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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Clinical studies on enteric fever

Arjyal, Amit January 2014 (has links)
I performed two randomised controlled trials (RCTs) to determine the best treatments for enteric fever in Kathmandu, Nepal, an area with a high proportion of nalidixic acid resistant S. Typhi and S. Paratyphi A isolates. I recruited 844 patients with suspected enteric fever to compare chloramphenicol versus gatifloxacin. 352 patients were culture confirmed. 14/175 patients treated with chloramphenicol and 12/177 patients treated with gatifloxacin experienced treatment failure (HR=0.86 (95% CI 0.40 to 1.86), p=0.70). The median times to fever clearance were 3.95 and 3.90 days, respectively (HR=1.06 [CI 0.86 to 1.32], p=0.59). The second RCT compared ofloxacin versus gatifloxacin and recruited 627 patients. Of the 170 patients infected with nalidixic acid resistant strains, the number of patients with treatment failure was 6/83 in the ofloxacin group and 5/87 in the gatifloxacin group (Hazard Ratio, HR=0.81, 95% CI 0.25 to 2.65; p=0.73); the median times to fever clearance were 4.7 and 3.3 days respectively (HR=1.59 [CI 1.16 to 2.18], p=0.004). I compared conventional blood culture against an electricity free culture approach. 66 of 304 patients with suspected enteric fever were positive for S. Typhi or S. Paratyphi A, 55 (85%) isolates were identified by the conventional blood culture and 60 (92%) isolates were identified by the experimental method. The percentages of positive and negative agreement for diagnosis of enteric fever were 90.9% and 96.0%, respectively. This electricity free blood culture system may have utility in resource-limited settings or potentially in disaster relief and refugee camps. I performed a literature review of RCTs of enteric fever which showed that trial design varied greatly. I was interested in the perspective of patients and what they regarded as cure. 1,481 patients were interviewed at the start of treatment, 860 (58%) reported that the resolution of fever would mean cure to them. At the completion of treatment, 877/1,448 (60.6%) reported that they felt cured when fever was completely gone. We suggest that fever clearance time is the best surrogate for clinical cure in patients with enteric fever and should be used as the primary outcome in future RCTs for the treatment of enteric fever.
32

Dentist-patient communication: How do patients make sense of oral health information and translate it into action?

Laorujiralai, Kamolchanok 01 1900 (has links)
Indiana University-Purdue University Indianapolis (IUPUI) / Purpose: Patient-provider communication has been studied extensively in the last two decades, and many researchers have confirmed the importance of communication between patient and provider in medical contexts. In spite of increased research in patient-provider communication in dentistry, dental care providers still report that patients often do not accurately follow oral health recommendations. Thus, there is the need for additional study on how patients make sense of the oral health information they receive and how they translate that information into action. This study aimed to obtain insight into how dental care patients perceive and make sense of the information they receive from their dentist and how they translate that information into action. Methods: 16 patients and 8 dentists from Indiana School of Dentistry’s (IUSD) Graduate Prosthodontic Clinic in Indianapolis, Indiana were included. Two in-depth interviews, one immediately following the dental visit and one 7-10 days later, were conducted with the patients, and one short interview was conducted with each patient’s dental care provider. Interviews were audio taped and transcribed. Results: The results show both patients and providers perceived the interaction during consultation positively. The majority of patients were able to accurately recall information they received from their dentists and made sense of new information through the lens of their previous experiences. Four additional factors that explain patients’ adherence with health advice were also found in addition to the previous studies. Conclusions: Successful dentist-patient interaction could be thought of as a match between what dentists think patients need to know, what patients think they want/need to know, and what patients actually know. Thus, some barriers that can keep dentists and patients from reaching information equilibrium are discussed. The study concludes by offering practical and theoretical implications.

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