Other Medicine and Health Sciences Commons^™

Validity Of Quality Of Life Measurement In Economic Evaluations In Total Joint Replacement: Agreement Between Western Ontario And Mcmasters' Osteoarthritis Index (Womac) And The Euroqol 5d (Eq-5d) Utility Scores, Sanju Valamparampil

Electronic Thesis and Dissertation Repository

Health economic evaluations are commonly conducted through a cost-utility analysis, where health benefits are measured using utility scores. A common utility measure is the European Quality of Life (EQ-5D). Osteoarthritis (OA) research studies commonly use disease-specific quality of life tools such as the Western Ontario and McMaster’s Universities Osteoarthritis Index (WOMAC) to derive utility scores, but the validity of this method is unknown. This research aims to determine the agreement between utility scores derived from WOMAC and the EQ-5D surveys among patients who have undergone Total Joint Replacement (TJR). To estimate the agreement, we calculated an intraclass correlation coefficient (ICC) …

Describing Healthcare Concerns Of Young People And Adults With Cerebral Palsy, Christina M. Winger

Electronic Thesis and Dissertation Repository

The purpose of this study was to identify healthcare concerns of young people and adults with cerebral palsy (CP) in the Transitional and Lifelong Care (TLC) program, and determine whether there were patient factors associated with the number of healthcare concerns. A retrospective chart review of initial TLC consultations was completed (n = 241). Descriptive and inferential statistics were used to explore and explain patterns in the sample population. The participants reported a high number of concerns of varied nature that were not easily predicted by condition-specific or demographic variables. This study may better healthcare delivery for young people …

Language-Based Strategies That Support Person-Centered Communication In Formal Home Care Interactions With Persons Living With Dementia, Reanne G. Mundadan

Electronic Thesis and Dissertation Repository

Background. Several studies recommend language-based strategies for communication with persons living with dementia. Language-based strategies improve coherence, clarity, reciprocity, and continuity of interactions. Person-centered communication (PCC) strategies are the gold standard, including facilitation, recognition, validation, and negotiation. Only one study has examined the overlap between language-based strategies and PCC in long-term care. Little is known about which language-based strategies support PCC in home care. Accordingly, this study investigated the overlap between language-based strategies and PCC in home care interactions. Method. Conversation analysis of 30 audio-recorded routine care interactions between home care workers and persons living with dementia was conducted. The …

Radiographic Predictors Of Functional Outcome In Degenerative Lumbar Spondylolisthesis Surgery, Patrick Thornley

Electronic Thesis and Dissertation Repository

Objective: To confirm the importance of sagittal spinal alignment on functional outcome with degenerative lumbar spondylolisthesis (DLS) surgery and to identify the radiographic parameters that predict functional outcomes after DLS surgery.

Methods: Retrospective analysis of the prospectively collected functional and radiographic outcomes of the Canadian Spine Outcomes and Research Network DLS database. All patients underwent either decompression, posterolateral fusion or interbody fusion surgery with a minimum of one-year postoperative follow-up.

Results: Most patients improve or remain unchanged in their sagittal spinal alignment regardless of surgery type with fusion procedures not experiencing statistically significantly improved alignment changes to decompression alone. By …

Quantifying Mid-Pregnancy Placental Metabolism In Guinea Pigs Fed A Lifelong Western Diet, Mary-Ellen E.T Empey

Electronic Thesis and Dissertation Repository

Maternal consumption of a Western diet (WD) has been linked to alterations in fetoplacental metabolic programming and risk for the exposed fetus to develop obesity, cardiovascular disease, and type II diabetes mellitus. It may also cause oxidative damage to the placental mitochondria. This thesis investigated the metabolic effects of a WD on placentae using a guinea pig model of pregnancy and hyperpolarized ¹³C MRI for metabolic quantification. It was hypothesized that placental glycolytic metabolism would increase, and placental oxidative metabolism would decrease in WD-fed sows. Control diet- and WD-fed, pregnant sows underwent metabolic MRI at 33 days gestation and …

