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Kopec, David M., and Jeffrey J. Gilbert. "Overseed Greens Trial 1997-1998." College of Agriculture and Life Sciences, University of Arizona (Tucson, AZ), 2001. http://hdl.handle.net/10150/216391.
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Perennial ryegrass germplasm was quicker to establish plot cover on a "Tifgreen" bermudagrass green than that of Poa trivialis when used alone. Poa trivialis alone produced lighter color turfs when compared to perennial ryegrass. Turfgrass color was generally uniform in appearance, however, within each entry. Therefore, color as a selection criteria is a matter of choice by the user. The turfgrass mixture "Catalina/Winterplay" (80% perennial ryegrass/20% Poa trivialis) was intermediate in turfgrass color. "Brightstar II" PR generally produced a dark turf throughout the growing season. For overall turfgrass quality, the perennial ryegrasses generally out performed the Poa trivialis germplasm. The mixture of "Catalina/Winterplay" produced a very dense turf, followed closely by "Turfstar Plus" PR, "95-1" PR and "PT-4" PT. ASnowbird@ PT had the least amount of living ground cover by May 31, which is desirable from a transition standpoint.
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Gray, Richard John. "A randomised controlled trial of medication management training for CPNs." Thesis, King's College London (University of London), 2001. https://kclpure.kcl.ac.uk/portal/en/theses/a-randomised-controlled-trial-of-medication-management-training-for-cpns(34bd9a07-da06-41f0-9002-222233ef3eba).html.
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Mancino, C. F., D. M. Kopec, A. E. Ralowicz, A. Maricic, and D. Nelson. "1989 Tall Fescue Variety Trial." College of Agriculture, University of Arizona (Tucson, AZ), 1989. http://hdl.handle.net/10150/216074.
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Tall fescue is a very heat and drought tolerant, cool season turf, which can remain green throughout the year in the arid Southwest. Data are lacking on the performance of tall fescue varieties in this location. Sixty-five tall fescue entries were established in November 1987 and their performance as a home-lawn turf rated for quality, color, density, percent ground cover, pest incidence and water use. All varieties performed very well during the first seven months of 1989, but a decline in August quality was observed during summer monsoons mainly due to the incidence of large brown patch (Rhizoctonia solani L.) and record-setting high temperatures. Turf still showed signs of stress by mid-September. Turfgrass irrigation water use from 1 January to 23 September totalled 43.3 inches (1100.5 mm) and averaged 63 % of predicted evapotranspiration.
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Mancino, C. F., D. M. Kopec, L. Salo, and R. Bermudez. "1988 Tall Fescue Variety Trial." College of Agriculture, University of Arizona (Tucson, AZ), 1988. http://hdl.handle.net/10150/215829.
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O'Neill, Katherine M. "The psychological management of chronic low back pain : a controlled trial." Thesis, University of Surrey, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321037.
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Townsend, Daphne. "Clinical trial of estimated risk stratification prediction tool." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27926.
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This work presents doctors with a model of the estimated degree of risk of rare and important neonatal outcomes to aid in better decisions and improved allocation of equipment and resources. An extensive list of admission day parameters is reduced to minimum variable sets to create models for outcomes that are relevant to decision-making in the neonatal intensive care unit. Models are applied to a special collection of cases and compared to neonatologists' risk estimates. A comparative analysis of physician's predictions and the models' discrimination abilities highlights areas of success and areas that can be improved for future trials. Doctors responded positively to the prediction interface concept and to the estimated risk stratification models. Physicians' strengths identified outcomes that could benefit from increased sensitivity.
A substantial effort was made to conduct the usability and performance evaluations within the ethical standards that are especially important for engineering healthcare management applications.
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Strong, Vanessa April. "The management of major depressive disorder in cancer patients : a randomised trial." Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/29385.
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MDD in cancer patients demands attention as it is a major determinant of quality of life, is associated with non-adherence to treatment, with greater functional impairment or disability, with increased medical costs and is associated with suicide and with an increased risk of death from all causes. However, there is only limited evidence to inform its treatment. In this thesis I describe the development of a nurse-delivered psychiatrist supervised multi-component intervention (problem-solving therapy, coordination of antidepressant drug treatment with primary care, and active monitoring and follow up of the patient’s progress) for the management of MDD in cancer patients and its evaluation in a randomised controlled clinical trial (RCT). 200 Outpatients with varied cancer diagnoses and stages, meeting criteria for MDD were randomly assigned in a single-centre two-arm RCT to receive either optimised usual care or optimised usual care plus the intervention. A clinically and statistically significantly better outcome was observed for patients who had received the intervention (difference of adjusted mean Symptom Check-List-20 score of 0.34; 95% CI 0.13 to 0.55) three months after trial entry. This trial provides evidence of efficacy. Further research is needed to test the efficacy of multi-component interventions for patients with poor prognosis cancers and to test the effectiveness of the intervention in normal clinical practice in a range of settings.
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Park, Janet. "Randomized controlled trial for stress and anxiety management| biofeedback and mindfulness meditation." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1568670.
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<p> The present study investigated the efficacy of two brief intervention programs, biofeedback and mindfulness meditation, on levels of state anxiety and perceived stress in Thai nursing students beginning clinical training. Eighty-nine participants from a public nursing college in Thailand were randomly assigned to one of two experimental groups, biofeedback group or mindfulness meditation group, or a control group. All participants were given pre- and post-intervention surveys including demographic information, the State-Trait Anxiety Inventory (State Anxiety Scale), and Perceived Stress Scale. Results indicated that biofeedback significantly reduced anxiety and maintained stress levels in nursing students. Mindfulness meditation similarly reduced anxiety levels while also significantly reducing stress levels. Additionally, the biofeedback group exhibited significant reduction in anxiety levels among the three groups at post-intervention. Despite the stressors and demands nursing students can experience as they begin clinical practice, findings from this study support the effective use of biofeedback and mindfulness meditation interventions to assist nursing students in managing stress and anxiety.</p>
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Golley, Rebecca Kirsty, and rebecca golley@gmail com. "FAMILY-FOCUSED MANAGEMENT OF OVERWEIGHT IN PRE-PUBERTAL CHILDREN A RANDOMISED CONTROLLED TRIAL." Flinders University. Medicine, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061018.021848.
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Over a quarter of children and two thirds of adults in Australia are overweight, with these estimates reflecting global trends. The literature review in Chapter 1 highlights that treatment of childhood overweight is an important part of the public health approach required to address the obesity epidemic. Energy moderation, behaviour modification and family support are the cornerstones of treatment of childhood overweight. However the evidence to guide best practice is limited, with a call being made for well designed studies to inform age-appropriate effective, long term child weight management. Studies are needed in a range of populations and to assess a range of health outcomes. This thesis tested the hypothesis that, pre-pubertal children whose parents participate in a parent-led, family-focused child weight management intervention comprising parent skills training and intensive lifestyle education will have adiposity, metabolic profiles and indicators of physical and psychosocial functioning after 12 months that are a) improved compared to children wait listed for intervention and b) no different to children whose parents participate in parenting skills training alone (without intensive lifestyle education).
Methods of the randomised controlled trial undertaken with 111 overweight, pre-pubertal 6-9 year olds to test this hypothesis are detailed in Chapter 2. Parents were defined as the agents of change, responsible for attending intervention sessions and implementing family-focused lifestyle change to support child weight management. Two interventions, both utilising parenting skills training, but differing in the presence or absence of intensive lifestyle eduction were compared to a group waitlisted for intervention with a brief pamphlet. Program effectiveness was defined in terms of adiposity together with broader health and evaluation outcomes.
Chapter 3 describes the study population, their flow through the study, the primary outcome BMI z score and waist circumference z score. With parenting plus intensive lifestyle education there was a 10% reduction in BMI z score over 12 months. However this was not statistically different to the 5% reduction observed with parenting alone or intervention waitlisting. There was a significant reduction in waist circumference between baseline and 12 months with parenting alone and parenting plus lifestyle education, but not waitlisting. There was a group, time and gender interaction, with boys receiving intervention having greater reductions in adiposity. In determining intervention effectiveness, growth, metabolic profile and psychosocial outcomes are presented in Chapter 4. While there were limited improvements in metabolic profile and body dissatisfaction, significant improvements were observed in parent-perceived HR-QOL relating to psychosocial and family functioning. Improvements were confined to the intervention groups, parenting plus lifestyle education more than parenting alone. Chapter 5 presents the study process and impact evaluation. Parents were satisfied with the program and reported that it provided the type of help they wanted. Personal, rather than program factors such as work and family commitments limited intervention attendance to 60%. Child health behaviours and parental weight status show positive change in all groups, but favour intervention. Chapter 6 highlights key findings, study strengths/limitations and areas for further research. In conclusion, a parent-led family-focused intervention utilising parenting skills training and healthy family lifestyle is a promising intervention for young overweight children.
