Background: Previous studies that have examined functional status in relation to vascular events have focused on the short term after events and have measured functional status a limited number of times. The trajectories of functional status before and after vascular events are not well characterized, and the factors influencing these trajectories are not well known. Methods: A comprehensive, structured, narrative review was performed on the topic of trajectories of disability and cognition surrounding vascular events. Then using 2 large population-based epidemiologic cohorts, the Northern Manhattan Study (NOMAS) and the Cardiovascular Health Study (CHS), trajectories of functional status were examined. In Analysis A, in NOMAS, the effect of inflammatory biomarkers (interleukin-6 [IL6], tumor necrosis factor receptor-1 [TNFR1], C-reactive protein [CRP], and lipoprotein-associated phospholipase-A2 [LpPLA2]) on the intercept and slope of functional status was determined over a median of 13 years, measured with yearly assessments by the Barthel index. In Analysis B, in NOMAS, a similar modeling strategy was used to examine whether subclinical ischemic disease on brain MRIs, measured by subclinical brain infarct (SBI) and white matter hyperintensity volume (WMHV), was associated with functional trajectories. In Analysis C, in CHS, participants had yearly assessments of disability with a combined activities of daily living (ADL) and instrumental ADL scale. The slope of change in disability was compared before and after vascular events (stroke and myocardial infarction [MI]). Results: In Analysis A, CRP (-0.41 BI points per 1 SD increase, 95% CI -0.82 to 0.002) and LpPLA2 (-0.40, 95% CI -0.75 to -0.04) were associated with baseline BI but not change over time. TNFR1 was associated with baseline BI (-0.93, 95% CI -1.59 to -0.26) and change over time (-0.36 BI points per year, 95% CI -0.69 to -0.03). In Analysis B, functional change was -0.85 BI points per year (95%CI -1.01 to -0.69); among those with SBI there were -0.88 additional points annually (-1.44 to -0.32). In WMHV models, annual functional change was -1.04 points (-1.2 to -0.88), with -0.74 additional points annually per SD WMHV increase (-0.99 to -0.49). In Analysis C, stroke (0.88, 95% CI 0.57-1.20, p<0.0001) was associated with a greater acute increase in disability than MI (0.20, 0.06-0.35, p=0.006). The annual increase in disability before stroke (0.06 points per year, 0.002-0.12, p=0.04) more than tripled after stroke (0.15 additional points per year, 0.004-0.30, p=0.04). The annual increase in disability before MI (0.04 points per year, 0.004-0.08, p=0.03) did not change significantly after MI (0.02 additional points per year, -0.07-0.11, p=0.7). Conclusions: In these large population-based studies with repeated measures of functional status and disability over long-term follow-up, several trajectories were found. In Analysis A, TNFR1 predicted worse overall functional status as well as accelerated decline over time. In Analysis B, both SBI and WMHV were associated with accelerated decline. In Analysis C, there was a steeper decline in function after stroke but not MI. These findings help to elucidate the course and potential etiologies of long-term functional decline related to vascular events, and they suggest directions for future research in this area.

