Purpose: To evaluate the influence of physical fitness on the metabolic and perceptual responses to chest compression-only (CCO) CPR. Methods: In a counterbalanced design, forty-seven CPR-certified participants were randomized to perform: 1) a fitness assessment in which muscular (e.g., push-ups = PU) and cardiorespiratory endurance (e.g., step test recovery heart rate = RHR) were determined, and 2) a 10-minute CCO-CPR trial in which the heart rate (HR) response and ratings of perceived exertion (RPE) were determined. Results: Both PU and RHR were significantly correlated to the HR response to CCO-CPR (r = - 0.45, p < 0.01; r = 0.54, p < 0.001). PU were significantly correlated to RPE: local muscular (r = - 0.43; p < 0.01), central (r = - 0.45; p < 0.01), and over-all (r = - 0.39; p < 0.01). Conclusions: Greater physical fitness lessens the metabolic and perceptual strain to CCO-CPR. / by Adam J. Berrones. / Thesis (M.S.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

The purpose of this study was to determine the relationships between the nurses' decision making model, frequency of Rapid Response Team (RRT) activation, and the nurse's skill at the early recognition of clinical deterioration. A descriptive, cross sectional quantitative design was used. The participants in this study were 167 acute care registered nurses who had activated the RRT at least once in the preceding 12 months. The participants first were asked to recall a time when they had made the decision to activate the RRT and then were asked to complete the instruments used in this study. Using the Nurse Decision-Making Instrument, the participant's decision making model then was categorized as analytic, intuitive, or mixed. The skill at early recognition of clinical deterioration was measured with the Manifestations of Early Recognition Instrument. Participant scores on the two instruments were significantly correlated with each other as well as to their frequency of RRT activation over the preceding 12 months. The findings of this study indicated that nurses who used analytical decision making activated the RRT with greater frequency than either the intuitive or mixed decision makers. In addition, registered nurses who used analytical decision making to activate the RRT tended to have higher levels of skill in the early recognition of clinical deterioration, as measured by the MER, than either the intuitive or mixed decision makers. Another finding of this study was that RNs with higher levels of skill in the early recognition of clinical deterioration tended to activate the RRT more frequently than RNs with lower levels of this skill. The implications of this study are that the use of analytical decision making may result in more frequent activation of the RRT. / Increased frequency of RRT activation has been linked in the literature with decreased patient mortality rates. The significance of the findings from this study is that the use of analytic decision making has the potential to reduce the incidence of the number one patient safety indicator, failure to rescue. / by Carlo G. Parker. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Introdução: A energia elétrica e ultrasônica são utilizadas com freqüência na prostatectomia radical laparoscópica e podem lesar os nervos cavernosos adjacentes através da dissipação térmica. Em contrapartida, a energia laser tem potencial para proporcionar uma dissecção precisa, com boa hemostasia e pequena lesão dos tecidos adjacentes. Este estudo avalia o efeito do laser KTP na dissecção laparoscópica do feixe neuro-vascular cavernoso em modelo experimental canino. Material e Métodos: Um total de 36 cães foi dividido igualmente em três grupos. Realizou-se a dissecção unilateral do feixe neurovascular cavernoso utilizando (1) laser KTP (KTP), (2) bisturi ultrasônico (BU), e (3) tesoura e clipes metálicos (TC), mantendo o lado contralateral intacto. Realizou-se a análise do tempo operatório e sangramento em cada grupo, assim como a análise funcional, através do coeficiente entre a pressão intracavernosa e pressão arterial média (PIC/PAM) durante a estimulação do feixe neurovascular cavernoso. Metade dos animais de cada grupo foi mantida viva por 30 dias e submetidos à nova neuroestimulação. Foram avaliados ainda os efeitos da dissipação térmica através da análise termográfica em fragmentos de peritôneo parietal e a extensão histológica da necrose tecidual na fáscia prostática desde a superfície de corte de cada instrumento. Resultados: O tempo de dissecção do feixe neuro-vascular cavernoso foi similar entre os grupos (KTP vs. BU p=0.21, KTP vs. TC p=0.81, BU vs. TC p=0.22). A dissecção utilizando o BU resultou em um prejuízo significativo na resposta à neuroestimulação quando comparado aos grupos TC e KTP no experimento agudo (BU vs. KTP p<0.001, BU vs. TC p<0.001), e crônico (BU vs. KTP p=0.02, BU vs. TC p=0.02). A análise histológica demonstrou uma área de necrose desde a superfície de corte com a utilização do laser KTP de aproximadamente 500 um, enquanto que com o uso do BU essa área se extendeu em média por 2 mm. A avaliação termográfica mostrou uma dissipação térmica significativamente maior do BU comparado ao laser KTP (laser KTP 0.98 mm vs. BU 6.25 mm, p<0.0001). Conclusão: O uso do laser KTP na dissecção laparoscópica do feixe neuro-vascular cavernoso apresentou resultado funcional semelhante à técnica sem emprego de energia térmica utilizando tesoura e clipes, enquanto o bisturi ultrasônico foi associado a um prejuízo significativo na função dos nervos cavernosos. / Introduction: Electrical and ultrasonic energy used in nerve-sparing laparoscopic radical prostatectomy can compromise cavernous nerve function. Laser energy may potentially allow fine dissection with good hemostasis and minimal adjacent tissue injury. This study examines the electrophysiological, histological and thermal mapping features of KTP laser dissection on cavernous nerve function in the survival canine model. Materials and Methods: A total of 36 dogs were divided into 3 groups. Laparoscopic unilateral neurovascular bundle (NVB) mobilization was performed using either: (1) KTP laser (n=12), (2) ultrasonic shears (US) (n=12), or (3) athermally with cold scissors (AT) (n=12). The contralateral NVB remained undissected as an internal control. NVB function was assessed acutely in all dogs, and after 1-month survival in 50% of the dogs of each group. Peak intracavernosal pressure response to cavernous nerve stimulation was measured as a percentage of mean arterial pressure (ICP/MAP). Strips of peritoneum were sectioned ex-vivo with the KTP laser and US shears for thermographic mapping. Histological evaluation of prostatic fascia necrosis from the cutting surface was also performed. Results: Comparing KTP and AT groups, the erectile response to nerve stimulation was similar acutely and at 1 month (acute ICP/MAP: KTP 92%, AT 96% p=0.54; chronic ICP/MAP: KTP 95%, AT 98% p=0.71). In contrast, US dissection resulted in a significant decrease in the ICP response compared to the KTP and AT groups (acute ICP/MAP: US 49%, KTP 92%, AT 96%. US vs. KTP p<0.001, US vs. AT p<0.001; chronic ICP/MAP: US 58%, KTP 95%, AT 98%, US vs. KTP p=0.02, US vs. AT p=0.02). Mean NVB dissection times were similar (KTP 27.5min, US 19.9min, AT 26.6min, KTP vs. US p=0.21, KTP vs. AT p=0.81, US vs. AT p=0.22). Histopathology demonstrated an acute zone of laser-induced necrosis of approximately 500 um compared to 2 mm with US dissection. Thermographic assessment demonstrated significantly less collateral thermal spread from the KTP laser compared to US (mean thermal spread >60 oC KTP 0.98 mm vs. US 6.25 mm, p<0.0001). Conclusions: Use of KTP laser for NVB mobilization preserved cavernous nerve function comparable to standard athermal techniques using cold scissors and was superior to ultrasonic shears.

