Background: Teeth affected by apical periodontitis (AP) that could be retained by root canal therapy (RCT) are increasingly being extracted and replaced with implant-supported crowns (ISC). Objectives: 1) To investigate preferences of dentists and patients towards retaining a tooth with AP using RCT versus its extraction followed by, no replacement, replacement with an ISC, or with a partial fixed or removable denture. 2) To investigate patients’ preferred role and dentists’ ethical responsibilities in decision-making. Methods: A mail-out survey (sent to: dental specialists, n=195, response rate=39%; patients, n=434, response rate=43%) and a web-based survey (general dentist sample, n=304, response rate =15%) were used to collect data. Statistical bivariate and multivariate analyses were undertaken with P set at < 0.05 with Bonferroni adjustment as necessary. Results: RCT or ISC were the most selected treatment choices for dentists, while the preference for RCT was reduced for teeth treated previously with RCT. Dentists’ preferences were associated with their specialty as well as clinical experience in endodontics and/or implant dentistry. Patients’ stated general preference for saving teeth was associated with higher self-rated oral health, frequent dental check-ups, and higher socio-demographic factors. Those with higher education, regular dental visits and previous experience of RCT preferred to undergo RCT for future treatment in comparison to those who never experienced RCT. Patients preferred a collaborative role with their dentists in making treatment decisions and valued the retention of natural teeth very highly. They also felt that communication with and trust in their dentist was paramount. Conclusion: Dentists should establish rapport with patients in a milieu that values and respects the patients’ autonomy. By following the highest standards of evidence-based care, and transferring unbiased information on treatment options and associated risks/benefits, it is highly probable that dental care will be delivered in a more ethical manner than would otherwise be possible.

Submitted by Liliane Ferreira (ljuvencia30@gmail.com) on 2018-11-28T12:11:28Z No. of bitstreams: 2 Dissertação - Andreia Prado Cortizo Vidal - 2018.pdf: 4289900 bytes, checksum: 4269b56ac46c672423d896fec8f70f86 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-11-28T13:55:22Z (GMT) No. of bitstreams: 2 Dissertação - Andreia Prado Cortizo Vidal - 2018.pdf: 4289900 bytes, checksum: 4269b56ac46c672423d896fec8f70f86 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-11-28T13:55:22Z (GMT). No. of bitstreams: 2 Dissertação - Andreia Prado Cortizo Vidal - 2018.pdf: 4289900 bytes, checksum: 4269b56ac46c672423d896fec8f70f86 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-11-30 / Aesthetic perception is a highly subjective concept and the opinion of professionals regarding smile aesthetic evaluation may not meet the perception and expectation of patients and lay people. Tools such as the Digital Smile Design (DSD) allows reproducing to the patient in a more comprehensive way, what was planned by the professional, still in the phases that anticipates the execution of the restorative treatment, such as diagnostic the wax-up and mock-up. However, the result obtained by the DSD may not meet the patient’s expectations, besides being a stage that demands time and training. This work aimed to evaluate whether the use of the DSD influences the making of the diagnostic wax up and the perception and preference of the patient and the dentist on the aesthetics of the smile with mock ups obtained from waxes with and without DSD. The sample consisted of 10 patients recruited from individuals who had interest and need for aesthetic smile treatment and 10 dentists who use the DSD on a regular basis. Initially, two wax-up were performed for each patient, one performed in the traditional way, without the DSD, and another guided by the DSD. Two mock-ups were performed, one for each wax-up. After installation, the following photographs were taken with the mock-up: 1. frontal facial at rest, 2. frontal facial at maximum smile, 3. frontal lip approximation at rest, 4. frontal lip approximation at maximum smile, 5. frontal lip approximation with retractor . The photos were presented to the patients individually, along with a Preference Sheet, where they assigned the alternative regarding the smile that most pleased them: 1. photo without intervention; 2. mock-up photo with DSD; 3. mock-up photo without DSD; 4. none of the above; 5. indifferent. The patients opted on their own photos and the dentists evaluated the photos of each one of the 10 patients. It has been observed that there is a tendency by the patients and dentists to prefer the mock-up without DSD, possibly because it is closer to the natural morphology of the teeth. / A percepção estética é um conceito altamente subjetivo e a opinião de profissionais em relação a avaliação estética do sorriso pode não coincidir com a percepção e expectativa de pacientes e leigos. Ferramentas computacionais como o Digital Smile Design (DSD) permitem apresentar para o paciente de uma maneira mais compreensível o que foi planejado pelo profissional, ainda nas fases que antecipam a execução do tratamento restaurador, como enceramento diagnóstico e mock up. Porém, o resultado obtido com o DSD pode não corresponder às expectativas do paciente, além de ser uma etapa que demanda tempo e treinamento. Este trabalho objetivou avaliar se o uso do DSD influencia na obtenção do enceramento diagnóstico e na percepção e preferência do paciente e do cirurgião-dentista quanto a estética do sorriso com mock ups obtidos a partir de enceramentos com e sem DSD. A amostra foi composta por 10 (dez) pacientes recrutados dentre indivíduos que tinham interesse e necessidade de tratamento estético do sorriso e 10 (dez) cirurgiões-dentistas que fazem uso corriqueiro do DSD. Inicialmente foram realizados dois enceramentos diagnósticos para cada paciente, sendo um obtido de forma tradicional, sem auxílio do DSD, e outro obtido de forma orientada com o DSD. Foram realizados dois mock ups para cada enceramento. Após instalação de cada mock up foram feitas as seguintes fotografias: 1. facial frontal em repouso, 2. facial frontal em sorriso máximo, 3. frontal aproximada dos lábios em repouso, 4. frontal aproximada dos lábios em sorriso máximo e 5. frontal aproximada em máxima intercuspidação habitual (MIH) com afastador. As fotos foram apresentadas aos participantes de forma individual, juntamente com uma Ficha de Preferência, onde assinalaram a alternativa referente ao sorriso que mais os agradou: 1. foto sem intervenção; 2. foto do mock up com DSD; 3. foto do mock up sem DSD; 4. nenhuma das anteriores; 5. indiferente. Os pacientes opinaram em relação a suas próprias fotografias e os cirurgiões-dentistas avaliaram as fotografias de cada um dos 10 pacientes. Observou-se que existe uma tendência por parte dos pacientes e cirurgiões-dentistas em preferir o mock up sem DSD, por este possivelmente se aproximar mais da morfologia natural dos dentes.