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Murray, Ellen Theresa. "Quality assurance for anticoagulation self-management (QAASM) : development, implementation and randomised trial evaluation." Thesis, Birmingham City University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.479117.
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Matheron, Michael E., and Martin Porchas. "Management of Powdery Mildew on Cantaloupe: Efficacy of Fungicides in 1995 Field Trial." College of Agriculture, University of Arizona (Tucson, AZ), 1996. http://hdl.handle.net/10150/214736.
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Powdery mildew of cantaloupe and other melons in Arizona is caused by the plant pathogenic fungus Sphaerotheca fuliginea. The disease is found in melon fields each year; however, the incidence and severity of the disease is quite variable. Disease development is favored by low relative humidity, moderate temperatures, and succulent plant growth. Potential new fungicides were evaluated for disease management in a field trial conducted in the spring of 1995. In this study, BAS-490 and Reach provided the highest level of efficacy among the materials and rates tested. Generally, lower levels of disease led to increased yield of marketable fruit.
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Matheron, Michael E., and Martin Porchas. "Management of Downy Mildew on Broccoli: Efficacy of Fungicides in 1996 Field Trial." College of Agriculture, University of Arizona (Tucson, AZ), 1996. http://hdl.handle.net/10150/214749.
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Downy mildew of broccoli is caused by the plant pathogenic fungus Peronospora parasitica. Cool damp weather with high humidity is highly favorable for sporulation, dissemination of spores, and infection by this pathogen. The severity of disease is affected by the duration of weather conditions favorable for disease development. Potential new fungicides were evaluated for disease management in a field trial conducted in 1996. Disease pressure was moderate and all tested fungicides except Ridomil MZ 72 and one Ciba G + Mancozeb treatment significantly reduced the number of downy mildew lesions on leaves compared to plants not treated with a fungicide. The level of disease reduction provided by all chemical treatments was equivalent to that given by Aliette and Bravo, two fungicides currently available for control of downy mildew on broccoli.
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Ackatia-Armah, Robert Samuel. "Community-based management of acute malnutrition in Malian children: a cluster randomized trial." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12704.
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Thesis (Ph.D.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.<br>Acute malnutrition (AM), characterized by wasting, affects 55 million children under five years of age in developing countries. In Mali, the prevalence of AM exceeds 15% in some seasons. There is currently no consensus on the most effective dietary treatment strategy for children with moderate AM (MAM).
Twelve health centers in rural Mali were randomly assigned to provide children with MAM (defined as mid-upper arm circumference (MUAC) < 12.5 and ≥ 11.0 cm or weight-for-length Z-score (WLZ) <-2.0 WHO standard and >70% NCHS reference median) 1 of 4 dietary regimens: 1) lipid-based, ready-to-use supplementary food (Supplementary Plumpy, SP); 2) special corn soy blend for MAM (CSB++); 3) locally processed, fortified food (Misola, MI); or 4) locally milled flours (millet and cowpea) plus oil, sugar and micronutrient powder (HFM). 1264 non-edematous children aged 6-35 months with MAM were offered ~500 kcal/d of assigned diet in addition to their usual food intake for 12 weeks. Hemoglobin (Hb) was measured in 1154 children, and plasma ferritin and transferrin receptor were measured in a subset of 452 children.
1178 children (93.2%) completed the study and attendance at weekly/bi-weekly follow-up visits was >85% in all groups. The adjusted mean (95% CI) change in weight in kg from baseline was greater with SP and CSB++ than other regimens (1.16 (1.08, 1.24), 1.04 (0.96, 1.13), 0.91 (0.82, 0.99), 0.83 (0.74, 0.92) for the respective study groups, p<0.001 ANOVA). MUAC changes followed a similar pattern. For length, SP and CSB++ differed significantly from HFM only. Recovery from MAM (defined as WLZ>-2.0, MUAC> 12.5cm) was higher with SP than the three other regimens (73%, 68%, 61%, 58% respectively, p less than O.OOO1). Total cost per treatment based on median time to recovery was $2.20 for SP, $1.43 for CSB++, $1.83 for MI and $1.65 for HFM. Anemia rates remained high (>81 %) in all groups after treatment. SP generally provided greater improvement in iron status compared to MI while CSB++ and HFM had intermediate effects.
SP was more effective than other dietary regimens for the treatment of MAM and improvement of iron status; however, the benefits must be considered in relation to product costs and availability.
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Ware, Lorraine, Tatsuki Koyama, Dean Billheimer, et al. "Advancing donor management research: design and implementation of a large, randomized, placebo-controlled trial." BioMed Central, 2011. http://hdl.handle.net/10150/610331.
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BACKGROUND:Given the persistent shortage of organs for transplantation, new donor management strategies to improve both organ utilization and quality of procured organs are needed. Current management protocols for the care of the deceased donor before organ procurement are based on physiological rationale, experiential reasoning, and retrospective studies without rigorous testing. Although many factors contribute to the lack of controlled clinical trials in donor management, a major factor is the unique challenges posed by research in the brain-dead organ donor.METHODS AND RESULTS:This article describes the study design and the challenges faced during implementation of the Beta-agonists for Oxygenation in Lung Donors (BOLD) study, a randomized, placebo-controlled clinical trial of nebulized albuterol vs. placebo in 500 organ donors. The study design and implementation are described with emphasis on aspects of the study that are unique to research in brain-dead organ donors.CONCLUSIONS:Experience gained during the design and implementation of the BOLD study should be useful for investigators planning future clinical trials in the brain-dead donor population and for intensivists who are involved in the care of the brain-dead organ donor.
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Matheron, Michael E., and Martin Porchas. "Management of Sclerotinia Leaf Drop on Lettuce: Efficacy of Fungicides in 1996 Field Trial." College of Agriculture, University of Arizona (Tucson, AZ), 1996. http://hdl.handle.net/10150/214737.
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Leaf drop of lettuce is caused by the plant pathogenic fungi Sclerotinia minor and S. sclerotiorum. Cool and moist environmental conditions favor disease development. Potential new fungicides were evaluated in a field trial for management of this disease in 1996. For plots containing Sclerotinia minor, all compounds and rates tested significantly reduced the number of diseased heads compared to plots not treated with a fungicide. All treatments except Ronilan at the 0.5 lb. a. i./A rate yielded a significantly higher number of marketable heads compared to nontreated plots infested with S. minor. For plots containing S. sclerotiorum, all materials except the Ciba compound at the low and high rates decreased the number of diseased heads and increased the number of marketable heads compared to nontreated plots.
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Schoenwald, Anthony V. "Nurse practitioner led pain management the day after Caesarean section : a randomised controlled trial." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/103760/1/Anthony_Schoenwald_Thesis.pdf.
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Caesarean pain is a major problem for women in the days after childbirth and is often not well controlled with the routine practice of twice daily controlled-release oxycodone. This randomised controlled trial demonstrated that a nurse practitioner intervention designed to support maternal participation using immediate-release oxycodone and supportive educational strategies was a safe and effective approach for pain management after caesarean section. At three months follow-up, a small subset of women had persistent pain which was strongly correlated with postnatal depression. Nurse practitioners have the potential to transform acute pain management by meeting individual patient needs over their healthcare journey.
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Clark, L. J., E. W. Carpenter, and J. C. Silvertooth. "Date of Planting by Long Staple Variety Trial, Safford Agricultural Center, 1996." College of Agriculture, University of Arizona (Tucson, AZ), 1997. http://hdl.handle.net/10150/210930.
