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Tesi sul tema "Pharmacological intervention"
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1
Tsoumpra, Maria. "Targeting the mevalonate pathway for pharmacological intervention". Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:fe945074-e645-4c1d-9598-e28b51a43cca.
Testo completoAbstract (sommario):
Farnesyl pyrophosphate synthase (FPPS) is a key branch point enzyme in the mevalonate pathway and the main molecular target of nitrogen-containing bisphosphonates (N-BPs), potent inhibitors of osteoclastic activity and the leading drug of choice for conditions characterized by excessive bone resorption. The main aim of this thesis is to investigate the interaction of N-BPs with FPPS in order to gain further insights into the mechanism of drug inhibition. Kinetic and crystallographic studies following site-directed mutagenesis of FPPS reveal key residues involved in stabilization of carbocation intermediate, substrate binding and formation of a tight enzyme-inhibitor complex. The aromatic ring of Tyr204 is involved in N-BP binding but not in the catalytic mechanism, where the hydroxyl moiety plays an important role. Lys200 is implicated in regulation of substrate binding, product specificity and enzyme isomerization which leads to a tight binding inhibition. Phe239 is considered important for the FPPS C-terminal switch which stabilizes substrate binding and promotes the inhibitor induced isomerized state. The highly conserved Arg112, Asp103 and Asp107 are pivotal for catalysis. Successful purification of the full length of Rab geranylgeranyl transferase (RGGT) complex downstream of the FPPS in the mevalonate pathway was achieved and may lead to co-crystallization with BP analogues and identification of the putative site of drug binding. Investigation of the in vitro effect of N-BPs on osteoclastogenesis suggest a correlation with FPPS inhibition kinetics for the most potent N-BPs but indicate an alternative mechanism of the disruption of bone resorption by alendronate. Together these results highlight the importance of the multiple interactions of N-BPs with side-chain residues of FPPS which dictate their strength of binding and advance the understanding of their pharmacophore effect.
2
Hastings, Erica, e University of Lethbridge Faculty of Arts and Science. "Environmental and pharmacological intervention following cortical brain injury". Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Arts and Science, 2003, 2003. http://hdl.handle.net/10133/180.
Testo completoAbstract (sommario):
This thesis focuses on the effects of pharmacological and environmental interventions following perinatal prefrontal cortex lesions. Rats given postnatal day 3 medial prefrontal cortex lesions were provided with one of the following treatments: basic fibroblast growth factor (bFGF), complex-housing, tactile stimulation, or a combined treatment of both bFGF and tactile stimulation or bFGF and complex-housing. Rats given postnatal day 3 orbital prefrontal cortex lesions were housed in a complex environment. The findings of these studies suggest that bFGF, complex-housing or tactile stimulation are beneficial after early brain injury. The combined treatment of bFGF with complex-housing provides a synergistic effect, as the combined condition is more advantageous than bFGF alone. In contrast, the combined treatment of bFGF with tactile stimulation produced adverse effects. These results suggest that pharmacological and environmental manipulations change cortical plasticity and therefore functional recovery after neonatal cortical injury.xv, 177 leaves : ill. (some col.) ; 29 cm.
3
Strigo, Irina A. "Visceral and cutaneous pain : neural correlates and pharmacological intervention". Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=38521.
Testo completoAbstract (sommario):
Our brain is involved in processing pain, whether it is superficial cutaneous pain, caused by a scratch or a burn, or deep internal pain, caused by heartburn or gas in the intestines. Moreover, activation of a common cortical network is suggested during different types of pain in humans, implying that as long as the stimulus is painful it will be processed similarly in the cerebral cortex. However, no one has yet made direct comparison between superficial and deep pain of similar intensity and location; direct comparison is necessary in order to see how superficial pain relates to a more clinically relevant deep pain and to further our understanding of the latter.In three separate studies, the perception of visceral and cutaneous pain in humans was examined using psychophysical, brain imaging and pharmacological approaches, respectively. The first study revealed that for a similar given intensity, duration and location, visceral pain is more unpleasant, more varied qualitatively, more diffuse and more persistent after stimulation has ended, suggesting that there are some significant distinctions in the neural processes of external and internal pain in humans. The second study examined such processes with functional magnetic resonance imaging (fMRI), disclosing substantial differences in cortical processing of sensory information from skin and viscera, including limbic areas associated with the emotional component of pain (anterior cingulate and insular cortices), and sensory areas (primary somatosensory cortex). In addition, several similar cortical areas were activated by both superficial and deep pain, consistent with the existence of a common pain network independent of the nature of pain. The final study examined a possible divergence in pharmacological processes underlying deep and superficial pain, which could arise from differences in neuronal processing. The findings revealed that NMDA-receptors mediate both visceral and cutaneous pain in humans, yet the affect of visceral pain might be more susceptible to their blockers, which may be a potential explanation for different treatments of visceral and cutaneous pains.
Together these studies provide direct evidence of the differences and similarities between visceral and cutaneous pain in humans within the perceptual, physiological and pharmacological domains.
4
Waldeck, Kristian. "Targets for pharmacological intervention in the bladder and urethra". Lund : Lund University, 1998. http://catalog.hathitrust.org/api/volumes/oclc/68945055.html.
Testo completo
5
Witt-Lajeunesse, Alane, e University of Lethbridge Faculty of Arts and Science. "Effects of behavioral therapies and pharmacological intervention in brain damage". Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Arts and Science, 2001, 2001. http://hdl.handle.net/10133/149.
Testo completoAbstract (sommario):
Maximizing recovery of function after brain injury is the goal for many neuroscientists and rehabilitation medicine professional alike. To further elucidate the neural mechanisms underlying compensatory changes in brain injury and to determine the possibility of enhancing these changes, three experiments are described. Experiment 1 looks at the effects of structured (skilled reaching) versus functional (enriched environment) training with and without FGF-2, a pharmacological intervention, as treatment paradigms for rehabilitation-induced recovery of function in cortical lesion adult rats. Experiment 2 examines the treatment effects of tactile stimulation to enhance motor abilities in postnatal day 4 rat pups sustaining cortical damage. Finally, experiment 3 explores changes in the cortical motor representation after cortical damage. Results indicate a marked improvement on behavioral testing combing FGF-2 and functional training. Tactile stimulation significantly enhances recovery of motor functions. Post-lesion cortical mapping reveals changes in the motor representation utilizing the adjacent posterior parietal cortex.xv, 127 leaves : ill. ; 28 cm.
6
Qiao, Shuxi. "Pharmacological Modulation of Oxidative and Proteotoxic Stress for Antimelanoma Intervention". Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/311348.
Testo completoAbstract (sommario):
Cumulative evidence suggests that constitutively elevated levels of proteotoxic stress represent a specific vulnerability of malignant cells that can be targeted by pharmacological modulation of the intracellular proteotoxic stress response. According to this emerging mechanism, small molecule stress modulators may induce deviations from protein homeostasis causing cytotoxicity confined to malignant cells already at a high set point of constitutive proteotoxic stress leading to functional impairment and even cell death. In contrast, normal cells with sufficient protein degradation capacity can tolerate the extra dysfunctional protein overload. My graduate research has focused on testing the feasibility of repurposing clinically used non-oncological drugs for experimental chemotherapy targeting metastatic melanoma cells. The following specific aims were pursued: (1) To identify clinically used non-oncological drugs that preferentially induce cytotoxicity in melanoma cells but not primary melanocytes through upregulation of proteotoxic and/or oxidative stress; (2) To explore the specific molecular mechanisms underlying induction of melanoma cell apoptosis by lead compounds focusing on oxidative and proteotoxic stress modulation; (3) To explore efficacy of selected lead compounds for antimelanoma intervention in a murine xenograft model. First, we demonstrate feasibility of using the FDA-approved redox-active D-cysteine-derivative D- penicillamine for chemotherapeutic intervention targeting human A375 melanoma cells in vitro and in vivo through induction of the unfolded protein response (UPR). Second, we demonstrate that the antimicrobial oligopeptide thiostrepton displays dual activity as a selective prooxidant and proteasome inhibitor causing proteotoxic stress that preferentially targets malignant melanoma and multiple myeloma cells. Third, we demonstrate for the first time that the clinically used 4-aminoquinoline antimalarial amodiaquine causes autophagic-lysosomal and proliferative blockade sensitizing human melanoma cells to starvation- and chemotherapy-induced melanoma cell death. Taken together, our data indicate the chemotherapeutic potential of small molecule proteotoxic stress inducers and strongly suggest feasibility of repurposing specific non-oncological drugs for proteotoxic stress-directed antimelanoma intervention.
7
Johnson, S. P. "Multimodality imaging of tumour pathophysiology and response to pharmacological intervention". Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1463534/.
Testo completoAbstract (sommario):
This thesis describes the need for imaging the tumour pathophysiological microenvironment in order to understand response to treatment. Specifically looking at tumour vascularisation in in vivo murine xenograft models of disease, response to treatment with vascular disruption is assessed via photoacoustic tomography (PAT) and magnetic resonance imaging (MRI). Photoacoustic imaging is a novel imaging modality based on the detection of ultrasound waves created by the absorption of nano-second pulsed laser energy within tissue chromophores. It has the spectral specificity of optical techniques whilst also achieving the high resolution of ultrasound. Haemoglobin is the main chromophore found in biological tissue and this modality is therefore ideally suited to imaging tumour vascularisation. Using a Fabry-Perot interferometer this thesis demonstrates for the first time the feasibility of using PAT for re-clinical research and the characterisation of typical tumour vascular features in a non-invasive non-ionising manner. Response to different concentrations of a vascular disrupting drug is then demonstrated, with novel insights in to how tumours recover from vascular damage observed. MRI of response to vascular disruption is also presented. As MRI is widely used in the clinic it can serve as a translational tool of novel imaging biomarkers, and serves to further understand the differences in response of pathologically vascularised of tumours. This thesis looks at markers associated with disruption of haemodynamics, using apparent diffusion (ADC) to elucidate onset of necrosis, increase in haemoglobin concentration (R2*) as indication of impaired flow, and arterial spin labelling (ASL) as a marker of tumour blood perfusion. This is shown in both subcutaneous and clinically relevant liver metastasis models. Taken as whole, the results from this thesis indicate that whilst understanding the response of the tumour vasculature to pharmacological intervention is complex, novel imaging techniques can provide invaluable translational information on the pathophysiology of tumours.
