Medicine and Health Sciences Commons^™

Understanding The Experience Of Medicare Advantage Patients In A Health Maintenance Organization, Curtis E. Boldman

UNLV Theses, Dissertations, Professional Papers, and Capstones

This study was conducted using a single Health Maintenance Organization in Las Vegas, NV to determine the key drivers and attributes of quality in the patient experience for Medicare Advantage holders. The purpose of this study was to investigate these perceptions of quality to assist the provider in identifying the areas in their treatment process which could be refined in order to better serve their customer base. With the recent changes in healthcare laws, patient satisfaction is now a key determinant in the financial compensation providers receive for services performed.

Data was collected by doing patient intercepts outside of the …

Slip, Trip And Fall Risk Among Elderly Men And Women Living In The Hawaii Adult Foster Care Home System, Michelle Echauz Ching

UNLV Theses, Dissertations, Professional Papers, and Capstones

Adults 65 years of age and older (hereby referred to as “elderly”) are one of the fastest growing populations in the United States (U.S.). A major public health concern affecting the elderly population is unintentional injuries, particularly slips, trips, and falls (STFs). While there is extensive research on STFs among the elderly living in the community and long-term health care facilities, little to no research is found on STFs among the elderly living in community-based health care facilities. Research has also shown that STFs are caused by the interaction between multiple risk factors. Therefore, the purpose of this quasi-experimental study …

Reliability Of A Multisegment Foot Model In Shod Running, Austin Coupe

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to determine kinematic and marker placement reliability of the Leardini multisegment foot model (LMFM) for tracking foot kinematics during barefoot and shod running without alteration of footwear. Eleven participants, five males (25.6±5 yrs, 73±15.8 kg, 1.75±0.05m) and six females (22.5±2.9 yrs, 66.6±7.2 kg, 1.71±0.05 m) granted institutionally approved written consent to participate. Three-dimensional motion capture (10 Vicon T40-S cameras) was used to capture kinematic data at 200Hz. Kinetic data was captured with an in-ground force platform (Kistler Instruments AG, Switzerland Model 9281B 60x40cm, 2000Hz). Participants were instructed to run at 3.5m/s ±5%. Velocity was …

Athletes’ Perceptions Of Athletic Trainers Quality Of Care, Chadley Foster

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to explore student athletes’ perceived satisfaction of care from certified and licensed athletic trainers (ATC) and satisfaction of care between full time and graduate student ATCs at University of Nevada, Las Vegas (n=61). Studies identify satisfaction as a method to measure quality of care and its influence on many aspects of athletes’ success including health outcomes. This is the first study that evaluated multiple aspects of care including type and length of sport participation, academic class status, number of ATCs seen, primary ATC (graduate or full time), number of interactions with primary ATC, injury, …

Patient Service Quality And Health Maintenance Organizations: Not An Oxymoron, Jessica Mcbeath

UNLV Theses, Dissertations, Professional Papers, and Capstones

Today’s quality movement in health care has driven the importance of patient satisfaction and experience across the industry. While the subject is of huge interest to researchers and health care companies, many struggle to identify a unified list of attributes that are applicable globally. Due to the industry’s uniqueness, it becomes necessary to understand the population and specific attributes for each. In review of previous service quality research, this study presents many dimensions and attributes for application. Using existing service quality framework 5Qs, this study provides unique findings correlated to existing literature and presents actionable items.

Purpose: The purpose of …

Comparison Of Muscle Latencies For Diabetic Neuropathy Patients Versus Healthy Controls During A Perturbed Balance Task, Kyle Mefferd

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to compare muscle latencies for patients diagnosed with diabetic neuropathy versus healthy controls during a perturbed balance task, with a secondary purpose to distinguish postural control strategies the groups used based on the muscle latencies. Five participants diagnosed with diabetic neuropathy (DN; 4 male, 99.7 ± 7.95 kg, 176 ± 9.58 cm, 46.6 ± 16.55 years) and 5 healthy control (HC; 4 male, 100.36 ± 12.61 kg, 173.76 ± 9.66 cm, 47 ± 13.42 years) participants were recruited. Participants granted institutionally approved written consent before participating. Delsys Trigino Wireless EMG sensors were placed on …

Survival Of The Fittest: The Role Of Linguistic Modification In Nursing Education, Brenda Strauch Moore

UNLV Theses, Dissertations, Professional Papers, and Capstones

This project’s long term goal was to improve English-as-a-Second-Language (ESL) nursing student retention. Improving the quality of multiple choice exams is a first crucial step. ESL students find multiple-choice exams to be one of the most challenging aspects of nursing school. One reason for this is the presence of linguistic errors in exam questions. Linguistic errors include: irrelevant question content, poor sentence structure, and culturally biased words or phrases. Non-ESL students are less affected because exams are written in their native language. Linguistic modification, as part of best practices in item writing, removes these types of errors. The U.S. Department …