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Four varieties of Long Staple cotton were tested over three dates of planting in this study. Two later maturing varieties, Pima S-6 and Oro Blanco, and two earlier maturing varieties, Pima S-7 and Conquistador (OA 312), were planted at three dates ranging from early April to mid May to find the optimal planting times as well as the yield reduction effects of planting too late for a particular variety.
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Armstrong, Nicholas J. B. "A question of priorities : court management of pre-trial civil litigation in England and Wales." Thesis, Nottingham Trent University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282475.
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Lycett, Deborah Anne. "Weight gain associated with smoking cessation : a cohort analysis and feasibility trial for dietary management." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3254/.
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Background: Quitting smokers gain weight, this offsets some advantages of quitting and may increase risk of type 2 diabetes above that of continuing smokers. The extent of weight gain, the associated characteristics, and management that will not hinder quit success are unclear. Method: Examination of weight gain in an 8year prospective cohort. Feasibility trial of smoking cessation combined with a very low calorie diet(VLCD) or individualised diet and physical activity planning(IDAP) with usual care. Results: Abstainers gained 9kg, 7kg more than smokers over 8years. Underweight and obese smokers gained most. Less weight gain (1.7kg) was associated with higher baseline alcohol consumption (14units/week vs. none). Recruitment from general practices was difficult and limited by VLCD contraindications. Following training, primary care nurses competently delivered specialist dietary interventions. The control condition was generally unacceptable. Half those on the VLCD were non-adherent. Mean weight change was +0.7kg(control), -1.3kg(IDAP), -7.1kg(VLCD) and +0.4kg for abstinence. We found lower cigarette cravings in the VLCD than control arm, but no difference in IDAP and unrelated to hunger. Relapse was greatest in the VLCD and least in the control. Conclusion: Weight gain after cessation is important and IDAP but not VLCD is a feasible approach for tackling this.
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Laheij, Christian. "A country of trial : Islamic reformism, pluralism and dispute management in Peri-Urban Northern Mozambique." Thesis, London School of Economics and Political Science (University of London), 2015. http://etheses.lse.ac.uk/3128/.
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This thesis presents the results of 23 months of fieldwork conducted between 2010 and 2012 in Nampula City, northern Mozambique. It analyses the manifestation of Islamic reformism in the city’s urban periphery where social organisation has historically been structured by principles of Makhuwa kinship and post-socialist citizenship, while religious life is dominated by Makhuwa ritual specialists, the Catholic Church and Sufi orders. Recently, however, the ranks of Sufi orders have been dwindling. The decline has been matched by a sharp increase in the number and influence of reformist mosques. With financial support from international Islamic donors, reformist mosques seek to bring local understandings of Islam in line with globally-oriented Salafi-inspired interpretations. The thesis describes the appropriation, contestation and impact of these interpretations. There are three main findings. First, I found that Islamic reformism unsettles existing conceptions of personhood. The majority of city dwellers combine their religious and national sense of belonging with Makhuwa notions of relatedness and conceptualise the self as interdependent. In contrast, reformists define themselves in relation to the divine, and objectify the self as they seek to make it available for self-fashioning. Second, the significance of this reorientation lies in its epistemological ramifications. A variety of social forms in northern Mozambique, including neighbourly assistance, the administration of justice and political relations, are premised on the understanding that events in this world are structured by invisible forces. Attempts of Islamic reformists to orient themselves towards God lead them to perceive reality in more objective terms, and consequently, their participation in neighbourhood sociality changes. Thirdly, this reorientation is tentative. In a setting where many do not share the outlook of reformism, it produces dilemmas and uncertainties. People cope with these uncertainties using strategies of confrontation, negotiation and compromise. Islamic reformism and other dimensions of social life become, as a result, mutually constitutive. These findings have several theoretical implications. The recent trend in anthropology has been to study Islamic reform movements through the lens of practices of ethical self-fashioning. This thesis argues that this focus is too narrow. My data shows that the multiplicity and complexity of the life worlds of Muslims need to be considered, and that attention should be paid to questions of how Islamic reformism shapes social practice as a system of knowledge.
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Matheron, Michael E., and Martin Porchas. "Management of Downy and Powdery Mildew on Lettuce: Efficacy of Fungicides in 1996 Field Trial." College of Agriculture, University of Arizona (Tucson, AZ), 1996. http://hdl.handle.net/10150/214738.
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Downy and powdery mildew are caused by the plant pathogenic fungi Bremia lactucae and Erysiphe cichoracearum, respectively. Cool and moist environmental conditions favor development ofdowny mildew, while warmer and dry weather is conducive for development of powdery mildew. Potential new fungicides were evaluated for management of these diseases in 1996. Both downy and powdery mildew developed in the test plots. All tested materials significantly reduced the severity of downy mildew compared to plants not treated with a fungicide. Compared to nontreated control plants as well as some tested materials and rates, significant reduction of powdery mildew was achieved with Azoxystrobin 80WDG + Latron B-1956, BAS 490 02F, Ciba G /MZ + Mancozeb 75DF, Dithane 75DF + Latron CS-7, Propamocarb 6EC (high rate), R11-7281 2F + Larron CS-7, and Microthiol 80WDG.
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Munday, Judy. "Perioperative temperature management for women undergoing Caesarean section." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/103084/1/Judith%20Munday%20Thesis.pdf.
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Perioperative hypothermia is a significant problem for women undergoing caesarean section but this population has been previously neglected in internationally accepted evidence-based recommendations for thermal care in surgical patients. This three-phased, in depth exploration of the phenomenon, has advanced understanding of the effectiveness of methods to prevent perioperative maternal hypothermia, particularly for women receiving intrathecal morphine. Findings confirm that temperature decline is significant across this vulnerable population and support recommendations for the development of health service policies and thermal management guidelines that incorporate consistent use of combined, multi-modal, effective warming strategies employed both preoperatively and intraoperatively in the place of single interventions.
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Richard, Katie. "Treating Binge Eating Disorder with Eye Movement Desensitisation Reprocessing: A preliminary randomised controlled trial." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18905.
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Cognitive Behavioural Therapy and Interpersonal Therapy have been recognized as the gold standard treatments used for people with binge eating disorder (BED). However, these treatments are lengthy - usually about 22 sessions and usually exclude the goal of weight loss despite the fact that the majority of binge eaters struggle with weight management. Because Eye Movement Desensitization Reprocessing (EMDR) is an evidence-based treatment found to an effective and efficient treatment for post traumatic stress disorder (PTSD) and trauma is prevalent in the BED population, a newly developed EMDR protocol was trialled for BED. This new protocol was based on Forester’s bulimia nervosa EMDR protocol designed in a ten 1-hour session format and included a resource development to improve engagement in exercise. Results indicated that the 16 participants randomly assigned to the EMDR treatment, administered by three trained experienced registered psychologists with EMDR training/certification, fared better than the 22 waitlisted participants in terms of BED symptoms (as assessed by the Eating Disorder Examination, Binge Eating Scale, Eating Beliefs Questionnaire), weight loss, mental health symptoms including anxiety and sleep (as assessed by the Trauma Symptom Checklist-40) and engagement in exercise (IPAQ). Though this is only a preliminary trial with a limited sample size, was not compared to an active control group and no follow-up period to see if results are maintained and weight further decreases, results are nevertheless encouraging. Furthermore, BED and comorbid weight management problems may be best treated with a multidisciplinary approach.
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Clark, Lee J., and E. W. Carpenter. "Date of Planting by Long Staple and Short Staple Variety Trial, Safford Agricultural Center, 1998." College of Agriculture, University of Arizona (Tucson, AZ), 1999. http://hdl.handle.net/10150/197037.
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Four varieties each of Long Staple and Short Staple cotton were tested over four dates of planting in this study. The first date of planting for the Long Staple cotton was delayed to the 3rd of April because of poor weather earlier. The latest planting was May 13th. Cultivars of differing maturities were tested for both long and short staple cotton to determine their optimal planting time. Many agronomic and hvi values were evaluated to determine the effect of different planting dates.
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Clark, L. J., and E. W. Carpenter. "Date of Planting by Long Staple and Short Staple Variety Trial, Stafford Agricultural Center, 1999." College of Agriculture, University of Arizona (Tucson, AZ), 2000. http://hdl.handle.net/10150/197457.
