Made available in DSpace on 2015-08-20T17:09:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-26. Added 1 bitstream(s) on 2015-08-20T17:27:11Z : No. of bitstreams: 1 000840966.pdf: 294356 bytes, checksum: 390fdd32d2ab5b9506a50b66541d14fc (MD5) / A raiva é uma zoonose transmitida aos mamíferos por meio do contato de ferimentos na pele ou mucosa com a saliva de animais infectados e o tratamento profilático pós-exposição tem sido usado como uma forma de se evitá-la. Este tratamentoébaseado nas características da lesão provocada pelo animal agressor, no seu estado de saúde no momento do acidente, na possibilidade de sua observação por dez dias, na procedência e hábitos de vida do animal e naclassificação epidemiológica da região geográfica onde ocorreu o acidente.Foi realizado um estudo retrospectivo dosdados das fichas de atendimento antirrábico humano do Sistema de Informação de Agravos de Notificação (SINAN), referentes ao município de Araçatuba -SP, no período de 1990 a 2010, com o objetivo de avaliar a conduta adotada para as indicações do tratamento antirrábico humano pós-exposição por agressões de cães e gatos, considerando a situação epidemiológica da doença.O cão foi o principal agressor, ocasionando acidentes em sua maioria leves, a dispensa do tratamento foi a conduta mais adotada tanto no período de raiva não controlada (1990-96) quanto no período de raiva controlada (1997-2010), porém na maioria dos casos em que foi indicado algum tratamento, este foi inadequado. Optou-se preferencialmente pelo tratamento completo com soro e vacina e pelo tratamento de até três doses de vacina Fuenzalida e Palácios ou até duas doses de vacina de cultivo celular em dias alternados. Noperíodo de raiva controlada observou-se com uma melhor adoção das condutas frente às recomendações técnicas quando comparadoaos período de raiva não controlada (p<0,0001), mesmo havendo uma aplicação excessiva de soro e vacinaem ambos o períodos / Rabies is a zoonosis transmitted to mammals by contact of saliva from infected animals with injury in the skin or mucous and the post-exposure prophylactic treatment is the only way to prevent this disease. This treatment is based on the characteristics of the injury caused by the aggressor animal, on his state of health at the time of the accident, on the possibility of their observation for ten days, on the origin and habits of the animal and on the epidemiological classification of the geographic region where the accident occurred. By means of a retrospective analysis of data from the records of rabies prophylactic treatment from Information System for Notification of Diseases (SINAN), concerning to Araçatuba - SP the conducts adopted for treatment of aggression by dogs and cats, considering the epidemiological situation of the disease. The dog was the main aggressor, causing mostly minor accidents, remission of treatment was the most adopted conduct in both period of non controlled rabies (1990-96) and controlled rabies (1997-2010), but, in the majority of cases when any treatment was adopted, this was inadequate. It was decided preferably by the full treatment with the serum and the vaccine and by the treatment with up to three doses of Fuenzalida and Palacius vaccine or up to two doses of cell culture vaccine on alternate days. In the period of controlled rabies there was a better adoption of conducts, based on technical recommendations, when compared to the period of uncontrolled rabies (p <0.0001), even with the excessive application of serum and vaccine in both periods

Resumo: A raiva é uma zoonose transmitida aos mamíferos por meio do contato de ferimentos na pele ou mucosa com a saliva de animais infectados e o tratamento profilático pós-exposição tem sido usado como uma forma de se evitá-la. Este tratamentoébaseado nas características da lesão provocada pelo animal agressor, no seu estado de saúde no momento do acidente, na possibilidade de sua observação por dez dias, na procedência e hábitos de vida do animal e naclassificação epidemiológica da região geográfica onde ocorreu o acidente.Foi realizado um estudo retrospectivo dosdados das fichas de atendimento antirrábico humano do Sistema de Informação de Agravos de Notificação (SINAN), referentes ao município de Araçatuba -SP, no período de 1990 a 2010, com o objetivo de avaliar a conduta adotada para as indicações do tratamento antirrábico humano pós-exposição por agressões de cães e gatos, considerando a situação epidemiológica da doença.O cão foi o principal agressor, ocasionando acidentes em sua maioria leves, a dispensa do tratamento foi a conduta mais adotada tanto no período de raiva não controlada (1990-96) quanto no período de raiva controlada (1997-2010), porém na maioria dos casos em que foi indicado algum tratamento, este foi inadequado. Optou-se preferencialmente pelo tratamento completo com soro e vacina e pelo tratamento de até três doses de vacina Fuenzalida e Palácios ou até duas doses de vacina de cultivo celular em dias alternados. Noperíodo de raiva controlada observou-se