Objetivos: Caracterizar o perfil audiológico dos indivíduos com malformações congênitas de orelha externa e/ou orelha média, na Divisão de Saúde Auditiva (DSA), do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), da Universidade de São Paulo (USP), campus Bauru e avaliar o benefício e a satisfação dos usuários de aparelhos de amplificação sonora individuais por condução óssea (AASI VO) retroauriculares. Modelo: Análise de prontuários, avaliação do benefício pelo teste de reconhecimento de sentenças com ruído competitivo e pelas medidas do ganho funcional e avaliação da satisfação pelo questionário internacional QI - AASI. Local: DSA, HRAC/USP, Bauru. Participantes: Foram analisados os prontuários de 170 indivíduos e, destes, selecionados 13, com malformações congênitas bilaterais de orelha externa e/ou orelha média, deficiência auditiva condutiva ou mista moderada ou severa e usuários de AASI VO retroauricular. Resultados: O perfil audiológico (n = 170) caracterizou-se pelo predomínio das malformações bilaterais (53%), das malformações no sexo masculino (61%), da deficiência auditiva condutiva moderada ou severa (80%) e da adaptação de AASI VO (56%). A orelha direita foi mais afetada (32%), quando consideradas apenas as malformações unilaterais. Na amostra selecionada (n = 13), o benefício foi comprovado pelo melhor desempenho obtido na avaliação proposta, na condição com AASI, quando comparada à condição sem AASI. A satisfação foi confirmada pelos escores elevados obtidos no QI-AASI. Conclusões: O uso do AASI VO retroauricular trouxe benefícios para o reconhecimento da fala no ruído e para a percepção do sinal acústico, além de satisfação aos indivíduos com malformações congênitas de orelha, portanto, esses dispositivos devem ser considerados como uma opção no tratamento dessa população. / Objectives: To characterize the audiological profile of the individuals with congenital malformations of the external and/or middle ear, in the Divisão de Saúde Auditiva (DSA) of the Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) of Universidade de São Paulo (USP), in Bauru and to evaluate the benefits and satisfaction of patients fitted with bone conduction hearing aid (BCHA). Model: Analysis of files, evaluation of benefits by means of test of recognition of sentences with competitive noise and by the measures of the functional gain, and evaluation of satisfaction by International Outcome Inventory for Hearing Aids (IOI/HA). Participants: 170 patients? files were analyzed, from which 13 were selected with bilateral congenital malformations of the external and/or middle ear, moderate or severe conductive or mixed hearing loss, and patients fitted with BCHA. Results: The audiological profile (n=170) was characterized by the prevalence of bilateral malformations (53%), of malformations in males (61%), of the moderate or severe conductive hearing loss (80%) and of the fitting of BCHA (56%). The right ear was more affected (32%) when considered the unilateral malformations only. In the selected sample (n=13), the benefit was demonstrated by the best performance obtained in the proposed evaluation, in the condition with hearing aid, when compared to the condition without hearing aid. The satisfaction was confirmed by the high scores obtained in the IOI - HA. Conclusions: Fitting BCHA denoted improvement at speech perception in noise and sound detection. Individuals with congenital malformations of the ear were satisfied with this device, so that must be considered as an option to the treatment of this population.