8
Wong, Philip Siva Vittozzi. "Cognitive enhancers: a pharmacological intervention for the treatment of substance dependence". Thesis, Boston University, 2012. https://hdl.handle.net/2144/31622.
Testo completoAbstract (sommario):
Thesis (M.A.)--Boston UniversityPLEASE 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.
Dependence from addictive substances is a serious public health concern in the United States. Alcohol appears to be the most popular abused substance, while cigarette smoking has the highest rates of mortality. Though not as popular, illicit drugs such as cocaine and opioids are able to cause incredible damage to the lives of addicted individuals and to the people around them. The toxic injuries produced in the brain and the presence of withdrawal symptoms often result in cognitive deficits. Individuals that are able to terminate the consumption of drugs often have a hard time regaining their previous cognitive abilities. This partially contributes to the high incidence of relapse, which represents a major problem faced by the medical community. So far treatment has relied on cognitive behavioral therapy and a number of pharmacological agents. Even when combined, these approaches have not yielded satisfying results. For some types of addictions, such as the one for cocaine, there are no approved medications. Therefore research has made tremendous efforts to understand how the brain responds to addictive substances with the hope that such knowledge will lead to new pharmacological treatments. Cognitive enhancers are a promising class of drugs that is under investigation for the treatment of substance dependence. Most of them have been tested for their ability to decrease drug craving and consumption. Some of them are also being examined for their ability to reverse the cognitive deficits produced by previous drug exposure. The present thesis will examine the current literature on four cognitive enhancers: atomoxetine, reboxetine, selegiline and modafinil. Even if still in the preliminary stages, the clinical trials on reboxetine have obtained the highest rate of success. On the other hand, modafinil is the only cognitive enhancer that has been tested for reversing cognitive deficits. Compelling results in a clinical trial make modafinil one of the most exciting projects in this field of research. Atomoxetine and selegiline have mostly failed the clinical stage, but more studies are needed to determine their usefulness. In general, the potential ability to reverse cognitive deficits is not supported by the current literature and more research should be focused in this direction.
2031-01-01
9
Shelton, Evan G. "Development and Evaluation of a Personalized Music Intervention for Dementia". Cleveland State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=csu1547483058896284.
Testo completo
10
Garcia, Monica. "Differential Effects of Hydrocortisone on PTSD Symptom Clusters". Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1523196739368854.
Testo completo
11
Borrill, Zoe. "Physiological and inflammatory markers of response to pharmacological intervention in chronic obstructive pulmonary disease". Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492843.
Testo completoAbstract (sommario):
Chronic obstructive pulmonary disease (COPD) is characterised by airway inflammation and progressive airflow limitation. Validated measurements of pulmonary function and inflammation are needed to assess the efficacy of novel drugs in this disease.
12
Baker, David James. "Effect of pharmacological intervention on skeletal muscle composition, metabolism and function in the rat". Thesis, University of Nottingham, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403309.
Testo completo
13
Ayling, Kieran. "Psycho-behavioural influences on vaccine success : towards a brief, non-pharmacological primary care intervention". Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/43908/.
Testo completoAbstract (sommario):
Vaccines against infectious diseases are less effective in older adults than in younger adults. This is of significant clinical importance as older adults are also the most vulnerable to contracting, and suffering the most severe consequences of, infectious diseases. Prior research demonstrates that behavioural and psychological factors can modulate the immune system and, in turn, influence how well vaccines work. However, there is a relative paucity of work focusing on older adults. Further, studies have tended to consider only one behavioural or psychological factor at a time - meaning it is unclear which factor, or combination of factors, should be the target of interventions to enhance vaccine effectiveness. This thesis presents three distinct, yet inter-related, pieces of original research which sought to further our understanding of the behavioural and psychological influences on vaccinations and inform the future development of interventions to enhance vaccine effectiveness. First, current approaches to measuring the immune response to vaccination (e.g., ELISAs) are limited in that they require large volumes of sera, antigen, and other consumables. This makes them expensive and time consuming, which limits their utility for larger studies. Thus, the first phase of the research involved establishing a novel high-throughput multiplex antigen microarray assay for quantifying influenza-specific IgG levels in sera. This involved adapting an existing microarray assay and validating it in a series of laboratory experiments. The microarray assay demonstrated acceptable intra- and inter-assay reliability and correlated well with ELISA (H1N1: rho=.534, p < .01; H3N2: rho=.802, p < .00001; B: rho=.454, p < .01). Crucially, the protocols developed could be adapted to suit a variety of research purposes in the future. Second, a prospective longitudinal observational cohort study was conducted to investigate the influence of modifiable psychological and behavioural factors on short and long-term antibody responses to influenza vaccination in older adults (n=138). Diary methods, pedometers, and anthropometric measurements were used to assess nutrition, sleep, physical activity, affect and perceived stress repeatedly over the 2 weeks prior to, and 4 weeks following influenza vaccination. Greater positive affect across the measurement period was found in multivariate regression models to be a significant independent predictor of both short- (β=.189, p=.036) and long-term H1N1 antibody responses following vaccination (β=.296, p=.003): with greater positive affect predicting a more robust antibody response. However, positive affect on the day of vaccination was found be even more salient, explaining greater variance than positive affect over the longer period (H1N1 short term model: R2=.077 vs .058; long term model: R2=.136 vs .125). Greater variability in perceived stress over the measurement period predicted poorer long-term antibody responses to both H1N1 (β=-.268, p < .05) and B strains (β=-.255, p < .05), even after taking overall stress exposure into account. Third, in view of the observed relationship between positive affect and immune responses to vaccination, and in particular the role of positive affect on the day of vaccination, a systematic scoping review was conducted to examine the effects of brief positive mood interventions on immunity. A moderate-sized (31 studies, 38 interventions), but relatively low quality, literature was identified. Few studies included older adults and none examined the effects on in-vivo immune challenges such as vaccination. While there was considerable heterogeneity in the form of interventions that elicited mood improvements, the clear majority of studies reported enhanced immunological outcomes (87.1%). However, many interventions were unsuitable in their current form for implementation within the current already resource-stretched UK health system. Together, the work presented in this thesis points to the potential utility of brief, positive affect enhancing interventions as a way of enhancing immune responses to vaccination in older adults. Further methodologically rigorous research is needed to systematically develop and evaluate positive affect interventions that are both acceptable for older adults and feasible for implementation in the NHS.
14
Eriksson, Malin Elisabeth Viktoria. "Sleep in patients with painful diabetic peripheral neuropathy : impact of pain, glucose and pharmacological intervention". Thesis, University of Surrey, 2010. http://epubs.surrey.ac.uk/804058/.
Testo completo
15
Yadav, Rahul. "HDL functionality and LDL quality : the influence of obesity, obstructive sleep apnoea and pharmacological intervention". Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/hdl-functionality-and-ldl-quality-the-influence-of-obesity-obstructive-sleep-apnoea-and-pharmacological-intervention(60e83156-3d19-4ccb-999c-f57ac5c6ca46).html.
Testo completoAbstract (sommario):
Aims: LDL oxidation plays an important role in the initiation and progression of atherosclerosis. HDL impedes oxidation, glycation and glycoxidation in vitro and there is evidence to suggest paraoxonase-1 (PON1) plays an important role in this. 1. In patients with dyslipidaemia treated with statins, I assessed the relationship of serum PON1 activity with in vitro HDL antioxidant capacity, susceptibility of LDL to oxidation and the protection offered by HDL. 2. I studied the effect of the presence and severity of obstructive sleep apnoea (OSA) in morbidly obese patients on HDL anti-oxidant and anti-inflammatory functions. 3. I investigated the influence of extended release niacin/ laropiprant (ERN/LRP) versus placebo in patients who had persistent dyslipidaemia despite receiving high doses of potent statins. I assessed the effect of ERN/LRP on mediators of vascular inflammation and HDL's in vitro anti-oxidant function. Methods: 1. LDL isolated from dyslipidemic patients was incubated with and without HDL, in the presence of Cu2+. Similarly isolated HDL was incubated alone. Lipid peroxides (LPO) generated over 3 hours were measured. Patients were divided into 2 groups based on median serum PON1 activity. 2. 41 morbidly obese patients were divided into two groups based on the presence or absence of OSA ("OSA" and "no OSA" group) or on severity of OSA (high or low apnoea-hypoapnoea index (AHI) groups). I studied HDL's ability to protect itself from in vitro oxidation and measured serum PON1 activity, tumor necrosis factor alpha (TNFalpha) and intercellular adhesion molecule 1 (ICAM1). 3. This was a randomised double blind cross over trial, where I studied the effect of ERN/LRP compared to placebo in 27 patients who had high LDL-C inspite of maximum tolerated doses of statins. I measured lipid profile, apolipoproteins, cholesteryl ester transport protein (CETP) activity, paraoxonase 1 activity (PON1), oxidised LDL (oxLDL) and related mediators of vascular inflammation. I also examined the capacity of HDL to protect LDL from in vitro oxidation. Results and conclusion: 1. In statin treated dyslipidemic patients the capacity of HDL to protect itself and LDL from oxidation in vitro is significantly better in individuals with higher serum PON1 activity. 2. The capacity of HDL to protect itself from in vitro oxidation in morbidly obese patients is reduced with onset and severity of OSA. The differences in TNFalpha and ICAM1 levels may suggest endothelial dysfunction due to OSA. Oxidative damage of PON1 attributable to OSA could be a mechanism for HDL and endothelial dysfunction. 3. Treatment with ERN/LRP resulted in a significant improvement in HDL-C but did not affect HDL's in vitro anti-oxidant function in patients who had persistent dyslipidaemia despite high doses of potent statins. For the first time I have shown that ERN/LRP reduces mediators of vascular inflammation.
