Medicine and Health Sciences Commons^™

Burnout Among Managed Care Clinicians, Dawn M. Waggoner

Theses

Burnout is a pattern of emotional overload in which one feels overwhelmed by the demands imposed by others . Those individuals who do "people work" of some kind are the most vulnerable to burnout. The purpose of this study was to determine if there is a relationship between the level of burnout and the number of months case workers have worked at the same managed care company. Thirty-two case workers from one managed care company completed the Maslach Burnout Inventory (MBI) to assess their current level of burnout. Data analysis run on all three subscales found that there was no …

Proactive Technique For Workplace Chemical Exposure, James A. Duru

Theses

The rapid increase in the number and quantities of chemicals released into the environment has been accompanied by a lack of adequate pre-released testing for advance health outcomes. Chemicals which serve as feed stock to millions of industries all around the world to produce and process food, cosmetics, equipment, and energy to propel industries, automobiles, home heating and electricity have serious adverse health consequences. They are hazardous. These substances can explode, ignite, react and corrode. Adapting the definition of the international program on chemical safety, a "hazard" is a source of danger. This thesis proposes some proactive prevention techniques useful …

The Medicare Program: Ripe For Reform, Gina M. Barhoumy

Theses

This thesis will evaluate several proposals to reform the Medicare system and how those proposals differ in terms of focus on either financial restructuring or care delivery redesign. This thesis proposes that an emphasis on managed care strategies will represent an effective way to reform the Medicare system.

The purpose of the study is to consider how a shift in focus from acute care treatment to illness prevention and chronic disease management would salvage the Medicare program. The thesis will further explore how an acute care focus has affected the Medicare program, turning a social policy into fuel that feeds …

Current Trends In Designing A Therapeutic Milieu For The Victims Of Alzheimer's Disease, Nancy J. Allen

Theses

The increasing awareness of the need to appropriately manage victims of Alzheimer's disease has created an explosion of special care units across the country. This research project was designed to investigate the most current trends in caring for these individuals and the complex issues that are involved in the creation and operation of a therapeutic environment. Several existing Alzheimer's special care units in the St. Louis area are examined and compared. The results of this survey reveal the status of these units and how they compare to the desired therapeutic milieu described in this exercise.

Methicillin Resistant Staphylococcus Aureus (Mrsa): Molecular Detection And Dna Fingerprinting, Leslie Cotter

Theses

Throughout the 1990s, the incidence of methicillin-resistant Staphylococcus aureus has increased in many health care areas including acute and chronic care facilities, outpatient clinics and in the community. Once introduced into a health care environment, this nosocomial pathogen can spread rapidly and as MRSA are resistant to multiple antibiotics, treatment is often difficult. Therefore effective infection control measures are required to prevent cross-infection and further spread of endemic strains.

In this study, a sensitive and specific triplex-PCR assay was designed for MRSA detection, wherein three genes, the methicillin resistance gene (mecA). femA and the extracellular thermonuclease gene (rmc) were simultaneously …

Development Of An Atomic Force Microscopic Immunosensor For The Ferritin Antigen, Brendan O'Connell

Theses

The adsorption conditions for a range of different immunoreactants to both polystyrene and ultrasmooth silanised silicon surfaces are optimised. The conditions studied were concentration of protein, time and temperature of incubation, pH, molarity and ionic strength of the buffer. The anti-ferritin surface was selected as our model system. This immunosensor was used to develop and evaluate a millispot ELISA for ferritin. The millispot ferritin ELISA developed utilises a sample volume of 6pl and a sample incubation time of 10 minutes. Precision and accuracy studies show the assay to have a dynamic assay range of 7.8-lOOng/ml ferritin. The millispot ELISA detected …

Evaluation Of The Role Of Fructosamine As An Indicator Of Diabetic Control, Katherine Hooley

Theses

Diabetes mellitus, a common metabolic disease, is characterised by excess circulating glucose concentrations. Such a hyperglycaemic status provides the stimulus for irreversible glycation (non-enzymatically post-translational) of structural and functional proteins. Protein glycation, although a cause of complication (neuropathy, micro/macrovascular disease), provides a time-averaged index of diabetes status and control. In particular, glycated plasma proteins analysis, i.e., the fructosamine assay, has received favourable response due to its speed, simplicity, low cost, and ease of automation. However, lack of standardisation and a universally-accepted calibrant has limited technical and subsequent clinical confidence in fructosamine analysis. In response, a comprehensive technical evaluation (including novel …

Development Of A Differential Assay To Selectively Measure Α-Amylase Isoenzymes., Miriam O'Connor

Theses

α-Amylase is a heterogeneous polypeptide, primarily found in the Salivary and Pancreatic glands, giving rise to two isoenzymes, namely Salivary- and Pancreatic-type Amylases. Total α-Amylase activity measurements are routinely carried out in hospital laboratories to aid in the diagnosis of diseases of the pancreas and in the investigation of pancreatic function in patients with severe abdominal pains. With the development and wide availability of modem chromogenic oligosaccharide substrates specific for Amylase, assays have become more sensitive, rapid and easier to use.