Evaluating The Implementation Of A Chronic Obstructive Pulmonary Disease Management Program Using The Consolidated Framework For Implementation Research: A Case Study, Stefan Paciocco

Electronic Thesis and Dissertation Repository

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage. Interprofessional teams are effective at providing chronic disease management and care that meets the needs of patients. As part of an ongoing spread, an interprofessional primary care COPD management program was implemented at a family health team in Ontario. A qualitative case study was performed to determine the supporting or hindering factors to the implementation of the program. Data collected was deductively analyzed using the Consolidated Framework for Implementation Research. Eleven constructs were determined to meaningfully affect implementation. Cosmopolitanism, networks and communication, engaging, design …

Experimental Determination Of Motion Parameters And Path Forces Of Robot-Driven Glenoid Reaming Procedure, Mayank Sharma

Electronic Thesis and Dissertation Repository

Glenoid reaming is one of the most challenging milestones of the total shoulder arthroplasty (TSA) procedure. For a successful TSA, adequate bone resurfacing is required to ensure a well-conformed positioning of the implant onto the native bone.

In this study, a light-weight robot was employed to assert a prescribed thrust-force and reaming depth to mimic clinical practice. Reaming of bone-analogs indicated that specimen density had a linear relationship with reamer velocity and apparent machining stiffness. Human cadaveric bone studies confirmed a linear relationship between specimen density and reamer velocity in both subchondral and cancellous regions of the glenoid. A reaming …

How Do Health Care Providers Identify And Address Lifestyle Factors With Community Dwelling Adults Who Have Chronic Wounds?, Linda Norton

Electronic Thesis and Dissertation Repository

Wound prevention and management best practice guidelines and literature contain recommendations that treatment plans need to consider the client’s lifestyle but offer little guidance about the specific lifestyle factors to be considered, nor how to address these. A post positivist constructivist grounded theory study was used to explore this gap Participants were health care providers with at least 5 years of experience working with community dwelling adults with chronic wounds. Data were transcripts of two semi structured individual interviews, a reflective journal, relevant documents identified by participants and transcripts of focus groups.

A common understanding of lifestyle factors was not …

Design, Development, Manufacturing And Biomechanical Testing Of Stand-Alone Cage For Posterior Lumbar Interbody Fusion, Fahad Alhelal

Electronic Thesis and Dissertation Repository

Introduction: The most common method of spinal fusion includes pedicle screws instrumentation, either with or without interbody cage fusion. This thesis aimed to develop and test a novel stand-alone intervertebral device that eliminates the need for pedicle screws and rods.

Method: The stand-alone cage was designed in collaboration with spinal surgeons and engineers using computer assisting drawings, and manufactured in titanium by 3D printing. Biomechanical testing comparing the stand-alone cage with standard posterior lumbar interbody fusion (PLIF) in sawbones (n=6) and cadavers (n=8).

Result: Compared to PLIF, the stand-alone cage demonstrated no significant difference in range of flexion, lateral bend …

The ‘Meanings’ And ‘Enactments’ Of Science And Technology: Ant-Mobilities’ Analysis Of Two Cases, Farrukh Chishtie

Electronic Thesis and Dissertation Repository

In this work I study two cases involving practices of science and technology in the backdrop of related and recent curricular reforms in both settings. The first case study is based on the 2005 South Asian earthquake in Muzaffarabad, Pakistan which led to massive losses including large scale injuries and disabilities. This led to reforms at many levels ranging from disaster management to action plans on disability, including educational reforms in rehabilitation sciences. Local efforts to deal with this disaster led to innovative approaches such as the formation of a Community Based Rehabilitation (CBR) model by a local NGO, which …

Continuity Of Care And Shared Decision-Making In Interprofessional Collaborative Maternity Practices In Canada, Dorothy Anne M. Malott

