Background and Objectives Oral anticoagulants (OACs) are among Canada's most frequently prescribed drugs and a top cause of medication-related serious harm leading to emergency department visits, hospitalizations, and fatalities. During the preparation to launch a Canadian Institutes of Health Research (CIHR)-funded randomized controlled trial (RCT) called "Improving Anticoagulant Safety at Hospital Discharge: A Randomized Trial," we faced some issues. First, as the RCT addresses OAC management, we needed to determine the barriers and facilitators for optimal OAC management, which were not identified in our literature search. Second, there is no core outcome set (COS) specific for OACs and the choice of outcomes and their measurement for the trial was not obvious. Finally, the drug-drug interactions between the OACs and other medications are not fully understood, particularly with regards to important clinical outcomes. Identifying the interacting medications and their interaction effect size, is vital to guarantee the safety of patients. To address these issues, the objectives of this thesis were: (1) to determine the barriers and facilitators for optimal OAC management, (2) to define the potential list for the COS of OACs, and (3) to explore the drug-drug interaction of OACs. Methods Several research approaches, including a systematic review, a systematic survey, a scoping review, a population-based retrospective cohort study with time varying methods, and a qualitative study were applied in this thesis. First, we applied both a synthesis review and qualitative research to explore the barriers and facilitators for OACs management to guarantee the evidence's robustness. Next, we used a systematic survey to address the lack of consensus on outcomes used and their v definitions for OAC treatment clinical trials. Finally, we used a systematic review and planned a population-based study to address drug-drug interaction related to OACs. Methodologic challenges and innovation In the scoping review (Chapter 2: Barriers and facilitators to optimal oral anticoagulant management: a scoping review) and the focus group study (Chapter 3: Perceptions on patient education to improve oral anticoagulant management) we employed a qualitative approach. The main methodological challenge for both the scoping review and the focus group focused on the rigorous way to synthesize the themes. In Chapter 4, we used a systematic survey to explore the outcome list for OAC management research. The primary methodological challenge referred to the outcome reporting in the included studies. Not all outcomes performed in the trials can be reported for the space limitation or potential publication bias. In Chapters 5 and 6, a systematic review with meta-analysis and an observational protocol were used to explore the drug-drug interaction for OACs. The main methodological challenge for Chapter 5 was how to evaluate the drug-drug interaction (DDI) evidence systematically. The main methodological challenge for Chapter 6 is to address confounding and bias in a population-based protocol on DOACs drug-drug interaction. Conclusion In summary, this standard thesis describes five different background projects to prepare for an OAC management RCT. The papers contribute to the literature by using several research methodologies to provide useful evidence for OAC management and OAC research. / Thesis / Candidate in Philosophy / Oral anticoagulants (OACs) (blood thinners) are among Canada's most frequently prescribed drugs and a top cause of severe medication-related harm. The objectives of this thesis include (1) to determine the barriers and facilitators for optimal OAC management, (2) to define a potential list for the core outcome set of OACs, and (3) to explore the drug-drug interaction of OACs. First, we applied a scoping review and a qualitative study to explore the barriers and facilitators for OACs management. Then we conducted a systematic survey to address the lack of consensus on outcomes and their definitions for OAC treatment clinical trials. Finally, we used a systematic review and planned a population-based study to address drug-drug interaction related to OACs. Different research approaches, including a systematic review, a systematic survey, a scoping review, a population-based study, and a qualitative study, were involved in this thesis.

No description available.

