Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Experimental Medicine, Department of Medicine, Faculty of Medicine & Dentistry. Title from pdf file main screen (viewed on November 21, 2009). Includes bibliographical references.

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

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

Purpose: To evaluate the influence of physical fitness on the metabolic and perceptual responses to chest compression-only (CCO) CPR. Methods: In a counterbalanced design, forty-seven CPR-certified participants were randomized to perform: 1) a fitness assessment in which muscular (e.g., push-ups = PU) and cardiorespiratory endurance (e.g., step test recovery heart rate = RHR) were determined, and 2) a 10-minute CCO-CPR trial in which the heart rate (HR) response and ratings of perceived exertion (RPE) were determined. Results: Both PU and RHR were significantly correlated to the HR response to CCO-CPR (r = - 0.45, p < 0.01; r = 0.54, p < 0.001). PU were significantly correlated to RPE: local muscular (r = - 0.43; p < 0.01), central (r = - 0.45; p < 0.01), and over-all (r = - 0.39; p < 0.01). Conclusions: Greater physical fitness lessens the metabolic and perceptual strain to CCO-CPR. / by Adam J. Berrones. / Thesis (M.S.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

The purpose of this study was to determine the relationships between the nurses' decision making model, frequency of Rapid Response Team (RRT) activation, and the nurse's skill at the early recognition of clinical deterioration. A descriptive, cross sectional quantitative design was used. The participants in this study were 167 acute care registered nurses who had activated the RRT at least once in the preceding 12 months. The participants first were asked to recall a time when they had made the decision to activate the RRT and then were asked to complete the instruments used in this study. Using the Nurse Decision-Making Instrument, the participant's decision making model then was categorized as analytic, intuitive, or mixed. The skill at early recognition of clinical deterioration was measured with the Manifestations of Early Recognition Instrument. Participant scores on the two instruments were significantly correlated with each other as well as to their frequency of RRT activation over the preceding 12 months. The findings of this study indicated that nurses who used analytical decision making activated the RRT with greater frequency than either the intuitive or mixed decision makers. In addition, registered nurses who used analytical decision making to activate the RRT tended to have higher levels of skill in the early recognition of clinical deterioration, as measured by the MER, than either the intuitive or mixed decision makers. Another finding of this study was that RNs with higher levels of skill in the early recognition of clinical deterioration tended to activate the RRT more frequently than RNs with lower levels of this skill. The implications of this study are that the use of analytical decision making may result in more frequent activation of the RRT. / Increased frequency of RRT activation has been linked in the literature with decreased patient mortality rates. The significance of the findings from this study is that the use of analytic decision making has the potential to reduce the incidence of the number one patient safety indicator, failure to rescue. / by Carlo G. Parker. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.