Objetivos: Caracterizar o perfil dos indivíduos com fissura labiopalatina e deficiência auditiva, adaptados com AASI, pela Divisão de Saúde Auditiva (DSA), HRAC/USP, Bauru e avaliar a efetividade e a satisfação da adaptação do AASI na amostra selecionada. Modelo: Análise dos prontuários, avaliação da efetividade do AASI pelo levantamento das características eletroacústicas, medidas com microfone sonda e teste de reconhecimento de sentenças no silêncio e no ruído e avaliação da satisfação pelo questionário QI-AASI. Local: Setor de AASI da DSA. Participantes: Para a caracterização do perfil, foram analisados os prontuários de 131 indivíduos e, destes, selecionados 8 com fissura labiopalatina, sem alterações associadas, deficiência auditiva condutiva e/ou mista e assíduos ao acompanhamento. Resultados: O perfil geral (n=131) caracterizou-se pela predominância de fissura transforame incisivo unilateral (27%), histórico de alterações de orelha média (56%) e intervenção cirúrgica (56%). Na amostra selecionada (n=8), a efetividade do AASI foi comprovada pelo melhor desempenho obtido com o aparelho, em comparação com as respostas sem ele, na avaliação proposta. A satisfação foi confirmada pelos escores elevados do questionário. Conclusões: O perfil geral dos indivíduos com fissura labiopalatina e deficiência auditiva, adaptados com AASI, caracterizou-se pela predominância do sexo masculino, fissura transforame incisivo unilateral, histórico positivo de alteração de orelha média, intervenção cirúrgica e deficiência auditiva sensorioneural bilateral de grau leve a profundo. Foi comprovada a efetividade e satisfação do AASI para os indivíduos com fissura labiopalatina e deficiência auditiva condutiva e/ou mista participantes deste estudo. É importante considerar a adaptação de AASI como alternativa para o tratamento desses indivíduos. / Aim: To characterize the profile and to assess efficacy and satisfaction of individuals with cleft palate and hearing loss that were hearing aids fitted at Divisão de Saúde Auditiva (DSA), Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru. Model: Analysis of patients? files, assessment of the hearing aid efficacy by raising the electroacoustic characteristics, measurements with a probe tube and test of recognition of sentences in silence and noise and assessment of the satisfaction by questionnaire International Outcome Inventory for Hearing Aids. Local: Hearing aid division of the DSA. Participants: For the characterization of the profile, 131 files were analyzed from which 8 were selected with cleft palate, without associated alterations, conductive and/or mixed hearing loss, and assiduous to routine appointments. Results: The general profile (n=131) was characterized by the prevalence of the unilateral incisive transforamen cleft (27%), history of alterations of the middle ear (56%) and surgery intervention (56%). In the selected sample (n=8), the efficacy of the hearing aid was demonstrated by the better performance obtained with the hearing aid in comparison with those not using it in the proposed evaluation. The satisfaction was confirmed by the questionnaire elevated scores. Conclusions: The general profile of the individuals with cleft palate and hearing loss, adapted with hearing aid, was characterized by male predominance, unilateral incisive transforamen cleft, positive history of alteration of the middle ear, surgery intervention and moderate to profound bilateral sensorioneural hearing loss. It was possible to demonstrate the efficacy and satisfaction of the individuals with cleft palate and conductive and/or mixed hearing loss who participated in this work. It is important to consider the hearing aid fitting as an alternative to the treatment of such individuals.

Orientador: Maria Lúcia Marçal Mazza Sundefeld / Banca: Tânia Adas Saliba Rovida / Banca: Dalton Francisco de Andrade / Resumo: O câncer de boca é uma das dez neoplasias mais frequentes em todo o mundo, sendo considerado uma doença multifatorial. Está diretamente associado aos fatores de riscos, tais como: o tabagismo, etilismo, exposição solar e dieta deficiente. É de extrema importância transmitir o conhecimento sobre câncer bucal para os escolares, visto que a população em geral chega à vida adulta sem informações prévias dessa doença. Antes de planejar ações de educação e prevenção é necessário conhecer a população em que se quer intervir. Um bom instrumento para medir esse conhecimento é o questionário. Atualmente, a Teoria da Resposta ao Item (TRI) está sendo aplicada na criação de uma medida para avaliar conhecimento, uma vez que trabalha com um conjunto de modelos matemáticos que analisam a probabilidade de um indivíduo dar uma certa resposta a um item como função dos parâmetros dele e da habilidade do respondente. Este estudo objetiva elaborar, padronizar e aplicar um questionário, validado pela TRI, para avaliação de conhecimento sobre câncer de boca, fatores de risco e prevenção em escolares da 3ª série do ensino médio da rede pública de Araçatuba/SP. O questionário, contendo itens de múltipla escolha com apenas uma alternativa correta, foi elaborado a partir de itens existentes na literatura e sugestões de especialistas. Para análise do questionário através da TRI utilizou-se o modelo logístico unidimensional de 3 (três) parâmetros. Realizaram-se duas aplicações do questionário em escolares de todas as escolas públicas de Araçatuba, SP, sendo a primeira aplicação para o projeto piloto e a segunda para a pesquisa final. As estimativas dos parâmetros dos itens e as probabilidades de acerto em diferentes níveis de conhecimento foram obtidas através do software Bilog-MG versão 3.11 e a avaliação do conhecimento dos alunos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Oral cancer is one of the ten most common worldwide cancers and is considered a multifactorial disease. It is directly associated with risk factors such as smoking, alcohol consumption, sun exposure and poor diet. It's extremely important to transmit knowledge about oral cancer to students, once the general population reaches adulthood without prior information of this disease. Before planning measures of prevention and education, it is necessary to know the population that wants to intervene. A good way to measure this knowledge is the questionnaire. Currently, Item Response Theory (IRT) is being applied in the development of a measure to assess knowledge, since it works with a set of mathematical models that analyze the probability of an individual giving a certain response to an item as a function of the parameters and ability of the respondent. This study aims to elaborate, standardize and apply a questionnaire, validated by TRI to assess knowledge about oral cancer, risk factors and prevention in senior year students from public school in Araçatuba / SP. The questionnaire containing multiple-choice items with only one correct alternative was elaborated from existing items in the literature and suggestions from experts. The unidimensional logistic model of three parameters was used for the questionnaire analysis. There were two applications of the questionnaire in all public school students of Araçatuba, SP, being the first application for the pilot project and the second for the final survey. The estimatives of parameters of the items and probability of sucess at different levels of knowledge were obtained through the software Bilog-MG and evaluation of students' knowledge processed by Epi Info 2000, version 3.5.1. The questionnaire was applied on 1012 present sudents in the classrooms on the day of the application... (Complete abstract click electronic access below) / Mestre