Understanding Perceptions Of Genetically Modified Food Among Natural Food Shoppers In Southern Nevada, Christian Murua-Aceves

UNLV Theses, Dissertations, Professional Papers, and Capstones

Today, 85% of corn, 93% of soybeans, and 88% of cotton in the U.S. are genetically modified (GM). Using laboratory methods, genes from one species, such as a plant, can be transferred to an unrelated species, such as an animal. Genetically modified crops may lead to higher yields, have improved food quality, texture, and nutritional value, and have an increased shelf life.

Despite these promising benefits, the potential health risks relating to the consumption of GM food remain inadequately assessed. Genetically modified food is not subjected to rigorous safety testing, such as epidemiologic studies, to identify potential health risks. Two …

The Impact Of Shift Work On Diabetes Self-Management Activities, Daniel Navarro

UNLV Theses, Dissertations, Professional Papers, and Capstones

In the United States 26 million people are affected by diabetes, which can result in microvascular and macrovascular complications. As a consequence, once a person is diagnosed with diabetes, aggressive clinical management is imperative to minimize poor glycemic control’s devastating outcomes. However, for some patients reaching optimum blood glucose levels is challenging due to the complexity of diabetes’ care. In order for patients with diabetes to achieve good blood glucose control, they must engage in self-care activities that include routine blood glucose checks, dietary control, physical activity, and routine medical provider visits, simultaneously with their medication regimen. Diabetes associated self-care …

Partnering With The Community For Establishment Of Alternate Care Sites During Disasters Or Emergencies: A Staff Training Matrix, Jean Marie Roberts

UNLV Theses, Dissertations, Professional Papers, and Capstones

An approach to fulfill a need for additional hospital beds during emergency and disaster situations has been establishment of alternate care sites (ACS). Kern County, California, with a population of about 856,000 and approximately 1,500 hospital beds, is at significant risk for inability to care for the medical needs of its residents in the face of a disaster or an emergency. Even the most conservative estimates of additional hospital beds requirements in a disaster or emergency would indicate the need for nine to ten ACSs accommodating up to 50 patients each in Kern County.

Recognizing the need for alternatives to …

Lead Hazard Control In Henderson, Nevada: Identifying Critical Areas And The Associated Costs, Khaye Gerazel Arcilla Rufin

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lead poisoning is a common, yet preventable childhood health problem in the United States today. Studies show statistically significant (p < .05) associations between higher childhood lead exposure and subsequent negative developmental outcomes. Since 1993, the U.S. Department of Housing and Urban Development (HUD) Lead Hazard Control (LHC) Grant Program has devoted more than $1 billion in funding to several cities.

This study investigated a total of n=75 homes enrolled into the Henderson Lead Hazard Control and Healthy Homes Program (HLHCHHP) from December 2013 – February 2015. A logistic regression was performed to ascertain the frequency of lead-based paint (LBP) found in homes based on the year it was constructed. Of the 75 enrolled and tested for LBP, 58 homes (77.3%) were found to contain LBP and 17 homes (22.7%) did not contain LBP. The significance value of p=0.013 shows that …

Improving Transitions Of Care In The Perioperative Setting, Brian Wayne Selig

UNLV Theses, Dissertations, Professional Papers, and Capstones

It is estimated that nearly 200,000 Americans die each year due to preventable medical mistakes (Gupta, 2012), and nearly 80% of all medical errors involve some form of miscommunication between healthcare providers (Joint Commission Center for the Transformation of Healthcare, 2013). Handoffs, or the transitioning of patient care from one provider to another, occur multiple times each day in the hospital setting and done incorrectly can lead to significant mistakes in patient care.

The purpose of this project was to improve the quality of handoffs that occurred between perioperative and inpatient nurses at an urban, tertiary medical center. A shared …

In Vitro Efficacy Of Combined Macrophage-Mediated Plasmonic Photothermal Therapy And Chemotherapeutic Agents, En Chung Shih

UNLV Theses, Dissertations, Professional Papers, and Capstones

Although both chemotherapy and hyperthermia therapy have their inherent advantages, the non-specific targeting of chemotherapy and ineffectiveness of hyperthermia therapy alone suggests a better method can be developed. To overcome this problem, the combined treatment of chemotherapeutic agents with plasmonic photothermal therapy (PPTT) is proposed. This is the first study to investigate the efficacy of combined chemotherapy and PPTT using monocytes as delivery vehicles for gold nanoshells. The results of this investigation shows that PPTT combined with cisplatin resulted in some degree of synergism while additive effects were observed for concurrent treatments of PPTT and doxorubicin and PPTT and bleomycin.