The thesis is comprised of three separate studies that each relate to one of the aforementioned therapy types: complementary, alternative, and integrative medicine (CAIM), natural health products (NHPs), and medical cannabis. Parallels can be drawn across these therapy types in general including patient preference and prevalence of use, quality of patient health information, and safety and effectiveness concerns. Knowledge of these parallels both informed the development of these three studies and emerged across findings. Chapter 1 provides a comprehensive introduction to these parallels in the context of CAIM, NHPs, and medical cannabis. Chapter 2 comprises a cross-sectional survey determining NHP use disclosure to primary care physicians among patients attending a Canadian naturopathic clinic. Chapter 3 comprises a qualitative interview study identifying attitudes towards medical cannabis among family physicians practicing in Ontario, Canada. Chapter 4 comprises a sentiment analysis of Twitter data to understand how CAIM is mentioned during the COVID-19 pandemic. Lastly, chapter 5 serves as the conclusion of this thesis, and summarizes the most important findings, addresses study strengths and limitations, and discusses future directions from this work. / Thesis / Doctor of Philosophy (PhD)

Idag står barnmorskor för 80 procent av förskrivningen av antikonception och 74 procent av kvinnor i 19 årsåldern har vid något tillfälle använt antikonception. Upprepade undersökningar tyder på att unga personer sexdebuterar tidigare, har fler sexpartners och samtidigt blir sämre på att använda skydd. På grund av detta är unga personer i behov av individanpassade och väl fungerande antikonception. För att som barnmorska kunna möta detta behov behövs kunskap om vilka faktorer som påverkar unga kvinnors i sitt val av antikonception. Mot bakgrund av detta finns ett intresse av att sammanställa den befintliga forskningen. Syftet var att belysa vilka faktorer som påverkar kvinnliga ungdomar och unga vuxnas val av antikonception.  Val av metod var en allmän litteraturöversikt med induktiv ansats som bearbetades via en integrerad analysmetod. Datainsamlingen skedde via databaserna PubMed och CINAHL under februari 2023. Artiklarna kvalitetsgranskades genom Caldwells kvalitetsgranskningsmall och sammanställdes i en artikelmatris. Genom numrering och färgkodning identifierades kategorier.  Det inkluderades sexton artiklar varav fem kvalitativa och elva kvantitativa. Resultatet sammanställdes under två huvudkategorier och fem subkategorier. Faktorer som påverkade unga kvinnor när de valde antikonception var metodens effektivitet, dess önskvärda egenskaper samt biverkningar och farhågor de hade om metoden. Mötet med hälso- och sjukvården samt kvinnans familj, vänner och hennes relationsstatus influerade även hennes val.   Slutsatsen var att unga kvinnor har olika prioriteringar när de väljer antikonception. Många kvinnor använder en metod vars egenskaper ej stämmer överens med deras individuella önskemål. Detta tyder på att hälso- och sjukvården brister i informationsöverföringen. Barnmorskan har ett ansvar gentemot unga kvinnor att stödja dem i att uppnå reproduktiv och sexuell hälsa. Vidare forskning om hur unga personer upplever antikonceptionsrådgivningen med barnmorskor hade varit av intresse. Detta skulle kunna resultera i kunskap om vilket stöd de unga personerna är i behov av under rådgivningen. / Today, midwives account for 80 percent of prescriptions of anticonception and 74 percent of women aged 19 have at some point used anticonception. Repeated surveys indicate that young people make their sex debut earlier, have more sex partners and at the same time are becoming worse at using protection. Because of this, young people are in need of individually adapted and well-functioning anticonception. In order for a midwife to be able to meet this need, knowledge is needed about the factors that influence young women's choice of contraception. Against this background, there is an interest in