• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 319
  • 244
  • 35
  • 21
  • 14
  • 13
  • 12
  • 8
  • 3
  • 2
  • 1
  • 1
  • 1
  • 1
  • 1
  • Tagged with
  • 817
  • 817
  • 211
  • 202
  • 175
  • 172
  • 141
  • 66
  • 62
  • 56
  • 49
  • 46
  • 46
  • 46
  • 43
  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
171

Cognitive behavioural therapies for social anxiety disorder (SAnD) review

McKenna, Ian January 2013 (has links)
Background: Social anxiety disorder (SAnD) is a highly prevalent condition, characterised by an intense fear of social or performance situations where individuals worry about being negatively evaluated by others. An up to date systematic review of the effectiveness of cognitive behavioural therapies for SAnD is required to guide practice. Objectives: To assess the efficacy and acceptability of cognitive behavioural therapy (CBT) compared with treatment as usual/waiting list (TAU/WL) for individuals with SAnD. Search methods: We searched the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, and international trial registers (ICTRP; ClinicalTrials.gov) in October 2011 and CINAHL in October 2012. We also searched reference lists of retrieved articles, and contacted trial authors for information on ongoing/completed trials. Selection criteria: Randomised and quasi-randomised controlled trials undertaken in out-patient settings, involving adults aged 18-75 years with a primary diagnosis of SAnD, assigned either to CBT or TAU/WL. Data collection and analysis Data on patients, interventions and outcomes were extracted by two review authors independently, and the Risk of bias in each study was assessed. The primary outcomes were social anxiety reduction (based on relative risk (RR) of clinical response and mean difference in symptom reduction), and treatment acceptability (based on RR of attrition). Results: Thirteen studies (715 participants) were included in the review, of which 11 studies (599 participants) contributed data to meta-analyses. Based on four studies, CBT was more effective than TAU/WL in achieving clinical response at post-treatment (RR 3.60, 95% CI 1.35 to 9.57), and on eleven studies (599 participants) it was more effective than TAU/WL in reducing symptoms of social anxiety. No significant difference was found between CBT and TAU/WL for attrition. No significant difference was demonstrated for social anxiety at follow-up and no studies examined follow-up data for clinical response or attrition. Authors' conclusions: The available evidence suggests that cognitive behavioural therapy might be effective in reducing anxiety symptoms for the short-term treatment of SAnD. However, the body of evidence comparing CBT with TAU/WL is small and heterogeneous.
172

A mixed methods investigation into aspects of medication wastage in Malta

West, Lorna Marie January 2015 (has links)
Reducing medication wastage is a paramount objective in promoting appropriate utilisation of finite resources and preventing negative consequences. The aim of this research was to investigate aspects of medication wastage in Malta by applying mixed methods research and, by doing so, contribute original knowledge to this area. A systematic review was conducted to appraise critically, synthesize and present the available evidence on the possible causative factors associated with medication wastage and the effectiveness of any interventions focusing on wastage reduction as an outcome measure. Findings indicated that only one published paper reported a definition of medication wastage. The main factors contributing to wastage were ‘change in medication’, ‘patient's death’, ‘resolution of patient's condition’ and ‘passed expiry date’. Very few studies reported medication wastage as an outcome measure. The Delphi technique was applied to define ‘medication wastage’ and its contributory factors in the context of the Maltese population. A definition for medication wastage was generated with 86% of panellists agreeing/totally agreeing and sixty-one possible factors leading to wastage were identified by the panellists. The perspectives of the Maltese population, healthcare professionals and students on medication wastage were investigated through cross-sectional surveys. Results of questionnaires indicate lack of patient education and knowledge with the free healthcare system and the overstocking of medication by patients due to previous or potential out of stock situations as contributors to medication wastage. The beliefs and behaviours regarding medication wastage of the Maltese public and healthcare professionals were explored during focus groups. The theoretical domains framework was adopted to design the focus group guide and to interpret systematically the findings. Five key themes emerged which were proposed as solutions to minimise medication wastage: system effects, practitioner effects, patients effects, political effects and awareness and educational effects Research results and findings from all four phases will facilitate the systematic development of strategies and policies, with emphasis on prioritisation, with the aim of minimising medication wastage at all levels.
173

