Thesis (M.D.)--College of Physicians and Surgeons of the University of the State of New York. / Microform version available in the Readex Early American Imprints series.

Thesis (Ph. D.)--University of Oklahoma, 1992. / Includes bibliographical references.

No description available.

Thesis (Ph. D.)--University of Michigan, 1973. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 120-124).

Thesis (Ph. D.)--University of Michigan, 1973. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 120-124).

Bakgrund: God symtomlindring anges tillsammans med främjande av välbefinnande som den viktigaste uppgiften för sjuksköterskor vid vård av patienter i sent palliativt skede. Smärta är ett av de vanligaste symtomen vid livets slut och smärtanalys och regelbunden skattning av smärtintensitet anges som en av de nationella kvalitetsindikatorerna för god palliativ vård. Sjuksköterskor på en geriatrisk sjukvårdsavdelning vårdar flera ofta multisjuka personer med en komplex sjukdomsbild och stora omvårdnadsbehov. Det är därför angeläget att undersöka hur sjuksköterskor arbetar med smärtbedömning och smärtskattning i sent palliativt skede vid en geriatrisk vårdavdelning. Syfte: Syftet med studien är att beskriva hur sjuksköterskor arbetar med smärtbedömning av patienter i sent palliativt skede på geriatrisk vårdavdelning - Vilka underlättande respektive försvårande faktorer finns vid bedömningen? Metod: En kvalitativ design med en induktiv ansats valdes där semistrukturerade intervjuer användes som datainsamlingsmetod. I studien medverkade tio sjuksköterskor från geriatriska verksamheter från mellersta samt södra Sverige. Kvalitativ innehållsanalys användes som analysmetod. Resultat: Vid analysen framkom kategorier som ”Användning av den kliniska blicken”, ”Användning av smärtskattningsinstrument”, Påverkan av arbetsplatskulturen vid smärtbedömning”, Påverkan av närstående vid smärtbedömning” och ”Palliativregistret som ett hjälpmedel vid smärtbedömning”. Samtliga kategorier belyste underlättande och försvårande faktorer vid smärtbedömning i sent palliativt skede. Slutsats: Samtliga sjuksköterskor i studien beskrev smärtbedömning i sent palliativt skede som ett svårt område men som engagerar och berör dem starkt. Resultatet visar på flera försvårande faktorer för smärtbedömning i sent palliativt skede. Äldre, multisjuka patienter med kognitiv svikt och oförmåga att verbalisera sin smärta fortsätter att vara en utmaning vid smärtbedömning. I studiens resultat framkommer den kliniska blicken och Palliativregistret som hjälpmedel som underlättade sjuksköterskornas arbete med smärtbedömning.   Nyckelord: Smärtbedömning, Palliativ vård, Geriatrisk vård, Klinisk blick, Omvårdnad / Background: Effective symptom relief and enhanced well-being are indicated as the most important tasks for nurses in the care of patients in late palliative stage. Pain is one of the most common symptoms at the end of life and pain analysis and regular assessment of pain intensity is one of the national quality indicators for good palliative care. Nurses in a geriatric ward care for people with multiple illnesses and high level of caring needs. It is therefore important to investigate how nurses work on pain assessment and pain estimation in late palliative stage in a geriatric ward.  Aim: The aim of this study is to describe how nurses work with assessing pain in patients in late palliative care. What are the facilitating and aggravating factors affecting this assessment?  Method: A qualitative design with an inductive approach was chosen where semi-structured interviews were used as a data collection method. Ten nurses working in geriatric wards in central and southern Sweden were interviewed and a qualitative content analysis was used as the analytical method.  Result: The categories included  "Using the clinical look", "Use of pain estimation tools," "Impact of the workplace culture on pain assessment", "Impact of relatives on pain assessment", "Palliative Register as a pain assessment tool ". All categories highlighted both facilitating and aggravating factors in pain assessment at late palliative stages. Conclusion: All nurses in the study described pain assessment in late palliative stage as a difficult area but one which engaged and affected them strongly. The result shows that there are several aggravating factors for pain assessment at this stage. Older patients with comorbidity, cognitive failure and inability to express their pain verbally, are clearly challenges within pain assessment in late palliative care. In the study results, the clinical gaze and the Palliative Register appear as tools that facilitated the nurses' work on pain assessment.     Keywords: Pain assessment, Palliative care, Geriatric care, Clinical gaze, Nursing care

Thesis (M.P.H.)--University of Michigan, 1946. / Also issued in print.

Thesis (M.P.H.)--University of Michigan, 1946. / eContent provider-neutral record in process. Description based on print version record.

