Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment seen within the outpatient orthopaedic clinic; therefore assessment and management of this common condition is of significant importance. Traditionally diagnosis has been made through detailed questioning; clinical examination and nerve conduction studies (NCS). There is however no true consensus as to the gold standard assessment of CTS and the use of NCS can confer additional costs and delay treatment. Previous studies have explored methods of predicting the presence of CTS including the clinician-administered Carpal Tunnel Questionnaire (CTQ) (Kamath and Stothard, 2003). The aim of the present studies is therefore to explore the versatility of the CTQ to see how a novel Patient-completed Version of the CTQ compares to the original Clinican-completed version. Psychometric properties of the questionnaire will be explored together the economic impact of integrating both versions within an orthopaedic care pathway. A further aim is to answer whether the CTQ more effective and cost-effective than NCS for patients referred to an orthopaedic clinic with suspected CTS. Method: 100 patients referred for further investigation of suspected CTS were assessed using parallel patient and clinician-completed versions of the CTQ and results were subsequently compared with those obtained from NCS. Item analysis explored each of the nine constructs of the questionnaire and the original scoring algorithm was validated using binary logistic regression and compared with alternative algorithms. Sensitivity and specificity of the questionnaire when compared to results of NCS was explored using Receiver Operating Characteristic (ROC) analyses. Inter-rater reliability was explored through Pearson’s correlation coefficient. Economic analysis and modelling was carried out to explore potential cost savings of use of the questionnaire rather than NCS for those with suspected CTS. Results demonstrated sensitivity of 92% and specificity of 54.67% (positive predictive value 95.35%) for the patient-completed questionnaire and 96% sensitivity with 70.67% specificity (98.15 positive predictive value) for the clinician-completed questionnaire when used to predict the outcome of NCS. Binary logistic regression confirmed the original scoring algorithm and a revised algorithm did not significantly improve sensitivity. Adoption of the clinician-completed CTQ would have screen out 54% of referrals for NCS, which in the case of the study site would have conferred cost savings of £73,305 per annum (base upon a referral rate of 750 per annum). The patient-completed CTQ in the current sample resulted in 43% of referrals with suspected CTS not requiring NCS to assist in diagnosis with a potential saving of £58,372.5 per annum. There are further considerations of the reduction in waiting times, which are explored further within the analysis. Conclusion: Economic evaluation is complex due to the variety of pathways adopted by different orthopaedic departments. While the results of the Patient-complete version of the CTQ may not be as convincing as the clinician completed the study does provide validation for its use and expands the versatility of this useful adjunct to the assessment of CTS. Both versions could potentially confer significant cost savings and reduce demands on investigative services, reducing waiting times and improving the patient journey in suspected CTS.

Self-report questionnaires are frequently used in health fields; however, subjective interpretation is often ignored. One way of assessing this is using techniques derived from cognitive interviewing. Of these, ‘think-aloud’, in which respondents speak their thoughts aloud as they complete a questionnaire, is the original paradigm. The thesis focusses on the use of ‘think-aloud’ methodology in the evaluation of questionnaires already in use in the health domain. The current thesis has been prepared in the format of scientific papers. Paper 1 is a systematic review (23 studies) of the appropriateness and usefulness of think-aloud techniques for evaluating health-related questionnaires. A descriptive account is provided of the aims of the studies reviewed; the justification for using think-aloud; populations studied; and methodology; an evaluative account depicts the usefulness of the think-aloud method in addressing researchers’ aims. Think-aloud was successfully used to address researchers’ aims and was effective at elucidating problems with questionnaires. Theoretical and clinical implications are discussed, and recommendations made for future research. Paper 2 is a cross-sectional observational study using think-aloud methods to examine the way in which people with End Stage Renal Disease (N=25) interpret and respond to the Emotion Regulation Questionnaire (ERQ). All questions were found to be problematic to some extent and reappraisal questions yielded the most problems. A tendency to deny or minimise negative emotions and present a positive self-image was also noted. Implications are discussed for use of the ERQ and replication with further samples suggested. Paper 3 is a critical appraisal of the above papers and provides personal reflections on the research process as a whole. The current thesis was a transition from a different study; amended due to time constraints. The journey is also outlined from this original study to the present thesis. Strengths and limitations are considered as well as areas for improvement and future research.

The aim of this thesis is to map out the situation with recent experience of czech firms with implementation of quality management system in the form of international standard ISO 9001 and confirm or disprove the hypothesis that the implementation of quality management has a positive impact for the company's economy and improves it's effectiveness. The theoretical part is devoted to the definition of quality management system and to the reason why companies implement this system and what benefits this system has. The practical part of this dissertation is devoted to the realization of questionnaire's survey between chosen companies which have implemented ISO 9001. This survey should discover benefits and costs of certification and the change of performance index of the firms.