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Four varieties each of Long Staple and Short Staple cotton were tested over five and four dates of planting, respectively, in this study. The first date of planting for the Long Staple cotton was the 18th of March and for Short Staple cotton the 1st of April. The latest planting was May 13th. Cultivars of differing maturities were tested for both long and short staple cotton to determine their optimal planting time. Many agronomic parameters were evaluated to determine the effect of different planting dates
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Forsander, Gun. "Clinical management of children with type I diabetes mellitus : a prospective, randomized psycho-educational intervention trial /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4551-9/.
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Marran, Jayne. "Anxiety and it's management during awake procedures in operating theatres : a survey and randomised controlled trial." Thesis, University of Bradford, 2010. http://hdl.handle.net/10454/4875.
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This study investigates the prevalence of peri-operative anxiety and the effective management of intra-operative anxiety during awake surgery. Plastic and vascular surgical patients were selected for the study as many procedures performed within these specialities are performed under local or regional anaesthesia. The study consists of two distinct stages. The first stage was a postal survey of patients (n=213) who had undergone awake plastic, renal access or carotid surgery up to two weeks previously, in order to determine retrospectively the prevalence of peri-operative anxiety. The second stage of the study was a randomised controlled trial of interventions for the effective management of intra-operative anxiety in patients (n=128) having undergone the same surgical procedures described in stage one. The interventions tested in stage two were handholding and an anxiety management package involving a relaxation technique and a procedural information leaflet, against a 'usual care' control. The findings from stage one of the study suggest that peri-operative anxiety prevalence is low, although unacceptable levels of anxiety are seen to elevate during the intra-operative phase. The RCT in stage two demonstrated that intra-operative anxiety was no more effectively managed by the interventions tested than by usual care alone. The validity and reliability of retrospective anxiety measurement was investigated by comparing anxiety scores from stage one with contemporaneous and post-hoc anxiety scores from stage two and found to be an accurate measure of anxiety experienced at the time of the event.
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Xue, Feng. "A randomised controlled trial of a manualised self-management programme for hypertensive patients in a Shangha." Thesis, University of York, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.488751.
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Moradian, Saeed. "Management of chemotherapy-induced nausea and vomiting : a pilot randomised controlled trial using Nevasic audio programme." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/management-of-chemotherapyinduced-nausea-and-vomiting-a-pilot-randomised-controlled-trial-using-nevasic-audio-programme(29571f19-466c-4fdd-a9b9-725cc2634889).html.
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Major advances in antiemetic therapy have been made over the past two decades. Despite these advances in antiemetic management, nausea and vomiting are still important problems in clinical practice, and approximately 50% of patients receiving chemotherapy still experience nausea and/or vomiting, highlighting the need for further developments in the field. Non-pharmacological interventions are suggested as possible adjuncts to standard anti-emetic therapy. A recently developed non-pharmacological intervention to alleviate nausea and vomiting is Nevasic, which may have potential to reduce CINV and improve management of these symptoms.This pilot trial was run to examine the feasibility of implementing and conducting a randomised controlled trial using Nevasic programme. In addition, the study aimed to evaluate the acceptability and potential effect of Nevasic on cancer patients undergoing chemotherapy. Ninety nine adult female breast cancer patients who had been prescribed a course of moderately high emetogenic chemotherapy were randomised to usual care (standard anti-emetics) plus one of (1) intervention group (using Nevasic), (2) attention group (listening to music), and (3) control group, receiving no additional intervention. Data were collected daily using the Rhodes Index of Nausea, Vomiting and Retching (INVR) and a structured diary questionnaire. The EORTC QLQ-C30 (and BR23) were used at baseline and day 6 post chemotherapy. Data were collected from cancer centres affiliated to Mashhad University of Medical Sciences in Mashhad, Iran.The findings from the trial highlight that conducting a non-pharmacological intervention using such an audio programme is feasible, although difficulties and limitations exist. This study did not detect any evidence for the effectiveness of Nevasic on CINV; however, the results show statistically significant less use of anti-emetics (post-chemotherapy) (p=0.03) and borderline non-significant (p=0.06) better global health status in Nevasic group. Further studies are required to investigate its implications from other perspectives such as use of anti-emetics - rather than looking only at the "level of nausea and/or vomiting" perspective.
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Matheron, Michael E., and Martin Porchas. "Examination of Soil Solarization as a Management Tool for Fusarium Wilt of Lettuce: 2005 Field Trial." College of Agriculture and Life Sciences, University of Arizona (Tucson, AZ), 2006. http://hdl.handle.net/10150/215031.
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Fusarium wilt of lettuce was first recognized in Arizona in 2001. Since this first discovery, the pathogen, Fusarium oxysporum f.sp. lactucae (Fol), has been recovered from infected lettuce plants from approximately 30 different fields. This fungus is a soil-borne pathogen that can remain viable in soil for many years. Cultural disease control measures, such as extended soil flooding and soil solarization, have shown promise in managing Fusarium wilt in other cropping systems. The specific research objective during the 2005 growing season was to further evaluate the effect of preplant solarization of planting beds on subsequent development of Fusarium wilt on lettuce. There was no significant difference between the short (28 days) and long (56 days) solarization period in the subsequent number of diseased lettuce plants; therefore, the disease incidence values for both solarization periods were combined and compared to nonsolarized plots. At each data collection date, the number of lettuce plants showing symptoms of Fusarium wilt was significantly lower in solarized beds compared to nonsolarized beds. At plant maturity (Nov 18), Fusarium wilt had claimed virtually all lettuce plants of the cultivar 'Lighthouse' growing in nonsolarized soil; however, only 19% of lettuce plants of the same cultivar growing in solarized soil showed disease symptoms. This equates to an 81% reduction in diseased plants in solarized soil compared to nonsolarized soil. The results of this field trial suggest that a 30-day summer solarization treatment of lettuce beds can significantly reduce the inoculum of Fusarium oxysporum f. sp. lactucae to levels that would allow substantial growth of a susceptible lettuce cultivar. Additional field studies are needed to refine the solarization process to potentially achieve further increases in efficiency of destroying propagules of Fusarium oxysporum f. sp. lactucae in infested fields.
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Nguyen, Thi Nguyet. "Self-management program for people with chronic kidney disease in Vietnam: A pragmatic randomised controlled trial." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/119220/1/Thi%20Nguyet_Nguyen_Thesis.pdf.
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Chronic kidney disease is a growing health problem worldwide. This thesis reports a three-phase study which translated and tested instruments into Vietnamese language followed by a pragmatic randomised controlled trial of a self-management program for people with chronic kidney disease. This study found that the program was a simple and effective way to improve a person's understanding of kidney disease, and to give them confidence and self-management skills to manage the disease as well as improving quality of life. Importantly for healthcare clinicians in Vietnam, the study provides strategies to better support people with earlier stages of this disease.
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Close, Ciara. "A feasibility randomised controlled trial investigating reflexology in the management of low back and/ or pelvic pain during pregnancy : the CAM (Complementary and Alternative Medicine) in pregnancy trial." Thesis, Ulster University, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.674731.
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Two thirds of pregnant women experience low back pain and one fifth experience pelvic pain that can adversely affect women's lives. There is evidence demonstrating benefits of reflexlogy for managing general low back pain. Therefore, this research aimed to investigate the feasibility of conducting a randomised controlled trial (RCT) investigating reflexology in the management of low back and/ or pelvic pain (LBPP) during pregnancy. Overall 90 primiparous women (mean age 30.9 +/- 5.6 years) participated in a feasibility RCT in an inner-city maternity unit. Women were randomised to usual care, a reflexology or footbath intervention. Primary outcome measures were; the Visual Analogue Scale (VAS) for pa in frequency and intensity. Qualitative data on women's experience of the RCT and their experience of LBPP were collected via focus groups after the intervention period. Biochemical physiological and labour data were also collected. In total 64 women completed the study period; retention rates for the reflexology group were 80%, usual care group 83.33% and footbath group 50%. The reflexlogy group demonstrated a Mean Clinically Important Change (MCIC) in VAS pain frequency (1.64cm). Second stage of labour was shorter in the reflexology group (73.56 minutes +/-53.78) compared to the usual care group (117.92minutes +/ -56.15), th is was statistically significant (p=0.045). A lesser increase in cortisol and decrease in beta-endorphin were found in the reflexlogy group. There was a statistically significant reduction in systolic blood pressure (p=0.03) in the reflexology group and a significant increase in diastolic blood pressure (p=O.Ol) in the footbath group. Qualitative data indicate that women perceive health-professional management of pregnancy-LBPP as insufficient. Results indicate it is feasible to conduct an RCT in this area, although a footbath is not suitable sham treatment. Reflexology may be helpful for pregnancy-LBPP; however to confirm this, a fully powered trial is required. Furthermore, management of pregnancy-LBPP needs to be re-evaluated.