Systematic review and meta-analysis of transgenic mouse models of Alzheimer's disease

Egan, Kieren January 2014 (has links)
The increasing prevalence of Alzheimer’s disease poses a considerable socioeconomic challenge in the years ahead. There are few clinical treatments available and none capable of halting or slowing the progressive nature of the condition. Despite decades of experimental research and testing over 300 interventions in transgenic mouse models of the condition, clinical success has remained elusive. Deepening our understanding of how such studies have been conducted is likely to provide insights which could inform future preclinical and clinical research. Therefore I performed a systematic review and meta-analysis on interventions tested in transgenic mouse models of Alzheimer’s disease. My systematic search was performed by electronically searching for publications reporting the efficacy of interventions tested in transgenic models of Alzheimer's disease. Across these publications I extracted data regarding study characteristics and reported study quality alongside outcome data for pathology (i.e. plaque burden, amyloid beta species, tau, cellular infiltrates and neurodegeneration) and neurobehaviour. From these data I calculated estimates of efficacy using random effects meta-analysis and subsequently investigated the potential impact of study quality and study characteristics on observed effect size. My search identified 427 publications, 357 interventions and 55 transgenic models representing 11, 688 animals and 1774 experiments. There were a number of principal concerns regarding the dataset: (i) the reported study quality of such studies was relatively low; less than 1 in 5 publications reported blinded assessment of outcome or random allocation to group and no studies reported a sample size calculation, (ii) the depth of data on any individual intervention was relatively poor-only 16 interventions had outcomes described in 5 or more publications and (iii) publication bias analyses suggested 1 in 5 pathological and 1 in 7 neurobehavioural experiments remain unpublished. Where I inspected relationships between outcomes, meta-regression identified a number of notable associations. Changes in amyloid beta 40 were reflective of changes in amyloid beta 42 (R2 = 0.84, p<0.01) and within the Morris water maze changes in the ‘training’ acquisition phase could explain 44% of the changes in the probe ‘test’ phase (p<0.05). Additionally, I identified measures of neurodegeneration as the best pathological predictors of changes in neurobehaviour (R2 = 0.72, p<0.01). Collectively this work identifies a number of potential weaknesses within in vivo modelling of Alzheimer’s disease and demonstrates how the use of empirical data can inform both preclinical and clinical studies.
174

An evaluation of the sub-regional legacy/impacts of the London 2012 Olympic Games in a non-hosting sub-region : a case study of Leicestershire

Chen, Shushu January 2013 (has links)
This thesis evaluates the legacy/impact of the London 2012 Games for a non-hosting sub-region Leicestershire, principally through evaluations of four legacy-programmes (i.e. the Workplace Challenge, Get Set, Sport Makers, and Games Makers programmes), drawing conclusions about lessons learned from the Leicestershire 2012 legacy experience. The selection of Leicestershire as a non-hosting sub-region reflects the fact that little is known about the legacy/ impact of the Games in such contexts. The nature of Olympic legacy evaluation is considered as a complex, wide-ranging, and multi-staged process. This thesis thus focuses on two main areas: i) conducting a systematic review of the literature (covering the period 1996-2011) to explore and establish an understanding of the concepts of Olympic legacy , and evidenced legacy/impact of hosting the Olympics in previous Games; ii) assessing the extent to which the London 2012 Games had impacted on the changed legacy outcomes for Leicestershire through realist evaluations. Together with realist evaluations, analytic logic models and the assessment of additionality approaches are adopted in this study, focusing on the four legacy-programmes evaluations, wherein quantitative and/or qualitative methodology are utilised in order to identify the causal mechanisms that produced the anticipated/unanticipated effects in their specific contexts. This study is an empirical example of the application of the realist evaluation and assessment of additionality. It also produces an evidence base for policy analysis in order to inform stakeholders thinking regarding sustaining the legacy of the Games and any future major sporting events by identifying lessons learned for non-hosting contexts.
175

Synergies of syntheses : a comparison of systematic review and scientific realist evaluation methods for crime prevention

