Digital Commons Network^™

The Association Of Health Insurance And Prescription Drug Coverage On Cost-Related Non-Adherence And Hospitalization Across Age-Related Groups Of Individuals With Copd, Shamika Martin Walls

Theses and Dissertations

Background: COPD patients have poor adherence to prescribed treatment. Individuals with COPD have higher out-of-pocket treatment cost than individuals without COPD. The significant out of pocket COPD related treatment cost can lead to prescription drug non-adherence especially for individuals without health insurance or prescription drug coverage.

Significance: Since the implementation of Medicare Part D on January 1, 2006, there are no studies that have used national data to evaluate the association of health insurance and prescription drug coverage on cost related non-adherence and hospitalization among individuals 50-64 years old with COPD compared to individuals 65 years and older …

Kujdesi Infermieror Tek Të Sëmuret Me Kancer, Suela Isufi

Theses and Dissertations

Praktika infermierore te kanceret përfshin të gjitha grupmoshat dhe fushat e infermierisë, ndërsa ofrohet në një sërë ambientesh të kujdesit shëndetësor, duke përfshirë shtëpinë, komunitetin, institucionet e kujdesit akut dhe qendrat e rehabilitimit. Gjatë kujdesit infermieror ndaj pacientit duhet të kemi parasysh në radhë të parë anën e tij psikologjike, Kur ai kupton se ka sëmundjen e kancerit ndjehet i traumatizuar, ndjehet sikur i ka ardhur fundi, prandaj dhe mbështetja infermierore rëndësi të madhe në këtë fazë te jetës së tyre. Për objektiv të këtij projekti kemi pasur hulumtimin e njohurive të infermierëve mbi sëmundjet kancerogjene dhe përvojat e tyre …

Hiv Care Location: An Evaluation Of Single Versus Multi Facility Utilization Of Hiv/Aids Care Services And Patient Health Outcomes And Clinical Indicators In South Carolina, Melanie Gwynn

Theses and Dissertations

Background: On the HIV/AIDS care continuum, the “retention in care” metric does not distinguish between single-facility (SF) or multi-clinic utilization (MC), also described as HIV care location (or type). SF utilization is vital as it has been linked optimal clinical outcomes among People Living with HIV/AIDS (PLWH). Published research detailing the prevalence of HIV care type and its association with health outcomes/clinical indicators, has been studied only in limited urban settings. Additionally, coinfections such as sexually transmitted infections (STIs), have yet to be evaluated as potential predictive factors for HIV care type.

Methods: A cross-sectional design was used …

Relationships Between Hospitals' Music Therapy Services And Hospital Consumer Assessment Of Healthcare Providers And Systems ( Hcahps ) Scores, Kimberly S. Iverson

Theses and Dissertations

Background: The implementation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measured patients’ satisfaction with their hospital stays. The HCAHPS brought increased public access regarding hospital performance and changes to repayment polices. As such, patient satisfaction became a popular topic in hospitals within the last several years. Previous research demonstrated medical benefits for the use music therapy in hospitals, but research regarding its relationship to patient satisfaction was limited.

Hypotheses: The hypothesis of the current study was that patients who received music therapy services while in the hospital would have higher HCAHPS scores than those who …

The Mausoleums Of Fatima Khatun And Al-Ashraf Khalil, Naglaa Muhammad Sami Hassan

Theses and Dissertations

This thesis will conduct an architectural analysis of two nearly contemporary mausoleums situated on the northern tip of the Southern Cemetery of Cairo near the Sayyida Nafisa shrine. The Southern Cemetery is the oldest one, which stretches from the east at Muqattam hill to the south at Fustat. The mausoleums of the princess Fatima Khatun and al-Sultan al-Ashraf Khalil date to the late 13th century. Among the interesting aspects of the mausoleum of Fatima Khatun (Umm al-Salih), the wife of al-Mansur Qalawun, is its unique Maghribi style minaret. In addition, apart from his splendid mausoleum, al-Ashraf Khalil, Qalawun’s son, constructed …

Exploring Turnover Among Nurse Managers, Directors, And Executives In Acute Care Hospitals, Deborah Hughes Warden

Theses and Dissertations

Background: The strength and quality of the nursing leader workforce is associated with staff nurse retention and patient outcomes. While leadership turnover is not always negative, there is still uncertainty, loss of program continuity, power shifts within an organization, and significant expense for the organization in recruiting and integrating a new leader.

