Predicting Risk for Adverse Outcomes Following Distal Radius Fracture

Some individuals remain at risk for adverse outcomes such as chronic wrist/hand pain, falls, and fall-related osteoporotic fractures after distal radius fracture (DRF) remain. This thesis includes five studies that were conducted to establish prediction rules or assessing the risk of these adverse outcomes following DRF. The first manuscript outlines a theoretical framework (RACE - Reducing pain, Activating, Cognitive reshaping, Empowering) for managing the risk of adverse outcomes, mainly chronic pain, in individuals with DRF. The RACE is one of the first frameworks to suggest a risk-based management approach for individuals with DRF. The Patient-Rated Wrist Evaluation (PRWE) is a condition-specific measure for DRF used in research as well as clinical practice to measure pain and functions in individuals with different wrist/hand injuries. The second manuscript contributes to the literature by providing the first systematic literature review that synthesizes the evidence regarding the psychometric properties of the PRWE. The review determined that the PRWE has excellent reliability, construct validity, and responsiveness in individuals with DRF. The third manuscript indicates that the baseline pain intensity is an independent predictor of chronic pain in individuals with DRF. The results also suggest that the individuals who score ≥35/50 on the pain scale of the PRWE at baseline have 8 times greater risk for developing chronic wrist/hand pain compared to those who score \u3c 35/50. The fourth and fifth manuscripts describe results of a two step study. The fourth manuscript is a structured literature synthesis that identified suitable measures for predicting the risk of falls and fall-related osteoporotic fractures following DRF. The fifth manuscript summarizes the results of preliminary analysis of psychometric properties of selected fall risk measures identified in the fourth manuscript. The fifth manuscript also provides feasibility and sample size requirements for conducting a fall prevention trial in individuals with DRF

The Examination of Expectations in Day-Surgery Patients and the Development of a Patient Satisfaction Questionnaire for Day-Surgery Patients

Patient satisfaction has become a growing area of study within health care. Existing hospital- wide satisfaction tools don’t provide the specificity that various departments require to truly get a sense of where they stand in terms of patient satisfaction. Further, many of these tools fail to consider an important component associated with satisfaction, patient expectations. Currently, there is no patient satisfaction tool specific to adult day-surgery patients that has been developed through a careful exploration of patient expectations. In this qualitative study, we conducted a series of semi-structured interviews on patients undergoing outpatient surgery to explore expectations. We performed a thematic analysis on our data and distilled six themes of expectations: Communication, Safety, Responsiveness, Compassionate Care, Flow, and Creating Confidence. Using these themes, we developed a preliminary Patient Satisfaction Questionnaire for Day-Surgery Patients. The resulting questionnaire can be used by institutions to gather patient satisfaction data in those undergoing day-surgery

Adviser\u27s Guide to Health Care, Volume 2: Consulting Services

https://egrove.olemiss.edu/aicpa_guides/2721/thumbnail.jp

Outcomes in Functional Urology: towards a prediction model in pelvic floor disorders

The two fundamental research questions of this thesis are: 1) Can we lay the foundations to construct a complete diagnostic and prognostic prediction model in pelvic floor disorders in the future? 2) Can we construct the first part of this prediction model, a prognostic model that predicts the outcome of urge urinary incontinence treatment

The treatment of menorrhagia with an evaluation of endometrial ablation and its evolution

This thesis is based on work performed in the Department of Gynaecology ofAberdeen Royal Infirmary. This is a regional referral centre with an established reputation in menstrual research, focusing on surgical trials. The work of this thesis continues and expands on this.Chapter 1 outlines and reviews the current literature on the treatment of menstrual disorders. The aetiology, epidemiology and options both surgical and medical are reviewed. A detailed review of the development, scientific and technical aspects of Microwave Endometrial Ablation is made. The evidence base is reviewed and discussed with a focus on randomised trials.Chapter 2 describes the 5 year follow up of an original trial comparing women initially referred to a gynaecologist with excessive menses who were randomised to either standard medical treatment or endometrial ablation in the form of Transcervical Resection of the Endometrium (TCRE). This represents the longest follow up of women randomised to medical treatment for menorrhagia. Those allocated to ablation were significantly more likely to report themselves as totally satisfied at 5 years as those allocated medical treatment. Acceptability was high for both arms but only 20% of women treated medically would recommend this to a friend compared to 79% of the ablation arm. Amenorrhoea rates were significantly higher in the ablation arm versus the medical arm (88% versus 66%). Quality of life measures using the generic tool SF 36 revealed that scores for the women in the ablation arm were restored to normative levels in all 8 subsets, whilst this was improved in only 4 for the medical arm. During the follow up period 77% of those in the medical arm underwent ablative surgery. The impact of offering ablative surgery early did not result in an increase in the incidence of recourse to hysterectomy with similar numbers in each arm (17% versus 18%) being hysterectomised at 5 years.Chapter 3 describes a multi-centre international randomised controlled trial comparing the first generation technique of Rollerball Endometrial Ablation (RBEA) with the second generation technique of Microwave Endometrial Ablation (MEA). This trial had 8 centres, both academic and private, in the United States, Canada and the United Kingdom. The trial randomised 322 women to MEA or RBEA in a 2:1 ratio. Menstrual Loss (PBLAC) diaries were used in the recruitment, follow up and definition of success (PBLAC score < 75). When comparing women allocated to MEA versus those allocated to RBEA they reported similar success rates and satisfaction. Higher post operative amenorrhoea rates were reported in the MEA arm but the result was not significant. In the subgroup of women with BMI's of over 30kg/m2 MEA was significantly more likely to be associated with success. The presence or absence of non-obstructing fibroids (< 3cm) did not affect success rates or amenorrhoea rates between MEA and RBEA. MEA treatment was significantly more often performed under local anaesthesia. This trial established MEA as being comparable in the majority of outcome measures to RBEAChapter 4 describes a randomised controlled trial of MEA performed in an outpatient setting in the early post menstrual phase to standard treatment performed in a day case theatre after endometrial preparation. All procedures were performed under local anaesthesia plus or minus sedation. 210 women were randomised in a 1:1 ratio to the treatment arms. Significantly more women found treatment post menses acceptable (89.5% versus 76%). Similar numbers were totally or generally satisfied (92.5% versus 84%). Amenorrhoea rates were similar (55.9% versus 61.9%). A significant difference in direct cost was seen with treatment as an outpatient in the post menses arm costing £124 less than treatment in day case theatre after endometrial preparation.Chapter 5 reviews the rates of surgery for excessive menstrual bleeding in Scotland and the Grampian region from 1998 - 2004. A 43% reduction in the hysterectomy rate is seen in Scotland over the time scale. A smaller reduction (34%) is seen in the figure for Grampian. This may be a reflection of Aberdeens pro-ablation stance and early general uptake of the procedure .A 25% reduction is seen in the total number of procedures in Scotland. The ratios of hysterectomy to ablation alter over time with a reduction from 5:1 to 1.7:1 seen. The ratio is Aberdeen is more marked with a ratio of 0.5 to 1, twice as many ablations being done as hysterectomy. The low uptake of vaginal hysterectomy and decline in minimally invasive technologies of Laparoscopic Assisted Vaginal Hysterectomy are outlined. Overall an increase of 65% in ablation rates in Scotland is seen with a shift from first generation to second generation techniques (11% reduction in 1st versus a 65% increase in 2nd generation technologies).Chapter 6 reviews the conclusions made form the work described in this thesis and there relevance to medical practice. Suggestions are made for areas of future research