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Clark, L. J., and E. W. Carpenter. "Date of Planting by Long Staple and Short Staple Variety Trial, Safford Agricultural Center, 1997." College of Agriculture, University of Arizona (Tucson, AZ), 1998. http://hdl.handle.net/10150/210301.
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Four varieties each of Long Staple and Short Staple cotton were tested over five and four dates of planting, respectively, in this study. The first date of planting for the Long Staple cotton was pushed up to the 18th of March because planting is now legal in Graham county as early as March 15th. The latest planting was May 13th. Cultivars of differing maturities were tested for both long and short staple cotton to determine their optimal planting time. Many agronomic and hvi values were evaluated to determine the effect of different planting dates
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Marshall, Max. "The effectiveness of case managers - a randomised controlled trial (an application of a standardised assessment of need)." Thesis, University of Bristol, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.260896.
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Edwards, Emily (Emily Rose). "Long range planning of biologics process development and clinical trial material supply process." Thesis, Massachusetts Institute of Technology, 2011. http://hdl.handle.net/1721.1/66068.
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Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division; in conjunction with the Leaders for Global Operations Program at MIT, 2011.<br>Cataloged from PDF version of thesis.<br>Includes bibliographical references (p. 50).<br>This thesis investigates the feasibility of using a complex model with a Monte Carlo simulation model to forecast the financial, personnel, and manufacturing capacity resources needed for biologic drug development. Accurate forecasting is integral across industries in order to make strong longterm, strategic decisions and an area many companies struggle with. The resources required for the development of a biologic drug are especially hard to estimate due to the variability in the time and probability of success of each development phase. However, in the pharmaceutical industry getting products to market faster allows the company more time to recoup the substantial development investments before the patent expires and also potentially has a large impact on a company's market share. For these reasons, Novartis Biologics wanted to develop a simulation model to provide an objective opinion and assist them in their long-range planning. This thesis describes the design, development, and functionalities of the resultant model. During validation runs, the model demonstrated accuracy of greater than 90% when compared against historical data for headcount, number of campaigns, costs, and projects per year. In addition, the model contains Monte Carlo simulation capabilities to allow users to forecast variability and test the sensitivity of the results. This proves the model can be confidently used by project management, operations, and finance to predict their respective future resource needs.<br>by Emily Edwards.<br>S.M.<br>M.B.A.
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Martignac, Patrick. "Management of the risks linked to the trial installation of new insulation blankets for single-aisle aircraft." Thesis, KTH, Aerodynamik, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-102080.
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The objective of this diploma thesis is to perform a complete risk assessment of an insulation blanket’s trial installation for an Airbus A320 aircraft. Technical and functional requirements have been described in order to understand the changes operated on the blanket. Through the study of non-conformities and graphs depicting deliverables versus time, quality issues and time delays are tracked in the best possible way in order to identify risks. Appropriate risk tables and matrix were chosen as a frame for this assessment. Risks associated with the trial installation of the new insulation blankets were then assessed, prioritized according to their criticality and placed automatically on a risk matrix using a VBA program. Mitigationactions were finally proposed and validated to achieve the main objective of this risk assessment: to annul the occurrence and to decline the impact of all potential unforeseen turns of event described in this report.
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Zarnke, Kelly B. "Hypertension management using home blood pressure monitors and patient-initiated drug dosage adjustments, a randomized equivalence trial." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0033/MQ30705.pdf.
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Grbcic, Stefania M. "A randomised controlled trial of a novel self-help stress reduction manual for the middle management population." Thesis, University of Essex, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.571600.
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Stress and stress-related disorders have been on the increase both in the UK and worldwide. UK Governmental bodies have proposed guidelines for managing stress at work; however most are aimed at reducing and preventing stress in employees. There are also a number of stress management programmes in place (including self-help), but very few have been empirically validated in a middle management population. A novel stress self-help manual based on cognitive behavioural therapy was developed for middle managers and evaluated in this randomised controlled trial (RCT; N = 102). Four outcome measures were used to measure change: Brief Symptom Inventory (BSI; primary outcome measure), Symptom Assessment-45 (SA45), Coping Inventory for Stressful Situations (CISS), and the Job Stress Survey (JSS). Treatment effects were evaluated using analyses of covariance (ANCOVA) with post- treatment scores as dependent variables and pre-treatment scores as covariates. Significant changes were obtained on the BSI (P<0.001) at post-treatment, as well as on the SA45 (P<0.001) indicating intervention effectiveness regardless of the frequency of work stressors and lack of organisational support remaining unchanged. Measures of coping indicated that the intervention increased task, emotion, and distraction-oriented coping styles (P<0.001). The intervention was not found to effect the avoidance- oriented or social diversion coping styles. Regression analyses indicated that discussing the manual with others during the treatment protocol had a significant effect on outcomes, suggesting that future interventions should encourage groups within organisations rather than individual participation, or using the manual as an adjunct to various forms of psychological therapy. Qualitative data was also collated, which revealed that the participants felt more in control and confident after working through the manual. While further evaluation by independent researchers is recommended, including cost effectiveness analysis, the manual has shown initial effectiveness and is considered a potentially useful tool for the development of improvements towards managing and preventing stress.
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Petersen, Trevor J. "Evaluation of a Stress Management Program for Newly Matriculated First-Generation College Students: A Randomized Controlled Trial." Ohio University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1375377440.
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Jha, Dr Pranav [Verfasser]. "Neuroprotective vs. Neurostimulating Management Options for Amytrophic Lateral Sclerosis. A Multiple Trial Based Comparison / Dr Pranav Jha." München : GRIN Verlag, 2020. http://d-nb.info/1215101902/34.
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Matheron, Michael E., and Martin Porchas. "Further evaluation of Soil Solarization as a Management Tool for Fusarium Wilt of Lettuce: 2006 Field Trial." College of Agriculture and Life Sciences, University of Arizona (Tucson, AZ), 2008. http://hdl.handle.net/10150/215033.
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Fusarium wilt of lettuce was first recognized in Arizona in 2001. Since this initial discovery, the pathogen, Fusarium oxysporum f.sp. lactucae (Fol), has been recovered from infected lettuce plants from over 40 different fields. This fungus is a soil-borne pathogen that can remain viable in soil for many years. Soil solarization has shown promise in managing Fusarium wilt in other cropping systems as well as in lettuce field trials conducted during 2004 and 2005. In an effort to maximize the solarization effect on subsequent disease development, the following factors were evaluated in a 2006 field trial: 1) solarization of unshaped versus preshaped beds, 2) the effect of soil moisture on solarization efficiency of preshaped beds, and 3) effect of lettuce type on Fusarium wilt incidence after solarization. The entire field was flood irrigated on Jun 21. Plots were solarized during Jul and/or Aug by covering beds with 1-mil thick clear plastic. During the solarization treatment from Jul 3 to Sep 10, the mean soil temperature in preshaped solarized beds at a depth of 2 and 9 inches was 116 and 95°F, respectively, and 102 and 97°F, respectively, in beds not covered with plastic. When solarization was initiated 15 days after soil irrigation, a 20% reduction in Fusarium wilt was recorded for a crisphead lettuce cultivar grown on solarized unshaped beds compared to a 56% reduction in disease when the same crisphead cultivar was grown on preshaped solarized beds. There was no significant difference between a one and two month solarization period in the subsequent number of diseased lettuce plants. Solarization of preshaped beds 15 days after irrigation for one month reduced Fusarium wilt on crisphead lettuce by 56%, whereas the same solarization period initiated seven days after irrigation resulted in a 96% reduction of disease. The same one-month solarization period started one week after soil irrigation reduced the incidence of Fusarium wilt on green leaf (Two Star) and romaine (Green Towers) by 97 and 88%, respectively, compared to plants grown on unsolarized beds. The data show that summer solarization of moist soil can 1) destroy propagules of Fusarium oxysporum f. sp. lactucae in infested fields and 2) be a useful cultural management tool to significantly reduce the incidence of Fusarium wilt in a subsequent crop of lettuce.