Purpose: The purpose of this study is to explore intent to leave and turnover experiences of acute care nurse managers, directors, and executives.

Methods: For this nationwide survey, recruitment was done via snowball sampling through state hospital associations and professional organizations across the US with a resulting sample …

The Social Role Of The Artist, Gabino A. Castelan

Theses and Dissertations

Gabino A. Castelán, tells a personal story of loss that influenced his artistic practice. He embraced this narrative to create two projects “Practice of Everyday Life-205 (PoEL-205) and the formation of a temporary collective called, Cultural Workers. He presents two case studies of twenty-first century artists, whose projects have business models that allow them to function in social roles during political and social turmoil. "Conflict Kitchen" and "Rebuild Foundation" provide context about running for-profit and not-for-profit artistic practices. Castelan writes about these projects' influencing his artistic practice in general.

Factors Associated With Hospital Readmissions Among United States Dialysis Facilities, Amber B. Paulus

Theses and Dissertations

Hospital readmissions are a major burden for patients with end stage renal disease (ESRD). On average, one in three hospital discharges among patients with ESRD are followed by a readmission within 30 days. Currently, dialysis facilities are held accountable for readmissions via the ESRD Quality Incentive Program standardized readmission ratio (SRR) clinical measure. However, little is known about facility-level factors associated with readmission. Additionally, unlike other standardized measures of quality in the dialysis setting, incident patients within their first 90-days of dialysis are included in the performance calculation. This study analyzed CMS Dialysis Facility Report data from 2013 to 2016 …

Post-Secondary Career Technical Education Instructional Practices, Giselle D. Bice

Theses and Dissertations

Although the current public education system's vision of college and career readiness is creating a substantial space for career technical education (CTE) in schools, little has been done regarding researching the current state of career educational education and adult learners. As colleges become further impacted by fiscal constraints, adding additional years for the completion of any post-secondary degree, a need exists to reassess the state's adult school CTE programs as an essential partner in post-secondary education. This study aimed to elucidate instructional best practices of CTE instructors within a public school setting as a foundation for further research in this …

A Qualitative Study Exploring Motivation And Engagement Among Millennial Volunteers In Nonprofit Organizations, Joanne Quinones

Theses and Dissertations

This applied dissertation focused on capturing the lived experiences of Millennials and explore their motivation and engagement for volunteering in a nonprofit organization. This study illustrates the importance of civic and social engagement in our society. The Millennials have been labeled as “Genme or the me generation” (Twenge, Campbell, Hoffman, & Lance, 2010, p. 1117; Twenge, 2006, p. 1), as they have been criticized for focusing on their own self-interest. While millennials have been considered as being technologically savvy, since they grew up with the internet. The millennials, have a social interest in offering support to a cause versus an …

Older Adult Caregivers’ Lived Experiences With Debilitated Chronically Ill Relatives In A Rural Southern County, Nancy J. Dameron

Theses and Dissertations

By 2030, the last of the baby boomer generation will reach the age of 65, which will expand the older adult population to more than 70 million in the United States. Based on the inflated numbers of the older adult population and the noted decreased birth rate in the younger population, fewer health-care providers will be available to teach, prepare, train, and assist caregivers in the ongoing care of their ill relatives.

