Stroke is a common and multifaceted disease that often involves motor deficits in the upper limb. This thesis investigated reliability and validity of existing clinical assessments of upper limb function in persons with post-stroke symptoms and in non-disabled controls. Study I was conducted in a clinical setting where the Motor Evaluation Scale of Upper Extremity in Stroke patients (MESUPES) was assessed in persons post-stroke by two physiotherapists selected from a group of four.  Study II-IV took place in a motion analysis laboratory with an optoelectronic system. Kinematic measures and clinical measures were used to investigate the validity of the Arm Posture Score (APS), the Finger-to-Nose test (FNT), and the Standardised Nine Hole Peg test (S-NHPT) in persons post-stroke and non-disabled controls.   The results showed that the MESUPES had a high inter-rater reliability while the concurrent validity was not fully confirmed. MESUPES has a maximum score of 58 and the minimal detectable change ranged from 5 to 8 for a confidence level of 80% and 95%. The Arm Posture Scores, which include either four or six arm movement variables, were able to distinguish between the affected and non-affected arms, as well as between the affected arm and the non-dominant arm of the controls. The total movement time of the FNT, which is a coordination test, was able to distinguish persons post-stroke from controls, at least at a group level. Movement smoothness, accuracy and compensation, obtained from kinematic analysis, were the most discriminative variables for the FNT. Smoothness was most strongly correlated with the timed FNT and had the greatest association with the variance of the timed FNT. For the S-NHPT, which is a dexterity test involving grasping and reaching, the movement times, smoothness and compensation discriminated between the stroke group and the control group. Persons post-stroke spent considerably more time in the grasp-related parts of the task compared to controls. Smoothness and upper limb impairments had the strongest correlation with the S-NHPT.   In conclusion, the clinical measures used within stroke rehabilitation seem valid and reliable, although some limitations are highlighted by the kinematic assessment. MESUPES was shown to be a reliable assessment of upper limb movement quality after stroke. The kinematic analysis revealed that the timed FNT does not have sufficient discriminative validity at an individual level. The timed FNT reflected speed-related aspects of pointing movements such as smoothness and length of the deceleration phase, but should not be used as an overall measure of upper limb coordination after stroke. The timed S-NHPT demonstrated sufficient discriminative validity and reflected smoothness and upper limb impairments. For both the FNT and S-NHPT, kinematic analysis showed that the clinical outcomes of those tests (time of performance) did not adequately detect qualitative aspects of the upper limb movements after stroke such as possible compensatory movements. Therefore, clinical assessments that capture qualitative aspects of upper limb movements would improve the assessment of upper limb coordination and dexterity after stroke. In addition, 3D movement analysis provided unique information about upper limb function after stroke, not least in persons with mild post-stroke impairments. The APS, for instance, which quantifies how much the arm swing during gait deviates from normal, discriminated between persons with stroke and non-disabled persons. Such subtle deviations are not possible to quantify with the human eye.

The purpose of this study was to assess the changes in size of periapical lesions 3-12 months following root canal treatment using CBCT. Patients who had non-surgical root canal therapy (NSRCT) or non-surgical retreatment (ReTx) from July 30,2014 to August 19, 2015 with a periapical lesion of endodontic origin and received NSRCT or ReTx and had a pre-treatment or intra-treatment CBCT were invited to participate. Volumetric and linear measurements of periapical lesions on initial and post- treatment CBCT images were performed. A total of 20 patients with 23 treated teeth with 30 separate periapical radiolucent lesions returned for follow up 91-390 days after the initiation of endodontic treatment. Lesions showed an overall reduction in volume (p=0.0096), maximum coronal diameter (p=0.0117), maximum sagittal diameter (p=0.0071), and maximum axial diameter (p=0.0006). Lesions show a significant reduction in size 3-12 months following non-surgical endodontic treatment using CBCT.

Health Studies / (D. Litt. et Phil. (Health Studies))

