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Background: Glaucoma is a chronic, progressive eye disease and the second cause of blindness in the world. To measure the patients’ perspective in randomised controlled trials (RCTs), patient-reported outcome measures (PROMs) are increasingly being used. However, the use of PROMs in glaucoma trials is low suggesting there may be a reluctance to use PROMs. Objectives: To explore three methodological challenges of using PROMs in RCTs in glaucoma: 1) PROM selection; 2) characterising glaucoma severity; and 3) interpreting PROM scores in terms of minimal important difference (MID). Methods: Vision PROMs used in glaucoma studies were identified and content validated using a systematic review approach and categorised by a new PROM taxonomy. Existing visual field staging systems (VFSSs) based on standard automated perimetry were systematically identified and quality assessed with a new tool developed for this review using a consensus method. The performance of four high quality visual field staging systems were evaluated and referenced against an experienced ophthalmologist in a diagnostic test accuracy study. A pilot study using the social comparison approach was undertaken to test the feasibility of an anchor-based approach in determining the MID of a vision PROM in a glaucoma population. Results: Thirty-three vision PROMs were identified and categorised, according to content into impairment, disability, status and satisfaction measures. Twenty-three VFSSs were identified but evaluation of quality assessment, particularly performance, was affected by poor VFSS reporting. The diagnostic accuracy study demonstrated suboptimal performance of the four highest quality staging systems. The pilot study to determine the MID for a vision PROM found the social comparison method to be a feasible approach in a glaucoma population. Conclusion: This thesis demonstrated how to select a PROM and identified difficulties with characterising glaucoma severity. Future research needs include development of robust methods for characterising glaucoma severity and full scale evaluation of MIDs in PROMs in glaucoma.

Missing data are a problem for any clinical trial outcome but are particularly an issue for quality of life (QoL) outcomes.  To investigate the problem of missing data and methods to deal with it, this thesis uses a novel approach, illustrated using seven completed trials. Data from postal reminders were used to investigate the missing data mechanism and test the accuracy of imputation procedures (as the true value was in fact known).  The previously analysis for five of the seven example trials was an analysis of covariance adjusting for baseline QoL and other patient characteristics.  Alternative analysis strategies taking account of other interim responses are considered and contrasted with the published analyses.  The economic impact of the different data collection methods is explored using two economic decision rules. Different analysis strategies were shown to have an impact on the result of the trial.  There is no single best way of dealing with missing data, but some recommendations for researchers are provided.  The role of reminders is shown to be extremely important as the reminder system is a cost-effective use of resources to maintain the sample size, decreasing the amount of missing data and reducing the threat of bias.  Data collected by reminders can be used to inform the selection of potential imputation methods, again reducing bias.  The aim of any trial is to obtain an unbiased as possible estimate of treatment difference to help inform and improve clinical practice to the benefit of patients; the use of reminders may be pivotal in this.

The purpose of this study was to examine the relationship among Healthy Work Environments (HWEs), nurse caring behaviors, and nursing-sensitive patient outcomes, specifically catheter-associated urinary tract infections (CAUTIs), patient falls with injury, and hospital-associated pressure injuries (HAPIs) Stage 2 and above in Magnet hospitals. A descriptive, cross-sectional, quantitative, study was conducted between January 1, 2018, and February 28, 2018, in seven Magnet-designated hospitals in a large faith-based system in the United States. A convenience, non-probability, purposive sample of permanently employed, direct-care RNs assigned to inpatient adult medical-surgical, telemetry, progressive care, stepdown, and critical care units were eligible to participate in the study. Three hundred and thirty-nine of 2632 eligible direct-care RNs participated in the study resulting in an overall response rate of 13.0% with a range of 5.5%–38.1% across hospitals. Nurse participants completed the AACN Healthy Work Environment Assessment Tool and the Nurse Caring Behaviors Inventory–24. Nursing-sensitive patient outcome data were obtained from patients cared for in the units during the study period. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Objective: The aim of the study was to evaluate the clinical outcomes of oral implant treatment provided at the School of Dentistry, University of Otago from 1989 to 2005. Methods: Oral implant patients (n=320) with 586 implants were identified and invited to attend for a clinical examination. Implant demographics of all the patients were extracted from the files. Implant demographics of the examined and unexamined patients were compared to assess if the examined patients were representative of the total group. One hundred and three patients with 214 implants agreed to attend for an examination. In the clinical examination full mouth plaque scores, probing depths, bleeding on probing and suppuration were measured. In addition, around implants recession and width of keratinized gingiva were also recorded. For the radiographic examination, baseline radiographs and radiographs taken at the time of examination were digitized and compared to measure the amount of bone lost or gained around implants using NIH Image J software. Results: There were equal numbers of males and females with a mean age of 46.3 � 15 years at the time of implant placement. The smoking history at the time of examination was recorded, 56% of the patients were non-smokers, 37% former smokers, and 7% were current smokers. More than half of the implants (56%) were placed in the anterior region. Based on the type of implant system, 79% were Branemark implants, 10% Straumann, 6% Southern implants and 4% were unknown. Most of the patients (64%) had implant-supported crowns, 19% had fixed denture prostheses, and 17% had implant-supported overdentures. The overall implant survival rate was 97.7% with five implants lost (2.3%) and 8 implants treated for peri-implantitis (3.8%). The mean PD around implants was 2.3mm (SD 0.6mm), mean recession was 0.5mm (SD 0.8mm) and mean attachment level of 2.8mm (SD 0.9mm). Probing depths [greater than or equal to] 4mm with BOP were recorded around implants in 8.9% of patients. The mean full mouth plaque score was 30% while mean plaque score around implants was 15.9%. The average bone loss around implants was 0.3mm (SD 0.8). Maximum bone loss observed was 2.9 mm. Conclusion: The prevalence of peri-implant inflammation and implant survival rates in this group of patients appeared comparable to that reported in the literature. The prevalence of peri-implant lesions was low in the group of patients examined.