16
Nazarov, Islom. "Dissecting the mechanisms of pacemaking in the heart using photo-affinity probes and pharmacological intervention". Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:4687943d-cfa3-4a14-8d84-9de193c2f67d.
Testo completoAbstract (sommario):
The aim of the work described in this thesis was to dissect the mechanisms underlying pacemaking in the heart using both pharmacological and chemical tools. The mechanisms underlying pacemaker activity in the sino-atrial node are controversial, with some researchers giving prominence to the role of the 'funny' current, If, others emphasising a 'calcium clock', and with still others highlighting the elusive sustained inward current, Ist. Autonomic modulators, particularly adrenaline and noradrenaline regulate all the proposed mechanisms. To investigate which adrenoceptors are responsible for driving positive chronotropic action in the heart, adrenoceptors a1, β1 and β2 were studied using selective blockers (prazosin, CGP20712A and ICI118551, respectively). The results imply that activation of the β1-adrenoceptor pathway is responsible for most positive chronotropic actions in the mouse heart. Selective blockers of If (ZD7288, ivabradine) and sarcoplasmic reticulum (SR) [ryanodine and cylopiazonic acid (CPA)] were used to explore the contributions of If and Ca2+ release from SR to cardiac pacemaking in the absence and presence of adrenoceptor stimulation. The results showed that both If and Ca2+ release from SR significantly contribute to pacemaking both in the presence or absence of β adrenoceptor stimulation. They also show that the effects of ivabradine and ZD7288 on heart rate are substantially reduced following CPA or ryanodine administration; this may reflect a possible effect of reduced activity of Ca2+-stimulated adenylyl cyclases (AC) present in SAN cells. To investigate this phenomenon genetically modified mice lacking Ca2+-stimulated (AC) were used. Contrary to predictions, the resting heart rates and responses to If blockers, CPA blockers and isoprenaline from genetically modified mice showed only small differences relative to control mice. With aim of identifying the sequence of the Ist protein a series of photo-affinity probes were developed to enable covalent photocapture of the Ist ion channel following exposure to UV light. Proof of concept studies involved for photo-crosslinking and pull-down experiments in pursuit of identifying the Cav1.2 channel. Subsequent to cross-linking the photo-affinity probe to its target, Western blot analysis identified a ~190 kD band, consistent with the L-type Ca2+ channel.
17
Howlader, M. H. "Microcirculation of chronic venous disease : role of leucocyte-endothelial activation and effects of pharmacological intervention". Thesis, University College London (University of London), 2004. http://discovery.ucl.ac.uk/1446657/.
Testo completoAbstract (sommario):
Many theories have been advanced to explain the development of venous ulceration in the lower limb. In recent years, the hypothesis of inappropriate leucocyte activation with the release of free radicals causing damage to the microcirculation in patients with CVD has gained popularity. No drug has so far been found to ameliorate these effects. In this thesis I have investigated a series of inflammatory markers in patients with various CEAP stages of venous disease. The aim was to asses which, if any, inflammatory markers were associated with worsening stages of venous disease. I also used a flavonoid drug, Daflon , in a randomised, controlled clinical trial and assessed the efficacy of treatment using the markers of systemic inflammation studied. Neutrophil and monocyte activation were investigated by measuring CD 11b and CD62L by flow cytometry. Soluble CD62L and endothelial adhesion molecules (VCAM-1, ICAM-1, E-selectin and P-selectin) and vWf were measured by commercially available ELISAs. The cytokines (IL-l , IL-l , IL-6 and TNF- ) and VEGF by ELISA and total NO using the Griess reaction were also measured. Patients' symptoms were assessed by using a visual analogue scale, and the correlation of these with inflammatory markers was also investigated. Capillary morphology was studied using a capillary videomicroscope and changes were graded and correlated with the severity and CEAP stages of CVD. In my study, I found evidence of a modest relationship between CEAP clinical stage and plasma level of VCAM-1 and neutrophil CD11b as well as monocyte CD62L data using multi-variate logistic regression. There was elevation of VEGF and total NO in patients with skin changes, although multi-variate analysis failed to show the significance of plasma nitrate. Capillary morphology changes were seen in the form of convolutions in advanced stages of venous disease. These have been classified in four grades. Daflon failed to down regulate plasma levels of these markers and to improve the symptoms. This study demonstrates a low-grade inflammatory response to venous disease but give no definite clue as to the role of leucocyte in the pathogenesis of venous disease. The capillary morphology changes I have observed suggest that angiogenesis is upregulated in skin affected by chronic venous disease. This may be attributable to increased VEGF expression.
18
Sun, Xiaowei. "Protective role of coronary endothelium during the development of cardiac hypertrophy insights from pharmacological intervention studies /". Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2010r/xsun.pdf.
Testo completo
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Balasubramaniam, R. N. "An analysis of ventricular arrhythmogenesis following genetic and pharmacological intervention in the isolated, perfused, mouse heart". Thesis, University of Cambridge, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.596297.
Testo completoAbstract (sommario):
I have adapted clinical techniques to look at ventricular arrythmogenesis in the genetically and pharmacologically modified mouse heart at the whole heart and cellular levels. Using programmed electrical stimulation, I have demonstrated the arrhythmogenic phenotype of murine models of LQT3 and LQT5. I have successfully applied a clinically derived analysis technique (paced electrogram fractionation analysis (PEFA)) in order to suggest a propensity to arrhythmogenesis. I have also demonstrated the efficacy of the sodium channel blocker, mexiletine and the L-type calcium blocker, nifedipine in arrhythmia suppression in murine models of LQT3 and LQT5 respectively. Following on from this, I have demonstrated the antiarrhythmic effects of the L-type calcium channel blockers, nifedipine and diltiazem, in the suppression of arrhythmias in the wild-type mouse heart rendered arrhythmogenic following the addition of the β-adrenergic agonist, isoproterenol. These effects were then correlated with those seen on parallel cellular experiments examining changes in cytosolic calcium using confocal microscopy and a calcium-sensitive dye, in which the increase in cytosolic calcium seen following the addition of isoproterenol was suppressed by either nifedipine or diltiazem. Finally, I examined the effects of caffeine and FK506, both of which are thought to increase the open probability of the cardiac ryanodine receptor, in common with what is thought to occur in heart failure. I demonstrated the arrhythmogenic effect of caffeine on the whole mouse heart and again correlated this with parallel cellular experiments where I was able to demonstrate an increase in cytosolic calcium release in high calcium solution following the addition of caffeine of FK506, an effect that was suppressed by diltiazem, but not nifedipine.
20
Li, Hong. "Development and evaluation of a creative expression intervention programme for people with dementia in China". Thesis, University of Bath, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.687354.
Testo completoAbstract (sommario):
Aim: The aim of this study was to develop and evaluate an evidence-based creative expression therapy for Chinese people with dementia in hospitals, LTC settings and household. Background: Creative expression (CE) has been shown to be effective for engagement of both people with dementia and carers to communicate in the USA. However, there are limited cross-cultural studies of psychological therapy of people with dementia in China. Method: The overall research strategy is a mixed method. To develop standard CE programme, action research was conducted by three sequential sessions in the geriatric wards, long term care institution and patients’ homes respectively. 7rounds of action research cycle including plan, action, observation, reflective discussion was complemented and 31 people with dementia received CE intervention and evaluating by means of observation, semi-structure interview. The following evaluation research is a controlled trial for people with dementia in LCT settings and hospitals. 91 cases of people with dementia were recruited and divided into two groups. While a series of social contact activities were conducted on the 48 cases control group, the revised CE intervention carried out on the 43 cases test group, both twice weekly for 6 weeks. The primary outcome was measured by MMSE、QOL-AD、CSDD and SFACS in week 0, week 7, week 10. Findings For the social communication and communication of basic needs in SFACS score, pleasure and general alertness mood by OERS, the test group presented significantly better effect than the control group (P < 0.05). Although both group had a decline effect on CSDD score, the test group were maintaining lower 1month after intervention (P < 0.05). Thus the revised CE programme may improve the communication ability and alleviate depression of people with dementia significantly .However, although the quality of life is less affected, it showed a rising tendency after CE programme. Conclusions: This study added trans-cultural evidence on dementia treatment and developed a standard and effective creative expression intervention on Chinese people affected by dementia.
21
Hackett, Katie Louise. "Developing a non-pharmacological intervention model to improve function and participation in people with primary Sjögren's syndrome". Thesis, University of Newcastle upon Tyne, 2017. http://hdl.handle.net/10443/3802.
Testo completoAbstract (sommario):
Background: Primary Sjögren’s syndrome (PSS) is an autoimmune disease which primarily targets secretory glands causing sicca/dryness symptoms. Patients with PSS also experience a range of other symptoms including fatigue, pain, sleep disturbances, low mood and anxiety. These symptoms impact on activities of daily living, participation and quality of life. PSS has been an under researched disease, and as a consequence many needs of patients remain unmet within clinical settings. Aim: To design a non-pharmacological intervention strategy for people with PSS focussing on patient-relevant targets in order to improve daily function and participation. Methods: In this project, I use a mixed methods approach. I conducted a systematic review of published interventions of non-pharmacological interventions for PSS. Then concept mapping, a participatory mixed methods approach, was used to identify factors which interfere with performance of daily activity for people with PSS. These results were discussed with a steering group and used as a basis to develop an intervention strategy. I then conducted focus groups with patients and their spouses to discuss the main factors deemed to interfere with activities, ascertain strategies patients use to manage these problems, and to determine the acceptability of potential future interventions to address these factors. Finally a model for the delivery of non-pharmacological interventions to address these factors was developed with patients. Results: The systematic review found there was insufficient published evidence to either support or refute non-pharmacological interventions for PSS. The concept mapping study revealed that in addition to dryness; fatigue, pain and sleep disturbances were priority targets for future interventions. The qualitative focus groups demonstrated that patients currently deploy a range of strategies to self-manage fatigue, sleep and v pain. However, these strategies are not always successful and patients require individualised therapies which target their own priorities and required level of support. Conclusion: The work within this thesis provides a comprehensive understanding of factors which influence daily function and participation in PSS patients. This work presents a stakeholder-informed model for delivering future non-pharmacological interventions to address stakeholder informed priorities. As such, a model has been developed which will ultimately support patients to manage symptoms of fatigue, sleep disturbances and pain, which are perceived by patients, their families and health professionals to impact on performance of daily activities and participation.