com uma melhor adoção das condutas frente às recomendações técnicas quando comparadoaos período de raiva não controlada (p<0,0001), mesmo havendo uma aplicação excessiva de soro e vacinaem ambos o períodos / Abstract: Rabies is a zoonosis transmitted to mammals by contact of saliva from infected animals with injury in the skin or mucous and the post-exposure prophylactic treatment is the only way to prevent this disease. This treatment is based on the characteristics of the injury caused by the aggressor animal, on his state of health at the time of the accident, on the possibility of their observation for ten days, on the origin and habits of the animal and on the epidemiological classification of the geographic region where the accident occurred. By means of a retrospective analysis of data from the records of rabies prophylactic treatment from Information System for Notification of Diseases (SINAN), concerning to Araçatuba - SP the conducts adopted for treatment of aggression by dogs and cats, considering the epidemiological situation of the disease. The dog was the main aggressor, causing mostly minor accidents, remission of treatment was the most adopted conduct in both period of non controlled rabies (1990-96) and controlled rabies (1997-2010), but, in the majority of cases when any treatment was adopted, this was inadequate. It was decided preferably by the full treatment with the serum and the vaccine and by the treatment with up to three doses of Fuenzalida and Palacius vaccine or up to two doses of cell culture vaccine on alternate days. In the period of controlled rabies there was a better adoption of conducts, based on technical recommendations, when compared to the period of uncontrolled rabies (p <0.0001), even with the excessive application of serum and vaccine in both periods / Orientador: Luzia Helena Queiroz / Banca: Cáris Maroni Nunes / Banca: Adolorata Aparecida Bianco Carvalho / Mestre

Introdução: A profilaxia antimicrobiana cirúrgica tem se demonstrado como uma das mais importantes medidas para redução das infecções de sítio cirúrgico. O momento da administração dessa profilaxia é essencial para atingir concentrações terapêuticas nos tecidos durante o procedimento cirúrgico, condição freqüentemente não observada. O objetivo deste estudo foi caracterizar o lapso de tempo transcorrido entre a profilaxia antimicrobiana e o início da incisão cirúrgica. Métodos: Amostra de procedimentos cirúrgicos eletivos realizados em um hospital geral acompanhada mediante observação direta do momento de administração da antibioticoprofilaxia e da incisão. Resultados: Foram analisados 130 procedimentos. A maioria dos pacientes da amostra era do sexo feminino (64,6%). Em 60% dos procedimentos avaliados, os pacientes internaram no mesmo dia da cirurgia e o antimicrobiano mais utilizado foi cefazolina (91,5%). O antimicrobiano profilático foi administrado com uma mediana de 8 minutos antes da incisão, sendo que em 18 (13,8%) procedimentos foi aplicado num tempo maior que 30 min e em 37 (28,5%), foi administrado após a incisão. Em apenas 13,8% a profilaxia foi administrada conforme o protocolo da instituição. As especialidades cujos procedimentos cirúrgicos apresentaram menor freqüência de adequação do horário de administração foram cirurgias plástica (4,5%), urologia (6,7) e vascular (9,1%). Conclusão: Apesar de consagrada, a administração da profilaxia em tempo adequado ainda permanece longe do ideal no nosso meio. As instituições devem adotar medidas eficazes para minimizar a inadequação desta medida. / Introduction: Antimicrobial surgical prophylaxis has been demonstrated as one of the most important steps to reduce surgical site infections. The timing of administration of prophylaxis is essential to achieve therapeutic concentrations in tissues during the surgical procedure, which is frequently not observed. The aim of this study was to characterize the lapse of time between antimicrobial prophylaxis and beginning of surgical incision. Methods: A sample of elective surgeries performed in a general hospital accompanied by direct observation of the timing of administration of antibiotic prophylaxis and the incision. Results: We analyzed 130 procedures. Most of the patients were female (64.6%). In 60% of the procedures evaluated, patients hospitalized on the same day of surgery and antimicrobial more used was cefazolin (91.5%). The antibiotic prophylaxis was administered with a median of 8 minutes before incision, and in 18 (13.8%) procedures were applied to a time longer than 30 min and 37 (28.5%) was administered after the incision. In only 13.8% prophylaxis was administered according to institutional protocol. Whose specialty surgical procedures had lower rates of appropriateness of administration time were plastic surgery (4.5%), urology (6.7) and vascular (9.1%). Conclusion: Although established, the administration of prophylaxis in a timely manner remains far from ideal in our midst. Institutions should adopt effective measures to minimize the inadequacy of this measure.

