Medicine and Health Sciences Commons^™

Building Capacity For Dementia Care In Latin America And The Caribbean, Francisco J. Gonzalez, Ciro Gaona, Marialcira Quintero, Carlos A. Chavez, Joyce Selga, Gladys E. Maestre

School of Medicine Publications and Presentations

Latin America and the Caribbean (LAC) have limited facilities and professionals trained to diagnose, treat, and support people with dementia and other forms of cognitive impairment. The situation for people with dementia is poor, and worsening as the proportion of elderly in the general population is rapidly expanding. We reviewed existing initiatives and provided examples of actions taken to build capacity and improve the effectiveness of individuals, organizations, and national systems that provide treatment and support for people with dementia and their caregivers. Regional barriers to capacity building and the importance of public engagement are highlighted. Existing programs need to …

Impact Of Implementing Performance-Based Financing On Childhood Malnutrition In Rwanda, Agnes Binagwaho, Jeanine Condo, Claire Wagner, Fidele Ngabo, Corine Karema, Steve Kanters, Jamie I. Forrest, Jean De Dieu Bizimana

Dartmouth Scholarship

Background: Malnutrition remains a serious concern in Rwanda, particularly among children under-5 years. Performance-based financing (PBF), an innovative health systems financing strategy, has been implemented at the national level since 2008. This study aimed to assess the impact of PBF and other factors associated with the prevalence of three classifications of malnutrition (stunting, wasting and underweight) in children under-5 years in Rwanda. Methods: The study is a cross-sectional study comprising of 713 children under five years old from 557 households, whose anthropometric measurements (height, weight and age) had been obtained as part of the 2008 Rwanda General Health and HIV …

Local Population Characteristics And Hemoglobin A1c Testing Rates Among Diabetic Medicare Beneficiaries, Laura C. Yasaitis, Thomas Bubolz, Jonathan S. Skinner, Amitabh Chandra

Dartmouth Scholarship

Background: Proposed payment reforms in the US healthcare system would hold providers accountable for the care delivered to an assigned patient population. Annual hemoglobin A1c (HbA1c) tests are recommended for all diabetics, but some patient populations may face barriers to high quality healthcare that are beyond providers' control. The magnitude of fine-grained variations in care for diabetic Medicare beneficiaries, and their associations with local population characteristics, are unknown.

Methods: HbA1c tests were recorded for 480,745 diabetic Medicare beneficiaries. Spatial analysis was used to create ZIP code-level estimated testing rates. Associations of testing rates with local population characteristics that are outside …

Black Infant Deaths Point To Flaw In U.S. Health Care System, Vanessa Lopez-Littleton

UCF Forum

In a recent interview on The Daily Show, TV host Jon Stewart asked Fox political commentator Bill O’Reilly: “Does white privilege exist?” O’Reilly denied the existence of white privilege but conceded that as a collective, blacks carry more of a burden than whites.

Mid-Atlantic Ethics Committee Newsletter, Fall 2014

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Hippi Care Hospital: Towards Proactive Business Processes In Emergency Room Services, Kar Way Tan, Venky Shankaraman

Research Collection School Of Computing and Information Systems

It was 2.35 am on a Saturday morning. Wiki Lim, process specialist from the Process Innovation Centre (PIC) of Hippi Care Hospital (HCH), desperately doodling on her notepad for ideas to improve service delivery at HCH’s Emergency Department (ED). HCH has committed to the public that its ED would meet the service quality criterion of serving 90% of A3 and A4 patients, non-emergency patients with moderate to mild symptoms, within 90 minutes of their arrival at the ED. The ED was not able to meet this performance goal and Dr. Edward Kim, the head of the ED at HCH, had …

Intellectual And Developmental Disability: Healthcare Financing, David A. Ervin, Joav Merrick

Pediatrics Faculty Publications

The World Health Organization (WHO) estimates global spending on healthcare at $6.5 trillion, approximately 10.5% of the world’s gross domestic product. The United States’ (US) share of that spending is $2.6 trillion, essentially quadrupling since 1980. The 2010 United States Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, has stimulated extensive debate over the way in which healthcare is financed, and whether or not the costs of healthcare are sustainable. Among publicly funded healthcare in the US, Medicaid and Medicare are primary sources of funding. In federal fiscal year 2012, Medicaid spending on acute health exceeded $275.4 …