The problem investigated in the study involved the present upsurge of the older adult population living longer and contributing to a shortage of health-care providers for older adults. …

Paraprofessional Counselors' Perceptions Of Storybooks To Facilitate Children's Communication Following Parental Suicide, Lindsay Jacalyn Regehr

Theses and Dissertations

A parent's death it is one of the most stressful and traumatic events in a child's life (Guldin et al., 2015; Worden, 1996, 2008). In particular, when bereavement is linked to a parent's suicide, children face unique challenges and are more vulnerable to potentially negative outcomes (Brent, Melhem, Donohoe, & Walker, 2009; Haine, Ayers, Sandler, & Wolchik, 2008; Pitman, Osborn, King, & Erlangsen, 2014; Young et al., 2012). Although many factors influence children's recovery following a parent's suicide, the surviving parent's emotional stability and emotional availability to support their children are of critical importance. Additionally, negative outcomes are often linked …

Cost Of Caring: The Effects Of Euthanasia On Animal Shelter Workers, Kim L. Nguyen-Finn

Theses and Dissertations

This mixed-methods study focuses on animal shelter workers, a population that has often been overlooked in research and clinical practice, and the emotional strains of the task of euthanasia. The effects of employment in a kill or no-kill shelter, participation in euthanasia, and number of years employed on mental health issues of substance abuse, anxiety, depression, secondary traumatic stress, and burnout were examined. A three-way MANOVA was run to test the hypothesis that there is a cell effect among the type of shelter employed in, participation in euthanasia, and years of experience on mental health, which was not supported by …

Certified Rehabilitation Counselors' Self-Perceived Competency In Facilitating End-Of-Life Care Services, Miranda Lopez

Theses and Dissertations

As of 2010, certified rehabilitation counselors (CRC) have been provided ethical guidelines addressing end-of-life care (EOL) service delivery for persons with disabilities. Due to the plethora of pertinent knowledge and skills sets needed to facilitate comprehensive EOL issues, it is vital to examine rehabilitation counselors’ self-perceived competence in facilitating EOL care service delivery. The study was conducted as a non-experimental exploratory design. Based on the study’s sample (N = 188), descriptive statistics reported 70% of counselors lacked education while 69% had not participated in EOL training. Approximately 81% of the participants reported the need for EOL education and training. …

Tides, Isa N. Gagarin

Theses and Dissertations

My artistic practice creates relationships between the abstract and the personal. I define the abstract in the context of my studio work as a material exploration of color and form. The personal encompasses autobiography in relation to my sense of time and place. In this text, I use my concept of oceanic tides (considered as a temporal and spatial shift between states) to chart my activities as an artist. These activities include making objects that change in character over time, and durational work including performance and video. Interwoven throughout Tides are narrative passages based on my personal experiences, including witnessing …

Galantamine's Deconstruction In The Quest Of A Pam Pharmacophore, Malaika Argade

Theses and Dissertations

Alzheimer’s disease is a progressive neurodegenerative disorder generally affecting people above the age of 65 years. Even though the pathophysiological hallmarks of AD were established more than a hundred years ago, there is yet to be a drug that can stop its characteristic neuronal damage. Of the five currently FDA-approved drugs, galantamine has a unique mechanism of action. Apart from being an AChE inhibitor, galantamine can effectively potentiate (positive allosteric modulator) the effect of agonists at nAChRs at concentrations lower than those required for its action as an AChE inhibitor. Perhaps the clinical benefits observed with galantamine are associated mainly …

The Effects Of Stand-Alone Prescription Drug Plans On Health Care Utilizations, Expenditures And Medication Adherence Among Elderly Medicare Beneficiaries, Jing Yuan

Theses and Dissertations

Since the implementation of Medicare Part D in 2006, a growing body of evidence has shown that Medicare Part D might offset the total healthcare spending by improving the use of prescription drugs. However, little is known about the impact of different types of Part D plans – Stand-alone Prescription Drug Plan (PDPs) and Medicare Advantage Prescription Drug Plan (MA-PDs) – on health care utilizations and expenditures. This dissertation examined the association between the effect in PDPs on health care utilizations as well as expenditures, and medication adherence among elderly Medicare beneficiaries, compared to MA-PDs. Data was pooled from 2006-2010 …

