Health Science Dissertations and Theses

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    How valid and useful is a locally-developed frailty tool for joint decision-making by patients, families and clinicians?
    (2016) Duffus, Benjamin; Eastern Institute of Technology
    There are increasing numbers of elderly patients in New Zealand hospitals. An ageing population coupled with increasing financial constraints has heralded concern about future management and sustainability of the health system. Another dimension of this issue is the growing concern with how elderly patients are managed and treated in the end stages of their lives and whether the “bio-medicalisation” of the ageing process has now become routine. The context of an ageing population, limited finances, and an emerging bio-ethical field concerning elderly medical treatment, has created a need to understand what frailty looks like, how it can be measured, and whether this knowledge can help clinicians and patients arrive at informed treatment decisions. A frailty tool, Frail CHeC, was developed at a regional hospital. It aims to provide a quick method of assessing patients for frailty that is easily understood by clinicians and patients. Research was conducted to determine whether the Frail CHeC tool was valid and useable for patients, and clinicians. This thesis used a quantitative research approach by way of a descriptive survey method. Twelve clinicians were recruited to participate in the study. They conducted 60 Frail CHeC assessments between them. Each Frail CHeC tool had a survey that was completed by the clinician and the patient at the conclusion of the assessment. Results of the Frail CHeC tool and the accompanying survey were summarised and descriptive and inferential statistics were calculated. The results of the Frail CHeC assessment were stratified across age bands and gender and compared to established frailty tools. Both patients and clinicians had favourable views on the Frail CHeC tool. Views were assessed using a Likert scale of 1-5 with one representing strongly disagree and five representing strongly agree. The mean score for whether the Frail CHeC tool results were a good representation of the patient’s level of frailty and health were 4.48 for clinicians and 4.24 for patients. The mean score for whether the assessment was a good use of time was 4.39 for clinicians and 4.13 for patients. The mean time to complete the Frail CHeC assessment was 33 minutes with doctors completing the assessment quicker than other professional groups.
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    The effects of practical muscle blood flow restriction training on running performance and physiology
    (2016) Addis, Shalako; Eastern Institute of Technology
    Performing training sessions in combination with blood flow restriction (BFR) has been shown to improve muscle mass and strength development. However few studies have investigated BFR effects on aerobic performance. The purpose of this study was to determine the effect of BFR on both aerobic and anaerobic capacity after completing eight sessions of running interval training. Sixteen recreationally trained, male and females (age 24.9 ± 6.9 years, height 172.9 ± 7.8 cm, weight 75.1 ± 13.8 kg) initially completed an incremental treadmill test to determine maximum oxygen uptake (VO2max) followed by a time to exhaustion test (TTE) at peak running velocity to determine anaerobic capacity. Participants were then pair-matched based on their VO2max and randomly assigned into either a practical blood flow restriction (pBFR) group (n = 8) or a control (CON) group (n = 8) for four weeks of training. The interval sessions consisted of two to three sets of 5-8 minute (30 seconds work, 30 seconds rest) runs at 80% of peak treadmill test velocity (9.6 – 12.0 km.h-1). Following the initial training session (two sets of 5-min), 1-minute was progressively added to each set until the fifth session, where a third set was employed, beginning at 5-minutes. For the final two weeks, time was subsequently increased in the same manner as the first four sessions until a final session (three sets of 8-min) was completed. Elastic knee wraps was used for practically occluding the lower limbs in the pBFR group and wrap tightness was subjectively set at a pressure of 7/10. Oneway ANOVA was utilised to determine both within-group and between-group differences pre-post training. In addition, mean percentage changes and 90% confidence limits were estimated and magnitude of changes was analyzed using the Cohen effect size statistic. Maximal oxygen uptake increased in both the pBFR (6.3%) and CON (4.0%) cohorts following training. Similarly TTE increased by 26.9% and 17.0% respectively for the pBFR and CON groups. However there were no significant differences (p >0.05) in assessed physiological and performance measures between groups. Effect size statistics showed small beneficial improvements in peak running velocity (D= 0.34) and TTE (D= 0.31) in favor of the pBFR group compared to CON. In conclusion, eight sessions of running interval training with, and without blood flow restriction improved physiology and performance measures in recreationally trained individuals. Subjects using BFR experienced small positive adaptations in performance measures compared to the CON group. Further research using a larger sample size is required in order to elucidate the potential positive impact of BFR during training.