Grove, Louise E. January 2010 (has links)
This thesis makes two significant contributions to the advancement of knowledge within crime prevention. The first of these is to evaluate the success of repeat victimisation prevention interventions. Interventions across four crime types are assessed herein, and the context-mechanisms-outcome configurations examined. The second contribution of this thesis is to assess two techniques of meta-evaluation: systematic reviews and realist syntheses. Each of these techniques is used in turn to assess the repeat victimisation prevention interventions. The contribution of each technique to the knowledge pool is then discussed, and the question of whether they are complementary or contradictory approaches answered. The thesis is framed in the context of evolutionary epistemology, which is the philosophy underpinning both approaches to meta-evaluation addressed herein. The thesis starts, with an examination of: firstly, how the evaluation methods in question have evolved, and the background to their scientific worth; and secondly, how situational crime prevention measures have evolved over time. The thesis then examines the two competing approaches for their contribution to the evaluation ecosystem by using both to assess repeat victimisation prevention interventions. Finally, the last section poses the question of whether it is survival of the fittest, or whether co-existence or adaptation could be the key to survival for these two meta-evaluative methodologies. Repeat victimisation prevention is revealed as an effective way of reducing crime, with a need for further research to apply the principle across further crime types. A requirement is identified for a greater breadth and depth of information to be included in future crime prevention evaluations. The systematic review is shown to be a useful way of assessing the overall effectiveness of the interventions, whilst the realist synthesis fills in the detail of why some interventions work and others fail. It is concluded that both approaches to meta-evaluation have useful contributions to make, and that a third way incorporating the best elements from each method should be developed.
176

Identification and management of prodromal symptoms in bipolar affective disorder : the role of individual, disorder, and treatment-related factors

Gadon, Lisa Alexandre January 2011 (has links)
Background: Traditional psychosocial treatments have been adapted for use with individuals with bipolar affective disorders due to the limited prophylactic nature of pharmacotherapy and the recognition of the role of psychosocial factors in the course of this disorder. Psychosocial interventions that include a prodromal monitoring and management component have been empirically shown to be an effective adjunct to medication for the treatment of bipolar disorder. Aims: There is a deficit of quantitative research that examines the impact of individualrelated (e.g. age, self-efficacy), disorder-related (e.g. time since diagnosis, experience of prodromal symptoms) and treatment-related (e.g. level of psychosocial input) factors on individuals’ ability to manage this disorder via the use of prodromal monitoring. The current research aimed to investigate factors that are associated with the identification and management of prodromal symptoms. Method: Participants completed five self-report measures in order to provide information on their experience of prodromal symptoms, current mood state, general self-efficacy, view of social support from significant others, and demographic and clinical-related variables. The data were collected from 101 participants, 58 of whom were female. The sample consisted of individuals with a diagnosis of bipolar disorder type I and II. Results: Univariate and bivariate analyses were used to explore the relationship between individual, disorder, and treatment-related variables associated with participants’ experience of bipolar disorder. Variables that were significantly associated with participants’ perception of their ability to identify and manage prodromes were further investigated using ordinal logistic regression analyses. The results indicated that general self-efficacy and prodromal-specific help from significant others were associated with an increase in participants’ perception of their ability to identify manic and depressive prodromal symptoms. General self-efficacy was also associated with participants’ view of their ability to manage cognitive and behavioural prodromes. Experience of prodromal symptoms (e.g. consistency of symptoms experienced, type of prodrome experienced) was associated the participants’ perception of their ability to identify and manage prodromes. In general, disorder-related variables (e.g. time since diagnosis, mood state, diagnosis type, and number of episodes experienced) were not significantly associated with the participants’ view of their ability to identify and manage prodromal symptoms. Individual-related variables such as gender and age, however, were associated with prodromal identification. Conclusion: The results indicated the need to consider constructs such as general selfefficacy and experience of prodromal symptoms (e.g. consistency of symptoms, types of prodromes experienced, and ability to recognise prodromes when they first present) when helping patients to learn how to identify and manage prodromal symptoms. In addition gender differences and the role of help from significant others were highlighted as variables that should be considered when using prodromal monitoring approaches with patients with bipolar disorder. Limitations of the research are reviewed in relation to the methodology used. Clinical implications and directions for future research are considered.
177

A comparison of methods for the systematic review of qualitative research : two examples using meta-ethnography and meta-study