Background: Dialysis is an intervention that involves the use of fairly advanced technology and is fairly expensive. Patients and health care funders are increasingly demanding evidence for the effectiveness for such high technology high cost interventions. While dialysis therapy has improved immediate prognosis in patients with kidney failure, the long-term survival of patients on chronic renal replacement therapy (dialysis or renal transplantation) is much lower than that of the general population and the mortality rates remain high for patients with acute renal failure needing dialysis. There are considerable variations between different countries and even between the dialysis centres within the same country with regards to the selection of the primary type of dialysis (haemodialysis or peritoneal dialysis) and in the different methods or equipment used to perform the various components of these various modalities. It is possible that variations in clinical practice are associated with variations in clinical outcomes such as mortality and morbidity. It is then important to identify the best practices from the various variations in current use and implementing these best practices may reduce morbidity and mortality of these patients. Methods: Systematic reviews, identifying and including only randomised trials, focusing on key clinical policy decision points in the dialysis process were undertaken. The review of literature was done in a systematic way according to a detailed scientific methodology. For all of the systematic reviews, a detailed protocol was written and agreed to by the authors of the review. The protocol detailed the clinical question, the types of studies, participants, interventions and outcomes to be included, search strategy and the statistical methods to be employed. Relevant randomised studies were then identified by systematically searching the electronic medical databases and reference lists of published studies; data relevant to predetermined outcome measures were extracted and where appropriate summary statistics were derived from meta-analysis. Recommendations and implications for clinical practice and future research studies were made following each review. The areas of dialysis policy reviewed were (1) Comparison of high-flux versus low-flux haemodialysis (HD) membranes for patients with end-stage renal disease (ESRD), (2) Comparison of extracorporeal renal replacement therapy technologies for patients with ESRD, (3) Comparison of intermittent (IRRT) and continuous renal replacement therapy (CRRT) for acute renal failure (ARF) in adults, (4) Comparison of antimicrobial interventions for the prevention of HD catheter related infections, (5) Comparison of continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) for patients with ESRD, and (6) Comparison of treatment measures for depression in dialysis patients. Conclusions: As the currently available evidence has not demonstrated superiority with high-flux membranes with respect to important clinical outcomes such as mortality, quality of life and hospitalisation, it is not possible to recommend the use of these membranes in preference to low-flux membranes. It has not been possible at present to demonstrate with the current evidence available that convective modalities (HF, HDF or AFB) have significant advantages over HD with regard to clinically important outcomes of mortality, dialysis-related hypotension and hospitalisation. It is not therefore possible to recommend the use of one modality in preference to the other. In ARF patients who are haemodynamically stable, the RRT modality does not appear to influence important patient outcomes, and therefore the preference for CRRT over IRRT in such patients does not appear justified in the light of available evidence. CRRT was shown to achieve better haemodynamic parameters such as MAP. APD appears to be more beneficial than CAPD, in terms of reducing peritonitis rates and with respect to certain social issues that impact on patients' quality of life. Further, adequately powered trials are required to confirm the benefits for APD found in this review and detect differences with respect to other clinically important outcomes that may have been missed by the trials included in this review due to their small size and short follow-up periods. APD may however be considered advantageous in select group of patients such as in the younger PD population and those in employment or education due to its psychosocial advantages. Firm conclusions on the efficacy of treatment measures for depression in chronic dialysis patients cannot be made as we identified only one small RCT that was of short duration. Current screening tools for depression are recognised to have poor specificity in the medically ill due to overlap of somatic symptoms of the medical illness. The development of a valid diagnostic tool would be helpful. The systematic reviews in general highlighted the paucity of large-scale randomised trials in nephrology even on topics of great practical relevance such as depression in dialysis. In many of the areas assessed adequate conclusions could not be reached as there was a lack of large-scale well designed randomised controlled trials raising the possibility that important clinical differences between the interventions assessed may have been missed due to Type 2 statistical error. We identified numerous RCTs which were small in size looking at surrogate end-points such as molecular markers of inflammation, especially in the areas of membrane flux and extracorporeal RRT technologies. Unfortunately benefits with surrogate end-points do not necessarily translate to better clinical outcomes. The urgent need of the hour is to conduct well-designed large scale RCTs in major areas of clinical importance such as the use of extracorporeal renal replacement therapy technologies looking at hard clinical end-points such as mortality, hospitalisation and quality of life.

Promoting healthcare and wellbeing requires the dedication of a multi-tiered health service delivery system, which is comprised of specialists, medical doctors and nurses. A holistic view to a patient care perspective involves emotional, mental and physical healthcare needs, in which caring is understood as the essence of nursing. Properly and efficiently capturing and managing nursing knowledge is essential to advocating health promotion and illness prevention. This thesis proposes a document-indexing framework for automating classification of nursing knowledge based on nursing theory and practice model. The documents defining the numerous categories in nursing care model are structured with the help of expert nurse practitioners and professionals. These documents are indexed and used as a benchmark for the process of automatic mapping of each expression in the assessment form of a patient to the corresponding category in the nursing theory model. As an illustration of the proposed methodology, a prototype application is developed using the Latent Semantic Indexing (LSI) technique. The prototype application is tested in a nursing practice environment to validate the accuracy of the proposed algorithm. The simulation results are also compared with an application using Lucene indexing technique that internally uses modified vector space model for indexing. The result comparison showed that the LSI strategy gives 87.5% accurate results compared to the Lucene indexing technique that gives 80% accuracy. Both indexing methods maintain 100% consistency in the results. / by Sucharita Vijay Chichanikar. / Thesis (M.S.C.S.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

