Merlin.net Patient Care Network is a St. Jude Medical product that is used for remote patient management. The basic concept of Merlin.net is to allow the physician to view patient device follow-up information as well as general patient and device information on a web application. The Merlin.net system also interfaces with the patient and will send them notification if they miss a follow-up. All device information will be collected automatically while the patient is sleeping. This information is sent through a telephone line to a Merlin.net server to process a report package and display the collected information on the Merlin.net web application. The Merlin.net verification team ensures that all reports generated by the Merlin.net servers are processed and outputted correctly. There are currently 296 device parameters supported by Merlin.net, and the manual extraction and comparison of the expected parameter values takes several hours for each patient follow-up session. Currently there are 250 patient follow-up sessions used for verification testing. Each new release will continue to create additional patient follow-up sessions. Merlin.net releases are approximately 6 months apart, and each new release adds approximately 30-50 new patient follow-up records to support the new devices. In order to meet aggressive project deadlines, while ensuring that the Merlin.net system is processing and outputting patient follow-up data correctly, it is necessary to come up with an automated process to verify the contents of the processed data is correct. This will save a tremendous amount of time as well as improve on the quality of the verification process by eliminating human error and rework. It is critical for patient safety that the patient device follow-up information is processed and outputted correctly. In this thesis an automated process was developed to verify the correct content of the Merlin.net server generated reports for each patient follow-up session. This process leveraged different tools and scripting languages to achieve automation. TDE (Test Development Environment) tool was used to extract the device parameters from the patient follow-up sessions. The TDE script was written to extracts the desired parameter values from the patient follow-up session and automatically populates parameters in a device parameters spreadsheet. Once all the device parameter values are extracted in the spreadsheet, they are passed through a set of mapping rules, which form the expected values. The mapping rules were implemented as VBA (Visual Basic for Application) macros, one macro for each report. The VBA macros write the expected values back to the spreadsheet to form an “expected values spreadsheet”. The patient follow-up session is then sent to the Merlin.net server to process, which generates a processed patient follow-up session that contains a reports package in .zip format. A perl script was then written to compare the parameter values in the Merlinet.net generated reports with the corresponding expected values from the expected values spreadsheet. The perl script generates a comparison report displaying the discrepancies between the actual and the expected values.

INTRODUCTION: Device discontinuance is a widespread problem with assistive technology (AT) and durable medical equipment (DME), affecting approximately one third of people with disabilities who successfully acquire equipment. Consumers’ dissatisfaction with service and device-related factors can directly lead to AT device non-use. Roger’s Diffusion of Innovation Theory provides a foundation for understanding how to address device discontinuance, potentially through follow-up services. OBJECTIVE: The aim of this doctoral capstone is to discuss the piloting and feasibility of using follow-up outcome measures in an outpatient occupational therapy rehabilitation setting in order to identify and address challenges with equipment discontinuance. METHODS: A sample of 69 clients receiving equipment recommendations from a specialty AT clinic were contacted. The COPM, ATUFS, and QUEST 2.0 were piloted to measure device use and satisfaction. The feasibility of using these measures within a follow-up protocol for this outpatient practice was then evaluated. RESULTS: A total of 63% of the sample (N=69) was successfully contacted. The site-specific protocol successfully determined whether these clients had acquired and used their devices, subsequently allowing AT practitioners to provide additional supports for clients who had experienced discontinuance or non-acquisition. CONCLUSION: Using standardized outcome measures to follow-up with clients in this setting was deemed not feasible secondary to time constraints and difficulty contacting clients. Recommendations for improving follow-up with and without use of standardized measures is discussed. Follow-up encouraged clients to schedule additional appointments, utilize recommended funding resources, or seek out referrals.

Background: Occlusal appliances for treatment of different temporomandibular disorders (TMD) have shown to have good effect. Patients treated with an occlusal appliance should return for follow-ups and they have a right for free follow-ups within 3 months. Despite this, there are patients that are not receiving their follow-ups. Aim: To evaluate follow-up routines after treatment with an occlusal appliance in public dental practice in Västerbotten, Sweden. To evaluate the most common indications for treatment with an occlusal appliance. To evaluate if the dentists register the outcome of the treatment with their occlusal appliance or not.  Methods: Onehundred randomly selected dental records were analysed from patients treated with an occlusal appliance during 2019 in public dental practice in Västerbotten county. The analysis was conducted using a Microsoft Excel document that had prior to analysis been created. The results were processed using IBM SPSS Statistics and Microsoft Excel. Results: Forty-eight of the 97 accessible patients had a scheduled follow-up. Out of these, 38 received their follow-ups. Seventy-three patients had bruxism as an indication for treatment, 40 had myalgia, 33 had tooth wear and 33 had replacement of an old appliance. Sixty-four out of 97 patients had no information about evaluation of treatment, 17 had improved symptoms.  Conclusions: The study showed an approximately 50% rate of scheduled follow-ups of occlusal appliances and the most common indication for that treatment was bruxism. The dentists did not evaluate the treatment outcome of patients’ symptoms. It is recommended to adhere to the decision-making model.