Lorsqu'une ischémie a lieu dans un territoire tissulaire des membres inférieurs, elle peut être à l'origine de douleurs survenant à la marche, limitant ainsi la capacité de marche des patients. Cette évaluation de la capacité de marche est difficile en raison de la difficulté qu'ont les patients à évaluer leurs limitations à la marche. Différents outils de mesure ont été développés comme des questionnaires, des tests de laboratoire notamment sur tapis et des tests ambulatoires comme le GPS. Les travaux menés ont permis de montrer les limites d'un questionnaire préalablement validé ( Walking Impairment Questionnaire) et de développer un nouveau questionnaire d'évaluation de la capacité de marche plus court et tout aussi fiable. De plus, le concept de variabilité de la capacité de marche à court terme a été mis en évidence par GPS. Cette variabilité à court terme pourrait être l'une des explications à cette difficulté d'évaluation de la capacité de marche. Les durées optimales du test sur tapis à charge constante ont aussi été précisées. Enfin, différentes localisations ischémiques ont été présentées au niveau des membres inférieurs et nous avons montré que certains patients avec une limitation de la capacité de marche ont une hypoxémie d'effort à la marche. Celle-ci pourrait être la cause de leur limitation de leur capacité de marche. Ces travaux permettront de mieux évaluer la capacité de marche de l'artériopathe à la fois pour le diagnostic mais aussi pour la prise en charge thérapeutique.

Thesis (Ph.D.)--James Madison University, 2009. / Includes bibliographical references.

Thesis--University of Oklahoma. / Includes bibliographical references (leaves 76-82).

Thesis (M.S.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 56 pages. Includes bibliographical references.

Syfte: Att testa den patientenkät som används i utvärdering av en leversjuksköterskemottagning på patienter med dekompenserad levercirros för att undersöka upplevelsen av att besvara frågorna samt frågornas relevans till patientens situation. Metod: Pilotstudiens metod var mixad. Resultat: Spridningen av deltagarnas upplevelse av oro/obehag av enkäten var stor (VAS 6-100 millimeter). Vid få sjukdomssymtom väcktes oro om framtida sjukdomsutveckling men vid längre tids sjukdom kändes samtliga symtom igen, tankar om tidigare beteende uppstod vid alkoholsorsakad sjukdom. En mindre spridning (VAS 66-92 millimeter) sågs gällande hur viktiga/väsentliga frågorna upplevdes. Frågor om bemötande ansågs viktiga och påverkade upplevelsen av rätten till vård. Kompletterande frågor om individuellt anpassad information samt upplevelsen av delaktighet vid information efterfrågades. Deltagarna visade hög uppskattning (VAS 73-95 millimeter) till att sjukdomen/situation uppmärksammades genom enkäten. Besöken till sjuksköterskan skiljde sig från läkarbesök. Sjuksköterskan fokuserade på egenvård och mer tid fanns för information. För en informant innebar försöksverksamheten ökade antal sjukhusbesök, samordning innebar för- och nackdelar. Vid symtom på fatigue och nedsatt koncentrationsförmåga upplevdes enkäten lång, tvådelad enkät efterfrågades. Vid lindrig sjukdom upplevdes enkäten inte ansträngande. Språket var enkelt att förstå och innehållet upplevdes relevant. De öppna frågeställningarna tillförde inte något för de tre informanterna. / Purpose: To test the patient questionnaire used in the evaluation of an intervention with nurse-led clinic for patients with decompensated liver cirrhosis to examine the experience of answering the questions as well as their relevance to the patient's situation. Method: The pilot study was conducted with a mixed method. Results: The variation of the participants' experience of anxiety/discomfort of the questionnaire was large (VAS 6-100 millimeters). Individuals with few disease symptoms had concerns about future development of the disease, in the case of long disease experience all the symptoms was familiar. Following alcohol induced disease thoughts of past behavior occurred. A smaller variation (VAS 66-92 millimeters) was seen regarding the experience of how important/essential the questions felt. Questions about treatment were considered important and affected the perception of care. Questions about individualized information was requested as well as the experience of participation in the exchange of information. The participants showed a high appreciation (VAS 73-95 millimeters) that the disease/situation was highlighted by the survey. The visits to the nurse differed from appointments to physicians. The nurse focused on self-care and more time was available for information. For one informant the intervention increased the total number of hospital visits, coordination meant advantages and disadvantages. Symptoms of fatigue and impaired concentration made the questionnaire experienced as too long, a two-parted questionnaire was requested, the size was not strain in mild disease. The language was easy to understand and the content perceived relevant. The open issues brought nothing for the three informants.