The purpose of this study was to describe the lived experience of nurses who care for hospitalized women outside of an addiction treatment setting who have a problem with drugs and/or alcohol. The relational experiences of ten registered nurses who had cared for women with drug and alcohol problems were elicited. Heideggerian hermeneutic phenomenology was the method used to interpret the nurse participant's meaning of their experience. The theoretical framework that was used to explore the nurses' experience o caring for women who abuse or are dependent on alcohol and/or drugs was Boykin and Schoenhofer's Nursing as Caring (1993). The relational themes that emerged were: Caring in the dark; Intentionally knowing the woman with AOD as a unique person; and Experiencing sisterhood. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

The objective of this study was to determine whether 11 independent variables or combinations of variables help to predict a diabetes-related hospital readmission for patients with diabetes within 60 days from discharge. The variables were categorized into four main groups: (a) patient characteristics, (b) lifestyle, (c) biomarkers, and (d) disease management aspects. A convenience sample of 389 historical medical records of patients who were admitted to a rural hospital in northeastern North Carolina with a diagnosis of, or relating to, diabetes was studied. After comparing predictive discriminant analysis (PDA) and logistic regression (LR), PDA performed better and was chosen to analyze a convenience sample of patients admitted to the hospital for a diabetes-related diagnosis from January, 2004 to December, 2006. The best overall subset accurately classified 27 cases with six predictors that included (a) systolic blood pressure, (b) smoking status, (c) blood glucose range, (d) ethnicity, (e) diabetes education, and (f) diastolic blood pressure. In an effort to simplify the prediction process, the subsets of two predictors were examined. The results of the analysis returned four subsets of 2-predictor variable combinations that correctly classified cases for readmission. Each of the four subsets has two predictors that are statistically and practically significant for predicting readmissions for a diabetes-related problem within fewer than 60 days. These combinations are the predictor subsets of (a) smoking status and being treated by a specialist or non-specialist physician, (b) a religious affiliation or a lack thereof and smoking status, (c) gender and smoking status, and (d) smoking status and ethnicity. / by Darwin E. Asper. / Vita. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

This dissertation examines factors with influence on the organizational cultural competence of Emergency Medical Services (EMS) systems. The purpose of this study was to draw on theories of representative bureaucracy and transformational leadership to assess cultural competence in Emergency Medical Services systems from the perspective of EMS leadership, within careful consideration of the external environment in which EMS systems operate. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015 / FAU Electronic Theses and Dissertations Collection

The primary aim of this study was to investigate the content and extent of psychotherapy patients’ disclosures to their spouses or significant others about their experiences in therapy, the perceived impact of disclosure about therapy on the spousal relationship, and its perceived impact on the therapeutic relationship and on treatment satisfaction. Adult psychotherapy patients (N = 84) in individual treatment, who identified themselves as either married or in a significant romantic relationship completed the Disclosure About Therapy Inventory – Revised (DATI-R; Khurgin-Bott & Farber, 2014), a revision of the Disclosure About Therapy Inventory (see Khurgin-Bott & Farber, 2011). This 52-question survey was designed to explore the extent and content of patients’ disclosures to their therapists, and the extent and content of their disclosures about therapy to their spouses or significant others (“partners”). The DATI-R also includes three outcome measures: the Revised Dyadic Adjustment Scale (RDAS; Busby, Christensen, Crand, & Larson, 1995) measures the quality of participants’ relationships with their partners, the Working Alliance Inventory – Short Revised (WAI-SR; Hatcher & Gillaspy, 2006) assesses the quality of their relationships (alliances) with their therapists, and the outcome items of the Disclosure to Therapist Inventory-III (DTI-III) assess their satisfaction with their treatment. Findings indicate that overall, patients were very disclosing to their therapists and moderately disclosing to their partners about their therapy. No demographic variables (including gender, marital status, duration of psychotherapy, and duration of marriage/relationship) were significantly associated with or predictive of the extent of patients’ self-disclosure about therapy. A significant positive association was found between the extent of disclosure to partners about therapy and the extent of self-disclosure to therapists. Greater extent of disclosure about therapy to partners was also associated with better quality of therapeutic alliances and with higher relationship satisfaction (with partners). Additionally, the quality of therapeutic alliances was strongly predictive of better treatment outcomes. These findings suggest that married (or coupled) patients in individual psychotherapy may benefit from the open discussion of their experiences in therapy with their spouses or significant others, or at least that such openness is characteristic of patients in satisfactory relationships (both therapeutic and marital). These findings are discussed in the context of the methodological limitations of the current study and the particular characteristics of the sample, and clinical implications and directions for future research are explored.