Rate Setting And Disclosure In Continuing Care Retirement Communities (Ccrcs), Seth C. Anderson, Jeffrey E. Michelman, Raymond M. Johnson, Kristi Quick

Jeffrey E Michelman

By 2026, the population of Americans age 65 and older will double to 71.5 million. According to a recent study by Metlife, et al., there are five important issues that impact both current and future retirees: Increased longevity with Americans living longer; Changing economic factors such as increased health care costs; A growing skills shortage in many industries; Different beliefs about work among the aging Baby Boomer generation; and Financial resources available for retirement. All five of these factors affect both the ways seniors plan for retirement and the ways that organizations providing services to seniors must respond. Continuing care …

Questions About Race As A Research Variable, Diane Powers Dirette

The Open Journal of Occupational Therapy

No abstract provided.

Social Actors Fight The Rising Tide Of Hiv In U.S. Southern Poor, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

The greatest number of persons living with HIV in the United States are now living in the South, and they face poorer health outcomes and increased AIDS-related deaths as compared to the rest of the country. The southern United States has a disproportionate share of low-income individuals, with many lacking access to health care and health insurance. Health facilities are also comparatively fewer and more difficult to reach than in other areas of the United States. The impacts of this already poor health infrastructure on low-income people living with HIV in the South can be life-threatening.

This policy brief summarizes …

Medicare Fraud In The United States: Can It Ever Be Stopped?, Chelsea Hill, Alex Hunter, Leslie Johnson, Alberto Coustasse

Management Faculty Research

The majority of the United States health care fraud has been focused on the major public program, Medicare. The yearly financial loss from Medicare fraud has been estimated at about $54 billion. The purpose of this research study was to explore the current state of Medicare fraud in the United States, identify current policies and laws that foster Medicare fraud, and determine the financial impact of Medicare fraud. The methodology for this study was a literature review. Research was conducted using a scholarly online database search and government Web sites. The number of individuals charged with criminal fraud increased from …

Informed Consent, Psychotropic Medications, And A Prescribing Physician's Duty To Disclose Safer Alternative Treatments, Rita F. Barnett

Rita Barnett-Rose

The use of psychotropic medication to treat any presumed mental health disorder always involves serious risks of harm. Accordingly, before prescribing psychotropic medication to control the behaviors associated with a presumed mental health disorder, prescribing physicians are required, under various medical ethical guidelines and informed consent laws, to first disclose information regarding available alternative treatment options, and the risks and benefits of such alternative treatment options. Indeed, because psychotropic medications are themselves experimental treatments due to the concededly unknown etiology of most mental health disorders, disclosing safer alternative treatments would seem to be a particularly critical aspect of a prescribing …

Health Care Delivery And The Hispanic Community In Knox County, Sean C. Barton

Chancellor’s Honors Program Projects

No abstract provided.

Understanding Hiv Care Delays In The Us South And The Role Of The Social-Level In Hiv Care Engagement/Retention: A Qualitative Study, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

Introduction: In a significant geographical shift in the distribution of HIV infection, the US South - comprising 17 states - now has the greatest number of adults and adolescents with HIV (PLHIV) in the nation. More than 60% of PLHIV are not in HIV care in Alabama and Mississippi, contrasted with a national figure of 25%. Poorer HIV outcomes raise concerns about HIV-related inequities for southern PLHIV, which warrant further study. This qualitative study sought to understand experiences of low-income PLHIV on the AIDS Drug Assistance Program in engagement and retention in continuous HIV care in two sites in Alabama. …

Mid-Atlantic Ethics Committee Newsletter, Spring 2014

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Student Experiences And Beliefs Regarding Normal Physiologic Birth, Alicia N. Harris