Electronic Thesis and Dissertation Repository

Problem: The number of maternity care providers varies across Canada. Women from rural communities or those marginalized due to physical, psychological or social issues including newcomers, often experience challenges accessing health care (Fraser Health, 2014; Rogers, 2003). Interprofessional collaborative maternity care [IPCMC] has been credited as a means of increasing access and promoting sustainability of services (Miller et al., 2012; Society of Obstetricians and Gynecologists of Canada, 2008). Midwifery could play a greater role in delivery of services through IPCMC. However, little is known about collaboration in these practices. The purposes of this study are to explore factors influencing enactment …

Registration And Familial Consent For Deceased Organ Donation Among Ethnic Minorities In Ontario, Canada: Opportunities For Improvement, Alvin Li

Electronic Thesis and Dissertation Repository

Canadians on the transplant waiting list are dying every day because there are not enough available solid organs for transplantation. An important aspect of addressing this problem is to increase deceased organ donation consent rates. Consent rates are, in part, affected by the number of adults registering their commitment to deceased organ donation in the event of their death through a donor registry. In provinces such as Ontario, approximately 30% of the population is registered for deceased organ donation and approximately 60% of families consent to organ donation. These low figures have been attributed, without evidence, to the relatively high …

Fitness-To-Drive Screening Measure© : Constructing And Validating The Short Form, Shabnam Medhizadah

Electronic Thesis and Dissertation Repository

The valid and reliable Fitness-to-Drive Screening Measure^© (FTDS) is a free online proxy measure that screens for at-risk older drivers using 54 driving-related items. This secondary data analysis aims to construct and validate a short form FTDS, using 200 caregiver FTDS response sets and 200 older driver on-road assessment pass/fail outcomes. To construct the short form, exploratory factor analysis and classical test theory techniques were employed to determine the most interpretable factor model and the minimum number of items that might be used to predict fitness to drive. Next, receiver operating characteristics curves were generated to evaluate the concurrent …

Sample Size Formulas For Estimating Intraclass Correlation Coefficients In Reliability Studies With Binary Outcomes, Mengxiao Xu

Electronic Thesis and Dissertation Repository

Introduction: Measurement errors can seriously affect quality of clinical practice and medical research. It is therefore important to assess such errors by conduct- ing studies to estimate a coefficients reliability and assessing its precision. The intraclass correlation coefficient (ICC), defined on a model that an observation is a sum of information and random error, has been widely used to quantify reliability for continuous measurements. Sample formulas have been derived for explicitly incorporation of a prespecified probability of achieving the prespecified precision, i.e., the width or lower limit of a confidence interval for ICC. Although the concept of ICC is applicable …

Development Of Holistic Classification Systems For Children With Cerebral Palsy, Deepa Jeevanantham

Electronic Thesis and Dissertation Repository

Cerebral palsy (CP) is a complex disorder. There is a gap in the literature in classifying children with CP broadly. The purpose of this thesis was to develop holistic classification systems for children with CP. As a first step, a search was conducted to explore the strategies used to classify children with developmental co-ordination disorder and autism-spectrum disorder. Two versions of holistic classification systems named the body function index in cerebral palsy (BFI-CP) versions I and II were developed using two methods. Then, the relationship and differences among the developed classification systems and the Gross Motor Function Classification System (GMFCS) …

First-Responders And Emergency Department Healthcare Provider Interactions During Emergency Situations: A Grounded Theory Study, Jennifer A. Mohaupt

Electronic Thesis and Dissertation Repository

Interactions between and among first-responders and emergency department (ED) healthcare providers impact the way in which patients are managed during emergency situations. The purpose of this study was to develop a grounded theory to explain the interactions between and among first-responders and ED healthcare providers during emergency situations. Interprofessional collaboration and teamwork has been extensively studied, however little is known about interactions that include first-responders. This study was guided by Strauss and Corbin’s (1990) approach to grounded theory. Data were collected through 256 hours of first-responder and ED observational opportunities and informal interviews with accompanying detailed field notes. As well, …

Evaluation And Treatment Of Lower Extremity Wounds In A Vascular Surgery Patient Population, Christine Anne Murphy

Electronic Thesis and Dissertation Repository

Purpose

To determine in a population with lower extremity wounds associated with vasculopathy if: (1) previously proposed clinical signs of infection are valid indicators of wound infection; (2) low frequency (22.5 kHz) contact ultrasound debridement (LFCUD) is well tolerated and feasible to apply in a nurse-led vascular wound clinic; (3) healing outcomes are improved for patients receiving LFCUD in comparison to patients receiving usual care (UC).