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Elahi, Maqsood M. "Effects of maternal high fat diet and pharmacological intervention on the developmental origins of metabolic & cardiovascular disease". Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/372924/.
Testo completoAbstract (sommario):
A high fat (HF) diet leads to hypercholesterolemia and predisposes the individual to developing cardiovascular disease (CVD). We hypothesised that mother‘s HF diet before and during pregnancy and lactation can also influence predisposition to CVD in offspring fed a similar diet. The thesis sets out to investigate whether (1) the effects of long-term consumption of a HF diet by the mother predisposes her offspring to developing a CVD/ metabolic syndrome in adult life and (2) pharmacological intervention using statin alleviates the detrimental effects of maternal HF diet on the health of the dams and their offspring. Female C57BL/6 mice were fed either a HF diet (45% kcal fat) or standard chow (C; 21% kcal fat) from weaning through pregnancy and lactation. Pregnant C57/BL6 mice on HF diet were further given pravastatin in the drinking water (5 mg/kg of body weight per day) either short-term (2nd half of pregnancy and during lactation) or long-term (from weaning through to pregnancy and lactation) to lower cholesterol and improve post-weaning maternal blood pressure. Weaned female offspring from each group were then fed either a HF or C diets to adulthood. Body weight, blood pressure, plasma cholesterol, C-reactive protein (CRP) and bone marrow derived endothelial progenitor cells (EPC) were measured at 24, 28 and 36 weeks post-weaning in different experiments. Histology of the liver and kidneys were performed. Offspring from hypercholesterolemic mothers on HF diet were significantly obese (bodyweight in grams; 17.2+4.2 vs. 13.8+4.7; P<0.05), hypertensive (SBP mmHg; 134+4.2 vs. 117+3.4; P<0.001), less active (distance in cm; 312 + 31 vs. 563 + 45; P<0.001), demonstrated increased lipid laden vacuoles in liver and kidneys; and showed reduced expression of EPC (P<0.05) than offspring from C dams independent of their postnatal nutrition respectively. Pravastatin therapy in HF mothers resulted in abrogation of these variables in offspring independent of post weaning nutrition (P<0.05). The effects were more permanent when the dams were given long-term statin treatment. The study demonstrates that long-term maternal HF feeding from weaning through pregnancy and lactation predisposes offspring to hypertension, raised plasma lipids, fatty liver, kidney disorders, raised CRP and inhibition of EPC numbers and expression in offspring. Pravastatin treatment of these dams inhibits these effects on the offspring and may reduce their risk of later cardiovascular pathophysiology. The findings may have implications for understanding the effects of the ‗nutritional transition‘ to higher dietary intake of fat which could lead to increased cardiovascular disease in many societies.
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Gourine, Andrey. "The importance of nitric oxide bioavailability and endothelial mechanisms for cardioprotection by pharmacological intervention during myocardial ischaemia and reperfusion /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-069-9/.
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Dächert, Christopher Armin [Verfasser], e Marco [Akademischer Betreuer] Binder. "Mathematical modeling of host cell determinants and pharmacological intervention in hepatitis c virus replication / Christopher Armin Dächert ; Betreuer: Marco Binder". Heidelberg : Universitätsbibliothek Heidelberg, 2020. http://d-nb.info/1213902428/34.
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Dächert, Christopher [Verfasser], e Marco [Akademischer Betreuer] Binder. "Mathematical modeling of host cell determinants and pharmacological intervention in hepatitis c virus replication / Christopher Armin Dächert ; Betreuer: Marco Binder". Heidelberg : Universitätsbibliothek Heidelberg, 2020. http://nbn-resolving.de/urn:nbn:de:bsz:16-heidok-285983.
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Stålman, Anders. "Synovial metabolism after different degrees of trauma. Effects of pharmacological and physiological intervention : a microdialysis study of the knee joint synovium /". Stockholm : Institutionen för klinisk vetenskap, intervention och teknik (CLINTEC), Karolinska institutet, 2010. http://diss.kib.ki.se/2010/978-91-7409-893-8/.
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Nijland, Esmé Aurelia. "Effects of hormone treatment on sexual functioning in postmenopausal women pharmacological intervention and female sexuality: a complex, controversial clinical and social issue /". [S.l. : [Groningen : s.n.] ; University Library Groningen] [Host], 2008. http://irs.ub.rug.nl/ppn/.
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Thomas, Lea Maria [Verfasser], Oliver [Gutachter] Werz, Gerhard K. E. [Gutachter] Scriba e Eugen [Gutachter] Proschak. "Molecular pharmacological investigation of archazolid for the intervention with inflammation and cancer / Lea Maria Thomas ; Gutachter: Oliver Werz, Gerhard K. E. Scriba, Eugen Proschak". Jena : Friedrich-Schiller-Universität Jena, 2017. http://d-nb.info/1177600269/34.
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Gueyraud, Cédric. "Jeu et maladie d'Alzheimer : le jeu libre comme intention de soin en direction de résidents d'EHPAD atteints de la maladie d'Alzheimer ou troubles apparentés". Thesis, Lyon, 2018. http://www.theses.fr/2018LYSE2050.
Testo completoAbstract (sommario):
Cette recherche interroge la question du jeu dans les EHPAD accueillant des personnes âgées atteintes de la maladie d’Alzheimer ou troubles apparentés. Elle a été réalisée dans le but d’inscrire le jeu libre et son cadre au cœur des projets d’établissements.Après une présentation de la maladie d’Alzheimer et de sa prise en charge non pharmacologique, une exploration de l’utilisation du jeu dans le soin été réalisée nous conduisant à réinterroger le concept de jeu, ses modalités de mise en œuvre et l’intérêt de viser le plaisir du jeu en première intention.Trois démarches distinctes ont ensuite été menées en parallèle. La première, dialectique et relativiste, tente de mettre en lien les enseignements offerts par les sciences du jeu avec la philosophie actuelle de la prise en soin des résidents d’EHPAD atteints de la maladie d’Alzheimer. La seconde démarche, vise à présenter les conditions matérielles et humaines pour la mise en place d’un cadre ludique adapté à la population en s’inspirant du modèle des ludothèques. Enfin, la troisième démarche, biomédicale, évalue l’impact de la situation de jeu libre dans une étude randomisée en simple aveugle auprès de 54 résidents dans six établissements. Des échelles et questionnaires ont permis d’évaluer la qualité de vie des résidents, leurs troubles du comportement ainsi que appréhension de l’outil de médiation par les soignants.La discussion des résultats interroge le cadre du jeu libre comme un objet frontière à l’interface du divertissement et de la thérapie non médicamenteuse. La médiation peut être mise en perspective d’une application clinique du modèle théorique contemporain de la résilience du sujet âgé et se présenter comme une application concrète des doctrines pédagogiques en éducation nouvelleThe purpose of this PhD research is to evaluate the usefulness of games in eldercare homes (EHPAD in French), for people who suffer from Alzheimer’s disease and diseases related to Alzheimer’s. It was carried out in order to include free play in the wider scope of the homes’ project. After a presentation on Alzheimer’s disease and a non-pharmacological approach to care, an in-depth study of the issue will be given, based on the review of medical literature that leads us to reconsider game design and implementation. This study used three different approaches that were implemented simultaneously. The first one presents the human and material working conditions that are necessary to set up a framework for the game, making certain that it is adapted to the people concerned. Game libraries and therapeutic mediations served as models. The second step, which is relativistic and dialectical, attempts to associate the benefit of game playing with the current approach to treating eldercare home residents who suffer from Alzheimer’s disease. Finally, the biomedical model evaluates the impact of the game in a randomized single-blind study of 54 residents in six eldercare homes. Different scales were used to assess the residents’ quality of life. The behavioral disorders were evaluated. The caregivers were given questionnaires to determine their understanding of the mediation tool used.The analysis of the findings supports free play as a tool which has both entertainment and therapeutic value. The role of mediation may be seen as a support mechanism to enhance resilience in elderly people. It is also a concrete implementation of progressive teaching methods
30
Osborne, Michelle. "EXPLORATION OF THE RELATIONSHIP BETWEEN PAIN INTENSITY, COMFORT LEVEL AND PATIENT SATISFACTION AMONG ORTHOPEDIC PATIENTS FOLLOWING KNEE SURGERY ON POSTOPERATIVE DAY ONE". Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1430142885.
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Elsalem, Lina Mohammedsuhail Ibrahim. "Aldehyde dehydrogenases (ALDH) expression in cancer tissues as potential pharmacological targets for therapeutic intervention : probing ALDH expression and function in 2D- and 3D-cultured cancer cell lines". Thesis, University of Bradford, 2016. http://hdl.handle.net/10454/11800.
