In der vorliegenden Arbeit wurde das Outcome von 112 Patienten mit intrakranieller Blutung analysiert, um das Blutungsvolumen und die unterschiedliche Dynamik der Blutungen als Einfluss- und prädiktive Faktoren zu korrelieren. 21.4% der 112 eingeschlossenen Patienten hatten ein EDH, 38.4 % ein SDH- bzw. 40.2% ein Intrazerebralhämatom. Die Sub- und Epiduralhämatome waren mehrheitlich traumatische Läsionen, die intrazerebralen Blutungen vorwiegend spontane. Im Gesamtkollektiv hatten 28.6% ein funktionelles, respektive 71.4% ein nicht funktionelles Outcome. Das Ergebnis der 71 traumatischen Blutungen war signifikant besser (38.0% funktionell) als das der 41 spontanen (12.2% funktionell, p=0.004). Bei gleichem Hämatomvolumen haben operativ versorgte spontane Blutungen eine 88% geringere Chance für ein funktionelles Ergebnis als operierte traumatische Blutungen. Im Untersuchungskollektiv wurde der reziproke Zusammenhang von Volumen und GOS sowohl für spontane und traumatische, als auch für akute und subakute Blutungen demonstriert. Nicht signifikant verschieden waren akut und subakut verlaufende Blutungen bezüglich ihres Outcomes (32.8% vs. 23.5% funktionelles Outcome, p= 0.302), und der Volumina (47.5ml vs. 52.8ml, p=0.102)). Der vermutete Zusammenhang zwischen Hämatomgröße und zeitlichem Verlauf konnte damit nicht gezeigt werden. Wir fanden auch keinen signifikanten Unterschied des klinischen Ergebnisses in Bezug auf den chirurgischen Interventionszeitpunkt (< 6h vs. > 6h). Bei den traumatischen Hämorrhagien wurde ein Modell mit 3 unabhängigen Faktoren (Alter, initaler GCS und Volumen) zur Prädiktion des Outcomes entwickelt. Kleine Volumina, ein niedriges Alter und ein initial hoher GCS lassen ein funktionelles Outcome vorhersagen. Weitere Faktoren, die jedoch nicht unabhängig mit dem Outcome assoziiert waren, sind Mittellinienverlagerung, initiale Blutglukose, Vorliegen eines Hirnödems und arterielle Hypertonie. Die initiale Glukosekonzentration kann zur Vorhersage des Outcomes nach traumatischen Blutungen beitragen, Als einziger unabhängiger Prädiktor wurde bei den spontanen Raumforderungen die Mittellinienverlagerung ermittelt. Volumen und initiale GCS waren nicht unabhängige Prädiktoren. Das schlechte Outcome nach spontaner Blutung, unabhängig vom Versorgungszeitpunkt, unterstreicht die kontroverse Datenlage bezüglich operativer Therapie dieser Raumforderungen. Traumatische Hämorrhagien in temporaler Lokalisation zeigen ein besseres Ergebnis als vergleichbare lokalisierte spontane Blutungen.

Thesis (Ph. D.)--Rand Graduate School, 2002. / Title from web page (viewed Aug. 27, 2003). Includes bibliographical references.

During the last two decades, managerial coaching has become increasingly popular in organizations. Despite its popularity, there is a paucity of empirical evidence in the study of managerial coaching outcomes. The purpose of this study was to examine the relationships between perceived managerial coaching behavior and employee self-reported affective and performance-related outcomes based on perceptions of selected organization employees. Three theories, path-goal leadership, career motivation, and organization support, were used to frame the hypothesized conceptual model of managerial coaching outcomes for the current study. The systematic review of relevant literature identified satisfaction with work, role ambiguity, satisfaction with manager, career commitment, job performance, and organization commitment for the potential outcomes of managerial coaching. A 36-item survey including seven existing instruments was utilized to collect data. An estimation of the readability level for the survey was Flesh-Kincaid Grade Level 7.1. The survey was sent electronically to all employees in the selected government organization. The sample included 431 respondents representing a population of 1,399 employees. Descriptive statistics, principal component analysis, Cronbach‘s alpha estimates for reliability, correlation analysis, two-step modeling techniques for structural equation modeling, and Sobel tests were the analysis methods used in the study. The results of the analyses indicated that the hypothesized conceptual model was adequately supported by the empirical data of the study sample (χ2/df = 3.53; CFI = .91; IFI = .91; RMSEA = .08). The further investigations suggested that managerial coaching had a direct impact on employee satisfaction with work and role clarity and an indirect impact on satisfaction with work, career commitment, job performance, and organization commitment. Role clarity, as a direct outcome of managerial coaching, influenced job performance—such mediation was consistent with the hypothesized model for the study. The hypothesized model had clear and comprehensive illustrations of how managerial coaching affects work and organization-related variables, satisfaction with work, role clarity, career commitment, job performance, and organization commitment. This study provides empirical support to the proposed benefits of managerial coaching in organizations, and enhances the selected theories by offering additional empirical support to them.