Submitted by PATRICIA DE FIGUEIREDO VIANA (patricia_patyfv@hotmail.com) on 2018-09-14T19:25:08Z No. of bitstreams: 1 dissertacao Patricia.docx: 903041 bytes, checksum: 045c598106e96a972706e95e8034f67d (MD5) / Rejected by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: problema 1: o arquivo submetido deve, obrigatoriamente, estar em formato PDF. Seu arquivo está em word. Problema 2: Capa No arquivo submetido faltou a capa, item obrigatório de acordo com as normas do seu programa de pós. A capa de ver estar na cor verde e deve conter no alto o nome da Instituição e Faculdade. Assim que tiver efetuado a correção submeta o arquivo, em PDF, novamente. Agradecemos a compreensão. on 2018-09-18T16:35:31Z (GMT) / Submitted by PATRICIA DE FIGUEIREDO VIANA (patricia_patyfv@hotmail.com) on 2018-09-19T02:51:29Z No. of bitstreams: 1 dissertacaomestradopronto.pdf: 523740 bytes, checksum: 6072623628de99f805ad0a900a587f21 (MD5) / Rejected by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: Problema 1: Capa No arquivo submetido a capa não está de acordo com as normas do seu programa de pós. Favor verificar o modelo na secretaria ou com a seção de pós-graduação. Problema 2: No arquivo atual consta uma folha adicional entre a capa e a folha de rosto. Favor verificar. O correto é capa, folha de rosto, ficha catalografica, ... Assim que tiver efetuado a correção submeta o arquivo, em PDF, novamente. Agradecemos a compreensão on 2018-09-20T13:54:20Z (GMT) / Submitted by PATRICIA DE FIGUEIREDO VIANA (patricia_patyfv@hotmail.com) on 2018-09-21T19:23:41Z No. of bitstreams: 1 Patricia_Viana PDF.pdf: 732990 bytes, checksum: c4b2e65c958375384e1f7cc84f03f2e7 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-09-25T13:11:50Z (GMT) No. of bitstreams: 1 viana_pf_me_bot.pdf: 732990 bytes, checksum: c4b2e65c958375384e1f7cc84f03f2e7 (MD5) / Made available in DSpace on 2018-09-25T13:11:50Z (GMT). No. of bitstreams: 1 viana_pf_me_bot.pdf: 732990 bytes, checksum: c4b2e65c958375384e1f7cc84f03f2e7 (MD5) Previous issue date: 2018-07-30 / O Acidente Vascular Cerebral (AVC), ocupou o primeiro lugar das principais causas de morte no Brasil e no mundo no ano de 2015. A ocorrência dessa doença ocasiona um marco na vida dos pacientes e de suas famílias devido às limitações físicas e emocionais apresentadas após a doença. Além disso, as sequelas geram impacto negativo econômico, social e familiar. Para prevenção da ocorrência da doença, se faz necessário controle rigoroso dos fatores de risco. O objetivo principal deste estudo foi avaliar da percepção dos pacientes acometidos de AVC sobre a doença e a eficácia da profilaxia secundária instituída no âmbito ambulatorial. Foram feitas 100 entrevistas com pacientes do ambulatório de Neurovascular, através de um questionário padrão. Foi visto que os pacientes não tiveram uma boa percepção dos sintomas para reconhecer um AVC e a eficácia da profilaxia secundária instituída na alta hospitalar foi bem aderida pelos pacientes, porém a maioria não sabia o motivo pelo qual estavam fazendo uso de tal terapêutica. / Stroke was the leading cause of death in Brazil and worldwide in the year 2015. The occurrence of this disease causes a milestone in the life of patients and their families due to the physical and emotional limitations presented after the disease. In addition, the sequels generate negative economic, social and family impact. To prevent the occurrence of the disease, strict control of risk factors is necessary. The main objective of this study was to evaluate the perception of stroke patients on the disease and the efficacy of the secondary prophylaxis instituted in the outpatient setting. A 100 interview with patients from the Neurovascular Outpatient Clinic was done through a standard questionnaire. It was seen that patients did not have a good perception of symptoms to recognize a stroke and the efficacy of secondary prophylaxis instituted at hospital discharge was well adhered to by the patients, but most did not know why they were using such therapy.