Methods

A total of 80 patients were in the study. First, a pilot group of ten patients were followed to determine tolerability, feasibility and wound response of 4 weekly LFCUD treatments. Then 70 patients …

Are Patients At The Centre Of Care?: A Qualitative Exploration Of Myotonic Dystrophy Type 1 (Dm1), Kori A. Ladonna

Electronic Thesis and Dissertation Repository

Health care for individuals living with myotonic dystrophy (DM1)—an uncommon, life-limiting neurological condition for which there are few treatments—may be challenged by patients’ symptoms including cognitive and behavioral impairments. Is patient-centered care—which incorporates the values, experiences and expertise of patients and their caregivers—feasible or achievable? Uncovering patients’ and their caregivers’ experiences of living with DM1, their health care expectations, and their health care providers’ (HCP) perspectives about care is essential for examining patient-centered care in this population. Therefore, the purpose of this research is to: (1) add patients’ and caregivers’ voices to the literature, (2) explore on-going care provision for …

American Ginseng Supplementation Does Not Attenuate Indices Of Exercise Induced Muscle Damage, Brent Smith

Electronic Thesis and Dissertation Repository

ABSTRACT

PURPOSE: To investigate the effect of American ginseng consumption on changes in average peak torque measures of dominant leg extensors following a downhill running bout. METHODS: Ten university aged male volunteers were divided equally into two groups in this double-blind study. Both groups performed baseline tests to determine average peak torque of leg extensors. Subjects then began a 4 week supplementation period of American ginseng or placebo. They then performed a downhill treadmill run at a speed between 9.7-11.3 km/h and -12% grade. The muscle strength protocol involving the dominant leg extensors was then repeated at one, two, and …

Managing Uncertainty In Young-Onset Parkinson's Disease, Michael J. Ravenek

Electronic Thesis and Dissertation Repository

Typically considered a disease of old-age, Parkinson’s disease can affect those younger in life, i.e., before the age of 55, when it is referred to as young-onset Parkinson’s disease (YOPD). Using constructionist grounded theory, this research sought to understand how, and why, individuals with YOPD became informed about their disease over time. A total of 39 individuals, who self-identified as living with YOPD, took part in this study which was organized according to four cycles of data collection. These cycles utilized focus groups, in-depth interviews and a private online discussion board, supplemented by 14 autobiographies written by individuals living with …

Construing Natural Restorative Environments In Individuals Treated For Cancer, Adam M.B. Day

Electronic Thesis and Dissertation Repository

Restorative environments (RE) are increasingly being explored for their potential to foster psychophysiologic restoration and promote health and well-being. However, there is a paucity of research that focuses on oncology populations. The purpose of this study was to explore whether individuals treated for cancer with chemotherapy construed natural restorative environments (NREs) differently than age- and gender-matched individuals never treated for cancer. Fifteen individuals treated for cancer with chemotherapy (11 females and 4 males; treatment group) and 15 age- and gender-matched individuals (comparison group) participated in interviews and completed repertory grids based on construing NREs. Constructs were elicited directly from participants …

Development And Assessment Of An Impact Apparatus And High-Speed Camera Motion Tracking System To Quantify The Effect Of Static Muscle Loads On Fracture Threshold Measures In The Distal Radius, Jacob M. Reeves

Electronic Thesis and Dissertation Repository

Distal radius fractures are prevalent, debilitating, and costly. This thesis conducts an in vitro investigation of these injuries, examining the role of static muscle loading on fracture threshold measures (i.e., force, impulse, energy). Initially, an impact apparatus and custom LabVIEW colour-thresholding program were designed and assessed for repeatability and accuracy in quantifying fracture measures and impact kinematics. These tools were then used to test six pairs of cadaveric forearms, with static muscle loads simulated in one specimen from each pair. Distal radius fractures were achieved in 5 pairs, with perilunate dislocations in the remaining pair. None of the …