Patients undergoing surgery with unrecognized obstructive sleep apnea (OSA) are at greater risk of complications. Ninety percent of those affected in the United States remain undiagnosed. To improve identification, screening tools such as the STOP-Bang questionnaire (Chung et al. 2008), provide anesthesia providers a method of detecting undiagnosed OSA. The purpose of this study is to assess anesthesia providers' practice of preoperative screening for OSA. An email survey was conducted at a Level-III trauma center in Phoenix, Arizona. The survey consisted of a 13 question, 5-point Likert scale questionnaire. It was sent to 29 Certified Registered Nurse Anesthetists (CRNA). A total of 8 CRNA's responded. Respondents were either neutral or disagreed that current methods of OSA screening works well and generally agree that the STOP-Bang tool would provide an advantage over the current methods, accurately detect OSA, and inform their anesthetic plan over current methods. Respondents leaned towards strong agreement that improving the recognition of undiagnosed OSA is needed. However, they were generally neutral on agreement that the STOP-Bang is necessary at their facility. Respondents agreed that the STOP-Bang tool is easy to use and interpret. However, most agreed that integrating the tool would add complexity to the preanesthesia evaluation but they remained neutral on whether it would add significant time to this process. Respondents were neutral on their observations that the STOP-Bang tool would improve early detection of OSA or reduce perianesthesia complications. Just 25% of respondents reported being aware of the existence of the STOP-Bang tool and none reported having used it. In conclusion, this project demonstrates that some providers have not used the STOP-Bang screening tool to detect undiagnosed OSA, but agree this tool is preferred over their current method. Results from the survey brought insight to a potential quality improvement strategy related to improving the perianesthesia care of patients with undiagnosed OSA. Improving knowledge through dissemination of evidence illustrates the value of the STOP-Bang prior to piloting the tool. The rates of perioperative complications justify the implementation of perioperative strategies such as the STOP-Bang as a tool for anesthesia providers.

This thesis deals with the golf theme. Popularity of golf is growing, and increasingly in the context of the rising new golf courses, which are competitors. The main target is to propose methods and measures to support the activities of the Golf Club Pardubice, which I chose on the basis of four years work experience. Prior to its implementation, I developed a survey of customer satisfaction. At the proposal continues marketing concept of Golf Club Pardubice. In this thesis, the emphasis is on the needs and wishes of the customer, as a key element of marketing itself.

