11 |
The Perceptions and Experiences of Acupuncture users: A New Zealand PerspectiveJakes, Daniel January 2014 (has links)
The use of Complementary and Alternative Medicine (CAM) is now widespread and endeavours are increasingly being made to incorporate CAM into conventional healthcare and move towards Integrative Medicine (IM). To date research has primarily focused on the prevalence of use, and safety and efficacy of CAM; less is known about patients' experiences of and reasons for using specific therapies. While therapeutically diverse, it has been suggested that many CAM modalities share mutually referential ideologies and that people who use them may be motivated to do so by specific health beliefs.
This study focuses on traditional acupuncture in a New Zealand context and investigates users' experiences and perceptions of the therapy, and discusses how personal health beliefs influence usage.
A systematic review of relevant international qualitative research informed the main study, which was carried out using an interpretive phenomenological methodology (Heidegger's approach). Data was gathered from interviews with 12 participants who had recently received treatment from traditionally trained (non-biomedical) acupuncturists.
Thematic analysis suggested that acupuncture was often sought for health conditions (typically of a chronic and benign nature) that are difficult to treat conventionally. Whereas initial access was primarily motivated by ineffective biomedical treatment, personal health beliefs-particularly subscription to holistic and vitalistic ideologies-often inspired more extensive and ongoing use. The therapeutic encounter was interpreted to contain many elements-other than needling-integral to treatment. Outcomes were perceived to be wide ranging, personal and necessarily subjective, and included the relief of symptoms, increased well-being, and changes to understandings and health behaviours.
It is concluded that the attraction of acupuncture for patients and many of its perceived benefits lie in therapeutic components that are ultimately embedded in Chinese medicine (holistic) theories of health. A more pluralistic schema for assessing evidence may be necessary to acknowledge treatment outcomes that are meaningful to patients, and to accommodate the divergent ontologies and practice models of acupuncture, other CAMs and biomedicine. Increased interdisciplinary cooperation and communication is suggested as a means to improve patient safety and satisfaction and as a scenario for moving forward with IM.
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12 |
The reluctant therapist? : the experience of working therapeutically with the older clientCollins, Ruth Elizabeth January 2014 (has links)
The research literature reveals a widespread reluctance on the part of therapists to work with older people therapeutically as it is believed to be an unrewarding experience and of little benefit for this cohort. This is in contrast to empirical research which shows that therapeutic interventions can be effective and beneficial for older people. There is little literature that looks at the lived experience of therapists who work with older people and none from a counselling psychology perspective. It is therefore hoped that gaining a phenomenological understanding of the experience will provide insight and understanding into the lived experience of therapists who work with older adults. The research question was: 'What is the experience of working therapeutically with the older client?' A qualitative methodology, Interpretative Phenomenological Analysis (IPA) (Smith and Osborn, 2003) was employed for both the conduct and the analysis of the research. Purposive sampling enabled the selection of seven participants for whom the research question was relevant. Semi-structured interview were carried out with three counselling psychologists and four therapists. The age range of the participants was 31-68 years; there were two males and five females. Three master themes emerged: (1) in respect of age - doing therapy differently; (2) the impact of the older client on the therapist; and (3) the reluctant therapist. A description of the master themes, and related constituent themes, is presented and discussed. Although these findings are consonant with the relevant research literature, the research is unique in capturing not only the therapist's lived experience but that of the counselling psychologist as well. It is therefore an important and significant contribution to the field of therapeutic work with older people and a vital addition to the counselling psychology literature. The results of the analysis and implications for counselling psychology are discussed.
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13 |
Evaluation of Newer Drug Therapies for Hepatitis C at a Specialty PharmacyGarfunkel, Michelle, Hoehn, David, Thompson, Kayleen, Mathews, Kelly, Patel, Sarjit January 2016 (has links)
Class of 2016 Abstract / Objectives: To compare the SVR12 rates of newer hepatitis C therapies, approved between November 2013 and December 2014, in patients at Avella Specialty Pharmacy to SVR12 rates from published literature. Insurance coverage rates will be compared to determine a difference among insurances.
