Medicine and Health Sciences Commons^™

Gender Does Not Influence The Relationship Between Posterior Cruciate Ligament Design And Patient-Reported Outcomes In Patients Receiving Primary Unilateral Total Knee Arthroplasty, Ryan Milan

Electronic Thesis and Dissertation Repository

The effect of the interaction between gender and posterior cruciate ligament (PCL) prosthesis design on patient-reported outcomes is an understudied area of research. We evaluated 1613 patients, from the Ontario Joint Replacement Registry (2001-2006), who underwent primary total knee replacement. This study investigated the impact of the gender-PCL design interaction on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) change scores and patient satisfaction, by performing linear regression analysis, using full-adjusted models that also included the gender-PCL prosthesis design interaction variable. PCL prosthesis design did not affect WOMAC change scores or satisfaction (p>0.05). Moreover, Gender did not influence either …

The Impact Of The Neuropeptide Y System On The Progression Of Breast Cancer, Philip J. Medeiros

Electronic Thesis and Dissertation Repository

Chronic stress is associated with elevated levels of sympathetic neurotransmitter release and immunosuppression. A growing body of evidence suggests that stress-related factors may contribute to the initiation, development and progression of breast cancer. Neuropeptide Y (NPY) has recently been determined as such a factor, however few investigations have addressed the functional effects of NPY on breast cells and tumors. Thus, the overall objective of this thesis was to elucidate the mechanisms by which NPY may contribute to the disease. Using the 4T1 murine breast cancer model, we began by first characterizing NPY receptor expression in cancer cells and tumors. Y1R, …

Evaluating The Impact Of Two Different Methods Of Diabetes Self-Management Education On Knowledge, Attitude, And Behaviours Of Patients With Type 2 Diabetes Mellitus, Laura B. Briden

Electronic Thesis and Dissertation Repository

This study compared the effectiveness of diabetes self-management education (DSME) methods by examining changes in knowledge, attitude, and behaviour (KAB) after receiving education. Participants from a convenience sample were randomized into two groups, one receiving education through conversation maps and the other through traditional group education. Participants’ knowledge and attitude changes were measured by using a repeated measures pre-test/post-test design and changes in Hb A1c were observed. Focus groups were conducted after education was received to obtain perceptions and self-reported behaviour changes. Significant knowledge and attitude score changes were observed in the conversation map group after education. When comparing the …

The Development Of A Decision Aid For Patients With Ulcerative Colitis Deciding Between Ileostomy Or Ileal Anal-Pouch Reconstruction, Luc A. Dubois

Electronic Thesis and Dissertation Repository

Objectives: To develop a prototype decision aid used to assist ulcerative colitis patients when deciding between ileal pouch-anal anastomosis (IPAA) and ileostomy.

Methods: Three separate systematic reviews (quality of life studies, IPAA studies, ileostomy studies) were conducted to populate the decision aid with outcome probabilities. Meta-regression was used to select appropriate pooled outcomes.

Results: Of 3920 studies reviewed, 9 studies reported on quality of life, 67 on outcomes following IPAA, and 11 following ileostomy. No difference in quality of life was found between procedures. Among IPAA patients, pooled pouch failure rate was 5.5%, with pouchitis being the most common complication …

A Pilot Trial Comparing The Effects Of Onabotulinumtoxina And Standard Oxybutynin Therapy As First Line Treatment For The Poorly Compliant Pediatric Neurogenic Bladder, Sumit Dave

Electronic Thesis and Dissertation Repository

Research question

Is it feasible to conduct a phase III RCT to compare OnabotulinumtoxinA injections to oxybutynin as primary therapy in pediatric neurogenic bladder?

Methods

Patients on a stable oxybutynin regimen were recruited for a pilot RCT and underwent randomization to either OnabotulinumtoxinA or continuation of oxybutynin. Primary outcomes included an a priori defined feasibility and acceptability assessment. Secondary outcomes included continence, urodynamic parameters, side effects and QOL.

Results

The study enrolled 8 subjects in the OnabotulinumtoxinA group and 6 in the oxybutynin group. The recruitment rate was 75 % and the dropout rate was 6.6 %. There were 2 …

Feasibility, Effectiveness, Costs And Patient Satisfaction Associated With A Web-Based Follow-Up Assessment Following Total Joint Arthroplasty, Jacquelyn Marsh

Electronic Thesis and Dissertation Repository

Objectives: To determine the feasibility, effectiveness, costs and satisfaction involved with a web-based assessment following total joint arthroplasty compared to the usual method of in-person assessment.

Methods: We determined agreement between electronic and paper versions of the WOMAC and SF-12 questionnaires (Chapter 2). We randomized patients who were at least 12 months post-operative to complete a web-based follow-up or to have their appointment at the clinic. We recorded travel distances, costs, and time involved with each appointment. We report the frequency of web-based patients who: 1) indicated they were having problems, 2) had an identified radiographic issue, 3) …

Augmented Image-Guidance For Transcatheter Aortic Valve Implantation, Pencilla Lang

Electronic Thesis and Dissertation Repository

The introduction of transcatheter aortic valve implantation (TAVI), an innovative stent-based technique for delivery of a bioprosthetic valve, has resulted in a paradigm shift in treatment options for elderly patients with aortic stenosis. While there have been major advancements in valve design and access routes, TAVI still relies largely on single-plane fluoroscopy for intraoperative navigation and guidance, which provides only gross imaging of anatomical structures. Inadequate imaging leading to suboptimal valve positioning contributes to many of the early complications experienced by TAVI patients, including valve embolism, coronary ostia obstruction, paravalvular leak, heart block, and secondary nephrotoxicity from contrast use.

