This thesis evaluates surgical correction in patients with paralytic scoliosis with emphasis on function and activity. The thesis includes four studies of 100 consecutive patients preoperatively evaluated and surgically corrected between 1992 and 1996 at Linköping University Hospital. Eighteen different diagnoses were represented. The postoperative follow-ups were at one year and in average seven years. Six patients dropped out during the first year and twelve during the long-term follow-up period. The assessments included general information, lung function, and measurements of radiographs, function and activity - seating posture, ADL, pain, care and need for rest. The patients or relatives view on the effects of surgery were evaluated in follow-up questionnaires. The preoperative results of the 100 patients described a heterogeneous group in terms of function and activity. Even when the patients were grouped into subgroups according to the Scoliosis Research Society classification, they remained heterogeneous. In patients who could understand verbal instructions assessments that needed co-operation could be used and in those who could not understand verbal instructions, assessments relied more heavily on measures of function and level of dependence. Preoperative results of weight distribution on the seating surface were explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity R2=0.45 (n=45). The one-year follow-up of 94 patients showed improvements in angle of scoliosis, sitting balance, weight distribution to the seating surface, seating supports in the wheelchair, time needed for rest. The results in subgroups were almost the same as in the whole group. The subjective results for patients or relatives in the follow-up questionnaire showed a positive outcome of surgery. In the comparison between the one-year follow-up and the long-term follow-up there were further improvements in sitting balance, ADL, and care given, but the angle of scoliosis was increased. These results were in line with patients’ and relatives’ assessments in the follow-up questionnaire and in the open-ended questions. Due to the heterogeneity of patients with paralytic scoliosis, irrespective of disorder, it is important to focus on different subgroups with regards to the patients’ total situation. The surgically corrected and stabilised spine resulted in the strength to keep the body upright with improvements in function, activity and possibilities to belong in social activities. Further improvements were shown between the one-year follow-up and the long-term follow-up. It is recommended that patients who have been surgically corrected for paralytic scoliosis are followed for more than one year.

Tyrimo tikslas - ištirti intensyvios terapijos ligonių slaugymo įtaką jų gydymo baigčiai ligoninėje. Tyrimo uždaviniai. Įvertinti intensyvios terapijos skyriaus ligonių gydymo rezultatus (mirštamumą, gydymo ligoninėje laiką, pakartotinių guldymų į intensyvios terapijos skyrių, kitų komplikacijų dažnumą). Nustatyti, kokią įtaką turi intensyvios terapijos ligonių slaugos intensyvumas jų gydymo baigčiai ligoninėje. Palyginti intensyvios terapijos skyriaus ligonių gydymo baigtį ligoninėje, priklausomai nuo jų slaugos intensyvumo intensyvios terapijos skyriuje. Tyrimo objektas. Ligonių slauga intensyvios terapijos skyriuje. Tyrimo metodai. Buvo atliktas retrospektyvinis tyrimas, pasirinkta dokumentų turinio statistinė duomenų analizė, į tyrimą buvo įtraukti 261 tiriamųjų ligonių, kurie nuo 2008-07-01 iki 2008-11-01 gydėsi 15 lovų I Reanimacijos - intensyvios terapijos skyriuje VUL Santariškių klinikose, ir kurie, perkėlus iš I RITS, tęsė gydymą Santariškių klinikose bendrosiose palatose. Ligoniai, gydyti I RITS trumpiau kaip 8 valandas, t. y. tie, kurių būklė aktyviai stebėta trumpą laiką arba kurie dėl ypač sunkios būklės greitai mirė, taip pat ligoniai kurie buvo iš I RITS iškelti į kitus stacionarus, į tyrimą nebuvo įtraukti. Slaugos procesas RITS buvo apskaičiuotas individualiai vienam pacientui, taikant validizuotą, iš anglų kalbos išverstą, Terapinių Intervencijų Apskaičiavimo Skalę – 28 (Therapeutic Inervention Scoring Sistem -28 (TISS-28)). Tyrimo duomenys buvo apdoroti ir... [toliau žr. visą tekstą] / Research objective – to analyze the influence of intensive care patients nursing on their hospital outcomes. Research tasks: To evaluate the results of treatment of intensive care unit patients (mortality, duration of stay in a hospital, frequency of repeated admissions to department of intensive care and other complications). To determine the influence of intensity of care delivered to intensive care patients to their hospital outcome. To compare hospital outcomes of intensive care unit patients according to intensity of care delivered to them in department of intensive care. Object of research: Nursing of patients in unit of intensive care. Method of research: There was a retrospective research accomplished and statistic analysis of document content chosen. The research included 261 surveyed patients who were treated in fifteen-bed Ist Department of Reanimation and Intensive Therapy of Vilnius University Hospital Santariškių klinikos and who continued treatment in general-purpose wards of Santariškių klinikos after transferring from Ist ICU. Patients who stayed in Ist ICU for less than 8 hours, i.e. those whose state was actively observed for a short period or those who died because of their particularly critical state and those who were transferred from Ist ICU to other hospitals, were excluded from the research. Nursing process in ICU was evaluated for each patient individually using Therapeutic Intervention Scoring System -28 (TISS-28). Main results of research:... [to full text]