Introdução: A energia elétrica e ultrasônica são utilizadas com freqüência na prostatectomia radical laparoscópica e podem lesar os nervos cavernosos adjacentes através da dissipação térmica. Em contrapartida, a energia laser tem potencial para proporcionar uma dissecção precisa, com boa hemostasia e pequena lesão dos tecidos adjacentes. Este estudo avalia o efeito do laser KTP na dissecção laparoscópica do feixe neuro-vascular cavernoso em modelo experimental canino. Material e Métodos: Um total de 36 cães foi dividido igualmente em três grupos. Realizou-se a dissecção unilateral do feixe neurovascular cavernoso utilizando (1) laser KTP (KTP), (2) bisturi ultrasônico (BU), e (3) tesoura e clipes metálicos (TC), mantendo o lado contralateral intacto. Realizou-se a análise do tempo operatório e sangramento em cada grupo, assim como a análise funcional, através do coeficiente entre a pressão intracavernosa e pressão arterial média (PIC/PAM) durante a estimulação do feixe neurovascular cavernoso. Metade dos animais de cada grupo foi mantida viva por 30 dias e submetidos à nova neuroestimulação. Foram avaliados ainda os efeitos da dissipação térmica através da análise termográfica em fragmentos de peritôneo parietal e a extensão histológica da necrose tecidual na fáscia prostática desde a superfície de corte de cada instrumento. Resultados: O tempo de dissecção do feixe neuro-vascular cavernoso foi similar entre os grupos (KTP vs. BU p=0.21, KTP vs. TC p=0.81, BU vs. TC p=0.22). A dissecção utilizando o BU resultou em um prejuízo significativo na resposta à neuroestimulação quando comparado aos grupos TC e KTP no experimento agudo (BU vs. KTP p<0.001, BU vs. TC p<0.001), e crônico (BU vs. KTP p=0.02, BU vs. TC p=0.02). A análise histológica demonstrou uma área de necrose desde a superfície de corte com a utilização do laser KTP de aproximadamente 500 um, enquanto que com o uso do BU essa área se extendeu em média por 2 mm. A avaliação termográfica mostrou uma dissipação térmica significativamente maior do BU comparado ao laser KTP (laser KTP 0.98 mm vs. BU 6.25 mm, p<0.0001). Conclusão: O uso do laser KTP na dissecção laparoscópica do feixe neuro-vascular cavernoso apresentou resultado funcional semelhante à técnica sem emprego de energia térmica utilizando tesoura e clipes, enquanto o bisturi ultrasônico foi associado a um prejuízo significativo na função dos nervos cavernosos. / Introduction: Electrical and ultrasonic energy used in nerve-sparing laparoscopic radical prostatectomy can compromise cavernous nerve function. Laser energy may potentially allow fine dissection with good hemostasis and minimal adjacent tissue injury. This study examines the electrophysiological, histological and thermal mapping features of KTP laser dissection on cavernous nerve function in the survival canine model. Materials and Methods: A total of 36 dogs were divided into 3 groups. Laparoscopic unilateral neurovascular bundle (NVB) mobilization was performed using either: (1) KTP laser (n=12), (2) ultrasonic shears (US) (n=12), or (3) athermally with cold scissors (AT) (n=12). The contralateral NVB remained undissected as an internal control. NVB function was assessed acutely in all dogs, and after 1-month survival in 50% of the dogs of each group. Peak intracavernosal pressure response to cavernous nerve stimulation was measured as a percentage of mean arterial pressure (ICP/MAP). Strips of peritoneum were sectioned ex-vivo with the KTP laser and US shears for thermographic mapping. Histological evaluation of prostatic fascia necrosis from the cutting surface was also performed. Results: Comparing KTP and AT groups, the erectile response to nerve stimulation was similar acutely and at 1 month (acute ICP/MAP: KTP 92%, AT 96% p=0.54; chronic ICP/MAP: KTP 95%, AT 98% p=0.71). In contrast, US dissection resulted in a significant decrease in the ICP response compared to the KTP and AT groups (acute ICP/MAP: US 49%, KTP 92%, AT 96%. US vs. KTP p<0.001, US vs. AT p<0.001; chronic ICP/MAP: US 58%, KTP 95%, AT 98%, US vs. KTP p=0.02, US vs. AT p=0.02). Mean NVB dissection times were similar (KTP 27.5min, US 19.9min, AT 26.6min, KTP vs. US p=0.21, KTP vs. AT p=0.81, US vs. AT p=0.22). Histopathology demonstrated an acute zone of laser-induced necrosis of approximately 500 um compared to 2 mm with US dissection. Thermographic assessment demonstrated significantly less collateral thermal spread from the KTP laser compared to US (mean thermal spread >60 oC KTP 0.98 mm vs. US 6.25 mm, p<0.0001). Conclusions: Use of KTP laser for NVB mobilization preserved cavernous nerve function comparable to standard athermal techniques using cold scissors and was superior to ultrasonic shears.