Methods: Data were collected electronically from patient charts utilizing the existing computer system and manually through chart review. A complete data collection form in excel compiled the collected data and included the SVR12 rates by therapy, and sub-analysis data such as demographic and descriptive variables. Therapies included Harvoni, Olysio + Sovaldi ± Ribavirin (RBV), Viekira Pak ± RBV, or Sovaldi + RBV. Demographic and descriptive variables included gender, medical insurance, hepatitis C genotype, fibrosis score, treatment-experienced, treatment-naïve, and adverse effects. Insurance coverage rates were also collected through a separate electronic report.
Results: A total of 578 patients were included in the analysis of SVR12 (mean age = 59, 60% male). There were 50% of patients with genotype 1a, 18% had cirrhosis, and 60% were treatment-naïve. The overall SVR12 rate achieved by patients at Avella was not significantly different from published clinical trials (91% vs 91%, p = 0.75). Data for coverage rates included a total of 6,284 patients and revealed that Medicare had the highest coverage rate (85%) while Medicaid had the lowest (30%).
Conclusions: Newer hepatitis C therapies used in a real world setting had similar SVR12 rates to published literature. Medicaid had a lower coverage rate compared to Medicare and commercial insurances while Medicare had the highest coverage rate.
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14 |
An Analysis of Intentional Kinesthetic Empathy: A Somatic Therapeutic ApproachVilaplana, Talia B 01 January 2016 (has links)
This paper examines the role and significance of kinesthetic empathy through a framework modeled in Dance/Movement Therapy. With the innate capacity to connect with others, understand ourselves in greater depth, and learn about the world around us, this paper argues for the human importance of creating empathy in intersubjective dynamics and relations, for the betterment of all parties involved. A system of phases is proposed which includes biological and psychological factors to create a model for intentional kinesthetic empathy. The model looks at empathy through the lens of kinesthesia, as the most authentic way to create this empathic potential to be used as a learning tool.
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15 |
Targeting hammerhead ribozymes against hepatitis B virusSmith, Richard January 1998 (has links)
No description available.
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16 |
Evaluation of combination therapy for Clostridium difficile infections at an academic hospitalStehmer, Theresa, Campbell, Jackie January 2012 (has links)
Class of 2012 Abstract / Specific Aims: The incidence of non-response, recurrence, relapse, and rate of complications of Clostridium difficile infections treated with combination of metronidazole and vancomycin versus vancomycin or metronidazole alone over a one-year period by treatment and strain type (i.e. NAP1/BI/027) were evaluated. The incidence of mortality in patients with moderate to severe Clostridium difficile associated diarrhea prescribed metronidazole, vancomycin, or combination metronidazole plus vancomycin as initial therapy was also determined. Additionally, significant factors associated with the use of combination vancomycin-metronidazole as initial therapy for moderate to severe CDAD were characterized.
Methods: T This retrospective medical record review has been approved by the Institutional Review Board. Adult patients with stool specimens tested for detection of Clostridium difficile toxin B by PCR between April 2010 and March 2011 at a tertiary care, academic medical center were evaluated. Patients were included in the study if diagnosed with moderate to severe disease and received either monotherapy with metronidazole, monotherapy with oral vancomycin, or combination therapy with metronidazole and oral vancomycin for at least 80% of the first 10 days of treatment. Patients who are discharged alive within 72 hours of admission or who received therapy for less than 48 hours were excluded.
Main Results: All patients (N=411) with laboratory evidence of Clostridium difficile during the study time period were evaluated. A total of 26 subjects who received oral vancomycin monotherapy and 56 subjects who received oral vancomycin along with metronidazole for at least 80% of the first 10 days of treatment were identified. Of the subjects who received oral vancomycin monotherapy during the first ten days of therapy, 5 (19%) were classified has a treatment failure or died within the first 21 days of therapy and 5 (19%) had either a recurrence or reappearance of Clostridium difficile associated diarrhea between 22 and 65 days post start of therapy. Of the subjects who received a combination of oral vancomycin and metronidazole during the first 10 days of therapy, 14 (25%) were classified has a treatment failure or died within the first 21 days of therapy and 22 (39%) had either a recurrence or reappearance of Clostridium difficile associated diarrhea between 22 and 65 days post start of therapy. In the combination therapy group, 5 (9%) were reported to have an ileus, toxic megacolon, or necrotic bowel during the first 10 days of therapy.
