Medicine and Health Sciences Commons^™

Client-Provider Relationships In A Community Health Clinic For People Experiencing Homelessness: A Critical Ethnography, Abram Oudshoorn

Electronic Thesis and Dissertation Repository

People who are experiencing homelessness have the highest rates of morbidity, and the lowest age of mortality in Canada. The importance of health care relationships in addressing the needs of people who are experiencing homelessness has been demonstrated. However, two gaps still exist in the literature. Firstly, the dialectical relationship between space/place and social relations has been neglected in the context of health care and homelessness. Secondly, there is a dearth of research on the role of formal and informal policies on the enactment of client-provider relationships in this context. Therefore, in this study three research questions are addressed: 1) …

The Characteristics Of Successful Evidence Retrieval By Nephrologists And The Impact Of Pubmed Search Filters, Salimah Shariff

Electronic Thesis and Dissertation Repository

Background: Clinicians frequently search PubMed to guide patient care. This study investigated the factors that impact successful searching and the utility of PubMed search filters.

Methods: A random sample of nephrologists was surveyed between 2008 and 2010; 160 valid responses were received (72% response rate). One group of 60 respondents was presented with the same two clinical questions, while the other 100 were each presented with a unique clinical question. The clinical questions were based on recently published systematic reviews. Respondents provided the search terms they would type into PubMed to address their clinical question(s). All physician-provided searches …

The Role Of Granulocyte Colony-Stimulating Factor In The Intestinal Immune System And The Response To Probiotics, Andrew J. Martins

Electronic Thesis and Dissertation Repository

Loss of immunoregulation in the intestine results in inflammation, such as is observed in the chronic, relapsing, inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis. However, our understanding of this process remains incomplete. The cytokine granulocyte-colony stimulating factor (G-CSF) is an important stimulator of granulopoiesis in steady-state and during inflammation, but has also been shown to have anti-inflammatory effects and is a potential therapeutic for IBD. In addition, certain strains of bacteria, termed probiotics, have been postulated to have anti-inflammatory effects in the intestine. The mechanisms by which these strains of bacteria elicit anti-inflammatory effects are not fully understood. …

Quantification Of Pulmonary Ventilation Using Hyperpolarized 3he Magnetic Resonance Imaging, Lindsay Mathew

Electronic Thesis and Dissertation Repository

Smoking-related lung diseases including chronic obstructive pulmonary disease (COPD) and lung cancer are projected to have claimed the lives of more than 30,000 Canadians in 2010. The poor prognosis and lack of new treatment options for lung diseases associated with smoking are largely due to the inadequacy of current techniques for evaluating lung function. Hyperpolarized ³He magnetic resonance imaging (MRI) is a relatively new technique, and quantitative measurements derived from these images, specifically the ventilation defect volume (VDV) and ventilation defect percent (VDP) have the potential to provide new sensitive measures of lung function. Here, we evaluate the reproducibility …

Hemodynamics In The Stenosed Carotid Bifurcation With Plaque Ulceration, Emily Y. Wong

Electronic Thesis and Dissertation Repository

The presence of irregular plaque surface morphology or ulceration of the atherosclerotic lesion has been identified as an independent risk factor for ischemic stroke. Doppler ultrasound (DUS) is the most commonly performed non-invasive technique used to assess patients suspected of having carotid artery disease, but currently does not incorporate the diagnosis of plaque ulceration. Advanced Doppler analyses incorporating quantitative estimates of flow disturbances may result in diagnostic indices that identify plaque ulcerative conditions. A technique for the fabrication of DUS-compatible flow phantoms was developed, using a direct-machining method that is amenable to comprehensive DUS investigations. In vitro flow studies in …

Ethical Challenges In Cluster Randomized Trials, Andrew Mcrae

Electronic Thesis and Dissertation Repository

Research Questions: This dissertation examines how ethical challenges in CRTs are addressed in practice. This dissertation also provides guidance as to who must be considered a research subject in a CRT, and when consent must be sought from research subjects.