Honors Projects

Lamaze International identifies six care practices used to promote, protect, and support the normal physiologic process of birth (Lamaze, 2007; Lamaze, 2014). These practices include: allowing labor to begin on its own; allowing freedom of movement throughout labor; providing continuous labor support; avoiding routine interventions; promoting spontaneous pushing in upright or gravity-neutral positions; and not separating mother and baby with unlimited breastfeeding opportunities. These care practices were adopted for nurses (Romano & Lothian, 2008) to support the normal physiologic birth (NPB.) The disparity between this recognized standard of care and the reality of nursing student education in the maternity clinical …

Recognizing Patient Safety Importance Through Instrument Validation On Physicians' Assessment Of An Ehr, Cherie Notebloom, Kathryn Dempsey Cooper

Interdisciplinary Informatics Faculty Proceedings & Presentations

Patient safety and high quality patient care are critical concerns for healthcare providers. The Institute of Medicine report suggests medical errors account for up to 98,000 patient deaths each year. Therefore, the US healthcare system is looking to information technology applications as one means of making patient care safer. This paper compares the psychometric properties of the Electronic Health Record Nurse Satisfaction instrument (based on the Health Information Technology Research-based Evaluation Framework) to our study that employed the same instrument but measured clinical physicians' opinions of an EHR to determine if the instrument could be used across domains of users. …

Intellectual And Developmental Disability: Healthcare Financing, David A. Ervin, Joav Merrick

Public Health Faculty Publications

No abstract provided.

Mid-Atlantic Ethics Committee Newsletter, Winter 2014

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Barriers To Qualitative Dementia Research: The Elephant In The Room, John Carmody, Victoria Traynor, Elena Marchetti

Faculty of Science, Medicine and Health - Papers: part A

As our population is aging, the global prevalence of dementia is rising. Recent extensive reviews of the dementia literature highlight a clear need for additional qualitative research to address the experiences of people with dementia and their carers. To date, the vast majority of published dementia research is quantitative in nature and, perhaps not surprisingly, attracts the bulk of government funding. In contrast, qualitative dementia research is poorly resourced and less frequently published. Although a myriad of factors are responsible for this dichotomy, we propose that inadequate funding represents the "elephant in the room" of dementia research. In this article, …

Leadership In Healthcare Is A Neglected Issue: A Call For Action, Waris Qidwai

Department of Family Medicine

Healthcare and medical profession stands at crossroads today. Unprecedented technological advances as a result of ongoing scientific research has revolutionized healthcare around the world. Despite these developments, we are still faced with a huge burden of communicable diseases, an ever rising burden of noncommunicable diseases, coupled with an increasing load of mental health diseases and accidents in healthcare. There are several reasons for our failure to address healthcare issues of our populations, including a desperate need to revamp existing medical and health care related curriculum. In addition to considering curriculum change, perhaps single most needed change we need to address …

Hypertension Management Among Cambodian-Americans In Rhode Island, Rathana Long

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Hypertension is a major risk factor for heart disease and stroke and the focus of much study in the US. However, there is limited transfer of this knowledge in terms of hypertension management in certain recent immigrant groups such as the Cambodian-­‐Americans. Cambodian-­‐Americans are often included among the Asian/Pacific Islanders and are one of the fasting growing populations in the US. The purpose of this study was to explore how Cambodians in Rhode Island manage hypertension. This study used a survey design with a convenience sample of 30 participants who could read, write, and understand English. It was conducted at …

Nurse Perceptions Of Influenza Vaccination, Leslie L. Brown

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

The purpose of this research study was to determine the perceptions of influenza vaccine of registered nurses who decline the annual influenza vaccination. Influenza is a serious public health issue because it is a highly contagious virus that is associated with considerable morbidity and mortality. The topic of making annual influenza vaccinations mandatory for health care workers remains controversial. A comprehensive review of the literature surrounding influenza vaccinations was explored and discussed. The data for this study was obtained via anonymous voluntary surveys with one open-ended and 14 closed-ended questions. A mixed method design was used to analyze the voluntary …

Intravenous Acetaminophen Use In Postoperative Pain Management, Selvi K. Kumar

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Surgery is a most common source of acute pain and effective postoperative pain management is crucial for wound healing and recovery. Opiods are the mainstay for acute pain management but have various adverse effects including death. The multimodal approach involves the use of multiple drugs with varying mechanism of action to achieve optimal pain relief with less adverse effects. Intravenous acetaminophen (IVAPAP) is a new addition to the multimodal approach that appears to afford effective pain relief with a low risk profile. The purpose of this research study was to examine the impact of IVAPAP use in multimodal pain management …