An Evaluation Of Select Physical Activity Exercise Classes (Pex) On Bone Mineral Density, Tori Michelle Stone

UNLV Theses, Dissertations, Professional Papers, and Capstones

INTRODUCTION: According to the National Institute of Health consensus, Osteoporosis causes premature disability in approximately 44 million people (National Institute of Health [NIH], 2001), 80% of this population being women (Ulrich, Georgiou, Gillis, & Snow, 1999). This chronic disease causes 1.5 million fractures annually, 700,000 occurring at the spine (NIH, 2001). One prevention technique developed in recent years is to build a high peak bone mass during growth and in young adult life (Almstedt, Canepa, Ramirez, & Shoepe, 2011). Several publications positively correlate an increase in BMD with increased amounts of exercise. Bone mineral density can be observed through DEXA …

The Effects Of The Hcahps Learning Module On Undergraduate Nursing Students During The Simulated Hospital Day, Ronnie C. Stout

UNLV Theses, Dissertations, Professional Papers, and Capstones

The introduction of the Affordable Care Act has brought about change in the way the Centers for Medicare and Medicaid Services (CMS) reimburses for hospital care. Hospitals are being rewarded for making the patient experience a positive one as evaluated by the patients. This information is provided through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. These survey results allow consumers to compare hospitals locally and nationally with other hospitals. Patients are able to evaluate the hospitals in their area and make informed decisions about where they want to get their care based on previous patients’ experiences. …

Examining The Role Of Supportive Others In Substance Abuse Treatment And Child Welfare, Jessica Marie Urgelles

UNLV Theses, Dissertations, Professional Papers, and Capstones

Child neglect is a prevalent problem and often co-occurs with parental substance abuse. Mothers are most often the perpetrators of child neglect. The currently available treatment programs appear to be failing to meet the needs of these mothers. Most mothers are not completing treatment, putting them at risk of losing custody of their children. The literature suggests that women may have different risk factors associated with their substance use, as compared to men. Social networks appear to play a particularly important role in the maintenance of women’s substance abuse problems. The role of social networks may be distinct for different …

Functional Capacity In Schizophrenia: Relationship Among Effort, Reinforcement Learning And Self-Beliefs, Sally J. Vogel

UNLV Theses, Dissertations, Professional Papers, and Capstones

Individuals with schizophrenia exhibit a wide range of complex neurocognitive, psychiatric and behavioral impairments. Recent research suggests that this complex array of symptoms can be at least partially accounted for by dysfunction in more basic mechanisms, such as the ability to learn from positive and negative reinforcement, or the ability to exert adequate effort when completing simple tasks. Evidence also suggests that deficits in these basic mechanisms may contribute to more complex symptoms, such as functional impairment. Also, the relationship between neurocognitive deficits and functional impairment has been found to be mediated by defeatist performance beliefs. However, studies have not …

Leukocyte Responsiveness To Exercise In Hcmv+ Individuals, Jared Nicholas Wilson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Emerging research suggests that the lymphocyte immune response during exercise is amplified in individuals who are positive for human cytomegalovirus (HCMV+). However, the responses of monocytes and neutrophils in HCMV+ individuals are unknown. HCMV, a type of herpes virus, infects 50% or more of the adult population in the United States. This virus can become a cause for concern in individuals who have a compromised immune system, which has been shown to occur after high-intensity exercise.

Purpose: The purpose of this study was to characterize the lymphocyte, monocyte, and neutrophil responses to exercise in HCMV+ individuals.

Methods: Participants were …

Preferences For Evidence-Based Depression Treatments: An Emphasis On Patient-Focused Care, Lauren A. Frye

Dissertations

Research indicates most depressed patients in the general U.S. adult population seek depression treatment in primary care settings where the prevailing method of treatment is antidepressant medication. Although primary care physicians regard this approach as a preferable first line method of depression treatment, studies indicate many patients do not. Several studies have found depressed patients in these settings prefer psychotherapy or counseling over anti-depressant medication. Many advocate patient preferences should be integral to the treatment decision making process. There is a demonstrated propensity towards psychotherapy or counseling over antidepressant medication among depression patients. However, it is unclear which psychological depression …

Increasing Physical Activity In Young Adults With Autism Spectrum Disorder, Katherine B. Lalonde