compiling the existing research. The aim is to shed light on which factors influence female adolescents and young adults' choice of contraception. The choice of method was a general literature review with an inductive approach that was processed via an integrated analysis method. The data collection took place via the databases PubMed and CINAHL during February 2023. The articles were quality-reviewed through Caldwell's quality review template and compiled in an article matrix. Through numbering and color-coding categories were identified. The study included sixteen articles, five qualitative and eleven quantitative. The results were compiled under two main categories and five subcategories. Factors influencing young women when choosing an anticonception method were the method's effectiveness, its desirable characteristics and side effects and concerns they had about the method. The meeting with the healthcare personnel as well as the woman's family, friends and her relationship status also influenced her choice. The conclusion was that young women have different priorities when choosing contraception. Many women use a method whose characteristics do not match their individual wishes. This indicates that the healthcare system is lacking in information transfer. The midwife has a responsibility towards young women to support them in achieving reproductive and sexual health. Further research on how young people experience anticonception counseling with midwives would have been of interest. This could result in knowledge of what support the young people need during counseling.

Background: Pre-operative anxiety remains a serious problem affecting surgical patients. The prevalence rate ranges between 60% to 80% percent among western surgical patients. Nothing is known about the prevalence of pre-operative anxiety among Nigerian Hausa speaking elective surgical patients. It is also not known what non-pharmaceutical pre-operative anxiety reduction interventions are preferable in reducing their anxiety before they undergo elective surgery. Participants: Thirty adult patients scheduled to undergo elective surgery in a tertiary health facility in north eastern Nigeria. Design/procedure: The study consists of three phases: Phase 1- translating and cross-cultural validation of Amsterdam Pre-operative Anxiety and Information Scale (APAIS) into Nigerian Hausa Language. Phase 2- administering the translated scale to assess the prevalence of pre-operative anxiety among the study participants. Phase 3 - finding out which non-pharmaceutical pre-operative anxiety reduction interventions would the Hausa speaking elective surgical patients prefer in reducing their anxiety before they undergo elective surgery. Results: The translated Hausa and validated version of the scale (APAIS-H) has shown a good psychometric property with Cronbach's alpha of 0.82 for anxiety related to surgery subscale and 0.71 for information desire subscale respectively. The finding of phase 2 revealed that there is high prevalence of pre-operative anxiety among the Hausa speaking elective surgical patients. The patients' anxiety continues to increase in intensity as they approach their time of operation. Results of phase 3 shows that the Hausa speaking elective surgical patients have high preference for counselling services, information and education, video-film intervention and low preference for music therapy. Conclusion: There is high prevalence of pre-operative anxiety among the Hausa speaking elective surgical patients. It is therefore recommended that, before undergoing elective surgery, clinicians should assess the Hausa patients' pre-operative anxiety so as to provide them with their preferred pre-operative anxiety reduction interventions proportionate to their level of anxiety. The thesis argued that the translated and validated APAIS-H is be a good measure of assessment particularly of those Hausa patients who could not read and understand the English Language version of assessment tool. / Yobe State University