Redefining Medical Necessity: A Consumer-Driven Solution To The U.S. Health Care Crisis, Ryan Abbott, Carl Stevens

Loyola of Los Angeles Law Review

The American health care system is plagued by high costs and poor public health outcomes, due in part to the overuse of costly diagnostic tests and treatments. In 2009, the Institute of Medicine estimated that unnecessary care wastes $750 billion, equivalent to about 30 percent of health care spending. Moreover, overtreatment can directly harm patients as a result of surgical complications, drug toxicity, and hospital-acquired infections. Yet while the problem of medical waste has long been recognized, solving the problem has proven elusive. In part, this difficulty is due to perverse economic incentives for physicians and hospitals, which still primarily …

Navigating The Health Care Labyrinth: Portraits Of The Socioeconomically Disadvantaged, Thomas C. Crawford Phd

Antioch University Full-Text Dissertations & Theses

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75% White that earned (primary care specialties) in …

A Nurse-Driven, Exercise-Based Intervention For Patients With Cancer-Related Fatigue When Severe Fatigue Interferes With Daily Activity, Nancy B. Opaluch-Bushy

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Cancer affects more than 1 million people each year. Of all of the symptoms related to cancer, the most frequently experienced is fatigue. Cancer-related fatigue (CRF) is an extreme tiredness that contributes to morbidity and mortality due to resulting inactivity. Extreme inactivity related to CRF may cause severe complications affecting multiple body systems. The Oncology Nursing Society (ONS) recommends exercise as the only evidence-based intervention shown to be significant for CRF. The purpose of this project was to provide a nurse-driven, exercise-based intervention to combat severe CRF. The site was an oncology out-patient clinic of a 247 bed Magnet hospital …

Timelines Of Oral Care And Early-Onset Ventilator Associated Pneumonia Prevention, Kristen M. Francoeur

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Hospital-acquired infections, including ventilator associated pneumonia (VAP), are a significant cause of morbidity and mortality and associated with increased costs and length of stay (Chastre & Fagon, 2002; NNIS, 2004). Ventilator associated pneumonia is believed to primarily result from aspiration of oropharyngeal secretions around the endotracheal tube cuff into the lungs (Grap, Munro, Unoki, Hamilton, & Ward, 2012). A randomized control trial tested early application of oral chlorhexidine (CHG) on oral microbial flora and VAP in trauma patients and suggested that early (within 12 hours of intubation) application may reduce VAP rates in trauma patients (Grap, Munro, Hamilton, Elswick, Sessler …

Nurses Perceptions Of Family Presence During Resuscitation In The Emergency Department, Jennifer L. Jennings

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Family presence during resuscitation has been a controversial and much debated topic for many years. In the past decade, the movement toward family presence has steadily grown. The Emergency Nurses Association (ENA) and the American Heart Association (AHA) have endorsed family presence and incorporated guidelines for its implementation. Although becoming more accepted in practice, there are still many hospitals without family presence policies, and some nurses and other health care providers continue to identify concerns about its’ use. The purpose of this project was to survey nurses’ perceptions of family presence during resuscitation in the Emergency Department. A researcher developed …

Exploring Nurses' Knowledge About Heart Failure Before And After The Implementation Of A Heart Failure Education Program, Suzanne H. Richmond

Master's Theses, Dissertations, Graduate Research and Major Papers Overview

Heart failure (HF) has become a national epidemic, with 5.7 million Americans currently living with HF. Although HF is incurable, it is manageable if health care professionals apply current practice guidelines to patient teaching. Nurses are charged with providing comprehensive education about HF self-­‐management and it is imperative they stay abreast of evidence-­‐based guidelines. The purpose of this project was to explore the current HF knowledge of Home Based Primary Care (HBPC) registered nurse Care Managers employed at the Providence Veterans Administration Medical Center (PVAMC). The logic model and Knowles andragogy theory assisted this researcher in the creation of a …