Background: Considerable attention has been paid to evaluating the roles and relationships of professionals participating in team-based or collaborative practice; however, less attention has been paid to exploring the patients’ views and impact of such practice despite claims of it being patient-centred. Objectives: To examine the relationship between patient and provider characteristics and patients’ ratings of measures of quality of care and integration, and to explore the patient views of care delivered in a patient-centred collaborative study involving chiropractors and physicians. Design: Cross-sectional survey. Method: A mixed methods sequential approach with a quantitative priority was used in data analysis. Quantitative data were collected from 2597 patients participating in a collaborative study involving chiropractors and physicians and 530 patients attending chiropractors not involved in collaborative care. All participants presented with musculoskeletal pain. The Primary Care Assessment Survey (PCAS) was modified and scores from six of its scales were used to assess attributes of quality patient-centred care between the two study groups. Qualitative transcript-based data from six purposefully selected focus groups was analyzed using an interpretivist approach. Results: The revised PCAS demonstrated acceptable psychometric properties. Patients in both study groups received quality, patient-centred care. Patients’ reporting being completely satisfied and feeling improved by their care was positively associated with rating chiropractors as high performers on all scales. Survey findings were confirmed in focus groups of study patients. Patients appreciated positive interpersonal interactions, sharing in the treatment decision-making process, having a choice in provider and treatment, and the provision of holistic care. Patients perceived that collaboration between chiropractors and physicians varied, favouring those who were co-located. Patients with chronic or co-morbid conditions desired greater involvement in their care. Patients felt sharing of clinical information was more important than co-location as facilitating coordination and integration of collaborative care. Conclusion: The study suggests that patients suffering from musculoskeletal pain benefit from interprofessional collaborative care that includes improved access to and choice of providers and treatment options, as well as enhanced interprofessional communication and coordination of care.