Garside, Ruth January 2008 (has links)
Systematic reviews and meta-analyses have been a central pillar of evidence-based practice and policy-making in healthcare over recent years. Traditionally, this has focused on effectiveness evidence from trials.. There is increasing understanding, however, that other study designs also provide essential information and this has led to interest in developing ways to review and synthesis such evidence. Qualitative research has unique potential to illuminate the patient experience. This research has three aims: 1) To review and compare the proposed methods of systematic review and synthesis of qualitative research. 2) To develop and assess two methods of systematic review and synthesis of qualitative research. 3) To compare these two methods and suggest how they might be used in a policy-making context. In addressing these aims, this thesis substantially contributes to debates about the purpose and practice of systematic review and synthesis of qualitative research, particularly in the context of health technology assessment and related pOlicy-making. I undertake a unique critical comparison of the methods suggested for reviewing and synthesising qualitative research, based on their approach to key stages of systematic review. This is used to produce a comprehensive framework for good practice~ I use the framework in two systematic reviews, one about heavy menstrual bleeding using meta-ethnography, and one about hysterectomy using meta-study. These two reviews allow a comparison of the two methods, and in particular explore the impact of expanding the meta-ethnography approach through meta-study, which adds explicit steps to assess the impact of study methodology and theory on findings. The ability of meta-study to unpack the procedures and theories that produce particular findings is key and illuminates the importance of theory in systematic reviews of qualitative research. Through the two systematic reviews, my thesis also contributes to understanding of these reproductive health topic areas through the creation of new insights and concepts from the synthesis. The synthesis of heavy menstrual bleeding studies produced a detailed patient illness model based on women's experiences. In addition, it allowed an understanding of elements that contribute to women's certainty or uncertainty about whether or not their periods could be seen as problematic and requiring medical help. This helps to establish the limitations of the medical model for doctors, as well as women who suffer from heavy menstrual bleeding. The synthesis of hysterectomy studies produced a detailed description of the journey that women make to, and through, hysterectomy, based on their experiences. I also created a theoretical framework, which shows that hysterectomy needs to be understood in the context of personal, physical experiences, together with sociocultural forces that affect the way in which hysterectomy is experienced, and that the interaction of these micro- and macro-concerns mediate through, and affect, relationships with key other people. Methodology affected the research questions posed and the conclusions of research. Comparing the two methods of review and synthesis showed the importance of taking account of the methods and theories that produce research findings. However this additional detail may be at the expense of certainty and requires additional resources.
178

An exploration of ehealth and digital literacy in pharmacy practice

MacLure, Katie January 2014 (has links)
The aim of this research programme was to explore ehealth technology in pharmacy practice in Scotland and, by doing so, contribute original knowledge to this area. Strategists worldwide believe technology has the potential to promote quality, safety and efficiency in healthcare. This has been reflected in national ehealth policies designed to support collaborative working between medical and non-medical healthcare practitioners and, more recently, the whole health and social care team. A meta-narrative systematic review was conducted to explore and contextualise research related to healthcare professionals’ views of the adoption of ehealth technologies to support shared care. Findings indicate the importance of organisational development and training for core and optional ehealth services with pharmacists particularly under-represented in ehealth research. Socio-technical systems theory and the computer supported cooperative working framework were adopted to explore healthcare practitioners’ perceptions of ehealth in relation to integrated care. Findings from the review indicate ehealth research continues to focus on doctors and nurses. No ehealth application was perceived to be an unqualified success with the socio-technical gap still evident. Multiple case studies were conducted to develop explanatory theory around the digital literacy experiences, education and training related needs of pharmacy staff in the NHS Grampian area. Digital literacy levels were self-reported as basic with mixed views on the need for formal education and training. Findings indicate organisational and social factors may act as restraining forces against implementation of technology in pharmacy and associated digital literacy training. A final theory testing, systematic review was conducted into digital literacy training experiences of pharmacy staff applying Kirkpatrick’s four level model. It found a lack of evidence of specific, measurable digital literacy levels but indications that suggest digital literacy should be included in pharmacy education at all levels and career stages. This research provides novel insight into ehealth and digital literacy in pharmacy practice. Combined ehealth, education and pharmacy research has been demonstrated to be an under-researched area therefore these findings contribute original knowledge.
179

HPV Vaccination Acceptability Among Immigrant and Ethnic Minorities in the United States: Systematic Review

