Faculty of Medicine- B.Sc. (Med) Projects http://hdl.handle.net/1993/5119 2013-04-26T17:29:20Z 2013-04-26T17:29:20Z Zylberman, Melina http://hdl.handle.net/1993/12282 2013-01-29T18:32:31Z 2012-11-26T00:00:00Z

Title: Understanding the impact of HIV among a vulnerable population in south India Authors: Zylberman, Melina Abstract: India has approximately 5.7 million people living with HIV/AIDS (PLWHA). Karnataka, a southern state in India containing the capital city of Bangalore, is a prime example of an area demonstrating high HIV prevalence. Snehadaan, a care and support centre for PLWHA in the outskirts of Bangalore, has requested assistance from partners at the Karnataka Health Promotion Trust and the University of Manitoba to understand better the needs of their patients to plan the expansion of their services. A retospective chart review of 210 charts from an adult population of HIV infected inpatients who died at Snehadaan between 2010 and 2011 was conducted to describe causes of mortality. Last admission details such as clinical presentation and tuberculosis (TB) and HIV diagnosis and treatment details were also explored. It was found that almost all the patients presented as WHO HIV stage III or IV (96.9%) and 76.4% had CD4 counts less than 200 cells/mm3, but only 56.7% were on antiretoviral therapy (ART) at time of admission. Furthermore, almost halt (49.6%) died within one year from their date of HIV diagnosis and 70.3% were diagnosed during their last admission with TB, a disease that accounted for 39.6% of the total deaths. These findings show that these patients presented late and at advanced stages in their disease and emphasize the importance of continuing to increase awareness of HIV for earlier testing and treatnent and of opportunistic infections such as TB, as they further compromise the health of an already immunocompromised population.

2012-11-26T00:00:00Z Zhang, Yiyang http://hdl.handle.net/1993/12281 2013-01-29T18:36:00Z 2012-11-26T00:00:00Z

Title: Accurate bedside clinical assessment of hypertensive and 'symptomatic' hypotensive patient's intravascular volume status with hand-carried ultrasound devices in hemodialysis clinic Authors: Zhang, Yiyang Abstract: The number of people diagnosed and living with kidney failure requiring dialysis in Canada has tripled in the last two decades. In center hemodialysis is a thrice-weekly treatment that attempts to remove fluid and toxins rapidly and in a short time. One of the major difficulties is determining how much fluid to remove from a patient in a given treatment as the bedside physical exam is often inaccurate. Therefore the aim of this study is to assess volume status in chronic dialysis patients by measuring the IVC diameter employing a hand-carried ultrasound. Patients with kidney failure were recruited to the study and each was scanned three times on three different dialysis sessions. Measurements of the inferior vena cava were taken pre, mid, and post dialysis sessions. Measurements of the inferior vena cava were compared to clinical surrogates of volume, which include blood pressure, symptoms, and ultrafiltration removed. The student learnt ultrasound techniques to scan for the inferior vena cava, as well, he learnt basic research and statistical skills in order to assess the reliability and feasibility of using hand-carried ultrasound in clinical practice.

2012-11-26T00:00:00Z Willcock, Michael http://hdl.handle.net/1993/12280 2013-01-29T18:36:05Z 2012-11-26T00:00:00Z

Title: Evaluation of a novel head and neck immobilization device for external beam radiation therapy Authors: Willcock, Michael Abstract: The purpose of this study was to compare the novel CDR Systems MayoMold to the Civco Medical Solutions standard neck roll in order to determine if the MayoMold should become widely used for head and neck cancer radiation therapy immobilization at CancerCare Manitoba. Fifteen patients were enrolled in the standard neck roll cohort and ten patients were enrolled in the MayoMold cohort. Bony landmarks of clinical interest were selected and daily imaging was used to quantify daily changes in patient set up and deformations with respect to the digitally reconstructed radiograph created from each patient’s planning CT. Bayesian statistics were employed with support from Epidemiology at CancerCare Manitoba in order to compare the patients to themselves across all of their treatment fractions, to different patients in the same cohort, and to the other cohort. Subjective end points concerning the MayoMold were solicited from patients and staff. Several measures of patient immobilization, especially concerning the mandible, were found to be inferior in the MayoMold cohort. These results were statistically significant but not clinically significant, allowing the conclusion to be made that the MayoMold was not superior to the standard neck roll with regards to patient immobilization. Adverse subjective feedback and the increased cost of using the MayoMold skewed the subjective end points towards the negative. In all, it was not recommended that CancerCare Manitoba adopt the MayoMold.

2012-11-26T00:00:00Z Wanigasekara, Nilupama http://hdl.handle.net/1993/12279 2013-01-29T18:36:02Z 2012-11-26T00:00:00Z

Title: Examining the effects of a novel model of cardiac rehabilitation in reducing wait times and increasing adherence to behavior changes promoted by the program Authors: Wanigasekara, Nilupama Abstract: Cardiac rehabilitation (CR) is an effective secondary preventative strategy in patients who have undergone a cardiac event. Even so, some aspects of CR programming remain to be optimized. For example, some patients delay their enrollment in CR based on personal factors or delay their CR enrollment because of program factors. There is also evidence in the literature indicating that group dynamics within the CR peer cohort can contribute to increased adherence to a physically active lifestyle. Therefore, this project was designed to determine if a rolling, continuous entry CR program, where patients can enter CR soon after referral, is more effective than the traditional CR program for modifying outcomes. The student was provided an opportunity to learn how to recruit participants for a prospective, interventional study, to utilize accelerometers to objectively measure physical activity behaviour, assess functional walking capacity and to utilize a variety of validated measures to characterize changes in mood status (depression), anxiety and general health amongst a cohort of CR participants. The student participated in an interdisciplinary, collaborative research team and completed a clinical placement shadowing the health professionals who conduct medical screening and stress testing for all of the CR program clients as well as those allied health professionals who deliver the healthy living and education initiatives within the CR program. The objective for the project was to distinguish a difference between the traditional entry model (TRAD) and the continuous entry model (CONTIN).

2012-11-26T00:00:00Z