Introdução: A profilaxia antimicrobiana cirúrgica tem se demonstrado como uma das mais importantes medidas para redução das infecções de sítio cirúrgico. O momento da administração dessa profilaxia é essencial para atingir concentrações terapêuticas nos tecidos durante o procedimento cirúrgico, condição freqüentemente não observada. O objetivo deste estudo foi caracterizar o lapso de tempo transcorrido entre a profilaxia antimicrobiana e o início da incisão cirúrgica. Métodos: Amostra de procedimentos cirúrgicos eletivos realizados em um hospital geral acompanhada mediante observação direta do momento de administração da antibioticoprofilaxia e da incisão. Resultados: Foram analisados 130 procedimentos. A maioria dos pacientes da amostra era do sexo feminino (64,6%). Em 60% dos procedimentos avaliados, os pacientes internaram no mesmo dia da cirurgia e o antimicrobiano mais utilizado foi cefazolina (91,5%). O antimicrobiano profilático foi administrado com uma mediana de 8 minutos antes da incisão, sendo que em 18 (13,8%) procedimentos foi aplicado num tempo maior que 30 min e em 37 (28,5%), foi administrado após a incisão. Em apenas 13,8% a profilaxia foi administrada conforme o protocolo da instituição. As especialidades cujos procedimentos cirúrgicos apresentaram menor freqüência de adequação do horário de administração foram cirurgias plástica (4,5%), urologia (6,7) e vascular (9,1%). Conclusão: Apesar de consagrada, a administração da profilaxia em tempo adequado ainda permanece longe do ideal no nosso meio. As instituições devem adotar medidas eficazes para minimizar a inadequação desta medida. / Introduction: Antimicrobial surgical prophylaxis has been demonstrated as one of the most important steps to reduce surgical site infections. The timing of administration of prophylaxis is essential to achieve therapeutic concentrations in tissues during the surgical procedure, which is frequently not observed. The aim of this study was to characterize the lapse of time between antimicrobial prophylaxis and beginning of surgical incision. Methods: A sample of elective surgeries performed in a general hospital accompanied by direct observation of the timing of administration of antibiotic prophylaxis and the incision. Results: We analyzed 130 procedures. Most of the patients were female (64.6%). In 60% of the procedures evaluated, patients hospitalized on the same day of surgery and antimicrobial more used was cefazolin (91.5%). The antibiotic prophylaxis was administered with a median of 8 minutes before incision, and in 18 (13.8%) procedures were applied to a time longer than 30 min and 37 (28.5%) was administered after the incision. In only 13.8% prophylaxis was administered according to institutional protocol. Whose specialty surgical procedures had lower rates of appropriateness of administration time were plastic surgery (4.5%), urology (6.7) and vascular (9.1%). Conclusion: Although established, the administration of prophylaxis in a timely manner remains far from ideal in our midst. Institutions should adopt effective measures to minimize the inadequacy of this measure.