Zahedi, Bita 22 May 2017 (has links)
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / To systematically review all studies examining HPV vaccination acceptability among immigrant and ethnic minority parents and eligible individuals for cervical cancer prevention in the Unites states. MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane database searches were conducted searching for English language, US‐based studies to examine immigrant and ethnic minority population’s acceptability of HPV vaccination. Thirteen of more than 3,098 potentially relevant articles were included in the final analysis. Results. Latinos were statistically more likely to accept vaccination for both their daughters and sons. Foreign‐born adult Latinas were more accepting of the vaccine than U.S.‐born Latinas after controlling for other variables. Overall African American and Asian American parents were less likely to accept HPV vaccination for their daughters than Hispanic and White parents. Of the African American parents who intended to vaccinate their children the majority were significantly non‐Baptist and had higher levels of education. The majority of Haitian immigrants intended to vaccinate daughters and the rest agreed that they would most likely have their daughters vaccinated if their daughters’ physicians recommended it. More research is needed, particularly in the context of health care provider HPV vaccination recommendation to immigrant and ethnic‐minority populations. Acceptance figures so far suggest that the vaccine is generally well received among Hispanic/Latin and Haitian immigrants, but details of ethnic variations among these groups and a qualitative understanding of lower rates of acceptability among African American and Asian American communities are still being awaited. Despite advances in cervical cancer screening rates in the US, cervical cancer remains disproportionately high among low‐income immigrant and minority women, making this subgroup particularly vulnerable to disparities in screening and its detection. The purpose of this study is to examine the qualitative aspects of institutional and community level interventions of Cervical Intraepithelial Neoplasia (CIN) within the immigrant and refugee populations and the use of HPV vaccination as a prevention method. Combinations of the following keywords/phrases will be used: CIN‐ Cervical Intraepithelial Neoplasia, Cervical diseases, Cervical dysplasia, Refugees, Pap smear, Cervical Cancer Screening, HPV‐ Human Papillomavirus, HPV vaccination, Ethnic minorities, Immigrants. Independent reviews of each article will be conducted to assess the study quality and confirm the accuracy, completeness, and consistency of the abstracted data.
180

Is Prehospital Emergency Telemedicine Implementation Feasible In Non‐Traditional EMS Settings: A Systematic Literature Review

Guevorkian, Mark 25 May 2017 (has links)
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The rate of technology expansion is rapidly covering even the most remote parts of the globe and in the lowest resource settings. With globalization however, low and middle income areas are facing emerging health issues such as injuries and chronic medical conditions. With these illnesses, there are inevitable demands on emergency services. It has been thought that technology be utilized to augment emergency medical care in such settings where formal Emergency Medical Services. To aggregate and analyze the existing literature on the topic a systematic literature review was conducted. This study analyzed the existing literature on prehospital emergency care in settings in which no formal EMS services were utilized. Four databases were searched with inclusion and exclusion criteria, yielding 1782 results. The initial screening excluded all but 21 articles. Of the 21 articles in full review, 15 were included in the final review. Studies included in the final review were grouped into those reporting outcomes from five categories: Feasibility, Quality of Care, Response Time, Patient Outcomes, and Cost Effectiveness. Only one study was identified to be of high quality. There was a lack of studies with adequate statistical analysis to conduct statistical aggregation. Most studies however reported prehospital telemedicine in settings without EMS to be feasible, provide quality care, are be cost effective. However, the lack of statistical analysis makes it difficult to make conclusions. Also, several studies did show response time of a trained basic life support volunteer to be faster than EMS in many of the settings. But no positive health outcomes were observed in patients treated with projects utilizing technology in the prehospital setting. The prehospital emergency medicine setting is a young field of study that may have significant hurdles in application. The studies conducted have shown promise in the use of technology in prehospital settings without formal EMS services, but are not robust enough to make strong conclusions or recommendations that could be put into practice. Thus, more robust, statistically oriented research is imperative in the field so that we can fully explore the potential of technology in the prehospital setting, especially in low resource and rural settings without formal EMS services. With more robust studies, we can hope to integrate new technologies into practice and better serve the populations without adequate EMS coverage to provide more timely emergency care.

Page generated in 0.0791 seconds