Testo completoAbstract (sommario):
The aldehyde dehydrogenase (ALDH) superfamily is gaining momentum in regard to stem cell and cancer research. However, their regulation and expression in the cancer microenvironment is poorly understood. The aim of this work was to understand the role of selected ALDH isoforms (1A1, 1A2, 1A3, 1B1, 2, 3A1 and 7A1) in colorectal cancer (CRC) and explore the impact of hypoxia on their expression. CRC cell lines (HT29, DLD-1, SW480 and HCT116) were grown under normoxic or hypoxic conditions (0.1% O2) and HT29 and DLD-1 in spinner flasks to generate multicellular spheroids (MCS). Hypoxia was demonstrated to have an impact on the ALDH expression, which appeared cell-specific. Notably, ALDH7A1 was induced upon exposure to hypoxia in both HT29 and DLD-1 cells, shown to be expressed in the hypoxic region of the MCS variants and in 5/5 CRC xenografts (HT29, DLD-1, HCT116, SW620, and COLO205). ALDH7A1 siRNA knockdown studies in DLD-1 cells resulted in significant reduction of viable cells and significant increase in ROS levels, suggesting ALDH7A1 to possess antioxidant properties. These findings were further supported using isogenic H1299/RFP and H1299/ALDH7A1 lung cancer cell lines. ALDH7A1, however, was found not to be involved in inhibiting the pharmacological effect or causing resistance to different cytotoxic and molecularly targeted anticancer drugs. To unravel the functional role of ALDH7A1, 9 compounds obtained from a virtual screening of 24,000 compounds from the Maybridge collection of compounds were used to probe ALDH7A1 functional activity. One compound, HAN00316, was found to inhibit the antioxidant properties of ALDH7A1 and thus could be a good starting point for further chemical tool development. Although this study underpins a potential important role of ALDH7A1 in hypoxic CRC, further work is required to fully validate its potential as a biomarker and/or pharmacological target.
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Elsalem, Lina M. I. "Aldehyde dehydrogenases (ALDH) expression in cancer tissues as potential pharmacological targets for therapeutic intervention. Probing ALDH expression and function in 2D- and 3D-cultured cancer cell lines". Thesis, University of Bradford, 2016. http://hdl.handle.net/10454/11800.
Testo completoAbstract (sommario):
The aldehyde dehydrogenase (ALDH) superfamily is gaining momentum in regard to stem cell and cancer research. However, their regulation and expression in the cancer microenvironment is poorly understood. The aim of this work was to understand the role of selected ALDH isoforms (1A1, 1A2, 1A3, 1B1, 2, 3A1 and 7A1) in colorectal cancer (CRC) and explore the impact of hypoxia on their expression. CRC cell lines (HT29, DLD-1, SW480 and HCT116) were grown under normoxic or hypoxic conditions (0.1% O2) and HT29 and DLD-1 in spinner flasks to generate multicellular spheroids (MCS). Hypoxia was demonstrated to have an impact on the ALDH expression, which appeared cell-specific. Notably, ALDH7A1 was induced upon exposure to hypoxia in both HT29 and DLD-1 cells, shown to be expressed in the hypoxic region of the MCS variants and in 5/5 CRC xenografts (HT29, DLD-1, HCT116, SW620, and COLO205). ALDH7A1 siRNA knockdown studies in DLD-1 cells resulted in significant reduction of viable cells and significant increase in ROS levels, suggesting ALDH7A1 to possess antioxidant properties. These findings were further supported using isogenic H1299/RFP and H1299/ALDH7A1 lung cancer cell lines. ALDH7A1, however, was found not to be involved in inhibiting the pharmacological effect or causing resistance to different cytotoxic and molecularly targeted anticancer drugs. To unravel the functional role of ALDH7A1, 9 compounds obtained from a virtual screening of 24,000 compounds from the Maybridge collection of compounds were used to probe ALDH7A1 functional activity. One compound, HAN00316, was found to inhibit the antioxidant properties of ALDH7A1 and thus could be a good starting point for further chemical tool development. Although this study underpins a potential important role of ALDH7A1 in hypoxic CRC, further work is required to fully validate its potential as a biomarker and/or pharmacological target.Jordan University of Science and Technology
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Oliveira, Nátali Castro Antunes Caprini. "A técnica da distração no alívio da dor em crianças hospitalizadas: um ensaio clínico randomizado". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/17/17148/tde-29052015-164625/.
Testo completoAbstract (sommario):
O presente estudo teve por objetivo avaliar a eficácia de uma intervenção não-farmacológica de distração no alívio de dor aguda em crianças hospitalizadas submetidas a procedimentos dolorosos por demanda clínica, controlando variáveis de estresse e catastrofização de dor. O delineamento do estudo foi um ensaio clínico randomizado cruzado (cross-over). A amostra do estudo foi composta por 40 crianças na fase escolar (6 a 11 anos), que estavam internadas na Enfermaria de Pediatria do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP e que foram submetidas a procedimento de punção venosa ou arterial prescrito por demanda clínica. Os participantes foram randomizados em dois grupos, sendo que todas as crianças receberam a intervenção e foram controles de si mesmas, mas em dois períodos distintos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do hospital. Inicialmente, avaliações do estresse e catastrofização de dor foram processadas, utilizando-se, respectivamente, a Escala de Estresse Infantil (ESI) e a Escala de Catastrofização de Dor para Crianças (PCS-C), a fim de controlar essas variáveis. Para avaliação da intensidade de dor foram utilizados os seguintes instrumentos: Escala Visual Analógica (VAS) e Escala de Faces Revisada (FPS-R). Na coleta de dados, o Grupo 1 recebeu a intervenção de distração audiovisual antes e durante um procedimento de punção realizado pela enfermeira e, em outro dia um segundo procedimento de punção foi realizado sem intervenção. No Grupo 2, por sua vez, o procedimento ocorreu de forma inversa, sendo primeiramente sem intervenção e posteriormente com intervenção. A intervenção constituiu-se na distração audiovisual com o direcionamento da atenção da criança antes e durante o procedimento doloroso para filmes de curta metragem com temáticas infantis. Após a conclusão dos procedimentos de punção eram aplicadas as duas escalas de dor para avaliar a percepção da intensidade de dor pelas crianças. A análise de variância ANOVA 2 X 2 com comparação entre- e intra-grupos foi processada com a finalidade de atender ao objetivo do estudo. O nível de significância adotado em todas as análises realizadas no presente estudo foi de 5%. Os resultados mostraram que os dois grupos foram semelhantes nas medidas basais de estresse e catastrofização de dor; não houve diferenças estatisticamente significativas nessas variáveis. Verificou-se que houve diferença estatisticamente significativa entre os grupos nos períodos com e sem intervenção da distração; os escores em ambas as escalas FPS-R e VAS mostraram-se menores no período com distração em comparação ao período sem intervenção. Além disso, a sequência de exposição da distração nos grupos e o período em que foi realizada a distração também interferiram significativamente no efeito da intervenção de distração. A análise do efeito carry-over mostrou que aproximadamente 30% dos efeitos estimados no alívio de dor foram atribuídos exclusivamente à intervenção de distração. Em conclusão, a intervenção de distração audiovisual foi eficaz na redução da percepção da intensidade de dor durante o procedimento doloroso agudo em crianças hospitalizadas. A técnica de distração pode ser recomendada como uma estratégia não-farmacológica simples e eficaz para alívio da dor aguda, podendo ser implementada na prática clínica em ambientes de cuidados pediátricos.The present study was aimed to evaluate the efficacy of a non-pharmacological intervention of distraction for acute pain relief in hospitalized children undergoing painful procedures by clinical demand, controlling variables of stress and pain catastrophizing. The study design was a crossover randomized controlled trial. The sample was composed of 40 children at school age (6-11 years), who was admitted in the pediatric ward of the Hospital of Clinics of Ribeirão Preto Medical School-USP and who underwent venipuncture or arterial puncture prescribed by clinical demand. Participants were randomized into two groups and all children that received the intervention were themselves controls, in two different periods. The study was approved by the Committee of Ethics on Research of the Hospital. Initially, the stress and pain catastrophizing assessments were performed using The Child Stress Scale (CSS) and Pain Catastrophizing Scale for Children (PCS-C), respectively, aiming to control these variables. The instuments used for pain assessment were the following: The Visual Analog Scale (VAS) and The Faces Pain Scale Revised (FPS-R). In the data collection, the Group 1 received the audiovisual distraction intervention before and during the puncture performed by the nurse and in another day a second puncture was performed without intervention. Contrarily, in Group 2 the procedure was first without intervention and subsequently with intervention in another day. The intervention consisted in audiovisual distraction by focusing the child\'s attention before and during the painful procedure to short films about infant thematics. The two pain scales were applied after the puncture procedures to assess the childrens perception of pain intensity. An ANOVA 2 X 2 analyses of variance was performed including between- and within-groups comparisons. The level of significance adopted in all analyzes of the present study was 5%. The results showed that the two groups were similar in the baseline of stress and pain catastrophizing outcomes; there were no significant differences between the groups in these variables. There was a statistically significant difference between groups in the periods with and without distraction intervention; the scores in both scales FPS-R and VAS were lower during distraction compared with the no intervention period. Furthermore, the sequence of exposure of the distraction in the groups and the period that distraction was performed also significantly interfered in the effect of distraction intervention. The analysis of the carry-over effect showed that around 30% of the estimated effects on pain reliefing were attributed to the distraction intervention. In conclusion, the intervention of audiovisual distraction was efficacy in reducing the perception of pain intensity during routine acute painful procedure in hospitalized children. The findings of the present study endorse that distraction is a simple and efficacious non-pharmacological management for acute pain relief, which could be implemented in clinical practice of pediatric care settings.
34
Persson, Maria, e Sibi Jellian Engdahl. "Oro relaterat till dyspné vid KOL : Icke-farmakologiska åtgärder". Thesis, Högskolan i Halmstad, Sektionen för hälsa och samhälle (HOS), 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-20607.