Methods: The association between consent practices in healthcare CRTs and particular trial features were examined using multivariable logistic regression modelling. Information on ethical challenges encountered by CRT researchers in practice was obtained by analyzing semi-structured interviews with experienced CRT investigators. Two normative questions, “Who is the research subject in CRTs?” and “When is consent required in CRTs?” were also addressed. …

Effects Of Work Environments On Nursing And Patient Outcomes, Nancy M. Purdy

Electronic Thesis and Dissertation Repository

Nurses are leaving the profession due to high levels of job dissatisfaction arising from current working conditions characterized by heavy workloads, limited participation in decision making and lack of development opportunities (Canadian Health Services Research Foundation [CHSRF], 2006a). To gain organizational support for workplace improvements and thereby improve nursing retention, evidence is needed to demonstrate the impact of the work environment on patient care. The purpose of this study was to determine the relationship between nurses' perceptions of their work environment and the quality and risk outcomes for both the patient and the nurse. Kanter's (1977, 1993) theory of structural …

A Stakeholder Generated Conceptualization For Successful Return To Work Outcome Evaluation: A Concept Mapping Approach, Rhysa Leyshon

Electronic Thesis and Dissertation Repository

Measurement of return to work (RTW) lacks attention to outcomes of relevance to all stakeholders. The objective of this thesis was to define what constitutes a successful RTW outcome from a stakeholder perspective and determine how to best measure it. A concept mapping method was used to create a conceptualization of successful RTW outcome based on indicators of interest and importance to various stakeholders. RTW researchers were questioned and the literature was searched for measures that mapped to the conceptualization and concepts. Stakeholders, made up of RTW consumers and providers, generated 48 indicators of successful RTW which were subsequently grouped …

Improvements In Cardiac Spect/Ct For The Purpose Of Tracking Transplanted Cells, Eric Sabondjian

Electronic Thesis and Dissertation Repository

Regenerative therapy via stem cell transplantation has received increased attention to help treat the myocardial injury associated with heart disease. Currently, the hybridisation of SPECT with X-ray CT is expanding the utility of SPECT. This thesis compared two SPECT/CT systems for attenuation correction using slow or fast-CT attenuation maps (mu-maps). We then developed a method to localize transplanted cells in relation to compromised blood flow in the myocardium following a myocardial infarction using SPECT/CT. Finally, a method to correct for image truncation was studied for a new SPECT/CT design that incorporated small field-of-view (FOV) detectors. Computer simulations compared gated-SPECT reconstructions …

Mapping The Flip Angle In Magnetic Resonance Imaging Using The Accelerated 3d Look-Locker Sequence, Trevor P. Wade

Electronic Thesis and Dissertation Repository

In the ongoing quest to extract more information from MRI images, there has arisen a need to rapidly map the flip angle. This has been primarily driven by the shift to stronger main field strengths, which bring with them improved SNR, but also new difficulties. In particular, the radio frequency field used to excite the magnetization can no longer be assumed uniform at field strengths of 3 Tesla and above. New rapid quantitative imaging techniques, such as DESPOT1 and DESPOT2, rely on accurate knowledge of the flip angle, and while this could safely be assumed to be the prescribed value …

The Health Of Ontario’S Transgender Communities: Prevalence Of And Risk Factors For Depression, "Do-It-Yourself" Transitions, And Health Effects Of Cross-Sex Hormones And Surgeries, Nooshin Khobzi

Electronic Thesis and Dissertation Repository

The purpose of this dissertation was to develop an understanding of, and draw attention to, the health and service access issues faced by trans (transgender, transsexual, or transitioned) Ontarians. This thesis is based on the Trans PULSE Project, a community-based research (CBR) initiative whose goal is to improve the health of trans people. Data collection was carried out between May 2009 and April 2010 using a quantitative survey. Trans participants were recruited through respondent-driven sampling (RDS), a network-based sampling method developed for the recruitment of hidden populations. Weighted prevalence estimates and 95% confidence intervals were calculated for all variables of …

Physical Function During Performance-Based Tasks And Throughout Daily Life. Is It Different Across Levels Of Frailty?, Olga Theou

Electronic Thesis and Dissertation Repository

The overall aim of this thesis was to provide a more focused understanding about the physical function of older women across levels of frailty. The specific aims were: 1) Examine the physical function of older women across levels of frailty during performance-based tasks and throughout their normal daily life; and 2) Review the effectiveness of current exercise interventions for the management of frailty. To answer these aims an observational study of community-dwelling older women (63-100 years) from rural Greece and a comprehensive systematic review on the impact of exercise on frail older adults were conducted. The performance-based measures that had …