Introduction: Ageing is a phenomenon that has preoccupied the minds of humankind for generations but it was only in the twentieth century that medical care dedicated to the elderly was created. The field of Geriatric Medicine has grown in South Africa and globally, to be recognized as a subspecialty of Internal Medicine in its own right. Physiological changes in the elderly impact on the increased prevalence of non–communicable diseases and the raised burden of disease in this age group. The altered spectrum of diseases in this age group and atypical manifestations of these conditions make geriatric health care truly unique. In spite of the recognition that the elderly have specific medical conditions, a dedicated health care policy to improve geriatric health care is yet to be developed In South Africa. For such a policy to be created, more needs to be known about the causes of mortality and morbidity that contributes to the burden of disease in this age group. Method: A retrospective chart review was conducted on 218 admissions of persons aged 60 years and over to the medical wards of King Edward VIII Hospital. This is a regional facility in Durban, South Africa, that provides mainly secondary and tertiary levels of care. An ethical waiver was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu- Natal and all data sheets were de-identified. A structured data extraction sheet was used to record demographic and clinical data, including the admission diagnoses, presence of concomitant diseases, management and complications of some of these diseases, length of hospitalization and outcome of admission. Results: The study population comprised 191 patients aged 60 years and over, with a mean age of 70.5 ± 7.4 years (range 60 – 90 years). The patients were predominantly female (61.3%) and Black African (83.8%). While the majority of patients had only 1 admission, most were admitted with multiple diagnoses. Four or more diagnoses were recorded for 58.1% of the patients, with 50 patients (26.2%) having four diagnoses and 38 patients (19.9%) having five diagnoses. A history of current smoking was recorded in 38% of males and 7.2% females. Respiratory disease was the most common admission diagnosis (42.7%), followed by cardiac (42.2%) and renal disease (40.4%). An infection was present in 116 cases (53.2%) on admission, the commonest being pneumonia in 71 (61.2%), followed by urinary tract infection in 34 (28%) and septicaemia in 11 (9.5%). Cardiovascular disease was the most common underlying chronic disease, with hypertension being present in 150 patients (68.8%) and cardiomyopathy in 60 patients (25.5%). Of the patients with hypertension, evidence of end organ damage was present in 128 patients (85.3%), with hypertensive heart disease in 97 patients (75.8%), renal disease in 61 patients (47.7%), cerebrovascular disease in 37 patients (28.91%), hypertensive retinopathy in 11 patients (8.6%) and peripheral vascular disease in 5 patients (3.91%). The most common risk factors for congestive cardiomyopathy were hypertension in 55 cases (67%) and diabetes mellitus in 24 cases (40%). In addition, infection was the most common identifiable precipitating factor for cardiac failure in 40 % of cardiac failure cases Eleven patients were on anticoagulant therapy, of which three (27.3%) presented with overwarfarinization. More importantly, eight of the 17 patients (47%) with atrial fibrillation were not on anticoagulants. Neurological disease was present in 27.5% of the admissions with cerebrovascular disease being the most common (75% of all neurological cases) A diagnosis of malignancy was recorded in 13.1% of admissions with the most common primary site being the lung. In eight patients (32 % of those with malignancy) there was evidence of metastatic disease. Men were more likely than women to be admitted with respiratory disease (22.8% vs. 2.2%, p < 0.0001) such as chronic obstructive airways disease (57% vs. 34.5%, p = 0.001). Although pneumonia was more common in men than in women, this did not reach clinical significance (40.5% vs. 28.8%, p = 0.053). In contrast, more women were admitted with arrhythmias (16.5% vs. 6.3%, p = 0.03), congestive cardiac failure (30.2% vs. 15.2%, p = 0.013) and endocrine diseases (23.7% vs. 12.7%, p = 0.048). Renal disease was more common in women than in men, but did not reach statistical significance (44.6% vs. 32.9%, p = 0.060) In the 191 patients, 64 deaths (33.7%) were recorded during hospitalization. The mortality rate was found to be significantly higher in patients with 15 cerebrovascular accidents, acute renal failure, diabetes mellitus, and infection (including pneumonias). Conclusion: This study confirms the high prevalence and disease burden of non-communicable diseases in older patients, with the majority of patients having multiple diagnoses on admission. Hypertension and other cardiovascular diseases were identified as being most common with a high prevalence of target organ damage. Furthermore, in the patients with malignancy metastatic disease was common. These findings suggest that older patients may present late due to a lack of awareness, limited access to appropriate health care, or lack of adequate treatment and screening programmes. In addition to the burden of non-communicable diseases (NCD), infection (particularly pneumonia) emerged as a common cause for admission and mortality. These findings confirm the high burden of non-communicable diseases and their complications in the older population and highlight the need screening programs to improve detection and better management of these conditions. Furthermore the association of a high mortality with infections, finding underscores the need for implementation and adherence to treatment guidelines, and to develop and adhere to vaccination guidelines. Furthermore, training of health care personnel at all levels should be intensified in an attempt to decrease the burden of disease in older persons and to improve their quality of life. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

Thesis (M. Phil.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 134-156).