Testo completoAbstract (sommario):
Patienter med kronisk obstruktiv lungsjukdom (KOL) upplever ofta oro relaterat till dyspné. Syftet med studien var att undersöka vilka icke-farmakologiska åtgärder som kan vidtas för att lindra patienters oro relaterat till dyspné vid KOL. En litteraturstudie genomfördes där vetenskapliga artiklar granskades och sammanställdes. Resultatet visade att det finns ett flertal icke-farmakologiska åtgärder så som andningstekniker, fysisk träning, avledning, nutrition och kommunikation som sjuksköterskan kan undervisa och informera om för att lindra oro relaterad till dyspné. Åtgärderna bör vara individanpassade, eftersom varje patient är unik. Sjuksköterskan bör själv eller tillsammans med andra vårdinstanser försäkra sig om att patienten får den information och utbildning om sin sjukdom som krävs för att lindra patientens oro i möjligast mån. Informationen och utbildningen bör vara omfattande, för att patienten ska kunna finna de strategier och hjälpmedel som hjälper just dem vid oro. Lungrehabiliteringsprogram visade sig vara av betydelse för patienternas möjlighet att finna strategier för att lindra oro relaterad till dyspné. Ytterligare forskning men även utbildning av sjuksköterskor behövs angående specifika icke-farmakologiska åtgärder som kan lindra oro relaterad dyspné. Det behövs även forskning om vilka icke-farmakologiska åtgärder som bör ingå i ett lungrehabiliteringsprogram.Patients with chronic obstructive pulmonary disease (COPD) often experience anxiety related to dyspnea. The purpose of this study was to investigate the non-pharmacological interventions that can be performed to alleviate patients' anxiety related dyspnea. A literature review was conducted and scientific articles were reviewed and summarized. The results showed that there are several non-pharmacological interventions that nurses can conduct to relieve anxiety related dyspnea, such as breathing techniques, physical exercise, diversion, nutrition and communication. Every patient is unique and therefore should the nurse interventions be individualized. It is the nurse task together with other health care professionals to ensure that the patients receives and understands the information that is given. The information and education should be extensive so that the patient will be able to find the right strategies that will help them to alleviate their anxiety. Pulmonary rehabilitation programs proved to be of great importance to patients' ability to find strategies to relieve anxiety related to dyspnea. Further research and education to nurses are needed on specific non- pharmacological interventions that can relieve anxiety related dyspnea. Research is also needed on which non-pharmacological interventions that should be part of a pulmonary rehabilitation program.
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Carbonnel, François. "Évaluation des interventions numériques visant un changement de comportement de santé : un enjeu paradigmatique". Thesis, Montpellier 3, 2017. http://www.theses.fr/2017MON30093/document.
Testo completoAbstract (sommario):
Face à la multiplication exponentielle du nombre de personnes souffrant d’une maladie chronique d’origine comportementale (e.g., tabagisme, alcoolisme, mauvaise alimentation, sédentarité), des interventions non médicamenteuses (INM) agissant sur ces comportements modifiables sont devenues incontournables en prévention et en complément des traitements. Parmi ces INM, les interventions numériques santé (INS) ouvrent un champ prometteur de changement durable de comportement de santé (e.g., objet connecté santé, application pour le téléphone, jeu vidéo). La thèse s’intéresse, au-delà de leur ergonomie et de leur fonctionnalité, à leur évaluation santé, de leur validation à leur surveillance. La première étude recense les modèles proposés dans le monde pour évaluer ces INS et les catégorise selon leurs paradigmes épistémologiques sous-jacents. Les résultats montrent une augmentation exponentielle de ces modèles et une absence de consensus ou de convergence vers un modèle comme cela a été le cas dans le médicament à la fin du XXème siècle. La deuxième étude s’appuie sur une revue systématique ayant identifié 90 essais interventionnels publiés testant les bénéfices et les risques de solutions numériques visant à lutter contre le tabagisme. Les résultats montrent une efficacité de certaines INS sur le tabagisme mais issue d’un corpus méthodologique très hétérogène limitant la portée des conclusions. Cette hétérogénéité est liée aux caractéristiques intrinsèques des INS (e.g., technologies utilisées et combinaison entre elles, multiplicité des théories du changement de comportement utilisées), aux méthodes d’évaluation utilisées (e.g., type de groupe contrôle, durée de suivi) et aux critères de jugement choisis (e.g., réduction du tabagisme ou arrêt). La discussion porte sur les limites actuelles dans la mise en évidence de l’efficacité et des risques des INS à cause d’approches paradigmatiques parallèles, le paradigme biomédical, le paradigme d’ingénierie et le paradigme comportemental. Le manque de consensus limite la comparabilité et la reproductibilité des résultats des études testant ces solutions numériques de santé. Elles restent pour la plupart à ce jour des solutions gadgets malgré un potentiel prometteur et promis par les industriels. La thèse encourage à la convergence vers un modèle consensuel de détermination du bénéfice/risque santé fondé sur la science de chaque INS et fait des propositions en ce sensTo deal with the exponential increase of chronic diseases caused by health behavior (e.g., smoking, alcoholism, unhealthy eating, physical inactivity), non-pharmacological interventions (NPI) have become essential as a prevention tool and as a complement to treatments. Among these NPIs, behavioral intervention technologies (BIT) open up a promising field to a sustainable change in health behaviour (e.g., connected health devices, smartphone health apps, serious games). Beyond their ergonomics and their features, this thesis focuses on their evaluation in health, from their validation to their surveillance. The first study identifies the existing frameworks proposed around the world to evaluate these BITs and categorizes them, based on their underlying epistemological paradigm. The results show an exponential increase of these frameworks and a lack of consensus or convergence towards a common framework, as it had been the case for the drugs, by the end of the twentieth century. The second study is based on a systematic review used to identify 90 published interventional studies evaluating the benefits and the risks of digital solutions to fight against smoking. The results show that some BITs are effective against smoking but their effectiveness is based on a heterogeneous methodological corpus limiting the significance of the results produced. This heterogeneity is related to the inherent characteristics of the BITs (e.g., employed technologies and combination of technologies, multiplicity of the theories to change health behavior), to the chosen assessment methods (e.g., kind of control group, follow-up time) and to the chosen outcome measures (e.g., smoking reduction, smoking cessation). The discussion is focused on the current limitations to demonstrate the effectiveness and the risks of the BITs., due to parallel paradigmatic approaches, the biomedical paradigm, the engineering paradigm and the behavioral paradigm. The lack of consensus limits the comparability and the reproducibility of the results of the studies evaluating these BITs. Most of them are still gadgets, despite a promising potential, as predicted by the manufacturers. This thesis promotes the convergence to a consensual framework to determine the evidence-based benefits and risks of each BITs and introduces proposals to this effect
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Nguyen, The Loc. "Non-Pharmacological Interventions : Terminology Acquisition and Visualization". Thesis, Montpellier, 2018. http://www.theses.fr/2018MONTS090/document.
Testo completoAbstract (sommario):
Le volume de données disponible croît de manière très importante et ouvre d'importants défis pour les exploiter. Les domaines scientifiques du Web sémantique et des ontologies sont alors une réponse pour aider à traiter les données de manière efficace. Ainsi les ontologies sont actuellement devenues incontournables dans de nombreux domaines d'application pour représenter la connaissance experte.Le domaine que nous considérons dans nos travaux est celui des Interventions Non Médicamenteuses (INM) nommées Non-Pharmacological Interventions (NPIs) en anglais. Elles sont de plus en plus étudiées sur le plan scientifique. Elles sont liées à divers secteurs : psychologie, thérapies manuelles, nutrition, activités sportives adaptées, solutions e-santé, etc.Avec l'augmentation de leur usage, il devient de plus en plus nécessaire d'évaluer leur efficacité de manière scientifique, dans une démarche pilotée par des spécialistes et expliquée de manière claire et accessible aux utilisateurs. Pour ce faire, il est essentiel de disposer d'une classification évolutive et consensuelle effectuée au niveau international pour les spécialistes. Dans ce domaine, le développement d'une ontologie est crucial pour faciliter les recherches bibliographiques et mettre en place des bonnes pratiques.Dans nos travaux, nous nous sommes intéressés à deux enjeux majeurs liés à la construction d'une telle ontologie, d'une part comment effectuer la collecte du vocabulaire et d'autre part comment aider à la compréhension par visualisation.La construction manuelle de l'ontologie est en effet fastidieuse et longue. En particulier, la collecte des termes liés au domaine des INM nécessite beaucoup d'efforts et de temps tant le champ du vocabulaire est large. Ainsi le terme INM lui-même est parfois remplacé par d'autres (médecines alternatives, médecines douces, etc). Une méthode automatique ou semi-automatique est alors vue comme une aide importante pour la construction de la représentation de la connaissance.De plus, les ontologies sont parfois considérées comme difficiles à prendre en main pour les personnes non spécialistes de modélisation, en raison de leur complexité, de leur taille ou des propriétés et relations qu'elles incluent. Ainsi, un outil de visualisation doit être proposé pour les experts des INM. L'outil aura deux buts, d'une part visualiser l'ontologie existante, d'autre part proposer des modifications relatives à la structuration de l'ontologie qui doit se construire de manière collaborative.Des contributions sont proposées dans cette thèse sur ces deux sujets (construction du vocabulaire et visualisation). Deux approches sont présentées pour la construction, l'une reposant sur la connaissance experte et l'autre sur un corpus. Une mesure de similarité est introduite et évaluée. Pour la visualisation, notre proposition repose sur l'utilisation de cartes conceptuelles. Il s'agit alors de ré-écrire l'ontologie sous ce nouveau format et de proposer des outils permettant de distinguer les différents éléments et liens entre les éléments. Un outil a été implémenté, permettant de transformer les ontologies décrites en OWL pour les visualiserThe explosion of data on the Internet leads to challenges in working with them. Semantic Web and ontology are required to address those problems. Nowadays, ontology plays more and more an important role as a means in domain knowledge representation.In recent years, Non-Pharmacological Interventions (NPIs) have attracted a lot of attention in the health care community. NPIs can no longer stop at a professional discipline to describe them (psychotherapy, manual therapy, dietary supplement, adapted physical activity, e-health solution, etc.). It requires access to a more concrete level of description where each NPI can be evaluated by science, monitored by professionals and explained to the patient. To do this, an international and evolutionary classification based on the results of science is necessary. Thus, developing an ontology for NPIs is crucial. This ontology will facilitate bibliographic research, usage statistics and the identification of good practices.Constructing this ontology manually is time consuming and thus an expensive process. Particularly, the step of collecting the NPI terminology requires much more time than the rest, because of heterogeneous and big resources in the context of NPIs. An automatic or semi-automatic method is thus essential to support NPI experts in this task.Besides, ontologies are often complex with lots of classes, properties and relationships. They are not easy to understand by domain experts. Therefore, a simple and friendly visualization of the ontology for NPI experts needs to be considered. The visualization does not only help NPI experts to easily understand the ontology but also provides support for the NPI ontology development process.In this thesis, we propose methodologies to address the aforementioned challenges. The first contribution concerns the semi-automatic process for collecting NPI terms. Two approaches, knowledge-based and corpus-based, are presented to retrieve candidate NPI terms. A new similarity measure for NPI is proposed and evaluated. The second contribution is a new method for ontology visualization based on MindMap. This work aims at providing a simple and friendly tool to visualize an ontology which is used by domain experts. We propose a MindMap-based notation for ontology visualization by transforming ontology components to MindMap elements. A web-based tool is then implemented to convert OWL ontologies to FreeMind documents which can be imported by existing Mind-Mapping applications to make visualizations
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Vargo, Sydney. "Approaching Alzheimer's Disease through Non-Pharmacological Interventions". Kent State University Honors College / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ksuhonors1494245264098204.