O objetivo deste estudo foi avaliar o possível efeito da saliva in situ, associada ou não ao flúor, sobre a recuperação da estrutura dentária do esmalte desmineralizado, que recebeu profilaxia utilizando jato de bicarbonato de sódio. Para isso, foram utilizados 40 blocos de esmalte de dente bovino de 4x4 mm, os quais foram submetidos a um processo de desmineralização in vitro para a formação de lesões artificiais de cárie. Sobre a superfície destes blocos, foi aplicado o jato de bicarbonato de sódio, simulando a realização de uma profilaxia profissional. Após essa etapa, os blocos foram divididos em dois grupos (GI e GII) e montados em dispositivos intra-bucais, os quais foram utilizados por 10 voluntários, durante dois períodos experimentais de quatro horas. Os blocos do GI foram expostos diretamente à saliva in situ, enquanto os do GII, foram expostos à saliva associada ao flúor sob forma de bochecho com solução de NaF a 0,2%, durante o minuto inicial. No primeiro período experimental, metade dos voluntários fez parte do GI e a outra metade do GII, havendo uma inversão dos grupos no segundo período. As possíveis alterações ocorridas na superfície do esmalte após as etapas do experimento, foram avaliadas através de testes de microdureza Knoop (25g/5s) e da quantificação do desgaste com o auxílio de um rugosímetro. Para a comparação dos valores de microdureza e de desgaste entre os grupos, e entre as etapas de cada grupo, foi aplicada a Análise de Variância a dois Critérios (ANOVA) e o teste de Tukey, adotando-se um nível de significância de 5% (p<0,05). Os resultados do teste de microdureza mostraram uma diminuição, estatisticamente significante, nos valores de microdureza superficial do esmalte após a etapa de desmineralização (183,7KHN), quando comparada à microdureza superficial inicial (342KHN). Em seguida, após a simulação da profilaxia, houve um aumento significante da microdureza (337,3KHN), não havendo diferença estatisticamente significante entre o valor inicial. Quanto ao desgaste, a simulação da profilaxia promoveu um desgaste no esmalte desmineralizado da ordem de 0,709µm. Após a etapa de remineralização, o valor da microdureza diminuiu um pouco em relação ao valor inicial (303,7KHN), embora tenha sido próximo ao mesmo. Em relação ao valor do desgaste, foi observada uma diminuição estatisticamente significante (0,476 µm), o que representa uma diminuição de quase um terço do valor inicial. Não houve diferença estatisticamente significante entre os resultados dos grupos I e II em todas as etapas do experimento. De acordo com as condições e com a metodologia adotadas na presente pesquisa, foi possível concluir que após 4 horas de remineralização in situ houve recuperação de parte da estrutura dentária perdida devido à aplicação do jato de bicarbonato de sódio sobre o esmalte desmineralizado, apesar de a realização de um bochecho adicional com solução fluoretada não ter promovido aumento no ganho mineral em relação à ação somente da saliva. / The aim of this study was to evaluate the effect of saliva in situ, in the recovery of the superficial structure of the demineralized tooth enamel in which a sodium bicarbonate jet was applied. The effect of an additional mouthrinsing with a NaF solution was also evaluated. A total of 40 specimens of bovine enamel (4x4 mm) were processed in vitro to obtain artificial caries lesions were utilized for this study. A jet of sodium bicarbonate was applied on the surface of the specimens simulating a prophylaxis procedure. The specimens were divided in two groups(GI and GII). They were mounted in an intra-oral model used by 10 volunteers for two fourhour experiments. During the first four-hour experiment, the specimens of GI were directly exposed to saliva in situ. Those of GII were exposed to one minute mouthrinsing with 0.2% NaF. In the second four-hour experiment, the volunteers were crossed-over to the opposite experimental treatment group. The changes on the enamel surface were analyzed by the superficial microhardness test (Knoop, 25g/5s) and perfilometry, using a rugosimeter to determine the superficial dental wear. In order to compare the degree of microhardness and wear, among groups in the different experimental phases, the ANOVA and the Tukey test were used with an acceptable significance of 5% (p<0.05). The microhardness test showed a significant decrease of the initial value from 342 KHN to 183.7KHN after the demineralization phase. In the prophylaxis simulation, the microhardness value increased to 337 KHN, while a 0.709 µm wear was detected. After the remineralization procedure, there was a mild decrease on the degree of superficial microhardness to 303.7 KHN. Considering the superficial wear, it was detected a significant decrease (0.476 µm) comparing to the value found after the prophylaxis. There were no statistical differences between GI and GII in all phases of the experiment. After a four-hour period of an in situ remineralization, we concluded that it is possible to have a partial recovery of the dental structure, initially lost due to the use of sodium bicarbonate on the demineralized enamel. The performance of an additional mouthrinsing with fluoridate solution did not lead to an increase in the mineral gain.