Economic Burden Of Renal Cell Carcinoma (Rcc) And Treatment Patterns, Overall Survival And Healthcare Costs Among Older Metastatic Rcc Patients, Hrishikesh P. Kale

Theses and Dissertations

Background

Renal cell carcinoma (RCC) is the most common type of kidney cancer. Patients diagnosed with metastatic RCC (mRCC) have shorter overall survival compared to those diagnosed at earlier stages. Several targeted therapies, which cost from $7,000 - $16,000 per month have been approved since 2005 to treat mRCC. In addition, there is a growing interest in the use of cytoreductive nephrectomy (CN) with targeted therapies among mRCC patients. However, little is known regarding the economic burden of RCC and role of CN and prescribing patterns of targeted therapies among older mRCC patients.

Objectives

1) To assess the economic burden …

Patient Characteristics, Discharge Disposition, And Hospital Factors Associated With All Cause 30-Day Hospital Readmission For Total Joint Arthroplasty In 2014, Hamad Yahya Alzamanan

Theses and Dissertations

Objective: Recent improvements in hospital care have come from a growing knowledge of factors that contribute to readmission. The objective of this work is to identify and describe the national readmission rate after Total Joint Arthroplasty, and to evaluate selected hospitals’ and patients’ factors for their association with the all-cause 30-day readmission rate after TJA in the United States in 2014. Method: Retrospective analysis of 938,504 TJA acute care hospital discharge records was performed, using a nationally representative database that is dedicated to the study of hospital readmissions, and accounts for 51% of total US hospitalizations. Logistic regression models were …

Nicu Nurses' Suggestions For Improving Obstacles In End-Of-Life Care, Rebecca Faye Isaacson

Theses and Dissertations

Background: Approximately 25,000 pediatric deaths occur in hospitals in the United States each year with over 50% of these deaths occurring in Newborn Intensive Care Units (NICU). NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles. Objective: The objective of this study was to obtain NICU nurses suggestions for improving obstacles in EOL care in NICUs. Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication …

Critical Care Nurses' Experiences Of Family Behaviors As Obstacles In End-Of-Life Care, Caitlin Brook Mallory

Theses and Dissertations

Background: Critical care nurses (CCNs) frequently provide end-of-life care for critically ill patients. CCNs may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care. Objective: What are the predominant themes noted when CCNs share their experiences of common obstacles, relating to families in providing EOL care? Methods: A random geographically dispersed sample of 2,000 members …

The Evolution Of A Black Butterfly: A Journey From Loss To Salvation, Subrinia Marie Bogan

Theses and Dissertations

“Honor thy Mother and thy Father” are the words that I have built my entire life around. After losing my dad, my world revolved solely around my mother. When her health started failing, I became her caregiver. I was there for the good days and the very bad ones. March 20, 2014, Mama died after a lengthy illness. My entire life was turned upside down. I had to learn how to build a life without her. Our lives were so intertwined that I ceased to exist. I had sacrificed my physical, spiritual, and emotional well-being in order to take care …

Ahead In Our Bulletin … Examining Kenyans’ Perceptions Of Cancer Messages In Television News And Use Of These Messages, James Ndone

Theses and Dissertations

Using the data collected from 212 participants, this study examined the perceptions that

Kenyans have toward television news with cancer messages and how the audiences use the messages. Using both close-ended and open-ended survey questions, this study investigated the motives that Kenyans have prior to watching news, how these motives affect their frequency of watching such news, how engaged they are with the news, their views of such news, how television news contribute to their knowledge about cancer, and their personal experiences with cancer.