No / Intermittent pneumatic compression (IPC) is a mechanical method of delivering compression to swollen limbs that can be used to treat venous leg ulcers and limb swelling due to lymphoedema. This review analyses the evidence for the effectiveness of IPC as a treatment for venous leg ulcers. OBJECTIVES: To determine whether IPC increases the healing of venous leg ulcers. To determine the effects of IPC on health related quality of life of venous leg ulcer patients. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (December 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 4, 2007; Ovid MEDLINE - 2006 to November Week 2 2007; Ovid EMBASE - 2006 to 2007 Week 49 and Ovid CINAHL - 2006 to December Week 1 2007. SELECTION CRITERIA: Randomised controlled studies either comparing IPC with control (sham IPC or no IPC) or comparisons between IPC treatment regimens, in venous ulcer management were included. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality were undertaken by one author and checked by a second. MAIN RESULTS: Seven randomised controlled trials (including 367 people in total) were identified. Only one trial reported both allocation concealment and blinded outcome assessment. In one trial (80 people) more ulcers healed with IPC than with dressings (62% vs 28%; p=0.002). Four trials compared IPC with compression against compression alone. The first of these trials (45 people) found increased ulcer healing with IPC plus compression than with compression alone (relative risk for healing 11.4, 95% Confidence Interval 1.6 to 82). The remaining three trials (122 people) found no evidence of a benefit for IPC plus compression compared with compression alone. One small trial (16 people) found no difference between IPC (without additional compression) and compression bandages alone. One trial compared different ways of delivering IPC (104 people) and found that rapid IPC healed more ulcers than slow IPC (86% vs 61%; log rank p=0.003). AUTHORS' CONCLUSIONS: IPC may increase healing compared with no compression, but it is not clear whether it increases healing when added to treatment with bandages, or if it can be used instead of compression bandages. Rapid IPC was better than slow IPC in one trial. Further trials are required to determine whether IPC increases the healing of venous leg ulcers when used in modern practice where compression therapy is widely used.

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 1998. / Typescript. Bibliography: leaves 118-128.

The complexities of how people learn have plagued researchers for centuries. A range of experimental and non-experimental methodologies have been used to isolate and implement positive interventions for students' cognitive, meta-cognitive, behavioral, and socio-emotional successes in learning. But the face of learning is changing in the digital age. The value of accrued knowledge, popular throughout the industrial age, is being overpowered by the value of curiosity and the ability to ask critical questions. Most students can access the largest free collection of human knowledge (and cat videos) with ease using their phones or laptops and omnipresent cellular and Wi-Fi networks. Viewing this new-age capacity for connection as an opportunity, educational stakeholders have delegated many traditional learning tasks to online environments. With this influx of online learning, student errors can be corrected with immediacy, student data is more prevalent and actionable, and teachers can intervene with efficiency and efficacy. As such, endeavors in educational data mining, learning analytics, and authentic educational research at scale have grown popular in recent years; fields afforded by the luxuries of technology and driven by the age-old goal of understanding how people learn. This dissertation explores the evolution and application of ASSISTments Research, an approach to authentic educational research at scale that leverages ASSISTments, a popular online learning platform, to better understand how people learn. Part I details the evolution and advocacy of two tools that form the research arm of ASSISTments: the ASSISTments TestBed and the Assessment of Learning Infrastructure (ALI). An NSF funded Data Infrastructure Building Blocks grant (#1724889, $494,644 2017-2020), outlines goals for the new age of ASSISTments Research as a result of lessons learned in recent years. Part II details a personal application of these research tools with a focus on the framework of Self Determination Theory. The primary facets of this theory, thought to positively affect learning and intrinsic motivation, are investigated in depth through randomized controlled trials targeting Autonomy, Belonging, and Competence. Finally, a synthesis chapter highlights important connections between Parts I & II, offering lessons learned regarding ASSISTments Research and suggesting additional guidance for its future development, while broadly defining contributions to the Learning Sciences community.