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Dinh, Thi Thuy Ha. "A Self-management program for people with heart failure in Hanoi, Vietnam : a cluster randomised controlled trial." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/101527/1/Thi%20Thuy%20Ha_Dinh_Thesis.pdf.
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This project examined teaching of heart failure self-management to both nurses and patients in Vietnam. The main study was an evidence-based clinical trial, revealing that a short individual self-care education intervention improved patients’ knowledge and adherence to recommended self-care behaviours. The thesis also highlighted that people often struggle to understand health information. It demonstrated that the teach-back method should be a priority strategy in delivering health education to those with low health literacy.
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Fry, Caroline Viola. "If you build it, they will run : the role of clinical trial infrastructure in neglected disease R&D." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/118009.
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Thesis: S.M. in Management Research, Massachusetts Institute of Technology, Sloan School of Management, 2018.<br>Cataloged from PDF version of thesis.<br>Includes bibliographical references (pages 21-22).<br>I investigate the role of country level clinical trial infrastructure on research and development (R&D) levels for neglected tropical diseases concentrated in those countries. Pre-existing clinical trial infrastructure in a location can affect the cost and time of clinical trials carried out there, thus influence returns on investments for diseases that are located in different places. Using a newly constructed dataset I assess the components that make up a country's clinical trial infrastructure, which varies for countries in different stages of development. Using data on neglected tropical disease global disease burdens and research levels, I find that the level of R&D into diseases concentrated in countries with poorer clinical trial infrastructure is lower than that for diseases concentrated in countries with better infrastructure. This paper suggests a need for further work into the role of research infrastructure in developing countries and its role on innovation outcomes for issues affecting the world's poorest countries.<br>by Caroline Viola Fry.<br>S.M. in Management Research
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Perry, Rebecca Anne, and rebecca perry1@gmail com. "Family management of overweight in 5-9 year old children: results from a multi-site randomised controlled trial." Flinders University. Medicine, 2008. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20100526.093139.
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Childhood overweight is a leading global public health issue. Chapter One of this thesis is a three part literature review of the evidence concerning the issue of childhood overweight and its management. Section One of the literature review describes this issue in terms of Australian and international prevalence rates and trends, health outcomes and aetiology. Sections Two and Three of the literature review examine the evidence to guide effective management of childhood overweight and analyse the thoroughness by which this evidence has been determined and translated into practice recommendations.
The assumed cornerstones of child weight management are dietary change, increased physical activity, decreased sedentary behaviour, family support and behaviour modification. Recently, the role of parenting skills in the management of childhood overweight has been identified as a promising area of research. This thesis study examined the effect of the addition of parenting skills training to a parent-led, family-focussed healthy lifestyle intervention for the management of overweight in 5-9 year old children (The Parenting, Eating and Activity for Child Health (PEACH) Study). The methodology of the intervention is presented in Chapter Two.
Families of overweight 5-9 year old children across two sites (three cohorts per site) were randomized to either a healthy lifestyle group program (HL) or a healthy lifestyle plus parenting group program (HL+P). Parents in both groups received eight 1.5hour group education sessions covering topics on child/family nutrition, physical activity and positive body image. Parents in the HL+P group were offered a four week parenting skills training program prior to this. All information was directed to parents and they were responsible for initiating and maintaining healthy lifestyle changes with their families. The intervention was delivered over a six month period and group differences were examined at this time point (intervention effect) and six months following with no further program contact (maintenance effect). The sample size (n=169) was calculated to demonstrate an estimated reduction in BMI z-score of 30% in the HL+P group and 10% in the HL group over 12 months, allowing for a drop out rate of one third (power=80%, significance=95%). Intention to treat analysis was conducted using ANCOVA.
The effectiveness of the intervention was measured against a comprehensive evaluation plan consisting of:
primary outcome indicators (body mass index (BMI) z-score and waist circumference (WC) z-score) (Chapter Three),
secondary outcome indicators (health-related quality of life (HRQoL), body size dissatisfaction and height z-score) (Chapter Three),
impact evaluation indicators (childrens lifestyle behaviours and parents parenting practices) (Chapter Four),
process evaluation indicators (participant attendance and satisfaction and maintenance of program integrity across sites) (Chapter Four) and
qualitative evaluation of the factors external to the intervention that supported or inhibited families to achieve their healthy lifestyle goals (Chapter Five).
Analysis of the primary outcomes (Chapter Three) found a significant group difference at the six month time point for BMI z-score (HL: -8%, HL+P: -13%, p=0.005), but not WC z-score (HL: -9%, HL+P: -11%, p=0.39). There were no group differences at the 12 month time point (six months following intervention end and with no further program contact). Application of the IOTF definition for childhood overweight and obesity to the full study sample found that 39 (23%) and 130 (77%) children were classified as overweight and obese respectively at baseline. By the six month time point (n=135), six (4%) children fell within the healthy weight range and 38% were classified as overweight and 58% as obese. At 12 months (n=123), 4% of children remained in the healthy weight range, 35% as overweight and 61% as obese. Childrens psychosocial health and linear growth were sustained during the intervention and maintenance periods.
There were no between-group difference observed for any of the childrens lifestyle behaviours (dietary and activity behaviours) or parents parenting practices. However, the group as a whole exhibited significant improvements from baseline for scores of diet quality at the six month time point that were maintained during the following six month non-contact period (p<0.001 for 0-6mth and 0-12mth) (Chapter Four). Small screen usage significantly decreased for the full sample from 0-6 months and 0-12months (p<0.001 for both), however time spent being physically active did not change. Parents in both groups reported improvements in aspects of parenting over both time periods.
Evaluation of process indicators showed that the intervention was well attended and accepted by families (Chapter Four). Seventy three percent (123) of subjects were retained to the 12 month time point and 44% (75) attended at least 75% of scheduled program sessions. Of the 131 parents who responded to a program satisfaction questionnaire, ninety four percent reported receiving the help they desired and 99% would recommend the program to others. The integrity of intervention sessions was upheld across sites providing reassurance that the program protocol was adhered to and demonstrating a good degree of generalisability.
The thematic analysis of interviews conducted with parents at the 12month time point identified more references to barriers than facilitators of healthy lifestyle goal achievement (433 vs 375) (Chapter Five). This chapter highlights the contextual nature of family-based interventions and weight management strategies and the need to consider these during program planning and delivery.
Chapter Six concludes the thesis by summarising its results and highlighting how they have contributed to the evidence base. Study strengths and limitations are described and implications of the findings on practice and future research are presented.
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Stolic, S., M. Mitchell, and F. Lin. "A Randomised Controlled Trial of a Symptom Management Education Package (SMEP) for People with Acute Coronary Syndrome (ACS)." Thesis, Griffith University, 2017. http://hdl.handle.net/10072/367170.
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More people die of cardiovascular disease in Australia than from any other condition. Acute Coronary Syndrome (ACS) is the acute event of the chronic condition coronary heart disease (CHD) represents a continuing spectrum of three conditions and can be divided into unstable angina, non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). Patients’ symptoms in all three conditions are self managed by the first line medication sublingual glycerine trinitrate (SLGTN). The aim of management of ACS is to minimise symptoms and improve quality of life (QOL). Education of this complex medication such as recommended route, timing, side effects, prophylactic use and response to emergency when symptoms are not relieved are essential for the person to be able to effectively self administer the medication.
Nitrates such as SLGTN have different biovariabilities and pharmokinetic properties which can have potent adverse effects such as vasodilatation if not taken correctly. Patients self-manage and prevent angina symptoms using SLGTN and rest when they are home; therefore it is essential that they have adequate knowledge of SLGTN and its use. However previous studies have reported patients have poor knowledge of SLGTN and appropriate symptom management.<br>Thesis (PhD Doctorate)<br>Doctor of Philosophy (PhD)<br>School of Nursing and Midwifery<br>Griffith Health<br>Full Text
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Ghahari, Setareh. "A randomised controlled trial of an online fatigue self-management group intervention for adults with chronic neurological conditions." Thesis, Curtin University, 2009. http://hdl.handle.net/20.500.11937/1988.