Some of the results suggest that the motives that Kenyans have are to gain knowledge on …

Healthcare Leaders Under The Age Of 40: Successful Strategies And Practices For Leading Healthcare Organizations, Rizalyn Reynaldo

Theses and Dissertations

As millennials and young adults under the age of 40 become the growing majority, it is critical to understand their leadership profile, the workplace challenges they face, and their strategies for overcoming obstacles as young leaders. Specifically, in healthcare, the rapidly changing industry presents internal and external environmental challenges that must be handled in the most professional and proficient manner to be an effective leader. As such, the purpose of this study is to gather best strategies and practices that healthcare leaders under the age of 40 can adopt for their respective organizations. There are 4 research questions that address …

Quarantine, Scott Chalupa

Theses and Dissertations

Quarantine is a collection of poems concerned primarily with pre-Stonewall and early AIDS histories of LGBT people.

Evaluation, Treatment, And Education In The Hospice Setting By Initiating A Formalized Pain Card, Alyssa M. Soprano

Theses and Dissertations

The purpose of this DNP quality improvement project was to evaluate the use of a formalized pain card that Nurse Practitioners could use to assist clients and caregivers in making the decisions necessary for safe and effective pain management with improving outcomes by using the Brief Pain Inventory Form for measuring: 1) decreased pain, 2) increased pain, 3) pain relief. The appraised evidence suggested that there was a need for a policy standard for patients to notify when pain is unrelieved despite exhausting all other efforts to control pain (Glowacki, 2015). Forty-one (n=41) hospice patients were surveyed pre and post …

How To Make A Mudsparkler, Ethan Fogus

Theses and Dissertations

How to Make a Mudsparkler is a collection of lyrical narratives that address issues of masculinity and identity. These poems are threaded through with repeated themes— religion, place, and the nature of work—as they interrogate familial lineage with inventories of memory. The first section ruminates on family history as it is linked to formative memories. Section two continues these themes, but adds an exploration of adolescence and isolation. Finally, section three is the most immediate section as the speaker explores the fundamental questions of love, loss, and the nature of friendship.

Impact Of Medicare Reimbursement Policy Change On The Utilization, Risks, And Costs Associated With Erythropoiesis-Stimulating Agents In Cancer Patients With Chemotherapy-Induced Anemia, Minghui Li

Theses and Dissertations

Background: Erythropoiesis-stimulating agents (ESAs) are biological drugs used to stimulate the production of red blood cells. ESAs are commonly prescribed for cancer patients with chemotherapy-induced anemia and chronic kidney disease (CKD) patients with low levels of hemoglobin. Due to the increasing safety concerns, Centers for Medicare and Medicaid Services (CMS) issued a Medicare reimbursement policy change for ESAs in cancer patients to regulate the utilization of ESAs. For chemotherapy-induced anemia, when patients had solid tumors, multiple myeloma, lymphoma, or lymphocytic leukemia, ESA treatment is reimbursable by CMS only when the hemoglobin level is < 10g/dL.

Objectives: The objectives of this study were …

The Impact Of The Federally Qualified Health Center Advanced Primary Care Practice Demonstration On The Poor And Elderly, Jaison R. Moreno

Theses and Dissertations

Implementing a difference-in-differences, I quantify the effects of the Federally Qualified Health Centers Advanced Primary Care Practice demonstration on the self-reported general health of 367 U.S. counties across 47 states. I find small positive statistically significant effects of the demonstration on the elderly and residents of high poverty communities.

Critical-Care Nurses' Suggestions To Improve End-Of-Life Care Obstacles: Minimal Change Over 17 Years, Kacie Hart Hadley

Theses and Dissertations

Background: Critical-care nurses (CCN) provide end-of life (EOL) care on a daily basis as one in five patients dies while in Intensive Care Units (ICU). CCNs overcome many obstacles to perform quality EOL care for dying patients. Objectives: The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2,000 members of the American Association of Critical-Care Nurses. Nurses were asked for …