Conclusions: In this study, the subjects who received a combination of oral vancomycin and metronidazole had higher rates of clinical failure, death, and recurrence than subjects who received monotherapy. Current guideline statements recommend combination therapy only in patients with an ileus with Clostridium difficile-associated diarrhea.
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17 |
What role do psychosocial factors play in influencing HIV positive people's compliance with medical treatment?Gavriilidou, Margarita January 2013 (has links)
Antiretroviral therapy has given hope and expectations for a better life to HIV positive individuals, however, HIV medication cannot be effective without HIV positive individuals’ compliance to it. This study investigated the ways in which living with HIV and taking medication is located within the psychological, social and cultural context of everyday life and relationships in Greece. It also examined gender and identity issues, which make compliance/non-compliance understandable from the HIV positive peoples’ perspective. In addition, emphasis was given to locating compliance to medical regimes in which the perspectives of HIV positive persons were prioritised and understood in relation to relationships with health care professionals. A mixed methods approach was undertaken to provide understanding of compliance and non-compliance factors to HIV medication in a holistic way. A self-completed questionnaire was used to examine the psychosocial factors underpinning compliance to medication. Face-to-face semi-structured interviews were used to explore issues of identity, gender, relationship between doctors and patients and social understandings of HIV. Finally, self-completed weekly diaries were used to document compliance actions, thoughts and feelings in order to reveal the ways medical regimes fit into everyday life. The study was conducted in three Public Hospitals, one Governmental Hospice and one Non-governmental Organization. Eighty (63 males and 17 females) Greek HIV positive patients completed the questionnaire. Interview sample consisted of 7 and 3 males and females respectively. Finally, 6 Greek HIV positive males and 3 females completed the diaries of the research. The questionnaire data was analysed using descriptive statistics via SPSS 11. In addition, a range of non-parametric tests (Mann Whitney and Kruskal Wallis) were used in order to check if ordinal variables influence compliance with HIV medication. Finally linear regression analysis was used in order to establish the influence of factors on compliance with HIV medication. Interviews and the diaries data were analysed though thematic analysis, focusing on identification of patterns and behaviours which were then interpreted in terms of themes. The findings of the study indicated that, when support was given from life partners compliance with HV medication was increased. However, when support was given from family members, compliance with HIV medication was decreased. According to the findings, family dynamics have changed in several cultures over recent decades, partner roles have changed especially in the west and in Mediterranean societies. In regards to 6 medicalization in everyday life, the study showed that when individuals were experiencing side effects, or had fears of future side effects, religious issues (punishment for homosexuality), loss of one’s freedom due to medication, non-compliant behaviours could occur. Finally, the study indicated that some HIV positive individuals perceived their health levels as good and believed that not taking medication once or twice a week was a compliant behaviour. Hence, false perceptions regarding health levels and compliance issues could lead to non-compliant behaviours. A further examination on the communication patterns of the family system and its impact on HIV positive individuals is recommended as it is clearly not very helpful any more. Further exploration of the general socio-cultural positioning of Greece is recommended as certain HIV positive individuals coped with HIV diagnosis and taking medication, by rejecting it. Finally, the need for psychological support is recommended as it is very rarely provided within the Greek health care system.
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18 |
Inhibition of Human Immunodeficiency virus replication through small RNA-induced gene silencing of HIV-1 Tat specific factor 1Green, Victoria Andress 14 February 2012 (has links)
Ph.D., Faculty of Health Sciences, University of the Witwatersrand, 2011 / The
HIV-‐1
pandemic
continues
unabated.