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Background: Fatigue is one of the most common symptoms of neurological conditions. Although the literature suggests different approaches to treatment of this pervasive symptom, there is not a single, agreed comprehensive and well-supported approach to manage fatigue. There is strong evidence (Mathiowetz, Finlayson, Matuska, Chen, & Luo, 2005; Mathiowetz, Matuska, Finlayson, Luo, & Chen, 2007) that the face-to-face fatigue self-management program designed by Packer et al (1995) is effective in improving fatigue in people with MS. However, in Australia and many other developed and developing countries this program is not available for those people who have difficulty accessing services due to geographical location, transportation problems, work commitments or who lack confidence to participate in face-to-face programs. Equity of access is an important issue not only for this particular program but also for any self-management program in Australia (and internationally) which has a large rural and remote population. Evidence highlights the need for self-management programs to be delivered in different formats to ensure equity of access. One of the suggested ways is delivering the programs online. There is sufficient evidence that people with a disability have access to the internet. Thus, this project was designed to refine and further develop a pre-designed online fatigue self-management (online FSM) program and to evaluate it in a sample of adults with chronic neurological condition through a randomised controlled trial (RCT). Further, the study intended to explore who and how people with fatigue improve in their health outcomes.Methodology and Results: The aims of the project were fulfilled through four studies: 1) a pilot study; 2) a randomised controlled trial of the online FSM program; 3) a comparison with the face-to-face FSM program; and 4) exploration of predictors of improvement.During the pilot study, three pilot tests were conducted for the purposes of formative evaluation and to make necessary changes to improve the program. During the third pilot test, the effectiveness of the online FSM was also tested using a pre-test post-test design on a sample of individuals with multiple sclerosis, Parkinson’s disease or post-polio syndrome. The pilot study resulted in a standardised 7-week online FSM program mimicking its face-to-face version. Participants were offered fatigue self-management skills through structured activities, sharing information and experiences, expressing their ideas or feelings and offering advice and support to one another. The participants in the third pilot study improved significantly on the Fatigue Impact Scale (p<.05) and showed a trend toward significance shown on the Personal Wellbeing Index (p=.08).The RCT, the second study, included 95 participants who were randomised into one of three groups: an online FSM, an information-only FSM (info FSM) and a control group. The groups were compared at three time points (pre-test, post-test and at 3-months follow-up) on Fatigue Impact Scale, Activity Card Sort and Personal Wellbeing Index (FIS, ACS and PWI). Sores on Generalized Self-efficacy (GSE), Duke Social Support Index (SSI) and Depression, Anxiety and Stress Scale (DASS) were also used as covariates. The results showed that although both the online and information-only FSM groups improved over time on the FIS and ACS (p < .05), they were not significantly different from the control group or from each other at any time point. The low power in all analyses when comparing the groups revealed that a larger sample size is required to detect possible differences between the online FSM and control groups. Results of the secondary analysis on a combined group (online FSM group plus info FSM groups) showed that the online FSM and info FSM group complemented each other. The combined group showed significant differences when compared to the control group. This further suggests that the need for a larger sample size.The literature suggests incorporating face-to-face interventions as one of the experimental conditions when testing the effectiveness of an online program. Therefore, in the third study, a face-to-face group was used as a non-randomized comparison group. As the online FSM program was designed to provide service for people who do not have access to the face-to-face program, randomisation of the participants to four groups (face-to-face FSM, online FSM, info FSM and control groups) was not feasible; restricting the inclusion criteria to participants who had access to both the face-to-face and online programs would have excluded the very people for whom the program was designed. Thus, this study compared a sample of 20 participants in a face-to-face FSM program with each of the three other groups (online FSM, info FSM and control groups) using a nonequivalent pre-test post-test study. The findings showed that after controlling for the baseline data these participants had better scores on the FIS than the control group at post-test while these results were not seen in comparison to the online and info FSM groups. The results of this study on the face-to-face FSM program in comparison with online FSM program suggest that the online and info FSM program were successfully mimicking its face-to-face version. Further, the differences in some outcome measures and some clinical and demographic characteristics clearly demonstrated that the participants with access to the face-to-face program were significantly different than those in the RCT study. The participants who volunteered for participation in the online FSM program had lower activity levels and higher fatigue levels than the participants who had access to the face-to-face program. It appears that the two versions of the program provide access to significantly different participants.The fourth study aimed to indicate predictors of improvement on the FIS, ACS and PWI. Regression analyses were performed to find whether baseline demographic, clinical characteristics and/or changes in clinical characteristics from pre-test to follow-up were predictors for positive health outcomes. In this study, 92 participants with complete data set (pre-test, post-test and follow-up) were included. In parallel to the results emerging in systematic reviews (Nolte, Elsworth, Sinclair, & Osborne, 2007; S. Taylor, 2005; Warsi, Wang, LaValley, Avorn, & Solomon, 2004), younger people with more severe baseline scores appear to be more likely to make clinically significant improvements in their health outcomes. Improvement in mood and selfefficacy of people with fatigue were found to be predictors of better results for fatigue. Another interesting finding of this study was that improvement in selfefficacy and stress helps people with neurological conditions to improve in their fatigue regardless of their activity level at baseline.Conclusion: While fatigue is a common problem for people with fatigue secondary to neurological conditions, this online FSM program is the first of its kind to be implemented. The primary purpose of the fatigue self-management program is to help the participants improve their everyday performance and quality of life by incorporating ‘energy conservation techniques’ and self-management principles into their own life. Through the application of the fatigue self-management program, occupational therapists and other health professionals expect that the participants will learn the self-management skills, make corresponding behaviour changes and experience a reduction in the effect of fatigue on their lives. New knowledge gained from this study can further support the idea of providing other self-management programs online. The results of this study also add to the growing body of evidence emerging regarding how information technology may assist with improving health outcomes related to chronic conditions. Further, some predictors of improvement in health outcomes in this group of people were determined. The findings provide some evidence of the potential benefits of online fatigue self-management program for people with chronic neurological conditions. Online interventions like the online FSM program represent an important strategy for bridging the gap in service for those who can not participate in face-to-face programs.
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Fjærtoft, Hild. "Extended stroke unit service and early supported discharge. : Short and long-term effects." Doctoral thesis, Norwegian University of Science and Technology, Faculty of Medicine, 2005. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-681.