Background: Considerable attention has been paid to evaluating the roles and relationships of professionals participating in team-based or collaborative practice; however, less attention has been paid to exploring the patients’ views and impact of such practice despite claims of it being patient-centred. Objectives: To examine the relationship between patient and provider characteristics and patients’ ratings of measures of quality of care and integration, and to explore the patient views of care delivered in a patient-centred collaborative study involving chiropractors and physicians. Design: Cross-sectional survey. Method: A mixed methods sequential approach with a quantitative priority was used in data analysis. Quantitative data were collected from 2597 patients participating in a collaborative study involving chiropractors and physicians and 530 patients attending chiropractors not involved in collaborative care. All participants presented with musculoskeletal pain. The Primary Care Assessment Survey (PCAS) was modified and scores from six of its scales were used to assess attributes of quality patient-centred care between the two study groups. Qualitative transcript-based data from six purposefully selected focus groups was analyzed using an interpretivist approach. Results: The revised PCAS demonstrated acceptable psychometric properties. Patients in both study groups received quality, patient-centred care. Patients’ reporting being completely satisfied and feeling improved by their care was positively associated with rating chiropractors as high performers on all scales. Survey findings were confirmed in focus groups of study patients. Patients appreciated positive interpersonal interactions, sharing in the treatment decision-making process, having a choice in provider and treatment, and the provision of holistic care. Patients perceived that collaboration between chiropractors and physicians varied, favouring those who were co-located. Patients with chronic or co-morbid conditions desired greater involvement in their care. Patients felt sharing of clinical information was more important than co-location as facilitating coordination and integration of collaborative care. Conclusion: The study suggests that patients suffering from musculoskeletal pain benefit from interprofessional collaborative care that includes improved access to and choice of providers and treatment options, as well as enhanced interprofessional communication and coordination of care.

Adams et al. was the first to demonstrate an association between improved outcomes and provider experience in a 1973 study examining complication rates from coronary arteriograms.[1] In this study, a questionnaire was mailed to the directors of coronary arteriography laboratories throughout the US. They found that mortality was eight times higher in institutions performing fewer than 200 examinations per two-year period compared to institutions performing more than 800 examinations per two-year period. It was not until 1979, however, that efforts to systematically study outcomes in surgery were made by Luft and colleagues.[2] They demonstrated lower mortality rates at high-volume centers compared with low-volume centers for several high risk procedures, such as coronary artery bypass graft surgery (CABG) and vascular surgery. This landmark study set the stage for outcomes research in surgery. Over the past decade, additional studies have continued to show higher surgeon or hospital volumes to be associated with improved patient outcomes. [3-13] To what degree surgeon versus hospital volume each contribute to outcomes is controversial and depends on the procedure examined. Nevertheless, formal recommendations encouraging certain high-risk procedures be performed at high-volume hospitals began as early as 2000 by the Leapfrog group and other policy initiatives.[14, 15] Formal recommendations for surgeon volume, on the other hand, have been lacking. There has been mounting evidence, particularly in the last decade, that surgeon volume is associated with improved patient outcomes, independent of hospital volume. To what measure these data have influenced referral patterns from low- to high-volume surgeons is unknown.

Thesis (Ph. D.)--University of Sydney, 2009. / Title from title screen (viewed Nov. 3, 2009) Includes tables and questionnaires. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Public Health, Faculty of Medicine. Includes bibliography. Also available in print form.

Thesis (M.Sc.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Speech Language Pathology, Department of Speech Pathology and Audiology. Title from pdf file main screen (viewed on January 24, 2010). Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.