Differential Amylase Isoenzyme assays ware developed to distinguish isoenzyme levels. Several methods were developed for isoenzyme determination. Of these. …

Development And Validation Of An Improved Ultrasensitive Assay For Cardiac Troponin I (Ctni), William G. Blake

Theses

Cardiac troponin I (cTnl) has been reported to be a highly specific marker for myocardial injury. In patients suffering from acute coronary syndromes, a sensitive serum marker which is closely related to the extent of myocardial damage which provides prognostic data and which can be measured rapidly is desirable. In this thesis a “sandwich” enzyme immunoassay was developed to measure cTnI. The developed assay was reproducible with the inter assay precision ranging from 4.8-14% and the intra assay precision ranging from 3.1-9.5%. The limit of detection of the assay was calculated as 0.385 ng/ml. The upper reference range (non-parametric 95% …

Development And Validation Of Flow-Injection (Continuous-Flow) Elisa Techniques., Declan Gerard Spillane

Theses

A flow-through enzyme-linked immunosorbent assay was developed based on affinity chromatography using the determination of ferritin in serum as a model system. In this method, samples and standards are introduced to separate columns containing immobilised anti-ferritin antibody, and antigen bound by solid-phase antibody is subsequently detected using an anti-ferritin-alkaline phosphatase conjugate. To detect immobilised label, p-nitrophenyl phosphate is added and product is developed in the column at room temperature. Following elution of product from the column, the absorbance is measured and the columns are regenerated using a low pH elution. The final developed system requires approximately 1.5 h for the …

Molecular Analysis Of The Factor V-Leiden Mutation In A Cardiac Transplant Patient Population, Caroline Maher

Theses

Venous thrombosis is a serious health problem affecting 1 in 1000 individuals annually. Until recently the pathogenic factors underlying thrombosis were associated with genetic defects in protein C, protein S and antithrombin III. However these were recognised in fewer than 5-10% of thrombotic patients. A breakthrough was made with the discovery of activated protein C resistance (APCr) which is associated in 90% of cases v/herein a G-->A transition in the factor V gene results in an abnormal molecule, Factor V Leiden. APCr is a major risk factor for thrombosis being present in 20-60% of thrombotic patients. Recently a G-^A …

Development Of An Elisa Method For The Measurement Of Cd44 Expression In Human Serum, Ciara Hurley

Theses

CD44 is a cell surface glycoprotein (mol. wt. =85-95 kDa) which has been implicated in lymphocyte-HEV interactions and the process of lymphocyte homing. CD44 is a complex glycoprotein which undergoes extensive alternative splicing to generate various CD44 isoforms. CD44 functions include the delivery of an activation signal to T-cells, binding to hyaluronate, mediation of lymphocyte homing, and the spread of metastatic cells. CD44 has been particularly implicated in the dissemination of non- Hodgkin's lymphoma and as such may serve as a useful prognostic marker of disease progression. CD44 measurement in serum may provide a rapid, inexpensive and relatively non-invasive prognostic …

"Ssmart Care": The Development Of Disease Management Programs Within An Integrated Health Care Network, Carol E. Oberaitis

Theses

This cumulative project paper will focus on the development of disease management programs by SSM Health Care - St. Louis, an integrated health care delivery network. This paper will detail the process used by the network to prepare for this project, the key roles and functions of the staff and physicians, the design phase and implementation phase of the project. The rationale for the project, the literature review, the barriers to the project and the outcomes will be included in this paper.

The purpose of this project paper is to share with other networks or individual hospitals the experience of …

Health Aspects Of Native American Indians And Alaskan Natives, Beverly V. Bennett-Maine

Theses

This thesis will focus on the decline in health of Native Americans and Alaskan Natives in regards to chronic diseases due to changes in their food habits, customs, traditions, and culture.

The purpose of this study is to explore why Native Americans and Alaskans health has deteriorated in relation to diabetes, obesity, heart disease, and alcoholism.

Limitation in access to health care facilities includes geographic location, cul tural, and linguistic barriers.

The studies to be discussed include: the Inter-Tribal Heart Project (ITHP) for cardiovascular disease; the Behavioral Risk Factor Surveillance System (BRFSS) for self-reported risk factors; and the Navajo Health …

Awareness And Usage Of Alternative Medicine In The Elderly Black Population, Deborah Martin Burks

Theses

Alternative medicine covers a broad range of healing philosophies, approaches and therapies. When these therapies are used alone they are referred to as ' alternative'. When they are used with conventional therapies or other alternative therapies then they are referred to as complimentary.

Alternative medicine also embraces health beliefs and practices that fall outside of orthodox medicine. They offer the opportunity for an individual or case manager to explore alternative forms of healing when conventional treatment alone is not effective. Research has shown an increased interest in alternative medicine for the treatment of chronic illness.

The overall goal of this …