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<p>Effekter av utvidet slagbehandling og samarbeid på tvers av forvaltningsnivå.</p><p>Hjerneslag er en av de hyppigste årsaker til alvorlig funksjonshemming og død i Norge, i tillegg at sykdommen medfører betydelige samfunnsmessige kostnader. Forekomsten er ca. 14 000 hjerneslag pr. år, og antallet forventes å øke betraktelig i årene fremover da antall eldre over 65 år vil øke sterkt.</p><p>Det er en stor utfordring å organisere helsetjenesten slik at behandlingstilbudet for denne pasientgruppen blir best mulig. Akuttbehandling i slagenhet er i dag det best dokumenterte behandlingstiltak, men effekten av videre rehabilitering og oppfølging har vært et lite prioritert område for forskning.</p><p>Hovedhensikten med denne avhandlingen har vært å framskaffe mer kunnskap om hva som kan oppnås for slagpasienter ved en systematisk organisering og samarbeid mellom sykehus og primærhelsetjeneste når det gjelder behandling og rehabilitering etter akuttbehandling i slagenhet. Studien som ligger til grunn for avhandlingen ble gjennomført ved Seksjon for hjerneslag, Medisinsk avdeling, St. Olavs Hospital i perioden 1995-1998.</p><p>Intervensjonen var å konstruere en ny behandlingskjede for slagpasienter hvor fokus på bedre samarbeid med primærhelsetjenesten, oppfølging av et ambulerende team, tidlig utreise fra sykehus og rehabilitering med utgangspunkt i hjemmet ble sterkt vektlagt. Den konstruerte behandlingskjeden ble evaluert med tanke på helsegevinst for den enkelte og bedre ressursutnytting sammenlignet med det tradisjonelle behandlingstilbudet.</p><p>Studien ble gjennomført som en klinisk randomisert kontrollert studie der 320 pasienter med akutt hjerneslag ble inkludert. 160 pasienter fikk ordinær slagenhet behandling med videre institusjonsrehabilitering og/eller oppfølging av primærhelsetjenesten, mens de øvrige 160 pasienter fikk oppfølging av et ambulerende team i henhold til den nye og konstruerte behandlingskjeden.</p><p>I de fire arbeidene som inngår i avhandlingen er det sett på risiko for alvorlig funksjonshemning og død, endring i funksjonsnivå og livskvalitet, samt kostnadsanalyser og ressursforbruk av helsetjenester. Pasientene i de to gruppene ble undersøkt og sammenlignet 6 og 12 måneder etter sykdomsdebut.</p><p>Resultatene av studien viste at sammenlignet med tradisjonell behandling oppnådde pasientene i intervensjonsgruppen signifikant bedre funksjonsnivå (p=0.017) og redusert risiko for alvorlig funksjonshemning og død (p=0.044) etter ett år. De viste også tendens til bedret livskvalitet samtidig som initial liggetid i institusjon ble redusert med 40 % (p=0.032). Det var ingen økning i totalt ressursforbruk eller kostnader i intervensjonsgruppen.</p><p>Oppsummert viser avhandlingen at en slagbehandlingskjede med fokus på samarbeid på tvers av forvaltningsnivå, oppfølging av et ambulerende team og rehabilitering mens pasientene bor hjemme gir meget positiv effekt.</p><p>Den kliniske betydning av disse resultater er at en oppfølging i form av en slagbehandlingskjede i tillegg til akutt behandling i slagenhet bør inngå som en integrert del av behandlingstilbudet for denne pasientgruppen.</p><p>Arbeidene er utført ved INM og ISM, Det medisinske fakultet, NTNU. 1.amanuensis, dr.med Bent Indredavik har vært hovedveileder og Professor dr.med Roar Johnsen biveileder.</p><br><p>Extended Stroke Unit Service and Early Supported Discharge. Short and Long-term Effects.</p><p><i>Background and purpose</i></p><p>Stroke imposes a considerable burden for patients, their caregivers and the society worldwide. It is a challenge to organise the healthcare service that can provide effective management of patients who have suffered from stroke. Several trials have shown that stroke unit care improves the outcome for stroke patients. More limited information exists about the most effective way to organise the follow-up care after the acute care in a stroke unit. Stroke patients conventionally receive a substantial part of their rehabilitation in hospital or in other institutions that offer 24 hours-stay.</p><p>The primary aim of this thesis was to increase knowledge about the organising of follow-up care for stroke patients after the acute care in a stroke unit. To achieve this we performed a trial to evaluate the short and long-term effects of an extended stroke unit service (ESUS), with early supported discharge from hospital, co-operation with the primary health care, and more emphasize on rehabilitation at home as essential elements.</p><p><i>Methods</i></p><p>We performed a randomized controlled trial in which 320 acute stroke patients admitted to the Stroke Unit at St. Olavs Hospital, Trondheim University Hospital were included and allocated either to ordinary stroke unit care (OSUS) (160 patients) with further in-patient rehabilitation or follow-up from the primary healthcare service, or to stroke unit care with early supported discharge (160 patients). The ESUS consisted of a mobile team which co-ordinate early supported discharge and further rehabilitation.</p><p>Included in this thesis are 4 papers based on data from this study population of acute stroke patients followed in one year after the onset of stroke. We wanted to compare the groups in relation to independency, quality of life (QoL) and resource use and costs.</p><p>• Functional outcome were measured as the proportion of patients who were independent as assessed by modified Rankin Scale (RS)(RS<2 =global independence) and Barthel Index (BI)(BI>95 = independent in ADL) at 26 weeks and 52 weeks, the differences in final residence and analyses to identify patients who benefited most of an early supported discharge service (paper I and II). All assessments were blinded.</p><p>• The outcome of QoL was measured by the Nottingham Health Profile (NHP) at 52 weeks. Other outcomes measured at 52 weeks were differences between the groups according to social activity, depression, cognitive function and the burden for carers’. (paper III).</p><p>• The use of all health services during the first 52 weeks was recorded prospectively in both groups; its costs were measured as service costs and represent a combination of calculated average costs and tariffs. Hospital expenses were measured as costs per inpatient day. The secondary objectives were to explore differences in costs between the groups with respect to different types of services, time of service delivery and stroke severity (paper IV).</p><p><i>Results</i></p><p>• Extended stroke unit service with early supported discharge and co-ordination by a mobile team improves functional outcome 6 months and 12 months after stroke. The Odds Ratio for independence at one year was 1.56 (95% C.I, 1.01-to 2.44). It was most beneficial for patients with moderate stroke (papers I and II).</p><p>• Extended stroke unit service with early supported discharge can improve long-term quality of life measured by global NHP. The ESUS group had a significant better QoL after one year than the OSUS group (p = 0.048). There were no significant differences between the groups in the secondary outcomes social activity, depression and cognitive function. The caregivers who got their patients early at home did not report an increased burden compared to caregivers whose patients became ordinary stroke unit care (paper III).</p><p>• The length of initial institutional stay (hospital and rehab.clinic) were reduced with 40 % for the patients offered extended stroke unit service (18.6 days in the ESUS versus 31.1 days in the OSUS) (p=0.032). There was also a reduction in average number of total inpatient days during the first year in favour of the ESD group (p = 0.012) (paper IV).</p><p>• The total health services costs for ESUS was equal or less than costs for ordinary care during the first year after stroke. There was a non-significant reduction in total mean service costs in the ESUS group (EUR 18937 / EUR 21824). The service seemed to be most cost effective for patients with moderate severity of stroke (23% lower mean costs compared to OSUS). The important cost savings caused by reduced length of institutional stay did not lead to an increase in costs for home-based rehabilitation (paper IV).</p><p><i>Conclusion</i></p><p>An extended stroke unit service with early supported discharge improved functional outcome and reduced the length of stay in institutions compared to traditional stroke unit care. It also seems that this service can improve long-term quality of life. The costs are equal or less than costs for ordinary care.</p><p>An early, well organised discharge from hospital co-ordinated by a mobile team seems to be an important contribution in the treatment of stroke patients and should be considered, in addition to organised in-patient stroke unit care, as a part of a comprehensive stroke care.</p>
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Shultis, Carol Lee. "Effects of Music Therapy vs. Music Medicine on Physiological and Psychological Parameters of Intensive Care Patients: A Randomized Controlled Trial." Diss., Temple University Libraries, 2012. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/172789.
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Music Therapy<br>Ph.D.<br>This randomized controlled trial examined the effects of Music Therapy (MT), Music Medicine (MM), or Attention Control (AC) on physiological and psychological parameters of stress for adult and older adult patients receiving care in the Intensive Care Unit of a community general hospital. Previous studies have indicated effectiveness of music therapy or music medicine for these medical patients, but few data are available for music therapy interventions. This study was an attempt to add to available information about the effects of music therapy compared to the effects of music medicine or attention control for this patient population. Participants (twenty-eight adults, ranging in age from 37-83 years; not mechanically ventilated at the time of session) were randomly assigned to music therapy, music medicine or the attention control group. Repeated measures of heart rate, blood pressure, respiratory rate, oxygen saturation, and anxiety and pain levels were collected before the session, immediately after the session and at 60 minutes post-session. Anxiety was measured using the Faces Anxiety Scale, and pain was self-reported via a Visual Analog Scale. Post-session length of stay was collected from the participants' medical records. Overall, there were no significant interactions among study groups and outcome measures. There was a statistically significant difference between length of stay for music therapy participants and attention control. Over time from pre-session to post-session, statistically significant decreases in anxiety scores were measured for both music medicine and music therapy groups. Pain scores decreased for both music medicine and music therapy groups, however not significantly. Some medically beneficial effects of music therapy or music medicine were evident in the data.<br>Temple University--Theses
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Grant, Clare Mace. "The management of psychosocial problems in primary care : a randomised controlled trial and economic evaluation of the Amalthea Project." Thesis, University of Bristol, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364952.
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Sit, Janet WH, Sek Ying Chair, KC Choi, et al. "Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial." DOVE MEDICAL PRESS LTD, 2016. http://hdl.handle.net/10150/621999.
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Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG = 105, IG = 105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P, 0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.