<p>The purpose of this thesis was to improve the understanding of pain measurement and management in people with knee OA through: 1) Developing a theoretical model that may help in pain management and measurement; 2) Exploring the knee OA individuals’ views about three pain measures and 3) To determine if low frequency (≤100 Hz) pulsed subsensory threshold electrical stimulation produced either through pulsed electromagnetic field (PEMF) or pulsed electrical stimulation (PES) versus sham PEMF/PES intervention is effective in improving pain and physical function in the knee OA population.</p> <p>After pain theories literature review, a theoretical model was developed to address the gap between pain theories and clinical pain measurement and management. The patient’s views about three pain measures were not explored before 96 participants were recruited and completed the Verbal Numerical Rating Scale (VNRS), Intermittent and Constant Osteoarthritis pain Questionnaire (ICOAP) and the Short Form-McGill Pain Quetionnaire-2 (SF-MPQ-2). Participants were asked how well each pain measure describes their pain on a 10 cm Visual Analogue Scale (0 = does not describe your pain at all, and 10 = describes your pain completely. The time taken to complete and score the pain measure as well as the number of errors and questions while filling the pain measures were recorded. Systematic electronic searches were performed. Duplicate title, abstract and full text screening, risk of bias assessment, data extraction and grading the quality of evidence were performed. Data analysis was performed using Revman 5 software.</p> <p>Our sample of individuals with knee OA showed that VNRS, SF-MPQ-2 and ICOAP describe knee OA pain experience with no preference of one over the others. The systematic review conclusion was that PEMF/PES may be beneficial to improve physical function but not pain in people with knee OA with low and very low quality of evidence respectively</p> / Master of Health Sciences (MSc)

由於社會人口結構逐漸老化，電子健康照護服務的需求日漸增長，在今日成為健康照護服務中成長最迅速的領域，因此，服務設計就在健康照護產業中成為一個關鍵的議題。設計一個成功且完善的服務系統，首先要先了解病患的特性及需求，我們引用調節變項模型的概念，提出一套電子化健康照護服務設計架構，研究病患的服務偏好以及服務特色之間的配適性關係。本研究採個案研究法，透過台大醫院遠距醫療照護服務計畫中收集資料，我們研究結果發現在病患服務偏好以及服務特色當中存在著高度的配適性關係，如同我們的假設，在這之間的配適度將是一個影響服務效能的關鍵因素之一，本篇論文的貢獻在於為電子健康照護服務產業上提供一個良好的服務系統架構，並且提出一個驗證後的模型以了解關鍵的相關服務特色。 / The demand of e-Health care has been dramatically increasing and is quickly becoming one of the fastest growing areas of health-care today, due to today’s rapidly aging society; service design has therefore become a critical issue in the e-Health industry. To design a successful e-Health system, one must consider the different characteristics and preferences of each patient and design a system from a practical point of view. According to the concept of fit through moderation, this research aims to propose an e-Health design framework that examines the correlational fit between e-Health features and patient preference for achieving the best performance. We conducted a survey, where data was collected from the e-Health care program at the National Taiwan University Hospital (NTUH). From these sources, we found that there is an existing fit between e-Health service features and the preferences of different patient segments. Our findings also coincide with our pervious hypotheses that the fit between service features and patient preference contribute the service performance. The contribution of study is to provide a better understanding of critical service features through a validated framework in order to develop a better service system design for the provision of e-Health service.

No / Enabling patients to be cared for in their preferred location often involves journeys between care settings. The challenge of ensuring journeys are timely and safe emerged as an important issue in an evaluation of palliative care services, which informed a service redesign programme in three areas of the United Kingdom by the Marie Curie Cancer Care 'Delivering Choice Programme'. This article explores perceptions of service users and key stakeholders of palliative care services about problems encountered in journeys between care settings during end-of-life care. This article draws on data from interviews with stakeholders (n = 44), patients (n = 16), carers (n = 19) and bereaved carers (n = 20); and focus groups (n = 9) with specialist nurses. Data were gathered in three areas of the United Kingdom. Data were analysed using a framework approach. Transport problems between care settings emerged as a key theme. Four particular problems were identified: (1) urgent need for transport due to patients' rapidly changing condition; (2) limited time to organise transfers; (3) the management of specialist equipment and (4) the need to clarify the resuscitation status of patients. Partnership working between Ambulance Services and secondary care is required to develop joint protocols of care to ensure timely and safe transportation between care settings of patients, who are near their end of life. Commissioning of services should be responsive to the complexities of patients' needs and those of their families.