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Background: Cancer is a collective name for many different diseases and occurs when the balance in a cell is disturbed and transforms into a tumor cell. Cancer is one of the leading causes of death worldwide. Suffering from cancer affects a person physically and psychologically, and surviving cancer can be just as wearing.  Aim: The purpose of the study was to describe people's experiences of surviving a cancer disease. Method: A literature study was used as a method. 12 articles were selected for the result. The articles were found in the databases Cinahl and PsycInfo. Results: The result gave rise to three main themes: "Loss of trust in healthcare", "Living with consequences" and "Feelings about the future". With seven associated subthemes: "Not getting information", "Feeling forgotten", “Lack of identity”, “Strategies for change”, “Having someone to talk to”, "Not feeling safe'' and “Daring to dream”. The results show how complicated the aftercare of cancer can be, both for healthcare professionals but not least for cancer survivors. Experiences of having survived cancer differed depending on the support network around. Conclusion: The results of the study showed that the healthcare system is lacking in several aspects when it comes to aftercare for cancer survivors. Where the healthcare system failed, there were family, friends and people with similar experiences as support. Fear of relapse, fear of dying and anxiety were leading emotions in the study's results.

Objective: The multidisciplinary follow-up of patients with cleft lip with or without palate (CL/P) is organized differently in specialized centers worldwide. The aim of this study was to evaluate the different treatment needs of patients with different manifestations of CL/P and to potentially adapt the frequency and timing of checkup examinations accordingly. Design:We retrospectively analyzed the data of all patients attending the CL/P consultation hour at a tertiary care center between June 2005 and August 2020 (n=1126). We defined 3 groups of cleft entities: (1) isolated clefts of lip or lip and alveolus (CL/A), (2) isolated clefts of the hard and/or soft palate, and (3) complete clefts of lip, alveolus and palate (CLP). Timing and type of therapy recommendations given by the specialists of different disciplines were analyzed for statistical differences. Results: Patients with CLP made up the largest group (n=537), followed by patients with cleft of the soft palate (n=371) and CL ±A (n=218). There were significant differences between the groups with regard to type and frequency of treatment recommendations. A therapy was recommended in a high proportion of examinations in all groups at all ages. Conclusion: Although there are differences between cleft entities, the treatment need of patients with orofacial clefts is generally high during the growth period. Patients with CL/A showed a similarly high treatment demand and should be monitored closely. A close follow-up for patients with diagnosis of CL/P is crucial and measures should be taken to increase participation in followup appointments.

学位プログラム名: 京都大学大学院思修館 / 京都大学 / 0048 / 新制・課程博士 / 博士(総合学術) / 甲第21933号 / 総総博第8号 / 新制||総総||1(附属図書館) / 京都大学大学院総合生存学館総合生存学専攻 / (主査)教授 積山 薫, 教授 杉本 均, 教授 山口 栄一 / 学位規則第4条第1項該当 / Doctor of Philosophy / Kyoto University / DGAM

The purpose of this study is to contribute to an increased understanding of how preschool teachers work with reading aloud in preschool and what they think about reading aloud as a way of working for children's language development. To investigate this and to gather empirical evidence, we have used qualitative interviews where we interviewed ten working preschool teachers. The collected empirical evidence is processed through a thematic analysis. The investigation takes the socio-cultural theory as a point of departure, where we analyze the results based on theoretical concepts. The theoretical concepts have given us an increased understanding of the results that we have obtained. The results of this study show that reading aloud is used frequently, both spontaneously and planned in the preschool’s activities. The preschool teachers repeatedly mention in our interviews that reading aloud is a central part of the activities. The reading aloud is further described as something that can be used as a starting point for several different follow-up works. Furthermore, reading aloud is described as developing on several levels, not at least as language development. The conclusion made in this study is that reading aloud is a central part of the preschool’s activities. The reading aloud takes place both spontaneously and planned, and in this study we have been able to see how the preschool teachers continue to work with the reading aloud. / Syftet med undersökningen är att den ska bidra till en ökad förståelse för hurförskollärare arbetar med högläsning i förskolan och vad de anser omhögläsningen som ett arbetssätt för barns språkutveckling. För att undersökadetta och samla in empiri har vi använt oss av kvalitativa intervjuer där viintervjuade tio verksamma förskollärare. Den insamlade empirin bearbetasgenom en tematisk analys. Undersökningen tar utgångspunkt i densociokulturella teorin där vi utifrån teoretiska begrepp analyserar resultaten.De teoretiska begreppen har gett oss en ökad förståelse för de resultat som vifått. Resultatet av undersökningen visar att högläsning används frekvent, bådespontant och planerat i förskolans verksamhet. Förskollärarna nämneråterkommande i våra intervjuer att högläsningen är en central del iverksamheten. Högläsningen beskrivs vidare som något som kan användassom en utgångspunkt till flera olika uppföljningsarbeten. Högläsningenbeskrivs ytterligare som utvecklande på flera plan, inte minst somspråkutvecklande.Slutsatsen som görs i denna undersökning är att högläsning är en central del iförskolans verksamhet. Högläsningen sker både spontant och planerat och vihar i denna undersökning fått ta del av hur förskollärarna arbetar vidare medhögläsningen.

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