p = 0.001 respectively). The symptom of crying showed significant improvement in group A (p = 0.001), but not for group B (P = 0.123). Likewise, choking episodes exhibited statistically significant reduction in group A (p = 0.001) and not in group B (p = 0.105). Coughing in the group A was reduced by 94.75% (p=0,001) and 75% in colic (p=0,001). In group B the cough remained with the same incidence (14 cases) (p=1,000) and colic increased significantly from nine to 17 cases (p=0,008). Therefore, it is concluded that the proposed OPT was effective in reducing symptoms of reflux in infants and symptoms of cough and colic associated in an approximate 29 days to levels close to zero, time lower than that described in the literature. It is understood that the protocol has reached the causal mechanisms of GER, and therefore the association of OPT with a medication treatment may be suggested in the approach of GER in infants less than one year old.