Although
treatments
exist
that
can
substantially
alleviate
the
morbidity
and
mortality
associated
with
HIV,
there
is
still
a
need
for
improved
anti-‐HIV
treatments
that
reduce
toxicities
and
administration
frequency
and
mediate
sustained
inhibition
of
viral
replication.
Given
the
high
mutability
and
variability
of
the
virus,
a
strategy
that
is
garnering
increasing
focus
is
the
targeting
of
host
factors
that
the
virus
requires
to
replicate,
so-‐called
HIV-‐dependency
factors
(HDFs).
It
is
hoped
this
will
reduce
the
emergence
of
viral
drug
resistance.
A
number
of
genome-‐wide
screens
have
been
performed
to
identify
HDFs,
although
many
remain
to
be
validated,
particularly
in
relevant
cells
lines.
An
objective
of
this
thesis
was
to
validate
three
host
factors
as
HDFs,
in
both
TZM-‐bl
reporter
and
T
cell-‐derived
cell
lines,
and
to
examine
their
potential
as
anti-‐HIV-‐1
therapeutic
targets
through
exploitation
of
the
cellular
gene
silencing
pathway,
RNA
interference
(RNAi).
These
were
HIV-‐1
Tat
specific
factor
1
(HTATSF1),
DEAD
(Asp-‐Glu-‐Ala-‐Asp)
box
polypeptide
3,
X-‐
linked
(DDX3X)
and
SWI/SNF
related,
matrix
associated,
actin
dependent
regulator
of
chromatin,
subfamily
b,
member
1
(SMARCB1),
selected
because
they
had
been
previously
implicated
in
HIV-‐
1
pathogenesis.
The
well-‐characterised
HDF,
PC4
and
SFRS1
interacting
protein
1
(PSIP1)/lens
epithelium-‐derived
growth
factor
(LEDGF)/p75,
was
included
in
the
study
as
a
positive
control.
Cassettes
expressing
short
hairpin
RNAs
(shRNAs)
targeting
the
four
host
proteins
were
generated,
although
shRNAs
did
not
suppress
endogenous
ddx3x
mRNA
levels.
The
ability
of
shRNAs
to
inhibit
HIV-‐1
replication
in
the
reporter
cell
line,
TZM-‐bl,
was
examined.
These
HeLa-‐
derived
cells
are
permissive
for
R5-‐tropic
HIV-‐1
infection
and
contain
an
integrated
luciferase
gene
driven
by
the
viral
promoter.
shRNAs
mediated
a
dose-‐dependent
inhibition
of
luciferase
activity
in
cells
infected
with
a
HIV-‐1
subtype
B
molecular
clone
and,
although
production
of
the
viral
protein
p24
was
unaltered,
infectious
particle
production
was
decreased
in
cells
treated
with
a
shRNA
suppressing
HTATSF1.
Little
effect
was
observed
with
a
shRNA
targeting
SMARCB1,
suggesting
that
this
may
not
function
as
an
HDF
under
these
conditions.
No
effect
on
infectious
particle
production
was
seen
with
the
shRNA
targeting
PSIP1,
which
was
a
result
of
the
long
half-‐
life
of
this
protein,
highlighting
a
limitation
of
using
such
reporter
systems
for
HDF
validation.
Importantly,
shRNAs
were
not
associated
with
any
cytotoxic
effects
in
TZM-‐bl
cells.
Whether
HTATSF1
is
a
potential
therapeutic
target
was
interrogated
further
in
the
more
relevant
T
cell-‐derived
SupT1
cell
line.
Lentiviruses
were
used
to
generate
populations
where
>90%
had
one
copy
of
the
integrated
shRNA
expression
cassette.
Replication
of
the
subtype
B
molecular
clone
p81A-‐4
was
significantly
inhibited
in
the
shH1-‐expressing
SupT1
cell
line,
which
targets
HTATSF1,
for
over
14
days
post-‐infection,
although
inhibition
was
not
as
pronounced
asthat
observed
in
the
shP1-‐expressing
SupT1
cell
line,
which
targets
PSIP1.