Class of 2012 Abstract / Specific Aims: The purpose of this study was to evaluate the effectiveness of various post-operative prophylaxis methods in lung transplant patients by comparing the incidence of venous thromboembolism (VTE) before and after the implementation of a standardized hospital order set at the University of Arizona Medical Center (UAMC) in April 2007. Methods: Paper and electronic medical charts were retrospectively reviewed if patients had a lung transplant date between October 31, 2003 – October 31, 2010. A computerized database was used to collect demographic data, length of stay (LOS), comorbid conditions, prophylaxis type (including dose/frequency), and date/type of thromboembolic events in the post-operative period prior to discharge and up to 1-year post-discharge. Main Results: Ninety-two patient charts were included in the study with 35 charts in the pre-order set (“Before”) group and 57 charts in the post-order set (“After”) group. All baseline characteristics were similar between groups except age (mean age difference 8.1 yrs, p=0.003), use of mycophenolate (Before n=24, After n=54; p=0.002), and use of medications that increase risk of VTE (Before n=6, After n=2; p=0.05). The April 2007 protocol significantly increased the number of patients receiving any method of prophylaxis (p<0.0001). However, receiving prophlyaxis did not significantly reduce event rates or readmissions due to VTE. Conclusions: Although implementation of the April 2007 protocol did not significantly reduce VTE event rates and readmissions, VTE prophylaxis should continue to remain a priority. Adherence to the implemented protocol may reduce the number of patients left without effective methods of prophylaxis.

Class of 2015 Abstract / Objectives: Guidelines from the Brain Trauma Foundation recommend that after traumatic brain injury (TBI) patients should be given seizure prophylaxis for up to seven days. Currently, phenytoin is the first line therapy for this indication. However, levetiracetam is increasingly being used as an alternative because it does not require serum concentration monitoring and has a desirable safety profile. Studies evaluating levetiracetam have used a loading dose, followed by a maintenance dose of 1000 mg every 12 hours. The primary objective of this study was to evaluate the efficacy of low-dose (500 mg every 12 hours) levetiracetam for seizure prophylaxis after TBI. Methods: This was a retrospective cohort study conducted in a tertiary care, academic institution that is designated as a level 1 trauma center. Institutional review board approval was obtained prior to data collection. Consecutive patients with TBI between 2010 and 2012, who received levetiracetam for seizure prophylaxis, were included. Patients who met at least one of the following criteria were included: cortical contusion on computerized tomography scan, subdural hematoma, epidural hematoma, intracerebral hematoma, depressed skull fracture, penetrating head injury, or Glasgow Coma Scale (GCS) of 10 or less. Patients were excluded if they were less than 16 years of age, had a previous head injury, previous neurosurgery, history of seizure, or anti-seizure medication, or were given a loading dose of levetiracetam, or given a maintenance dose greater than 500 mg every 12 hours. The primary outcome was the occurrence of a seizure within seven days of TBI. A one-sample test of proportions was used to compare the rate of seizures while being treated with levetiracetam to a hypothesized value of 3.6 percent (from previous trials), using an a priori alpha for 0.05. Results: There were a total of 146 patients included in the study, who were treated with levetiracetam 500 mg every 12 hours. The median age was 51 years (interquartile range 31 to 65 years), 110 (75 percent) were male, and the median GCS on admission was 11 (interquartile range 5 to 14). The mechanisms of injury were fall (n equals 49), motor vehicle or motorcycle collisions (n equals 42), pedestrian or bicyclist (n equals19), assault (n equals16), suicide attempt (n equals 2), and other (n equals18). The median time to first dose of levetiracetam was 4 hours after injury (interquartile range 1 to 13 hours). After initiation of levetiracetam, there were 5 (3.4 percent) patients who had a seizure within seven days. This was not significantly different than the hypothesized population value (p equals 0.910). The median length of stay was 13 days (interquartile range 9 to 21) and 7 (4.8 percent) patients died during hospitalization. Conclusions: A low-dose of levetiracetam 500 mg every 12 hours after TBI was effective for early seizure prevention. This regimen may be an appropriate alternative to phenytoin or traditional dose levetiracetam for this indication. Future, prospective studies are needed to confirm these findings.