Objectifs: D’une part étudier les effets de la SCP à moyen et long terme chez les patients de notre centre ayant une forme génétique de MP, d’autre part effectuer une étude clinique, génétique et transcriptomique d’un groupe de patients parkinsoniens ayant une mutation du gène SCA2 (dits patients SCA2).Méthode: 1/ Effet de la SCP chez des patients ayant une forme génétique de MP: cinq patients ayant une forme génétique de MP, appartenant à une cohorte de 52 patients parkinsoniens ayant bénéficié d’une stimulation à haute fréquence du noyau sous-thalamique entre 1998 et 2000, ont été examinés avant la chirurgie puis à 1 et 5 ans. Les patients ont été évalués avec et sans L-dopa par plusieurs échelles: UPDRS II et III,dyskinésies, Schwab et England, Mattis et MADRS. Les résultats ont été comparés aux patients de la même cohorte ayant une forme sporadique de MP.2/ Etude des patients parkinsoniens SCA2 : la description clinique est rapportée rétrospectivement. Les études génétique et transcriptomique ont été effectuées chez 7 patients parkinsoniens et 8 patients cérébelleux SCA2, sur des cellules mononuclées sanguines. Le séquençage de l’ADN a permis de déterminer la longueur de la répétition de triplets CAG et d’identifier les interruptions par des triplets CAA. Le transcriptome de ces patients ainsi que de 13 témoins (sujets sains appariés sur le sexe et l’âge) a été réalisé sur deux plateformes de puces à ADN (Agilent et Illumina). L’analyse de l’expression des gènes chez les patients parkinsoniens et cérébelleux comparés à leurs contrôles respectifs a été réalisée avec le logiciel Genespring GX. Les gènes ayant une expression significativement différente (variation d’expression >1,3 et Welch t-test p< 0,05) ont été analysés à l’aide du logiciel Ingenuity Pathways Analysis qui identifie les voies canoniques significativement dérégulées.Résultats: 1/ Effet de la SCP chez des patients ayant une forme génétique de MP: les résultats de l’ensemble des parkinsoniens étaient comparables à la littérature. Les mouvements involontaires compliquant la dopathérapie s’amélioraient au cours du temps. Les patients ayant une forme génétique bénéficiaient d’un meilleur résultat que les autres parkinsoniens sur les signes dopasensibles et sur les complications dopa-induites.2/ Etude des patients parkinsoniens SCA2 : cliniquement, la MP était tout à fait classique, l’âge moyen de début était de 55,2 ans, tous les patients étaient dopasensibles et les complications typiques de la MP étaient constatées. Le séquençage de l’ADN a montré des expansions légèrement plus longues chez les patients cérébelleux (37-41 triplets) que chez les patients parkinsoniens (35-39). Les patients cérébelleux n’avaient pas d’interruptions CAA sur leur allèle muté. Tous les patients parkinsoniens avaient en revanche une séquence d’interruptions CAA inhabituelle. Pour ce qui concerne l’étude transcriptomique, nous avons constaté chez les patients cérébelleux et chez les parkinsoniens la dérégulation de l’expression de gènes connus pour interagir avec l’ataxine 2 (DDX6, PABP, gènes de la voie du métabolisme des inositol phosphates), ainsi que de gènes impliqués dans le métabolisme du cancer et dans l’immunité. Les patients parkinsoniens avaient un dérèglement des voies de signalisation de la sclérose latérale amyotrophique, du VEGF et de HIF1. Chez ces patients, l’expression de SNCA était diminuée, y compris chez les patients les moinsVIIsymptomatiques, alors qu’elle ne l’était pas chez les cérébelleux. Chez les patients cérébelleux, plusieurs voies concernant le métabolisme des ARN étaient dérégulées, ainsi que le métabolisme du phosphate inositol. Plusieurs voies canoniques impliquant l’apoptose étaient dans les 2 groupes de patients, avec une expression de gènes pro- et antiapoptotiques en faveur de l’apoptose chez les cérébelleux et en sa défaveur chez les parkinsoniens. / Objectives: First, to study the mid- and long term effects of DBS in patients with a genetic form of PD from our clinic, and second, to achieve a clinical, genetic and transcriptomic study of a group of parkinsonian patients bearing a mutation in the SCA2 gene (so called SCA2 patients)Methods: 1/ Effects of DBS in patients with a genetic form of PD: five patients with a genetic form of PD, belonging to a cohort of 52 PD patients who underwent a subthalamic nucleus high frequency stimulation between 1998 and 2000, were evaluated before surgery and then after 1 and 5 years with and without L-dopa, using several scales: UPDRS II and III, dyskinesia, Schwab and England, Mattis and MADRS. The results were compared with the patients of the same cohort having a sporadic form of PD. 2/ Study of the parkinsonian SCA2 patients: the clinical picture is related retrospectively. Genetic and transcriptomic studies were performed on blood mononuclear cells from 7 parkinsonian and 8 cerebellar SCA2 patients. DNA sequencing allowed to determine the length of the CAG triplets repeat and to identify the interruptions by CAA triplets. Transcriptomes of these patients and of 13 matched controls (healthy subjects paired according to gender and age) were profiled using 2 platforms of whole human genome expression micro-arrays (Agilent and Illumina). Analyses of differential expression in cerebellar and parkinsonian patients vs their respective controls were performed with GeneSpring GX software. Genes with significant differences (fold change >1.3 and Welch t-test p< 0.05) were analyzed using Ingenuity Pathway Analysis software which identified significantly deregulated canonical pathways.Results: 1/ Effects of DBS in patients with a genetic form of PD: the results concerning the whole cohort of PD patients were similar to the literature. L-dopa-induced involuntary movements improved over time. Patients with a genetic form of PD had a best result than other patients on dopa-responsive signs and dopa-induced complications.2/ study of the parkinsonian SCA2 patients: clinical features were very typical of PD, with a mean age of onset of 55.2 years, a good L-dopa responsiveness, and classical complications of PD. DNA sequencing showed slightly longer expansions in cerebellar (37-41 triplets) than in parkinsonian patients (35-39). Cerebellar patients had no CAA interruption on their mutated allele. All parkinsonian patients had an unusual pattern of CAA interruptions. Concerning the transcriptomic study, cerebellar and parkinsonian patients had a deregulation in the expression of genes known to interact with ataxin-2 (DDX6, PABP, genes in the inositol phosphates metabolism pathway), as well as genes involved in the metabolism of cancer and in immunity. Parkinsonian patients had a deregulation of amyotrophic lateral sclerosis, VEGF and HIF1 signaling pathways. In these patients, including the least symptomatic ones, SNCA expression was down-regulated, whereas it was not in cerebellar patients. In cerebellar patients, several pathways concerning the metabolism or RNAs were deregulated, as well as p53 signaling. Several canonical pathways involving apoptosis were deregulated in both groups of patients, with an expression of pro- and antiapoptotic genes in favor of apoptosis in cerebellar patients and going against apoptosis in parkinsonian patients. .