In
contrast
to
a
previous
report,
no
change
in
the
ratio
of
unspliced
to
singly-‐
or
multiply-‐spliced
HIV-‐1
transcripts
were
detected
in
shH1-‐expressing
SupT1
cells,
suggesting
that
HTATSF1
does
not
function
as
a
splicing
cofactor
in
this
system.
A
slight
rebound
in
p24
levels
at
14
days
post-‐infection
was
accompanied
by
increased
HTATSF1
expression
and
a
decrease
in
the
percentage
of
cells
with
transgene
expression
in
the
population.
In
addition,
there
was
a
slight
decrease
in
shH1-‐derived
guide
strand
expression,
but
no
change
in
transcription
rates
of
the
htatsf1
gene,
suggesting
that
cells
within
the
population
with
shH1
expression
and
HTATSF1
suppression
may
have
a
growth
disadvantage.
Thus,
although
this
work
demonstrates
for
the
first
time
that
HTATSF1
functions
as
an
HDF
in
T
cell-‐derived
SupT1
cells,
it
may
not
constitute
a
viable
therapeutic
target.
A
second
objective
of
this
thesis
was
to
examine
the
feasibility
of
transcriptional
gene
silencing
(TGS)
of
HDFs
as
an
anti-‐HIV
strategy.
TGS
is
a
small
RNA-‐induced
gene
silencing
pathway
that
operates
through
chromatin
remodelling
with
the
potential
to
mediate
long-‐term
silencing
of
gene
expression.
Thus,
its
application
may
reduce
the
frequency
of
drug
administration
and
associated
toxicities.
Short
interfering
RNAs
(siRNAs)
targeting
the
htatsf1
promoter
were
able
to
reduce
target
mRNA
expression,
which
was
accompanied
by
decreased
htatsf1
transcription
rates
in
HEK293T
cells,
suggesting
silencing
via
a
TGS
mechanism.
The
htatsf1
silencing
inhibited
infectious
HIV-‐1
particle
production
from
TZM-‐bl
cells.
This
work
provides
proof
of
principle
that
TGS
induction
at
a
HDF
may
inhibit
HIV-‐1
replication.
siRNAs
targeting
the
ddx3x
promoter
did
not
induce
TGS.
To
examine
whether
gene
susceptibility
to
TGS
may
be
influenced
by
promoter
architectures,
49
promoter
features
were
examined
for
enrichment
in
genes
at
which
small
RNA-‐induced
TGS
has
been
reported.
Initially,
the
TGS
group
was
compared
to
a
random
set
of
2,000
promoters
and
then
all
other
promoters
in
the
genome.
To
control
for
gene
activation,
two
further
analyses
were
performed
comparing
the
TGS
group
features
to
those
from
promoters
active
in
the
THP-‐1
cell
line
and
housekeeping
genes.
Whilst
difficult
to
ascribe
differences
between
the
TGS
group
and
the
control
groups
to
anything
beyond
a
variation
in
the
proportion
of
active
genes
within
each
group,
there
was
enrichment
for
certain
promoter
features
that
are
independent
of
activity;
the
TGS
group
was
characterised
by
broad
transcription
start
regions,
high
CpG
content
and
a
single
expression
profile.
Moreover,
the
fraction
of
promoters
with
reported
non-‐coding
RNA
overlap
was
greater
in
the
TGS
group
than
the
control
groups.
Thus,
there
is
some
evidence
that
a
number
of
promoter
features
are
associated
with
TGS
susceptibility.
It
is
hoped
this
novel
analysis
will
facilitate
selection
of
future
TGS
targets,
including
HDFs.
In
summary,
the
work
presented
in
this
thesis
paves
the
way
for
development
of
improved
anti-‐HIV
therapies
involving
HDF-‐targeted
TGS-‐based
gene
therapies
that
mediate
sustained
inhibition
of
the
virus.