Introdução: O zumbido é um sintoma que acomete cerca de 10% da população e pode prejudicar bastante a qualidade de vida, sendo considerado um importante problema de saúde pública mundial. Os modelos fisiopatológicos atuais do zumbido consideram que a compensação da perda auditiva poderia prevenir ou reverter mudanças no córtex auditivo central acerca do zumbido. Próteses auditivas com gerador de som integrado têm sido utilizadas como alternativa para potencializar o tratamento do zumbido nos pacientes com perda auditiva associada. Contudo, não existe evidência científica suficiente para suportar a superioridade do uso combinado de ferramentas em relação à amplificação convencional. Objetivo: verificar se o uso combinado de amplificação e gerador de som é mais eficaz do que somente amplificação na redução do incômodo com o zumbido em pacientes com zumbido e perda auditiva neurossensorial bilateral simétrica de grau leve a moderado. Métodos: 49 pacientes com zumbido e perda auditiva participaram de um ensaio clínico cego randomizado. Um grupo foi adaptado bilateralmente com uso combinado de amplificação e gerador de som e o outro grupo foi adaptado somente com amplificação. O incômodo com o zumbido foi medido pelo THI e escala numérica. As medidas psicoacústicas do zumbido também foram realizadas. As avaliações inicial e final foram realizadas por um avaliador cego. Resultados: Após três meses, no grupo da adaptação combinada, 62,5% dos pacientes apresentaram redução do incômodo com o zumbido e no grupo da adaptação simples, 78%, sem diferença estatisticamente significante entre os grupos. Para o THI, escala numérica e intensidade sonora de zumbido, detectou-se efeito do nível mínimo de mascaramento, em que maiores valores de nível mínimo de mascaramento estão associados a maior incômodo e maior intensidade do zumbido. Conclusão: O uso combinado de amplificação e gerador de som e o uso de amplificação convencional foram igualmente eficazes na redução do incômodo com o zumbido / Introduction: Tinnitus is a symptom that affects about 10% of the population and can greatly impair the quality of life. In fact, it is considered as an important public health problem worldwide. The current pathophysiological models of tinnitus consider that the compensation of hearing loss could prevent or reverse changes in the auditory cortex. Hearing aids with an integrated sound generator have been used as an alternative to enhance the treatment of tinnitus in patients with hearing loss. However, there is no sufficient scientific evidence to support the superiority of the combined use of sound generator and amplification compared to conventional amplification alone. Objective: to verify whether the combined use of amplification and sound generator is more effective than amplification alone in reducing bothersome tinnitus in patients with mild to moderate bilaterally symmetrical sensorineural hearing loss. Methods: 49 patients with tinnitus and hearing loss underwent a blind randomized clinical trial. One group was bilaterally fitted with the combined use of amplification and sound generator, and the other group was fitted with amplification alone. The tinnitus annoyance was measured by THI and numerical scale. Psychoacoustic measurements of tinnitus were also performed. The initial and final assessments were performed by a blinded evaluator. Results: After 3 months, 62.5% of patients showed a reduction in tinnitus annoyance in the group of the combined use of amplification and sound generator, and 78% in the group with amplification alone, with no significant difference between the groups. For THI, numeric scale and tinnitus loudness, it was detected an effect of the MML, where higher values of MML are associated with greater discomfort due to tinnitus. Conclusion: The combined use of amplification and sound generator and the use of conventional amplification alone were equally effective in reducing tinnitus annoyance

Training studies involving competitive runners and road cyclists have shown substantial gains in sprint and endurance performance when sessions of high-intensity interval training were added to their usual training in the competitive phase of a season. Further research has shown large performance benefits in sprint and endurance power (7 - 9%) when cyclists combined explosive single-leg jumps with cycling-specific high-intensity interval training during a competitive season. The aim of the present study was to assess the contribution of the jumps to the gains in performance in competitive cyclists in a randomized control trial.The training protocol for the control group was based on previous experimental work in which the control group (n=8) completed cycle specific interval training followed by a series of explosive single-leg jumps. The experimental group (n=7) carried out the same cycle specific interval training but did not participate in the explosive single-leg jumps. While the current study did not use a true control group, the investigation was carried out in the knowledge that a combination of high intensity interval cycling and explosive single-leg jumps causes changes positive changes in performance. Participants took part in 10 x 30-min sessions consisting four sets of high intensity intermittent cycling (4 x 30-s maximum efforts at 50 - 60 min-1 alternating with 30-s recovery). Between each set of 4 x 30 s sprints the control (ballistic) group carried out one set of explosive single-leg jumps (20 for each leg), while the experimental (continuous) group cycled for 20 s at 50 - 60 min-1.Before and after the training period all cyclists completed an incremental peak power test for assessment of VO2max, lactate threshold, exercise economy and peak power, a 30 s Wingate sprint test and a 20 km time-trial. Relative to the control group the percent mean changes (±90% confidence limits) in the experimental group were: power at 4-mM lactate, -4.2 (±6.3); VO2max, -3.1 (±3.7); mean time-trial power, -0.7 (± 4.7); peak incremental power, -1.7; (±5.0); power at 80% max heart rate, -2.8; (±5.6); Wingate peak power, -4.2; (±7.8). We conclude that high-intensity training may improve performance but the combination of high-intensity training and explosive resistance training in the competitive phase is likely to produce greater gains in trained cyclists than high intensity cycling alone.