Risk Factors For Diabetes Mellitus: A Comparative Analysis Of Subpopulation Differences In A Large Canadian Sample, Michael James Taylor

Electronic Thesis and Dissertation Repository

Objectives: Certain Canadian subpopulations observe numerous modifiable and non-modifiable risk factors for diabetes. This study compares immigrants and Aboriginals (First Nations, Inuit, and Métis) with Canada-born individuals at higher risks for diabetes, and deciphers the determinant differences between them.

Methods: Pooled Canadian Community Health Survey data (2001-2010) were used. Time trends for diabetes within each subsample were calculated using individual survey year prevalence rates; diabetes diagnoses were self-reported (N=33,565). Various risk factors were also examined using logistic regression.

Results: Diabetes prevalence rates significantly increased from 2001 to 2010 for each subpopulation, as well as the total sample: Canada-Born individuals (3.9% …

Gait Initiation In Parkinson's Disease: The Manipulation Of Cue Expectancy In A Dual Task Paradigm, Derrick Nield

Electronic Thesis and Dissertation Repository

Introduction. This study examined movements of the center of pressure (CoP) during forward gait initiation, in Parkinson disease (PD) patients and healthy controls, in a dual task paradigm with manipulations of cue expectancy. Methods. The CoP trajectory was divided into three periods and, prior to testing, subjects were given instructions as to whether they would receive the cue to initiate gait. The secondary task was a numerical recitation. Results. PD patients demonstrated significantly reduced CoP movements and greater variability in the timing of the vocalizations compared to healthy controls. Both groups demonstrated significant increases in CoP movements when uncertain and …

How Do Parents Use Health Information With The Aid Of A Knowledge Broker When Living With And Caring For Their Young Children With Cerebral Palsy?, Stephanie E. Lagosky

Electronic Thesis and Dissertation Repository

This research aims to understand how parents use health information (such as those developed from the Move & PLAY study) with the aid of a knowledge broker when living with and caring for young children with cerebral palsy. This research was conducted under a qualitative case study methodology and used questionnaires and in-depth interviews to collect data. Findings include the complexity of both parental use of health information and the desire to use a knowledge broker. A provisional model has been created to help describe information use of parents with young children with cerebral palsy. This provisional model is an …

Reductions In Muscle Quantity And Quality In Old And Very Old Men: New Insights Into The Progression Of Sarcopenia, William J. Booth

Electronic Thesis and Dissertation Repository

Healthy adult aging is associated with sarcopenia; a loss of skeletal muscle mass known as. Major contributors to this process include functional and morphological changes in the contractile tissue and within the neuromuscular system. Currently, the relationship between muscle mass, normalized strength, structural integrity, and neuromuscular properties [such as motor unit number estimates (MUNE)], in the tibialis anterior (TA) with aging is largely unknown. Therefore, to examine this relationship we recruited twelve young (25 ± 3 years old), six old (68 ± 5 years old) and six very old (79 ± 3 years old) men. Magnetic resonance (MR) images were …

Understanding The Subjective Norms Surrounding Noise Exposure And Hearing Conservation In Children, Jill E. Lowther

Electronic Thesis and Dissertation Repository

Hearing conservation programs (HCPs) often take an atheoretical, information-based approach to reducing noise-induced hearing loss. This research assesses HCPs through a Theory of Planned Behavior lens, with the goal of understanding subjective norms in children surrounding sound exposure and hearing conservation. Twelve participants engaged in one individual, structured interview. Data analysis consisted of three concurrent activities: data reduction, data display, and conclusion drawing/verification. This research ensured trustworthiness through the criterion of neutrality, which was achieved through the incorporation of both truth value and consistency. Four major themes emerged from the analysis of interview data: (1) knowledge regarding sound exposure and …