Dialysis patients are operated to have AV Fistula which is a joint junction of an artery and vein in the arm, operated to increase the blood flow through the dialyzer machine. AV- fistula is a type of vascular access which is a path into the body to connect/disconnect devices, but in this case, it is mainly Dialyzer. To reduce the failure rate during maturation period of AV Fistula, doctors recommend squeezing ball exercise as a necessary precaution for AV Fistula failure. Doing Squeezable interaction for about 3-4 times a day is recommended based on patient’s health condition. Hence, the proposed architecture adopts this squeezable exercise by embedding with sensor and measuring the angle at which the sensor is bent. The framework also proposes a new care coordination system having the hardware layer which has key components such as raspberry Pi, sensor which help in recording the pressure values when user presses the ball and software layer which solely focuses on data sync among the applications used by the user. It has been recorded that 53 % of patients having AV-Fistula fail because of negligence and lack of care. The maturation period is so critical and important which made us to build a gamification platform to monitor the exercise and track the activity through android application to keep users motivated and disciplined. In further chapters of the study will focus on different clinical like procedure around AV-Fistula and technical information such as different technologies used and implemented in the proposed system along with sensor circuit. This project goal is to present a way of monitoring patients and to keep track of the compliance whether the patient is active doing exercise daily. This way we are trying to present a care monitoring system for patients to help prevent AV Fistula failure. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Thesis (M.Cur) --University of Limpopo, 2013 / Adherence to antipsychotic medication is very important to patients with schizophrenia. Therefore, if patients with schizophrenia are non-adherent to treatment, they are at risk of relapse and being re-admitted at a mental health care institution in the Limpopo Province. Despite the proven benefits of antipsychotic medications, half of the patients with schizophrenia do not take their prescribed drugs. The researcher has observed the following occurrences during practice: • Lack of adherence to antipsychotic medications of schizophrenic patients results in symptoms not being relieved, poor drug effectiveness and patients developed other serious or costly consequences, such as being violent and damaging property; • High rate of relapse; and • High rate of re-admissions. This research questions has guided the study: • What are the factors affecting adherence of mentally stable schizophrenic patients to antipsychotic medications at a mental health institution in the Limpopo Province? • Do mentally stable schizophrenic patients adhere to prescribed treatment? • Are there any guidelines used to promote adherence to antipsychotic treatment? The aim of the study has been to determine the level of adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental healthcare institution in the Limpopo Province. The objectives of the study have been to describe adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental health institution in the Limpopo Province. It implies that participants have been given the opportunity to describe their experience while on medication. vi Their responses have led to the development of guidelines to promote adherence of mentally stable schizophrenic patients to antipsychotic medication. The study site has been the Thabamoopo Mental Healthcare Institution in the Capricorn District of the Limpopo Province. A descriptive, exploratory and contextual qualitative research design has been used in this study. The population has consisted of all mentally stable schizophrenic patients and all the carers of such patients. Non-probability purposive sampling has been used to select participants in this study. The researcher has used a semi- structured interview with two schedule guides for the patient and carers/relatives, which have specified the issues and questions covered. It has assisted the researcher with gathering information about the problem studied (De Vos et al. 2005).A total of twenty (n = 20) participants, consisting of fourteen (n = 14) mentally stable schizophrenic patients and six (n = 6) carers/relatives has been included voluntarily in the semi-structured interview sessions. The steps of data analysis as described by Tesch (1990) in Cresswell (1994) have been followed in this study. The findings of this study reveal a central storyline which indicates that participants share the same point of view in connection with aspects of adherence to antipsychotic treatment and also knowledge about the causes of mental illness and its prognosis. The following four themes and their sub-themes have emerged during data analysis: Theme 1: Participants share the same point of view related to aspects of adherence to antipsychotic treatment; Theme 2: Knowledge related to mental illness; Theme 3: Health seeking behaviours of mentally ill patients; and Theme 4: Experiences of relatives caring for mentally stable patients on treatment. Guidelines and recommendations based on the findings of this study are described in Chapter 4. The criteria for establishing the trustworthiness of qualitative data maintained in this study have been: Credibility, dependability, confirmability and transferability. The following ethical principles have been adhered to: The principle of beneficence, justice, the principle of human respect and dignity, permission to conduct the study, informed consent and confidentiality, privacy and anonymity.