Bakgrund och syfte: Intresset för enteral administrering av probiotika i förebyggandet av infektioner och diarré har på senare tid ökat. Nosokomiala infektioner och diarré är ett stort problem hos intensivvårdpatienter.  Syftet med denna studie var att undersöka hur enteral probiotika påverkar sjukdomsförloppet hos intensivvårdspatienter, med avseende på mortalitet, infektioner totalt, ventilatorassocierad pneumoni (VAP) och diarré. Metod: En systematisk litteraturstudie med sökning i Pubmed och Cinahl genomfördes med följande Meshtermer; probiotics, lactobacillus, critical illness och intensive care unit. Därefter genomfördes en metaanalys av randomiserade kontrollerade studier, utförda på vuxna intensivvårdspatienter, där man jämfört patienter som erhållit probiotika med patienter som fått placebo eller annan behandling. Resultat: Totalt 15 studier med sammanlagt 1293 patienter inkluderades. Ingen signifikans med avseenden på mortalitet, infektioner totalt, VAP och diarré kunde utläsas i metaanalysen. En trend mot en minskning av infektioner totalt (p=0,075) och VAP (p=0,090) i probiotikagruppen var dock tydlig. Konklusion: Probiotika kan komma att ha en betydande roll inom intensivvården i framtiden, då det förefaller ha en positiv effekt på infektionsfrekvensen. I dagsläget finns emellertid ej tillräckligt vetenskapligt stöd för användning av probiotika i behandlingen intensivvårdspatienter. Det behövs större och väl genomförda randomiserade multicenterstudier. / Background and aim: The interest in enteral administration of probiotics to prevent infections and diarrhea has recently arisen. Nosocomial infections and diarrhea are common problems among intensive care unit patients. The aim of this study was to investigate how enteral probiotics influence the course of intensive care unit patients with focus on mortality, total infections, ventilator associated pneumonia (VAP) and diarrhea. Method: A systematic literature review was undertaken. Pubmed and Cinahl were searched using the following Meshterms; probiotics, lactobacillus, critical illness and intensive care unit. Thereafter a meta-analysis was conducted combining the results of the randomized controlled trials that compared a group of adult intensive care unit patients taking probiotics with a group that did not. Result: A total of 15 studies with a total of 1293 patients were included. For mortality, total infections, VAP and diarrhea no significance was detected in the meta-analysis. However a trend towards a decrease in over all infections (p=0.075) and VAP (p=0,090) in the probiotic group was seen. Conclusion: In the future the probiotics may play an important role in the field of intensive care, as it seems to confer a positive effect on infection rates. However, there is currently a lack of conclusive evidence to support the use of probiotics in the treatment of intensive care unit patients. Larger well designed randomized multicentre studies are required

Source: Masters Abstracts International, Volume: 47-06, page: 3551. Advisers: Florence J. Dallo; Raul Caetano. Includes bibliographical references.

Training studies involving competitive runners and road cyclists have shown substantial gains in sprint and endurance performance when sessions of high-intensity interval training were added to their usual training in the competitive phase of a season. Further research has shown large performance benefits in sprint and endurance power (7 - 9%) when cyclists combined explosive single-leg jumps with cycling-specific high-intensity interval training during a competitive season. The aim of the present study was to assess the contribution of the jumps to the gains in performance in competitive cyclists in a randomized control trial.The training protocol for the control group was based on previous experimental work in which the control group (n=8) completed cycle specific interval training followed by a series of explosive single-leg jumps. The experimental group (n=7) carried out the same cycle specific interval training but did not participate in the explosive single-leg jumps. While the current study did not use a true control group, the investigation was carried out in the knowledge that a combination of high intensity interval cycling and explosive single-leg jumps causes changes positive changes in performance. Participants took part in 10 x 30-min sessions consisting four sets of high intensity intermittent cycling (4 x 30-s maximum efforts at 50 - 60 min-1 alternating with 30-s recovery). Between each set of 4 x 30 s sprints the control (ballistic) group carried out one set of explosive single-leg jumps (20 for each leg), while the experimental (continuous) group cycled for 20 s at 50 - 60 min-1.Before and after the training period all cyclists completed an incremental peak power test for assessment of VO2max, lactate threshold, exercise economy and peak power, a 30 s Wingate sprint test and a 20 km time-trial. Relative to the control group the percent mean changes (±90% confidence limits) in the experimental group were: power at 4-mM lactate, -4.2 (±6.3); VO2max, -3.1 (±3.7); mean time-trial power, -0.7 (± 4.7); peak incremental power, -1.7; (±5.0); power at 80% max heart rate, -2.8; (±5.6); Wingate peak power, -4.2; (±7.8). We conclude that high-intensity training may improve performance but the combination of high-intensity training and explosive resistance training in the competitive phase is likely to produce greater gains in trained cyclists than high intensity cycling alone.