The sexual abuse of children is an issue that society must address with urgency and commitment, given the profoundly damaging effects and widespread occurrence of this kind of crime. Providing psychological treatment to identified offenders is an important endeavour of the criminal justice system, with the aim of reducing recidivism and thereby preventing future victims. This dissertation explores a number of areas relevant to the treatment of sexual offenders on a sample of 223 adult males who completed a prison-based programme for child sexual offenders in New Zealand. Specifically, the assessment of treatment outcome and its relationship with recidivism, risk assessment, and the influence of specific offender factors on estimates of treatment outcome and risk were investigated. Study 1 (N = 218) is an independent validation of the validity of the Violence Risk Scale: Sexual Offender Version (VRS:SO; Olver, Wong, Nicholaichuk, & Gordon, 2007), a recently developed risk assessment instrument for sexual offenders that incorporates both static and dynamic risk factors and contains protocols for the assessment of change as a result of treatment. Results indicate support for the inter-rater reliability, concurrent validity, and predictive validity of the VRS:SO with regard to sexual recidivism, with pre-treatment and post-treatment scores showing superior predictive validity relative to a widely used measure of static risk (Static-99; Hanson & Thornton, 1999) and a measure of "Deviance" based on a 4-factor battery of relevant psychometric tests (Allan, Grace, Rutherford, & Hudson, 2007). In Study 2 (N = 218), three separate methods of assessing proximal treatment outcome (representative of three categories of treatment outcome measures that have previously been applied in the literature) are applied and compared in terms of their predictive validity with regard to sexual recidivism, and the relative advantages and disadvantages of their use. These measures are: change on a battery of relevant psychometric tests administered prior to and following treatment; change across treatment on the VRS:SO; and post-treatment ratings of the attainment of treatment goals as measured by a modified version of Hogue’s (1994) Standard Goal Attainment Scaling for Sexual Offenders (SGAS). Results indicate that positive treatment outcomes as measured by all of these methods are associated with reduced sexual recidivism. SGAS scores are identified as being relatively simple and efficient to obtain, however the VRS:SO and the psychometric battery are both able to provide useful pre-treatment clinical information regarding potential treatment targets for a particular offender. Study 3 (N = 223) and Study 4 (N = 216) are explorations of the influence of particular offender characteristics on response to treatment and risk of recidivism. Of particular interest was the personality construct of psychopathy (measured using the Psychopathy Checklist-Revised, PCL-R; Hare, 1991), and both studies are attempted replications and extensions of previously reported interaction effects involving this construct (Heilbrun, 1979; Seto & Barbaree, 1999). The results of Study 3 indicate that there is no interaction effect between PCL-R scores and treatment outcome (as measured by the SGAS) on sexual recidivism, in contrast to an influential study by Seto and Barbaree (1999). Study 4 reports an interaction effect between PCL-R scores and intelligence on recidivism, such that higher than average IQ scores appear to moderate the well-known association between psychopathy and risk. Overall, the findings reported in this dissertation suggest the importance of considering dynamic factors as well as static factors in sex offender risk assessments, and support the premise that dynamic factors are changeable, with change being associated with changes in recidivism. The potential for certain offender characteristics to influence treatment response and risk of recidivism is highlighted, and several areas for further exploration are identified.

The Diagnostic and Statistical Manual of Mental Disorders arranges co-occurring clusters of symptoms into distinct disorder categories, which theoretically have specific etiologies, pathologies, and treatments. However, researchers and clinicians alike have consistently found DSM diagnoses to have high rates of comorbidity, low diagnostic specificity, and no disorder has proven to be a discrete category. There is mounting evidence that dimensional taxonomies more accurately capture the underlying structure of mental illness and clinical presentations. The recently proposed hierarchical taxonomy of psychopathology presumes to address the issues of categorical nosologies using a data driven approach to create a dimensional model of psychopathology. However, heretofore there are no empirical examinations of HiTOP's ability to predict psychotherapy treatment outcomes. This study compared the predictive validity DSM, RDoC, and HiTOP criteria using natural language processing on free text narrative notes. Of the three GMM run, only the model using DSM criteria as predictors had adequate model fit. Additionally, none of the nosologies significantly predicted treatment course. Implications for the application of RDoC and HiTOP are discussed.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Oklahoma. / Bibliography: leaves 152-163.