Stroke is one of the leading causes of mortality and disability worldwide. The majority of stroke patients are elderly. Advanced age, hypertension, diabetes mellitus, atrial fibrillation, smoking and heavy alcohol drinking are the major risk factors. Treatment of modifiable risk factors is an important strategy for primary and secondary stroke prevention. The primary aim of this thesis was to examine stroke risk factor profile, risk factor management and clinical outcomes, as well as their association with ethnicity (defined as English-speaking background ? ESB, and non-English-speaking background - NESB) in a group of elderly patients from a multiethnic background. Stroke risk factor profile and outcomes of stroke were similar between English and non-English-speaking background patients. However, a higher prevalence of diabetes mellitus in the NESB patient group was observed in the study (41% vs. 10% in the ESB patient group) (Chapter 2). In addition, predictive factors and predictive models for stroke outcomes were developed. Advanced age, visual field loss and stroke type were the main predictors for mortality and functional dependency at 12 months post-stroke (Chapter 3). Delirium occurred in one quarter of the elderly patient post-stroke and was also associated with a worse clinical outcome (Chapter 4). Risk factor management may be suboptimal in elderly patients. For example, anticoagulant therapy for stroke prevention in patients with atrial fibrillation was underused, particularly in NESB patients (Chapter 2). The reasons for under-usage of anticoagulant therapy were investigated in a general practitioner survey (Chapter 6). Results showed that NESB, older age, cognitive impairment (especially living alone) were significant potential barriers for anticoagulant prescription by general practitioners. Stroke units have been proven to be a better care model for stroke patients, with shortened hospital length of stay and improved clinical outcomes. Clinical audits from Bankstown Combined (Co-located) Acute and Rehabilitation Stroke Unit and later the newly established Blacktown Combined Co-located Stroke Unit have demonstrated these benefits (Chapter 5). However, further studies need to be performed in order to determine whether a combined co-located stroke unit care model is superior to other stroke unit care models, and if so, the reasons behind this.

<p>One third of all Swedish people will suffer in cancer. Pain is a common symptom in cancer patients. The pain is subjective and includes several dimensions. The dimensions of pain are the physical, psychological, social and spiritual. This is a literature review and the aim with this study was to identify the pain experience in patients with cancer receiving palliative care. Nineteen articles were analysed. The result shows that the physical pain was experienced as chronicle or episodic pain.</p><p>Psychological pain included fear, distress and anxiety. Social pain was a result of loss of relationships and ability to take part of activities. Spiritual pain was expressed as feelings of meaningless, hopelessness and fear for the future. Different kinds of dimensions cooperate with each other. They can strengthen each other and one dimension of pain can lead to another. The articles that have been analysed focus on several dimension of pain. To be able to relieve the pain and other symptoms, the nurse needs to have a holistic view of patients and to be aware of how all dimensions of pain that is expressed by the patient.</p>

One third of all Swedish people will suffer in cancer. Pain is a common symptom in cancer patients. The pain is subjective and includes several dimensions. The dimensions of pain are the physical, psychological, social and spiritual. This is a literature review and the aim with this study was to identify the pain experience in patients with cancer receiving palliative care. Nineteen articles were analysed. The result shows that the physical pain was experienced as chronicle or episodic pain. Psychological pain included fear, distress and anxiety. Social pain was a result of loss of relationships and ability to take part of activities. Spiritual pain was expressed as feelings of meaningless, hopelessness and fear for the future. Different kinds of dimensions cooperate with each other. They can strengthen each other and one dimension of pain can lead to another. The articles that have been analysed focus on several dimension of pain. To be able to relieve the pain and other symptoms, the nurse needs to have a holistic view of patients and to be aware of how all dimensions of pain that is expressed by the patient.

Dissertation--Universität Stuttgart. / Résumé en anglais p. 14-15. Bibliogr. p. 226-235.

Reproduction de : Thèse d'exercice : Pharmacie : Nantes : 2008. / Bibliogr.

Thesis (M.A.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 90-93).