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    Mild traumatic brain injury in New Zealand: Post-concussion symptoms and recovery
    (2016) Henry, Janis; Eastern Institute of Technology
    RESEARCH QUESTION What impact does the amount of time between injury and assessment date, along with the post-concussion symptoms reported at assessment, have on the length of stay in a concussion service? ABSTRACT Traumatic brain injury is predicted to become the third largest cause of disease burden globally by 2020. Of these, it is estimated that between 70-90 percent will be categorised as mild which is also known as concussion. The current study looks to determine what impact a delay in time between injury and assessment date, along with the post-concussion symptoms reported at assessment, has on the length of stay in a concussion service within New Zealand. A retrospective, descriptive, quantitative methodology that reviewed medical records was employed to determine whether statistically significant associations existed between the variables for 107 clients. Results showed no significant correlations for the cognitive and physical clusters but did show that a delay in time between injury and assessment was significantly correlated with higher psychological symptoms being reported along with a longer stay in service. These findings highlight the importance of early diagnosis and intervention for mTBI, with education programs, awareness and symptom management possibly being the solution to lessen the impact of mTBI.
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    Water fluoridation: A contest of control; An analysis of social discourses in the New Zealand fluoride debate
    (2016) Westwood, Kirsten; Eastern Institute of Technology
    Community water fluoridation involves the addition of an artificial fluoride compound to public drinking water supplies. This is done under the scientific principle that fluoride, ingested in small amounts, results in significant improvement in the incidence of tooth decay. Dental health remains a major issue for much of the New Zealand population. Dental decay remains the most prevalent chronic (and irreversible) disease worldwide, and disparities still exist in oral health status. Notwithstanding this, benefit and harm arguments have been hotly debated since its original introduction in the USA in the 1950s. Critical theorists have questioned the assumption on which medical ‘experts’ self-ruling and enormously powerful position in society is based. The ‘age of the internet’ has enabled unforeseen access to information allowing ‘non-experts’ to become increasingly more knowledgeable and articulate about health issues. In a shift from traditional medical models of health, everyday people are seeking to regain control and have a say in the types of intervention that are administered and the general care they receive. A critical discourse analysis of the fluoride debate offers the potential to discover the role and scope of language and power relationships that science, policy, law, ethics and community viewpoints have to play in determining the reasons for ongoing debate. The implications of these discourses for policy makers and dental care agencies are also considered. Findings are that significant societal changes since the inception of fluoridation 60 years ago have shaped a growing wave of uncertainty. Medical science; once the undisputed truth can no longer assume to have the complete trust of the general public in the modern world.
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    Factors Māori perceive essential for success in undergraduate nursing education in Aotearoa/New Zealand: A descriptive study
    (2017) Chittick, Hannah; Eastern Institute of Technology
    Increasing the number of Māori in the health workforce has been identified as being key to improving health outcomes for Māori. This can be achieved by more Māori being involved in decision-making processes regarding Māori health, improving access to health services for Māori, and being key personnel in the development of health services based on the Māori world view (Ministry of Health, 2014b). However, to increase the number of Māori Registered Nurses (RNs) in the nursing workforce, more Māori are required to enter into undergraduate nursing programmes and successfully complete the qualification. Literature has identified several barriers that can impact on Māori engagement and success in tertiary education, including organisational, personal, social and financial barriers (Ratima et al., 2007; Ratima et al., 2008). Knowledge and understanding of these barriers are important steps for improving proportionality between Māori and non-Māori RNs in nursing education and ultimately the nursing workforce. What is not clearly understood is the support systems or strategies that Māori nursing students perceive would help them succeed in gaining their undergraduate nursing qualification. This research aimed to understand what factors support Māori to succeed in Bachelor of Nursing education in Aotearoa/New Zealand. This qualitative descriptive study has explored the perceptions of seven Māori Bachelor of Nursing graduates, through semi-structured face to face interviews. Analysis of the data was guided by Braun and Clarke’s thematic analysis process (2006), and five themes were identified as main factors that support Māori to succeed in undergraduate nursing education. These included Striving to be a nurse; Whanau, financial and institutional support; Importance of relationships; Cultural nurture and connectedness in the learning environment; and finally, Developing resistance in the face of racism and unconscious bias. Several recommendations have been made for both Tertiary Education Providers (TEPs) and clinical learning environments as a result of this study to improve the success rates for Māori in undergraduate nursing education. These include, creating teaching and learning environments that are more culturally appropriate; bringing Māori support services to Māori; increasing Māori mentorship through model such as the tuakana/teina model; providing a culturally safe, culturally nurturing learning environment through professional development of faculty staff including correct pronunciation of te reo Māori and increasing the professional development of cultural competence of registered nurses in the current nursing workforce.