The aim of this thesis is to analyze the satisfation of employees in the company ACTIVE 24 and to propose measure leading to removal of deficiencis. The introduction describes the issues and the aim of this thesis. Based on a theoretical basis which appears in the fisrt part the hypothesis are set, the research metodology is decribed and the tools for data collection are specified. Research is implemented through questionnaire surfy. It focuses on the nature of work, compensation and the employee benefits, training, personal development, work environment, relationships with colleagues and superiors. The practical part contains the results of research and verification of hypotheses. Based on identified deficiencies the measures for improvement are set.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic and Somatology, Durban University of Technology, Durban, South Africa, 2016. / Background Chiropractic is practiced in over 100 countries and is considered to be the fastest growing health care profession internationally. Several studies investigating the practice characteristics of chiropractors have been conducted in selected countries, however, as far as is known, no study has been conducted where chiropractors from countries across the globe are assessed for their practice characteristics in order to determine if regional differences exist. Gaining insight into chiropractic practice and its influencing factors, relating to both the profession itself and the chiropractor can enable organisations such as the World Federation of Chiropractic to have a greater understanding of how chiropractors are currently practicing and how the profession is being utilised by the public. Improved insight into the profession provides a baseline description for the public and other health care practitioners to fully comprehend what chiropractors can offer to the health care system. Aim: The aim of this study was to determine the demographic profile and practice characteristics of chiropractic delegates attending the World Federation of Chiropractic’s 12th Biennial Congress 2013. Method A pre-validated questionnaire and letter of information and consent was distributed to all registered chiropractic delegates (N = 406) attending the World Federation of Chiropractic Congress in Durban, Kwa-Zulu Natal 2013. The questionnaire was part of the delegate packages and they self-selected to participate. Due to a low response rate at the congress, the questionnaire was made available electronically on Survey Monkey®, for six weeks after the congress. Questions relevant to this study were coded, reduced where necessary and utilised for data analysis with IBM SPSS Version 21. Descriptive data was then summarised and presented using tables and graphs. The study was approved by the Durban University of Technology’s Institutional Research Ethics committee. Results: The response rate was 34.72%, with 52.5% being female, mean age was 42 (SD ± 13years, and all seven geographical regions were represented. The majority of respondents were from Africa (51.1%), followed by North America (22.7%) then Europe (14.2%). South Africa (48.6%) was the most represented country. Respondents held either a Master’s degree in Chiropractic (51.8%) or a Doctor of Chiropractic (DC) degree (48.2%). The mean years since graduating as a chiropractor was 15.7 years (SD ± 3.6). The majority of respondents (71.2%) engaged in full-time clinical practice, for between 5 to 15 years (39.8%) with 51.4% purporting to have an evidence based philosophical approach to practice. The majority (72.5%) viewed the role of a chiropractor in the health care system as a primary health care practitioner with a focused scope of practice. The majority of respondents (n = 52) personally treated 50 patients or less per week, with approximately one third of the respondents (n = 34) having high volume practices (>100 patients weekly). The respondents favoured being one of two chiropractors (36.9%) in a practice setting followed by sole practices (31.6%). The top chiropractic technique utilised was the diversified technique (74.5%) followed by extremity adjusting (68.8%). Various adjunctive, active and passive, axillary techniques were utilised in the daily management of patients. The patient demographics were majority female (55.7%), older than 30 years of age (66.7%) and Caucasian (77%), complaining of head, neck, mid-back and low back pain, which was mostly acute in nature. Trends suggested that females were more likely to select an evidence-based philosophical orientation than males. Females were more likely to delegate adjunctive therapies to non-chiropractic assistants (p = 0.029), and favoured sending patients to a physical therapist (p = 0.018), whereas males were more likely to refer to nutritionists and paediatricians (p = 0.030 and p = 0.038, respectively). Females were less likely to utilise mobilisation techniques (p = 0.008), massage therapy (p = 0.018) and nutritional counselling (p = 0.032). In terms of age, those selecting an evidence-based approach were significantly older than those who adopted a mixer approach to practicing (p = 0.002). The mean age of the respondents, irrespective of the region, was not significantly associated with the number of patients treated per week (p = 0.377) or the hours worked per week (p = 0.474). Trends show that the number of years spent in practice differed among the regions with North American chiropractors spending more years in practice than those from Europe and Australasia. The respondents from South Africa spent fewer years in practice (15 years or less) than respondents from Asia, Australasia, Europe and North America. Geographic region was not significantly associated with practice setting (p = 0.182). The only chief complaint that differed between regions was patients presenting with headaches accompanied by neck pain (p = 0.007), where Asian and North American respondents reported seeing less patients than their colleagues from other regions. Trends suggested that the respondents who attained a Masters of Technology in Chiropractic were more inclined to select a mixer orientation whereas those with a DC qualification selected an evidence-based philosophical approach. Conclusion: The WFC congress provided a platform to successfully determine the demographic profile and practice characteristics of chiropractors from various regions. Similar demographics were evident, with males no longer showing dominance within the profession. Chiropractors adopting an evidence-based and mixer philosophical orientation are synonymous in the role that they play in the health care system and display similarities in chiropractic practice and patient management. Investigating chiropractors who adopt a straight philosophical approach would be beneficial as it will allow for better comparison of demographics and practice characteristics. It is evident that selected demographics do influence how one would opt to practice, with regional differences showing that the chiropractic profession in South Africa is still relatively young. / M