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Nowinski, Karolina J. "Ventricular repolarization in the human heart : effects of pharmacological and non-pharmacological interventions /". Stockholm : [Karolinska institutets bibl.], 2001. http://diss.kib.ki.se/2001/91-7349-069-5/.
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Henes, Kathrin. "Traces of a trauma - pharmacological interventions of PTSD". Diss., lmu, 2012. http://nbn-resolving.de/urn:nbn:de:bvb:19-142756.
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Monk, A. "Pharmacological interventions for pain relief during orthodontic treatment". Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3005667/.
Testo completoAbstract (sommario):
Background: Pain is a common and unwanted side effect of orthodontic treatment, caused by a reduction in blood flow during tooth movement using orthodontic appliances. Pain has been shown to be the most common reason for patients wanting to discontinue treatment. Pharmacological methods of pain relief have been investigated in the literature showing promising results, although there remains some uncertainty among orthodontists as to which painkillers are most suitable and whether pre-emptive analgesia is beneficial and therefore present as a simple intervention to prevent this unwanted side effect of treatment. Therefore a Cochrane review is warranted to assess and summarise the international evidence. Objectives: To determine the most effective drug intervention for pain relief during orthodontic treatment. Search methods: We searched the following databases up to August 2016: Cochrane Oral Health Group Trials Register, Cochrane Pain, Palliative and Supportive Care Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, EMBASE via Ovid and CINAHL via EBSCO. We searched the US National Institutes of Health Trials Registry, and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on language or date of publication when searching databases. Selection criteria: We included randomized controlled trials (RCTs) relating to pain control during orthodontic treatment measured on a visual analogue scale (VAS), numerical rating scale (NRS) or any categorical scale. Data collection and analysis: Two reviewers independently extracted information regarding methods, participants, interventions, outcomes, harms and results, independently and in duplicate. The Cochrane risk of bias tool was used to assess the methodological quality of the studies. Main results: 22 RCTs were identified which included 2110 participants. A meta-analysis was carried out on twelve papers that compared analgesics versus control, nine that compared NSAIDs versus paracetamol and two comparing pre-emptive versus post-treatment ibuprofen for pain control following orthodontic treatment. Analgesics were found to effectively reduce pain at 2, 6 and 24 hours following orthodontic treatment (mean difference -24.48, 95% CI -30.54 to -18.43, P= < 0.00001). No difference was found between the efficacy of NSAIDs and paracetamol, except low quality evidence that paracetamol is more effective at reducing pain associated with initial archwire placement at 2 hours (MD 14.63, 95% CI 0.77 to 28.50, P=0.04). Pre-emptive ibuprofen gives better pain relief at 2 hours (MD -11.33, 95% CI -16.09 to -6.58, P= < 0.00001) however the effect reduces over time. No difference was found between the use of topical NSAIDs and local anaesthetic. However overall quality of evidence was poor and levels of heterogeneity were variable (I2 results varied from 0% to 87%). Authors' conclusions: Analgesics are effective at reducing pain following orthodontic treatment. There is no difference between the efficacy of systemic NSAIDs and paracetamol, or topical NSAID and local anaesthetic. Pre-emptive ibuprofen gives better pain relief at 2 hours however the effect reduces over time. More high quality research is needed to investigate the effect of NSAID and paracetamol and the effect of pre-emptive and post-treatment administration of analgesics for orthodontic pain.
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Lampa, Jon. "Studies of pharmacological interventions and pathogenesis of rheumatoid arthritis /". Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-372-4/.
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Johansson, Jakob. "Cardiopulmonary Resuscitation : Pharmacological Interventions for Augmentation of Cerebral Blood Flow". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4281.
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Subramanian, Leena. "Behavioural effects of pharmacological and neurofeedback interventions in Parkinson's disease". Thesis, Bangor University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.529753.
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Lazzaro, Izabela. "Icke-farmakologiska interventioner för att minska preoperativ ångest hos vuxna patienter : en litteraturöversikt". Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-6581.
Testo completoAbstract (sommario):
Bakgrund: Forskning tyder på att preoperativ ångest utgör ett vanligt förekommande problem hos patienter som skall genomgå kirurgi. Flera studier visade att den kan leda till olika postoperativa komplikationer. Det är sjuksköterskans ansvar att både identifiera och åtgärda ångest inför ett kirurgiskt ingrepp. Syfte: Att beskriva vilka icke-farmakologiska interventioner finns för att minska preoperativ ångest hos vuxna patienter. Metod: Studiens design var en litteraturöversikt som genomfördes enligt Fribergs metodbeskrivning. Litteraturöversikten bygger på tolv kvantitativa studier publicerade mellan 01/2007 och 09/2017. Sökningar utfördes i databaserna CINAHL Complete och PubMed. Resultat: Denna litteraturöversikt tyder på att det finns flera, olika interventioner som kan användas som komplement till farmakologisk behandling för att effektivt minska preoperativ ångest hos vuxna patienter. Ångest i den preoperativa fasen kan lindras om patienten får en utökad, individuell anpassad information. Ångest kan också minskas om patienten får ett känslomässigt stöd eller hjälp med att finna tröst i andlighet/religion. Litteraturöversiktens resultat tyder dessutom på att ångestnivå kan sänkas med hjälp av en lugn musik, naturljud eller vägledd dagdröm. Det framkom även att den preoperativa ångesten kan minskas genom avslappningsövningar, aromaterapi, akupunktur och zonterapi. Endast en fotografisk utställning har inte visats vara effektiv för att minska ångest i det preoperativa skedet. Diskussion: Resultatet av litteraturöversikten har diskuterats i relation till sjuksköterskans ansvarsområde. Resultatdiskussionen koncentreras kring praktiska frågor gällande implementering av de icke-farmakologiska metoderna i vården. Jean Watsons teori om mänsklig omsorg utgjorde översiktens teoretiska referensram som hjälpte författaren i resultatdiskussionen.Background: Research indicates that preoperative anxiety is a widespread problem among patients undergoing surgery. It has been shown in several studies that preoperative anxiety may lead to different postoperative complications. It is the nurse's responsibility to identify and to reduce patients' anxiety. Aim: To describe which non-pharmacological interventions are available to reduce preoperative anxiety in adult patients. Method: The study was designed as a literature review performed according to the Fribergs method. This literature review is based on twelve quantitative articles published between 01/2007 and 09/2017. The search for the articles was conducted in CINAHL Complete database and PubMed database. Results: The result of this review indicates that there are several, different interventions that may be used in addition to pharmacological treatment in order to effectively reduce preoperative anxiety in adult patients. Anxiety in the preoperative phase can be alleviated by providing the patient with information tailored to the individual's needs. Anxiety can also be reduced by providing emotional support or by helping the patient to find comfort in spirituality/religion. The result of this review indicates moreover that the level of anxious can be minimized by listening to soothing music, nature sounds or guided imagery. Relaxation exercises, aromatherapy, acupuncture and reflexology were also found to reduce preoperative anxiety. Only the photographic display was not found to be effective in reducing anxiety in the preoperative phase. Discussion: The result of this review was discussed in relation to the nurse's responsibilities. The discussion of the results was focused on the practical issues about implementation of the non-pharmacological methods in the clinical practice. Jean Watson's Theory of Human Caring was used as a theoretical framework that helped the author in results analysis.
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Dawoud, Hazem Elsaid. "Nanomedical Studies of Angiographic Contrast-Induced Renal and Vascular Injury: Clinical Implications". Ohio University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1522677857523823.
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Reid, Rosemarie Esther. "An animal model of congenital hypothyroidism : behavioural characteristics and pharmacological interventions". Thesis, University of Ulster, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.412131.
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Peredo, Nunez De Arco Rossana. "Youth at risk of psychosis : neurocognitive profiles and non-pharmacological interventions". Master's thesis, Université Laval, 2017. http://hdl.handle.net/20.500.11794/33247.