Class of 2015 Abstract / Objectives: To assess the efficacy of fluconazole prophylaxis in the prevention of coccidioidomycosis in the post-heart transplant patient and to identify risk factors for coccidioidomycosis infection. Methods: Heart transplant patients with ICD-9 code V42.1 from October 2001 to October 2013, were selected and electronic medical records were retrospectively reviewed for coccidioidomycosis history, Coccidiodes serologies, reason for transplantation, immunosuppressive drug therapy regimens, rejection treatment course, fluconazole dose, and demographics. Negative Coccidiodes serology results post transplantation relative to negative Coccidiodes serology results prior to transplantation will be determined using a Chi Square test. Risk factors for disease contraction will be analyzed using multivariate logistic regression. Results: Between October 2001 and October 2013, 244 patients received a heart transplant at this institution. Fourteen (5.7%) heart transplant recipients with a negative Coccidiodes serology pre-transplantation had a positive Coccidiodes serology post-transplantation. Nine (64.2%) of those recipients received antifungal prophylaxis (p=0.16). Risk factors for developing a positive Coccidiodes serology included using tacrolimus (p=0.05) and non-ischemic cardiomyopathy (p=0.04). Conclusions: Antifungal prophylaxis does not reduce the risk of developing a positive Coccidiodes serology after heart transplantation. Risk factors for developing a positive Coccidiodes serology include the use of tacrolimus and having non-ischemic cardiomyopathy prior to transplant.

Introduction: Haemophilia is an inherited bleeding disorder caused by a deficiency in one of the coagulation or blood clotting factors in the blood. When injured someone with haemophilia does not bleed more intensely than a person without haemophilia, but they tend to bleed for a much longer time. For people affected by severe haemophilia, the deficiency in coagulation factor can cause spontaneous internal bleeding in joints and muscles, as well as intracranial bleeding, and bleeding in soft tissues (e.g. nosebleeds or bleeding gums). The most common form is Haemophilia A which is caused by a deficiency in factor VIII. Haemophilia B is caused by a deficiency of factor IX and tends to be less severe than haemophilia A. Haemophilia is treated by replacing the deficient coagulation factor in the blood through intravenous injections of factor concentrate. Treatment can be on-demand, where medication is used to treat a bleeding episode; or preventative, where factor replacement treatment is used to increase the concentration of coagulation factor in the blood to prevent bleeding. Most young people with severe haemophilia in the UK follow a preventative treatment regimen (prophylactic treatment or prophylaxis). Patients with severe haemophilia A usually take 3 or 4 injections per week on alternate days, whereas patients with severe haemophilia B usually take 2 or 3 injections per week. There is good evidence that prophylaxis reduces bleeds and joint damage, whilst also improving quality of life. Therefore it is imperative for future health and functioning that young people with haemophilia (YPH) follow the prophylactic regimen they agreed with their haemophilia team. However, reported adherence levels among YPH vary widely (17 - 93%). Additionally, drivers of (non)adherence among YPH specifically have not been evidenced. Aims: The overall aim of the research described in this thesis was to gain a better understanding of the extent to which YPH adhere to their prophylactic treatment, and better understand what drives their (non-)adherence. The aims of the quantitative questionnaire study were to measure levels of adherence among YPH, and to assess whether psychosocial factors that have been shown to be associated with adherence among young people with other chronic illnesses, such as self-efficacy and social support, are also associated with adherence among YPH. Based on previous research on adherence and social cognitive models of illness, it was hypothesised that: - there would be differences between adolescents and young adults in relation to psychosocial correlates of adherence. - higher perceptions of pain and impact of pain would be associated with better adherence (De Moerloose, Urbancik, Van Den Berg, & Richards, 2008; Treil, Rice, & Leissinger, 2007). - higher perceptions of chronicity, consequences and treatment control would be predictive of higher adherence (Chilcot et al., 2010; Horne & Weinman, 2002). - greater perception of necessity of prophylaxis would be predictive of higher adherence whereas concerns about prophylaxis would not be predictive (de Thurah, Nørgaard, Harder, & Stengaard-Pedersen, 2010; Horne et al., 2013; Horne & Weinman, 1999; Llewellyn, Miners, Lee, Harrington, & Weinman, 2003; Wileman et al., 2014). - greater negative mood would be associated with lower adherence scores (Cox & Hunt, 2015; Helgeson, Siminerio, Escobar, & Becker, 2009; Snell, Fernandes, Bujoreanu, & Garcia, 2014). In addition, based on evidence that lower adherence results in worse disease outcomes (Berntorp, 2009; M. J. Manco-Johnson et al., 2007), it was anticipated that non-adherence to prophylaxis would be associated with higher numbers of bleeds and hospital visits. The aims of the qualitative interview studies with YPH, parents of YPH, and haemophilia healthcare professionals were to examine perceptions and experiences in relation to prophylaxis and how they make sense of these experiences. It was anticipated that this would provide evidence to gain a better understanding of the complexities surrounding prophylaxis and of the barriers and facilitators to adherence among YPH.