Dissertations

Experts recommend that individuals walk 10,000 steps or more per day and doing so has been shown to have several health benefits. Unfortunately, many people fall short of 10,000 steps per day. Exercise levels are characteristically lower in people with Autism Spectrum Disorders (ASD) than in people without ASD. The present study comprised two experiments that used goal setting and reinforcement to increase physical activity in young adults with ASD. The first study employed a multiple-baseline-across-participants design in combination with a reversal design to determine the effects of a treatment package on the number of daily steps taken by young …

Choices Related To Maximizing Quality Of Life At End Of Life, Theresa Lynn

Dissertations

Humans, including those residing in the United States, can live in denial of their own mortality. Because of this, futile care is sometimes provided, often at great monetary expense and for little or no return in terms of quality or length of life. At least two opportunities exist for making choices regarding care at the end of life in the U.S.: completing advance directives and choosing hospice care. This dissertation consists of three studies related to this topic. The first is a quantitative study about advance directives and attitude toward death. The advance directive completion rate among adults in the …

An Evaluation Of The Primary Care Providers’ Perspective Of The Effects Of Moderate Alcohol Consumption On Health, Gisele Tchamba

Dissertations

The complexity of health benefits of moderate alcohol consumption (MAC) is well documented. From the World Health Organization recent report, impact of harm from alcohol consumption was 3.3 million deaths or 5.9 percent of all global deaths (WHO, 2014).

Yet, the benefits of MAC for better health and longer life expectancy compared with abstinence are advocated in numerous studies (Nova, Baccan, Zapatera and Marcos, 2012). However, the nature of alcohol, its role on human sufferings has generated disagreements in the scientific community. Analysis of the results of early studies advocating better health for moderate drinkers, reveal discrepancies regarding the influence …

A Participatory Design Framework For Customisable Assistive Technology, Pearl O'Rourke

Doctoral

High product costs and device abandonment negatively affect people with disabilities who require Assistive Technology (AT), and poor product design is a root cause. The purpose of this research is to develop and demonstrate a participatory design framework for customisable AT, which addresses the need for low-cost assistive products that satisfy a broad range of consumers’ needs. This framework addresses two main gaps in the literature. First, user involvement in the design process of medical and rehabilitative products helps create products that are more effective but, although methods to involve users exist, there are currently scant techniques to translate the …

Bridging The Location Gap: Physician Perspectives Of Physician-Pharmacist Collaboration In Patient Care (Bridge Phase Ii), Keri D. Hager, Donald Uden, Daniel M. Tomaszewski

Pharmacy Faculty Articles and Research

Background: To optimize patient outcomes, the patient-centred medical home model emphasizes comprehensive team-based care. Pharmacists are qualified to enhance appropriate medication use and help improve patient outcomes through provision of medication therapy management (MTM) services. To optimally provide MTM, pharmacists must effectively collaborate with physicians. This study explored factors that influence pharmacist-physician collaboration.

Methods and Findings: A convenience sample of five physicians participated in semi-structured interviews and the resulting data were analyzed using qualitative methods. Transcripts of the interviews were independently coded for themes by two researchers. Five themes emerged: trustworthiness, role specification, relationship initiation, effects on practice, …

Evidence-Based Strategies To Minimize Risk For Opioid Pain Medication Misuse Among Patients With Chronic Pain In A Primary Care Setting, Carolyn Diane Coleman

Doctoral Projects

Background: Prescription opioid pain medication misuse has become a nationwide epidemic. Many states have implemented prescription drug monitoring programs (PDMP) to assist in combating the problem of prescription opioid pain medication misuse. Evidence-based clinical practice guidelines as well as the PMDP should be utilized by healthcare providers to guide treatment of chronic pain with opioid pain medications. Purpose: The purpose of this doctoral capstone project was to determine if providers are accessing the Prescription Drug Monitoring Program (PDMP) and utilizing evidence-based guidelines to minimize opioid pain medications misuse among patients with chronic pain in a primary care setting. …

Reducing The Risks Of Wrong Site Surgery Using The Joint Commission’S Targeted Solutions Tool For Safe Surgery, Stephanie Kelly Parks

Doctoral Projects

The purpose of this project was to utilize the ‘Institute for HealthCare Improvement’s Model of Improvement as a consultation framework to facilitate improvement in core processes for the prevention of wrong site surgery (WSS) using The Joint Commission Targeted Solutions Tool for Safe Surgery© Program at a surgery center in Mississippi. The TST Program was conducted across 6 months and had 6 phases: 1) Getting Started, 2) Training Data Collectors, 3) Measuring Risk Factors, 4) Analyzing Data, 5) Implementing Solutions, and 6) Sustaining the Gains. A convenience sample of 47 surgical staff participated and 8 data collectors observed behaviors. The …