This thesis describes a methodology presented in a pattern language for design of questionnaire / survey information systems. It is intended to be used by professional programmers with negligible experience in the domain of questionnaire / survey software. A system of individual and discrete design patterns of various types is interconnected by varying relations enabling the user to navigate effortlessly and to implement a customizable level of expertise contained within the language. The design patterns contain expert knowledge about construction and contents of a universal high-end questionnaire / survey information system. Data structures, graphical user interface and psychological ramifications of questions’ formulations are discussed in detail. The descriptions of two different prototypes of information systems are supplied. They were created using the expertise of the pattern language and serve as a proof of eligibility for it. The innovation in the thesis is driven by the absence of pattern language for questionnaire design, usage of various types of design patterns / relations in the created language and the very design of universal metadata-based questionnaire information system described in the created language.

The purpose of this research study was to improve the nursing care of intravenous catheters by providing evidence on the effects of prolonged duration of intravenous administration set use. Intravenous therapy is a vital part of modern health care. However, its invasive nature can result in infection, with high associated morbidity and mortality. The highest infection rates are displayed in intensive care patients with central venous catheters. The duration of intravenous administration set use may have an impact on infection rates,however the current practice usage and the optimum duration of use is unknown. Previous studies of central venous catheters have reported equal infection rates with 1 to 4 days of administration set use; however few patients have been evaluated with administration sets used beyond this time. Previous research has been limited by the inadequacy of available definitions for Catheter-Related Infection. A prospective, randomised, controlled clinical trial was performed to assess the infection risk of using administration sets for prolonged periods. In the developmental phase prior to the clinical trial; definitions of Catheter-Related Bloodstream Infection (CRBSI) were developed; a nursing practice survey was undertaken to establish the current duration of administration set use; and laboratory experiments were executed to assess the impact of prolonged use on administration set physical integrity and performance. Central venous catheters were randomised to have their administration sets used for 4 days (n = 203) or 7 days (n = 201). Percutaneous central venous catheters were enrolled into the study from two adult intensive care units at a metropolitan, tertiary-referral, teaching hospital. Catheters were multiple-lumen, chlorhexidine-gluconate and silver-sulphadiazine coated lines, both inserted and removed in the intensive care unit. Catheters were cultured for microbial colonisation on removal using the Maki roll-plate technique. Patients were assessed for CRBSI using the developed definitions consisting of categories: definite, probable (type I and II), possible and absent. Prior to the clinical trial, a practice survey questionnaire was administered, and laboratory experimentation was performed. Normality of distribution for continuous variables was assessed using the Kolmogorov- Smirnov statistic. The distribution between groups of variables considered risk factors for Catheter-Related Infection were tested to assess for bias using Chi-square and T-test. Logistic regression modelling was performed to analyse the influence of potentially confounding variables. The incidence of catheter colonisation and CRBSI was tested between groups using Kaplan-Meier survival curve with Log-rank test. Paired T-tests were performed to test for difference in programmed and delivered volumes of administration sets. A general linear model (ANOVA)± a Scheffe post hoc test to isolate difference was fitted to the standardised values of delivered volumes to determine the effects of day of measurement and volume delivery rate on the accuracy of volume delivery. There were 10 colonised tips in the intervention group and 19 in the control group. This difference was not statistically significant (Kaplan Meier survival analysis, Log Rank = 0.87, df = 1, p = 0.35). There were 3 cases of CRBSI per group and the difference in survival from CRBSI was not statistically significant (Kaplan Meier with Log Rank test, p = 0.86). The pre-clinical trial phases of the research programme established that current clinical practice was 3 to 7-day use of administration sets; that administration sets were physically intact and delivered clinically accurate volumes after 7 days of use; and developed useful definitions of CRBSI. Prolonged intravenous administration set use of 7 days was found to have no significant impact on patient infection indicators or physical performance of the sets. This finding is congruent with previous research and trends in current clinical practice. In conclusion, the research findings support the use of intravenous administration sets for 7 days.