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19 |
The clinical effects of neuromodulation therapies in the treatment of faecal incontinenceThin, Noel N. K. S. January 2016 (has links)
Background and Aims Sacral nerve stimulation (SNS) is an established therapy for faecal incontinence (FI). Percutaneous tibial nerve stimulation (PTNS) is a newer, less-invasive treatment. The effectiveness, cost and acceptability of these treatments have not been systematically compared. Methods A systematic review of neuromodulation interventions for FI and an investigator-blinded, randomised pilot trial of PTNS vs. SNS including parallel quantitative (clinical outcomes and cost) and qualitative studies. Results The systematic review determined on intention-to-treat, the median success rates for SNS were 63% (range 33-66%), 58% (range 52-81%) and 54% (range 50-58%) in the short, medium and long terms respectively. The success rate for PTNS was 59% at 12 months. In the pilot trial: 40 patients (39 female; mean age 59 years) met eligibility criteria. As designed, 23 were randomised to receive SNS and 17 PTNS. 15 patients progressed to permanent SNS implantation and 16 patients received a full course of PTNS. Within group effect sizes were marginally greater for SNS than PTNS on available case analysis. FI episodes per week at baseline, 3 months and 6 months follow-up: SNS median 5.75 (IQR 5.75-15.5 ) [mean 11.4 (SD 12.0)], 2.5 (2-4.5) [4.0 (4.0)], 1.75 (1.5-5) [4.9 (6.9)], vs. PTNS median 6.5 (IQR 2.5- 16.5) [mean 10.6 (SD 11.2)], 3.5 (0.75-7.25) [5.8 (6.9)], 2.5 (0.75-10.75) [6.3 (6.9)]. At least 50% improvement in FI episodes per week at 6 months: SNS 61% vs. PTNS 47%. Effect estimates for SNS with chronic implanted stimulation were larger (67% at 6 months). Clinical FI scores and quality of life improvements complemented these results. Qualitative analysis demonstrated a very high acceptability and safety profile for both treatments. Total costs were £2,906 (SD £122) per patient for PTNS and £12,748 (SD £4,175) for SNS. Conclusions Definitive trial data between SNS or PTNS is lacking. This RCT pilot study determined that in the short-term, SNS confers a small clinical benefit over PTNS for FI but is much more expensive.
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20 |
The negotiation of blame in family therapy with families affected by psychosisAmoss, Sarah January 2014 (has links)
Despite wide agreement in the systemic field that therapists should take a non-blaming stance, historically there has been little exploration of how this stance is achieved in practice. The difficulty in knowing how to put ‘non-blaming’ into practice is further heightened by competing models of intervention with families affected by psychosis. This study contributes to a body of literature that is concerned with how complex issues of morality are achieved dialogically by considering how family therapists manage the tension of intervening to promote change whilst maintaining a multi-partial, non-blaming stance. Two therapies carried out with families affected by psychosis are analysed using the methods of Conversation Analysis (CA) and Membership Categorization Analysis (MCA). In both therapies the sequences examined are drawn from the second session of therapy where explicit blaming events occur. By examining blaming events chronologically through the course of a session the study shows how the rules about the way blame is talked about are achieved interactionally. The analysis demonstrates that systemic theory’s emphasis on the importance of being non-blaming is grounded in a sophisticated understanding of the threat blame poses to co-operation and agreement. In both therapies, the delicacy and ambiguity with which blame is treated serves to enable the conversation to continue without withdrawal. However the cost of ambiguity is a possible misunderstanding of the intent of the speaker. The resulting misalignment, where it continues over several turns and sequences, leads to explicit blame becoming relevant as a solution to a redundant pattern of interaction. The findings indicate that the management of blame requires both the exploration of blame and its interruption when emotions and conflict run high. The former enables understanding and movement towards therapeutic goals while the latter is necessary to promote therapeutic and family alliances. An unintended consequence of the injunction to be non- blaming might be the premature closing down of topics, militating against problem resolution. The study concludes that CA and MCA offer a wealth of knowledge about mundane conversational practices that can be applied fruitfully to systemic therapy process research, teaching and supervision.
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