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Alzheimer's disease (AD) is a condition marked by progressive intellectual decline and memory loss, which typically affects individuals over the age of 60. Its origins are unknown but genetic factors are suspected in some cases. There is limited information about the subjective experience of AD although it is often described as a calamity that inevitably destroys the self irrespective of its victims' social circumstances. This dissertation offers an alternative to this nihilistic portrayal that draws on a critical phenomenological framework. It explores the loss of self as an intersubjective phenomenon that is mediated by three contexts: (1) Western representations of the self as autonomous and individualistic; (2) the public description of AD; and (3) the biomedical practices that construct AD as a diagnostic object. / The dissertation examines the experiences of 16 patients and 37 family members who participated in a multi-disciplinary assessment at a dementia clinic. The participants also include 14 clinicians and staff members from the clinic. The findings are derived from a prospective study that includes in-depth, at-home interviews and observations of clinical assessment activities and research-based genetic counseling. The dissertation examines how memory trouble interferes with the intersubjective fabric of everyday life in families as affected participants lose the ability to meaningfully reciprocate on the basis of their individualistic identities. The analysis emphasizes the role of the clinical assessment, diagnosis, and public description in restoring intersubjective order. A salient aspect of this process is the way in which medicalized interpretations of memory trouble facilitate reinterpretation of the eroding self as being animated by pathology. The self is thus rendered meaningful again as it is being indexed to lay descriptions of what people do and say in AD. The analysis also considers how this process extends to participants who came to perceive themselves as victims of AD although they were assessed as not having a dementia disorder. The dissertation finally considers the impact of acquiring genetic knowledge about AD on interpretations of the self. Overall, the research underscores the loss of self in AD as a phenomenological process that is mediated by familial and institutional contexts.

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1987. / Bibliography: leaves [226]-233. / Microfiche. / xiii, 233 leaves, bound ill. 29 cm

Obstructive sleep apnea (OSA) is a prevalent disease. Often resources to provide care for OSA are inadequate, leading to long patient waiting times. Simpler validated methods of care are needed. In the first study in Chapter 2, the utility of a new high-sampling rate oximeter to diagnose OSA was explored. The home oximetry data collection was robust, with few failures and the data allowed the “rule in” or “rule out” of moderate-severe OSA with high degree of certainty. It is concluded that home oximetry could replace polysomnography (PSG) as a diagnostic test in a significant proportion of patients, thus allowing limited resources available for the care of those with OSA to be re-directed e.g. towards providing therapy. In Chapter 3, the diagnostic information from the oximeter was used to underpin a study designed to demonstrate that a nurse-led model of care could produce health outcomes in moderate-severe OSA not inferior to physician-led care. A randomised controlled multi-centre non-inferiority clinical trial was performed. 1,427 patients referred to 3 sleep medical centres with possible OSA were assessed. 195 patients were randomised to 2 models of care. Model A, a simplified model, involved home oximetry to diagnose moderate-severe OSA, auto-titrating constant positive airway pressure (APAP) to set a therapeutic constant positive airway pressure (CPAP), with all care supervised by an experienced nurse. Model B involved 2 laboratory PSG’s, to diagnose OSA then titrate CPAP, supervised by a sleep physician. The primary endpoint was change in Epworth Sleepiness Score (ESS) measured before and after 3 months of CPAP. A range of other outcome measures were collected. The change in ESS for nurse-led management (Model A) was not inferior to the physician-led service (Model B) since the lower limit of the two-sided 95% CI did not include -2, the margin of equivalence (difference 0.13, 95% CI -1.52 to -1.25). 11 patients in Model A and 10 in Model B were lost to follow up during the trial. There were no significant differences between Model A and Model B after 3 months of CPAP in any of the other outcome measures, including CPAP adherence at 3 months. It is concluded that a simplified nurse-led model of care can produce non-inferior results to physician-directed care in the management of moderate-severe OSA. In Chapter 4 the efficacy of CPAP in normalising or improving subjective and objective sleepiness, quality of life and selected neurocognitive measures was explored. It was shown that only a proportion of patients (60% on ESS, 35% on FOSQ) normalised their scores after 3 months of CPAP therapy. This is important information. As new health care delivery strategies evolve as a result of the data presented in Chapter 3 and elsewhere, it will be crucially important to train new health care professionals in the complexities of OSA management, such that they are aware that the symptoms of patients presenting for OSA investigations can have multiple aetiologies, and may not always resolve by simply applying CPAP. The data presented in this thesis add to the evidence base in treatment of moderate-severe OSA and will help further evolve health care delivery for this important disease.

Thesis (PhD)--University of South Australia, 1997

Video presents ten simulated clinical problems. The tape may be stopped so that questions can be answered. / Thesis (MAppSci in Physiotherapy) -- University of South Australia, 1992

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.