Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 6 uppsatser.

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (M.H.A.)--University of Michigan, 1959.

Thesis (Ph. D.)--Duquesne University, 2004. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 138-143).

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (M.H.A.)--University of Michigan, 1959.

Thesis (M. Med. Sc.)--University of Hong Kong, 2005.

OBJECTIVES: Inflammatory bowel disease (IBD) is a chronic condition with increasing pediatric incidence. Transition from pediatric to adult care is associated both with disruption of links with familiar caregivers and differences in health care delivery. This study explored the impact of the transfer from pediatric to adult care on health services utilization for pediatric-onset IBD patients. APPROACH: A population-based retrospective cohort study identified all children diagnosed with IBD 1994-2008 and treated by pediatric gastroenterologists from within Ontario health administrative data. Self-controlled case series analyses compared health services utilization in the 2 years before and after transfer to adult gastroenterologists, with a 6-month washout period at transfer. Outcome evaluated included IBD related/specific hospitalization, emergency department (ED) utilization, outpatient visits, and laboratory utilization. Relative incidence (RI) in the post-transfer was compared to pre-transfer periods using Poisson regression analysis controlling for transfer starting age. Analyses were stratified by IBD types: Crohn’s disease (CD) and ulcerative colitis (UC). RESULTS: 536 patients were included in the study (388 CD, 148 UC). ED utilization rate was higher after transfer for both CD (RI 2.12, 95% CI 1.53-2.93) and UC (RI 2.34, 95% CI 1.09-5.03). Other increases in health care provision included outpatients visits (CD: RI 1.56, 95% CI 1.42-1.72; UC: RI 1.48, 95% CI 1.24-1.76), and laboratory investigations (CD: RI 1.43, 95% CI 1.26-1.63; UC: 1.38, 95% CI 1.13-1.68). There was no statistically significant change in hospitalization (CD: RI 0.70, 95% CI 0.42-1.18; UC: RI 2.41, 95% CI 0.62-9.40). Sensitivity analysis revealed similar results when only the first year post-transfer period was assessed. CONCLUSIONS: In the largest study to date examining the transfer from pediatric to adult IBD care, health services utilization increased significantly in the two years after transfer for measures of access to health care providers. Understanding causation and rigorously evaluated transition programs may help to better manage the resources and meet the needs of pediatric-onset IBD patients.

Sometimes referred to as “the stethoscope of the future,” ultrasound has many advantages over other imaging techniques which make it ideal for use in primary care. With a unique combination of portability, dynamic imaging, affordability, and real-time interpretation point of care ultrasound (POCUS) is ideal for use in many practice settings. The use of POCUS as the primary imaging modality for many diseases can drastically shorten the time to definitive treatment, and as such is the preferred modality for some presentations. The purpose of this project was to investigate means to improve resident physician knowledge of POCUS and to evaluate if increased knowledge would lead to increased utilization in our outpatient clinic. We started with a pre-test survey covering basic POCUS knowledge as well as a question concerning current utilization of ultrasound imaging in the clinic. We followed that with an educational lecture about the basics of POCUS and some hands-on practice. Afterward a posttest survey was conducted. We found that there was a significant increase in both basic knowledge and the number of residents who intended to use POCUS in the clinic compared to the pre-test. These findings confirm that education on point of care ultrasound can increase both knowledge and utilization in the outpatient clinic. Further education and research could be done to see if there is an actual increase in utilization with continued education.

Abstract Not Provided. / Thesis / Bachelor of Arts (BA)