The first objective of this thesis was to determine the relationship between scores on the AC Test of Creative Ability and scores on the Cree Questionnaire. This task was undertaken as a response to the scarcity of comparative data among the few objective measures of creative ability which are currently available. The second objective was to construct a self-rating scale of personality traits shown by past research to be associated with creativity. The third objective was to investigate the relationship between scores on each of the two standardized measures of creative ability and scores on the self-rating scale of traits related to creativity.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-19T18:12:45Z No. of bitstreams: 1 Rejane Agnelo Silva de Castro.pdf: 1052641 bytes, checksum: 1f8691a5b4f1dcb3d43ec9c6aa9e4345 (MD5) / Made available in DSpace on 2018-06-19T18:12:45Z (GMT). No. of bitstreams: 1 Rejane Agnelo Silva de Castro.pdf: 1052641 bytes, checksum: 1f8691a5b4f1dcb3d43ec9c6aa9e4345 (MD5) Previous issue date: 2015-11-27 / Introduction: Instruments to objectively assess the perception of symptoms in patients with BCQ are scarce. Patients with COPD and bronchiectasis (BCQ) share similar symptoms. Therefore, COPD Assesment Test (CAT), originally developed for COPD may be suitable for use in these patients. Objective: To validate and test the reproducibility of the CAT for non-cystic fibrosis (non–CF) bronchiectasis patients. Methods: Hundred patients (FEV1 52 ± 25%; FVC 67 ± 22%; 48 ± 14 years; 42 males) underwent spirometry, cardiopulmonary exercise testing (peak workload and VO2), and shuttle walk test (ST). They answered the Saint George Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) scale, and the CAT in two different days (CAT-1 and CAT-2). A pedometer recorded the No. of steps/day (NSD). Results: CAT showed a positive correlation with SGRQ domains (r = 0.74, p< 0.001) and MRC (r = 0.49, p< 0.001). A negative correlation was observed among CAT and lung function (FVC%: r= -0.33, p= 0.001; FEV1%: -0.28, p = 0.004), peak workload (r = -0.31, p = 0.001), VO2 (r = -0.44 p< 0.001), distance walked on ST (%, r= -0.46, p< 0.001), and NSD (r = -0.74, p< 0.001). There was an excellent reliability in the scores from CAT-1 and CAT-2 (21 13.25 – 26.75 and (19 13 – 26.75, respectively) with high intraclass correlation coefficient (ICC: 0.92 [95% CI: 0.83 – 0.96], p< 0.001). Conclusion: CAT is a valid instrument for measuring the impact of bronchiectasis in well-being and daily life of patients with BCT, and is a reproducible questionnaire. / Introdução: Instrumentos que avaliam objetivamente a percepção dos sintomas em pacientes com BCQ são escassos. Pacientes com DPOC e bronquiectasia (BCQ) compartilham sintomas semelhantes. Portanto, o COPD Assesment Test (CAT), originalmente desenvolvido para DPOC, pode ser adequado para uso nesses pacientes. Objetivo: Validar e testar a reprodutibilidade do CAT para BCQ. Métodos: 100 pacientes (42 homens, 48 ± 14 anos, VEF1 52 ± 25% prev, CVF 67 ± 22% prev) foram submetidos à espirometria, shuttle walk test incremental (SWTI) e teste de exercício cardiopulmonar exercício (TECP, carga e VO2 pico). Eles responderam ao Saint George’s Respiratory Questionnaire (SGRQ), à escala de dispneia Medical Research Council (MRC) e ao CAT (este em dois dias diferentes CAT-1 e CAT-2). O número de passos por dia (NP) foi registrado por pedômetro. Resultados: Os escores do CAT correlacionaram-se positivamente com os escores dos domínios SGRQ (r de 0,74, a p< 0,001) e MRC (r= 0,49, p= 0,001). Foi observada correlação negativa entre o CAT e a função pulmonar (CVF%: r= -0,33, p= 0,001; VEF1%: -0,28, p= 0,004), carga (r= -0,31, p= 0,001), VO2 (r= -0,44 p< 0,001), distância no SWTI (r= -0,46, p< 0,001), e NP (r= -0,42, p< 0,001). Houve excelente reprodutibilidade entre os escores de CAT-1 e CAT-2 (21 13,25 – 26 e (19 13 – 26,75, respectivamente), com elevados coeficiente de correlação intraclasse (ICC: 0,91 [95% CI: 0,87-0,94], p<0,001). Conclusão: CAT é um instrumento válido para medir o impacto da BCQ no bem-estar na vida diária dos pacientes com BCQ, e é um questionário reprodutível.

Sports-related concussions are one of the most complex injuries in the sports medicine field since head traumas are hard to recognize, discover and manage. Adolescent brains are under development and therefore more sensitive to concussions. Even though it is well established that concussions are a frequently occuring injury amongst youths, research on concussions on the youth ice hockey level in Sweden have not been previously investigated. Therefore, the primary aim of the present study was to investigate the cumulative prevalence of concussions amongst ice hockey players 13-15 years of age. A total of 188 players were invited to participate. The response rate was 40% whereas 61 players (girls n=6, boys n= 55) met the inclusion criteria. More than one-third (41%) reported at least one concussion, the majority of them hockey related. The study did not only investigate the prevalence of concussions, the understanding on concussions have also been examined, which revealed that half of the participants recognized Hjärntrappan. Although the study could not detect any significant relationship regarding potential risk factors and reported concussions, the investigation have illuminated a complex injury. In conclusion, the prevalence of concussions in the cohort was relatively high since more than one-third (41%) reported at least one concussion. Further, half of the participants recognized Hjärntrappan. The result emphasizes more education regarding head traumas for players, coaches and parents in youth ice hockey in order to prevent disastrous consequences such as premature career ending, future cognitive dysfunction and mental illness.