A …

Elucidating The Function Of Transplanted Islets Of Langerhans And Predicting Their Ability To Reverse Diabetes, Andrew R. Pepper

Electronic Thesis and Dissertation Repository

Type 1 diabetics require daily injections of exogenous insulin to control hyperglycemia. Unfortunately, patients are still plagued by vascular and hypoglycemic complications. Beta cell replacement therapy by either whole organ pancreas or islet transplantation has been shown to restore carbohydrate control to these patients. A major barrier to successful islet transplantation is the lack of a reliable pre-transplant assay of post-transplant function thus providing an objective measure of whether a particular islet isolation should be transplanted. Such an assay would also prove to be a valuable tool in the experimental evaluation of innovative islet isolation strategies and technologies. The initial …

Preoperative Angiotensin Converting Enzyme Inhibitor Or Angiotensin Receptor Blocker Use And Acute Dialysis: A Population Based Cohort Study, Mitesh K. Shah

Electronic Thesis and Dissertation Repository

Angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use prior to major surgery is controversial. We performed a population based retrospective cohort study of 237,208 elderly patients (of whom 101,494 (42.8%) were ACEi or ARB users) who underwent major elective surgery from 1995 to 2010 in Ontario, Canada. The primary outcome was acute kidney injury treated with dialysis (AKI-D) within 14 days following surgery (810 (0.34%) patients). The secondary outcome was all-cause mortality within 90 days following surgery (11,089 (4.67%) patients). After adjusting for potential confounders, preoperative ACEi or ARB use was associated with a lower relative risk …

Mri-Based Attenuation Correction In Emission Computed Tomography, Harry R. Marshall

Electronic Thesis and Dissertation Repository

The hybridization of magnetic resonance imaging (MRI) with positron emission tomography (PET) or single photon emission computed tomography (SPECT) enables the collection of an assortment of biological data in spatial and temporal register. However, both PET and SPECT are subject to photon attenuation, a process that degrades image quality and precludes quantification. To correct for the effects of attenuation, the spatial distribution of linear attenuation coefficients (μ-coefficients) within and about the patient must be available. Unfortunately, extracting μ-coefficients from MRI is non-trivial. In this thesis, I explore the problem of MRI-based attenuation correction (AC) in emission tomography.

In particular, I …

Methodological Challenges And Clinical Applications Of Hair Cortisol Analysis, Evan W. Russell

Electronic Thesis and Dissertation Repository

This thesis examines methodological and clinical aspects of hair cortisol analysis. The methodological study examines the role of sweat as a contributor to hair cortisol concentrations. Hair cortisol analysis is an effective measure of chronic stress. Cortisol is assumed to enter the hair via blood, sebum, and sweat, however the extent to which sweat contributes to hair cortisol content was unknown. This study concluded that human sweat contains cortisol that likely contributes to hair cortisol content. Subjects with prolonged sweating at the time of hair collection may have increased hair cortisol concentrations that cannot be decreased with conventional laboratory washing …

Hearts And Minds: Examining The Evolution Of The Egyptian Excerebration And Evisceration Traditions Through The Impact Mummy Database, Andrew D. Wade

Electronic Thesis and Dissertation Repository

Egyptian mummification and funerary rituals were a transformative process, making the deceased a pure being; free of disease, injury, and disfigurements, as well as ethical and moral impurities. Consequently, the features of mummification available to specific categories of individuals hold social and ideological significance. This study refutes long-held classical stereotypes, particularly dogmatic class associations; demonstrates the apocryphal nature of universal heart retention; and expands on the purposes of excerebration and evisceration implied by synthetic and radiological analyses.

Features of the embalming traditions, specifically the variable excerebration and evisceration traditions, represented the Egyptian view of death. Fine-grain analyses, through primary imaging …

The Role Of Religion And Spirituality In The Care Of Patients In Family Medicine, Michael F. Lee-Poy

Electronic Thesis and Dissertation Repository

Aims: This thesis explored patients’ perspectives on discussing their religious and spiritual beliefs with their family physicians and family physicians’ behaviours in discussing patients’ religion and spirituality.

Methods: This thesis examined the role of religion and spirituality in patient care in family medicine using qualitative and quantitative methodologies including in-depth interviews of patients and a survey of family physicians.

Findings: The majority of participants believed that religion and spirituality was important in patient care in family medicine. Barriers and facilitators were identified to the integration of religion and spirituality into patient care. Both studies identified physician comfort level as a …

Targeted Intracellular Therapeutic Delivery Using Liposomes Formulated With Multifunctional Fast Proteins, Rae L. Nesbitt

Electronic Thesis and Dissertation Repository

Prostate cancer is the most common malignancy in North American men and there is no treatment currently available which offers a clear survival advantage to patients with prostate cancer. We studied liposomes formulated with the fusion-associated small transmembrane (FAST) protein, p14. In this study, we hypothesized that therapeutics delivered in molecular targeted fusogenic liposomes will increase intracellular delivery and specificity for prostate cancer. We demonstrated that liposomes formulated with p14-bombesin significantly increased the delivery of fluorescein isothiocyanate (FITC) into human prostate cancer (PC-3) cells compared to either standard liposomes or non-targeted fusogenic liposomes. Delivery of FITC to benign prostate hyperplasia …