Thesis (M.S.)--University of Michigan, 2003. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.S.)--University of Michigan, 1995.

Thesis (Ph.D. in Clinical Sciences) -- University of Colorado at Denver and Health Sciences Center, 2005. / Typescript. Includes bibliographical references (leaves 103-110). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Real life decision-making frequently involves some level of affect, and research has demonstrated that individuals decide differently when outcomes are more or less rich with feeling. This difference in choice has previously been attributed to probability insensitivity in the presence of affect. In a series of three studies, we explored this possibility, while also testing alternative explanations, namely, that differences exist because of outcome characteristics such as comparability or precision. Individuals made choices between affect-rich side effects and affect-poor monetary lotteries in either a strictly numeric format, or with the addition of an icon array. Across the three studies we found little evidence that the icon array was beneficial, casting doubt on the previous explanation that differences in affect-rich and affect-poor choice are due to probability insensitivity. Contrary to our predictions, we did not find evidence that differences in choice could be attributed to outcome comparability, as there continued to be decrements in affect-rich choice, despite making affect-rich outcomes more comparable. As predicted, when precision in each affective context was better equated by describing monetary outcomes in less precise terms, the difference in affect-rich and affect-poor choice disappeared. It appears that it is difficult to choose well when outcomes are vague, which we suggest is potentially the result of a challenge integrating probability and outcome information. This research is a first step in providing a viable explanation for the “affect gap” and contributes to our understanding of how and why affect-rich and affect-poor choice may differ.

Research elucidating high rates of burnout, depression, and suicide among US clinicians has caused national concern for the sustainability of our healthcare workforce and the quality of patient care. In response, US healthcare organizations are using measures of clinician burnout in new contexts beyond their traditional use in research. Outcome measures of clinician burnout are being used to evaluate health system performance, identify demographic disparities, and educate individual clinicians regarding their own outcomes. Yet, critical gaps in the literature exist regarding the measurement properties of burnout assessments in these contexts and the relationship between clinician distress and healthcare quality. This dissertation contains three studies on measuring clinician distress and its relationship with healthcare quality. Studies 1 and 2 aim to advance what is known regarding the interpretability, reliability, and validity of a commonly used clinician burnout assessment, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS). In Study 1, we aimed to improve the interpretation of the MBI-HSS by using item response theory to describe the burnout symptoms and precision associated with MBI-HSS scores in US physicians. We produced response profiles that allow health policy makers and healthcare leaders to relate actionable, qualitative meaning regarding individuals’ and groups’ burnout symptom burden to the MBI-HSS’s quantitative subscale scores. In Study 2, we examined whether demographic disparities in US physician burnout are explained by differences in the MBI-HSS’s functioning across physician age, gender, and specialty groups. Our findings revealed that differences in the MBI-HSS’s functioning across age, gender, and specialty groups did not account for observed disparities, supporting the use of the MBI-HSS as a valid tool for identifying demographic disparities in physician burnout. In Study 3, we examined the association of clinician depression, anxiety, and burnout with the inappropriate use of antibiotic prescriptions for acute respiratory tract infections (RTIs) in a retrospective cohort study of outpatient visits at Boston Medical Center. We found a significant positive association between clinician depression, anxiety, and burnout and inappropriate prescribing for acute RTIs, which depended on the visit location and diagnosis group. Our findings suggest that clinician depression, anxiety, and burnout may play an important role in the quality of routine outpatient care. As federal agencies and healthcare organizations seek to address clinician distress on local and national levels, our findings offer important implications for future assessment and intervention. / 2023-01-19T00:00:00Z

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