Testo completoAbstract (sommario):
Introduction: L'intérêt pour les premiers stades de la psychose a augmenté au cours des dernières années, vu que cette maladie apparaît pendant l'adolescence. Ensuite, de nombreuses études ont révélé que l'identification et le traitement précoces peuvent retarder la transition vers un trouble mental, et aussi prévenir des effets néfastes sur le fonctionnement global. Afin d'identifier ces individus, certains critères cliniques ont déjà été développés, on sait ainsi que les enfants avec risque génétique de psychose s'engagent tôt dans une trajectoire cognitive déficiente. Même si les modèles de prédiction sont très prometteurs, le nombre de faux positifs est élevé, ce qui nuit au développement de traitements préventifs. L'objectif du premier article était d'identifier deux profils neurocognitifs parmi les descendants des parents avec psychose. Le deuxième article avait comme objectif d'évaluer l'effet sur la transition d'interventions non pharmacologiques, chez les individus à risque de psychose et leur effet sur les comorbidités non psychotiques. Méthodologie: Une analyse de cluster hiérarchique a été effectuée afin d'identifier deux profils neurocognitifs. Ensuite, une analyse systématique et méta-analyse d'essais contrôlés randomisés a été effectué pour analyser les interventions non pharmacologiques publiées jusqu'à cette date. Résultats: L'analyse de cluster a montré l‟existence de deux sous-groupes de descendants à risque élevé, l'un d'entre eux ayant montré une performance cognitive presque identique aux sujets témoins, tandis que l'autre ayant eu des résultats pires que les scores du groupe control. La méta-analyse a rapporté que les thérapies non pharmacologiques étaient associées à un risque réduit de transition vers la psychose. Conclusion: Les interventions non pharmacologiques peuvent avoir du potentiel de traitement chez les individus à risque de psychose. Toutefois on a besoin de plus d‟études concentrés à réduire les taux de retrait. Notre étude suggère que les interventions visant à renforcer l‟aspect neurocognitif devraient être abordées plus tôt. D'autres recherches de types longitudinales sont nécessairesIntroduction: Interest in the early stages of psychosis has been increasing in the last years, mainly because it appears mostly in adolescence. Also, numerous studies have reported that early identification and treatment may not only delay the transition to a frank mental disorder, but also prevent detrimental effects on global functioning. In order to identify these individuals, some clinical criteria have already been developed; it is known for example that children at genetic risk of psychosis engage early in a deficient cognitive trajectory. Even though models of prediction are very promising, the number of false positives is still high, which impairs the development of preventive treatments. The objective of the first article was to identify two neurocognitive profiles among offspring at genetic risk of psychosis. The objective of the second article was to assess, the effect of non-pharmacological interventions on transition to psychosis, compared to any no non-pharmacological treatment, in individuals at risk of psychosis and the effect of these interventions on non-psychotic comorbidities. Methodology: First a hierarchical clustering analysis was performed in order to identify the two neurocognitive profiles. Then a systematic review and meta-analysis of randomized controlled trials was conducted to analyse all non-pharmacological interventions published until now. Results: The cluster analysis yielded two subgroups of high risk offspring, one of them showing a cognitive performance almost identical to control subjects, whereas the other having performed worse than the control scores. The meta-analysis reported that non-pharmacological therapies were associated with a reduced risk of transition to psychosis. Conclusion: Non-pharmacological interventions may have potential in the treatment of individuals at risk of psychosis however; further research is needed accompanied by efforts to diminish withdrawal rates. Our study suggests that interventions with a neurocognitive target should be addressed earlier. Still further research is needed in longitudinal studies.
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Reed, Sydney Lain, e Sydney Lain Reed. "Evidence based practice recommendation: non-pharmacological pain management interventions during labor". Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/626738.
Testo completoAbstract (sommario):
The purpose of this thesis is to explore best practices for non-pharmacologic pain management during the birthing process in order to create an educational pamphlet that explains to women their options for pain management during labor and birth. The focus of this project is to provide best practice recommendations to pregnant women so that they can make informed decisions on birth plans and specifically decide what pain management techniques they may use during labor and birth. The goal is to inform all expecting women with necessary information to ensure her knowledge about pain control options during the birthing process and promote a healthy birth experience. The author conducted an extensive literature review that explores outcomes of different pain management techniques and focused on non-pharmacologic pain management techniques to provide women with the resources needed to have an improved labor experience. Based on the evidence in the literature review a pamphlet will be created to describe the various pain management options available to women with explained risks and benefits. The hope is that a well-informed decision on pain management to promote a birthing experience in which coping is enhanced and suffering is reduced.
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Calcagni, Nicolas. "L’évaluation des prises en charge non-médicamenteuses dans le cadre d’affections chroniques. Etudes interventionnelles basées sur des Protocoles Expérimentaux à Cas Unique". Thesis, Bordeaux, 2020. http://www.theses.fr/2020BORD0222.
Testo completoAbstract (sommario):
Les Interventions Non-Médicamenteuses (INM), et autres procédures qui peuvent leur être associées (Médecine Traditionnelle, Médecines Complémentaires et Alternatives), sont aujourd’hui d’une prépondérance à ne pas sous-estimer dans l’optique d’une santé intégrative. Une évaluation scientifique robuste est nécessaire afin de trier les pratiques néfastes ou inefficaces, de celles attestant de réels bénéfices. Dans ce domaine, les essais randomisés contrôlés (ERC) font loi, à un titre discutable du fait de leurs limites intrinsèques. Par le biais d’une revue systématique de littérature centrée sur les pratiques de manipulation corporelles comme soins de support proposés en oncologie, nous confirmons la difficulté qu’ont les ERCs de tirer des conclusions fermes et bien appuyées. Nous présentons alors une méthode interventionnelle différente et peu enseignée, les protocoles expérimentaux à cas unique, et proposons leur illustration à travers quatre études. Celles-ci portent sur l’évaluation de différentes interventions dans des contextes de maladies chroniques ou de problèmes de santé variables : 1) Jeu vidéo thérapeutique dans le cadre de la réadaptation physique de la maladie de Parkinson, 2) Intervention musicale en Soins Palliatifs, 3) Hypnose face aux restrictions hydriques de patients sous hémodialyse et 4) Séances de shiatsu face à la dysménorrhée primaire. Ces études rendent compte de résultats intéressants, et permettent de discuter des forces et faiblesses de cette méthode. Nous plaidons alors en sa faveur du fait de ses principes expérimentaux légitimes ainsi que son adéquation avec la pratique fondée sur la preuve. Nous profitons enfin de la faible qualité des études que nous avons menées pour dresser une liste de recommandations et d’écueils à considérer afin de les employer de façon optimaleToday, Non-Pharmacological Interventions (NPIs), and other procedures that may be associated with them (Traditional Medicine, Complementary and Alternative Medicine), are of a preponderance that should not be underestimated in the perspective of integrative health. A robust scientific evaluation is necessary to sort out the harmful or inefficient practices from those that show real benefits. In this field, randomized controlled trials (RCTs) reign supreme, but their intrinsic limitations are debatable. Through a systematic review of the literature focusing on manipulative and body-based practices as supportive care in cancer, we confirmed the difficulty of RCTs to infer a definitive decision. We then presented a different and little-taught intervention method, the single-case experimental design (SCED) and illustrated them through four studies in various health topics for the evaluation of different NPIs (Parkinson's Disease and Serious Game, Musical Intervention in Palliative Care, Hypnosis and Renal Disease, and Shiatsu and Painful Menstruations). These studies reported interesting results and provided an opportunity to discuss the strengths and weaknesses of this method. We then argued in favor of its use given its legitimate experimental principles and its adequacy with evidence-based practice. Finally, the low quality of the studies we conducted gave us an opportunity to propose a list of recommendations and pitfalls to consider when using SCED
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Levesque, Linda Estelle. "Pharmacological interventions in type 2 diabetes: observational studies and bias related issues". Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=18785.
Testo completoAbstract (sommario):
Oral hypoglycemic agents are the treatment of first choice in the management of type 2 diabetes. Information available to date regarding the safety of these agents comes primarily from small, short-term, randomized controlled trials of highly selected populations that were powered to detect changes in plasma glucose. Consequently, concerns regarding their cardiovascular safety warrant further study using a population-based approach. In this thesis, we first assessed the risk of myocardial infarction associated with the use of oral hypoglycemics using the administrative health databases of Saskatchewan. We then evaluated the potential for residual confounding in this study by examining the distribution of unmeasured risk factors, obtained from survey data, across exposure groups. Next, we developed a simulation-based tool to study the behaviour of this bias and correct the observed exposure-outcome associations in the primary study for the impact of residual confounding. Finally, in a separate study of cholesterol lowering “statins” and diabetes progression, we addressed the issue of immortal time bias in cohort studies. The study cohort consisted of 42,775 adults, newly treated with an antidiabetic medication. We found that among users of monotherapy, sulfonylureas were associated with a small increased risk of myocardial infarction compared with metformin (RR 1.24, 95% CI 1.06-1.45). The use of thiazolidinediones, primarily rosiglitazone, was also associated with an increased risk (RR 3.78, 95% CI 1.23-11.67) which persisted regardless of the treatment to which it was compared. We did not observe an increased risk with the use of other oral agents (RR 1.1., 95% CI 0.48-1.45). Using data from the Canadian National Population Health Survey, we found important differences between users of sulfonylureas and metformin with regards to income, level of education, smoking status, alcohol consumption, physical activity and obesity. However, a simulaLes hypoglycémiants oraux représentent le traitement de première intention dans la prise en charge du diabète de type 2. L'information concernant la sécurité de ces médicaments provient essentiellement d'essais cliniques randomisés de courte durée, à partir de populations hautement sélectionnées et de faible effectif, conçus pour détecter les changements de la glycémie. Alors, leur sécurité cardiovasculaire nécessite de ce fait de plus amples investigations à l'aide d'études observationnelles. Dans cette thèse, nous avons dans un premier temps évalué le risque d'infarctus du myocarde associé aux hypoglycémiants oraux en utilisant les bases de données administratives de Saskatchewan. Nous avons dans un second temps évalué la possibilité de biais de confusion résiduel dans notre étude, en examinant la distribution des facteurs de risque non mesurés, obtenus à partir de données d'enquête, dans les différents groupes d'exposition. Nous avons ensuite développé un outil basé sur la simulation afin d'étudier le comportement de ce biais de confusion résiduel et d'en corriger l'impact dans les associations observées entre exposition et évènement dans notre étude initiale. Enfin, dans une étude distincte portant sur les hypocholestérolémiants de type statines et la progression du diabète, nous avons abordé le problème du biais de temps immortel dans les études de cohorte. La cohorte d'étude incluait 42 775 adultes, nouvellement traités par médicaments antidiabétiques. Parmi les patients sous monothérapie, nous avons trouvé que les sulfonylurées étaient associées à un risque légèrement augmenté d'infarctus du myocarde comparativement à la metformine (RR 1,24, IC 95% 1,06-1,45). L'utilisation des thiazolidinediones, représentées essentiellement pas la rosiglitazone, était également associée à un risque augmenté (RR 3,78, IC 95% 1,23-11,67) et quel que soit le traitement de comparaison. Nous n