Most pediatric orthopaedic interventions are intended to improve or preserve physical function, yet their outcomes have been assessed using primarily surrogate measures (e.g., radiographic indices) that may not accurately represent patients'function. Physical function may be more appropriately measured with activity-based scales, but these have been infrequently applied in surgical studies. The purpose of this study was to identify existing activity-based physical-function scales appropriate for pediatric orthopaedics, to present criteria useful for scale selection, and to discuss the special problems of measuring physical function in children. Twenty-one scales relevant to pediatric orthopaedics are described according to their target population, purpose, method of administration, content, and quality of standardization. These scales have been further classified according to a new taxonomy. The unique aspects of measuring physical function in children are discussed and include the effect of age and development, method of reporting, and question formats. Standardized measures of physical function based on physical-activity ability exist and should be used more frequently to assess pediatric orthopaedic interventions

Thesis (Ph. D.)--University of California, San Diego, and San Diego State University, 2004. / Vita. Includes bibliographical references (leaves 122-130).

Thesis (Ph. D. in Hearing and Speech Sciences)--Vanderbilt University, Dec. 2009. / Title from title screen. Includes bibliographical references.

To identify those with kidney disease early and thus facilitate earlier instigation of disease-progression slowing treatments, new definitions of chronic kidney disease (CKD) were introduced in 2002 (KDOQI). After this, the worldwide introduction of estimated glomerular filtration rate (eGFR) reporting (2006 onwards), also facilitated more widespread identification of those with CKD. Prognosis in those with CKD identified in this way was not known and the numbers with CKD appeared higher than originally expected. This thesis aimed to improve understanding of outcomes in those who met the definition of chronic kidney disease and facilitate better directed care. Data-linkage of several healthcare datasets including to laboratory, morbidity and mortality healthcare data for individuals in the Grampian region with measures of renal function in 2003 allowed those aims to be addressed. Patterns in the testing of kidney function over time were also described. Mortality and RRT initiation during the GLOMMS-I cohort's 6.5 years of follow-up were described, as were variables that were associated with these outcomes. Other measures of decline of kidney function over time (progression), were explored and compared to the ultimate measure of progression - the initiation of RRT. Various models to predict outcomes (RRT initiation, mortality and survival) were explored. Measures of model performance including discrimination, calibration, goodness of model fit and predictive performance were described. Overall the aim of this thesis was met - to improve the understanding of the prognosis of those currently labelled with chronic kidney disease. The work in this thesis has also provided the necessary information to plan and start a much wider population based study of outcome in those both with and without CKD (GLOMMS-II).

In this study, two primary hypotheses drawn from Cognitive-Experiential Self-Theory (Epstein, 1994, 1998, 2003) and the treatment preference literature (Arnkoff, Glass, & Shapiro, 2002) were tested in the broader contexts of similarity/matching research and eclecticism in psychotherapy. Specifically, it was hypothesized that client-therapist similarity/dissimilarity in terms of (a) their Rational and Experiential Thinking styles (Pacini & Epstein, 1999), and (b) their preferences for a Cognitive ("Thinking") versus an Experiential ("Feeling") theoretical orientation (Hutchins, 1984), would affect the process and outcome of early therapy. Forty-seven client-therapist dyads participated in the study. In the seven hierarchical linear regressions conducted, no statistically significant effects were found on any of the dependent variables (working alliance, empathic understanding, session depth, session smoothness, satisfaction with treatment, perceived change, and objective change). Study limitations included its modest statistical power to detect small and moderate effect sizes.Three exploratory questions were also investigated in a sample of 89 clients and 79 therapists and were found to be statistically significant. Specifically, client rational and experiential thinking styles made substantial contributions in the expected direction in predicting client preference for a cognitive versus an experiential treatment. Similarly, therapist experiential thinking style was predictive of therapist treatment preference. These findings suggest that client and therapist personality (thinking styles) are more significant predictors of treatment preference than variables such as gender and clinical experience (as a therapist or a client). Last, rational thinking style was predictive of client intrapersonal adjustment, and experiential thinking style was predictive of client social adjustment. / Department of Counseling Psychology and Guidance Services