Leadership Practices Among Undergraduate Nursing Instructors, Melissa Martin Bryant

Dissertations

The purpose of this study is to identify leadership practices of nursing instructors in the southern U.S.; and to determine if instructor leadership practices differ from the ‘norm’ leadership practices reported by the LPI instrument (Posner 2008), or from the practices observed by their matched students (observer version). Further, the purpose is to determine the relationship between instructors self-reported leadership practices (self-version) and student observed practices based on institution type, and instructor education level. The consisted of a group of instructors and students that were primarily Caucasian and female. The demographics for the instructors and students were similar to the …

Analysis Of Embryo Scoring And Comparison Of Clinic Performance In In-Vitro Fertilization, James W. Whistler

Master's Theses

Clinical Assisted Reproductive Technology (ART) practices seek to make improvements in embryo quality and resultant procedural success rates. There is a significant variance in live birth rates among clinics nationwide. The goal of this thesis is make comparisons of embryo quality among clinics and understand these differences. This analysis focuses on the stage between egg retrieval and embryo transfer. Because the currently accepted embryo scoring methods are not directly proportional to performance, a new scoring methodology is proposed and applied. Data provided by the Society for Assisted Reproductive Technology (SART) consisting of 36,836 patient cycles from 40 anonymous clinics nationwide …

Transarterial Chemoembolization Is Ineffective For Neuroendocrine Tumors Metastatic To The Caudate Lobe: A Single Institution Review., Lawrence A Shirley, Megan Mcnally, Ravi Chokshi, Natalie Jones, Patrick Tassone, Gregory Guy, Hooman Khabiri, Carl Schmidt, Manisha Shah, Mark Bloomston

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Caudate lobe liver metastases occur commonly in patients with neuroendocrine tumors. It is unknown, however, how these lesions respond to regional therapy and how their presence impacts outcomes. We reviewed our experience treating these lesions using transarterial chemoembolization (TACE).

METHODS: We reviewed radiographic response to TACE in 86 patients with metastatic neuroendocrine tumors to the liver. We determined the impact of caudate lesions on outcomes in comparison to the cohort of patients without caudate lesions, as well as response of caudate lesions to TACE versus lesions elsewhere in the liver.

RESULTS: Caudate lesions were identified in 45 (52%) patients. …

เจตคติต่อการเป็นเพื่อนกับนักเรียนออทิสติกเรียนร่วมบางเวลาในโรงเรียนระดับประถมศึกษา, ขวัญใจ อธิปัญญาวงศ์, ศิริวรรณ ศิริบุญ, ชัยชนะ นิ่มนวล

Chulalongkorn Medical Journal

เหตุผลของการทำวิจัย : เด็กออทิสติกที่เข้าเรียนร่วมมีความบกพร่องทางการสื่อสารพฤติกรรมซ้ำ ๆ และแยกตัวจากสังคม ดังนั้น กลุ่มเพื่อนซึ่งเป็นนักเรียนปกติในชั้นเรียนจึงมีบทบาทสำคัญในการช่วยเหลือดูแลเด็กออทิสติกทั้งทางตรงและทางอ้อม ซึ่งยังไม่พบว่ามีงานวิจัยที่พรรณนาเกี่ยวกับเจตคติของเพื่อนนักเรียนออทิสติกเรียนร่วมบางเวลาในระดับประถมศึกษาวัตถุประสงค์ : เพื่อพรรณนาเจตคติต่อการเป็นเพื่อนกับนักเรียนออทิสติกเรียนร่วมบางเวลาในโรงเรียนจิตรลดาระดับประถมศึกษารูปแบบการวิจัย : การวิจัยเชิงคุณภาพ ภายใต้กระบวนทัศน์ปรากฏการณ์วิทยา(Phenomenology)สถานที่ทำการศึกษา : โรงเรียนจิตรลดาระดับประถมศึกษาตัวอย่างและวิธีการศึกษา : เก็บข้อมูลนักเรียนในชั้นเรียนปกติจำนวน 13 คน และครูประจำชั้น/ครูวิชาปกติ และ ครูการศึกษาพิเศษจำนวน 5 คน โดยการสัมภาษณ์ร่วมกับการสังเกตอย่างมีส่วนร่วมนักเรียนในห้องเรียนโดยผู้วิจัยวิเคราะห์ข้อมูลด้วยการวิเคราะห์ประเด็นหลักผลการศึกษา : ผู้ให้ข้อมูลหลักทั้งที่เป็นนักเรียน และครูมีเจตคติในส่วนความเข้าใจและความคิดเห็นเกี่ยวกับออทิสติกใกล้เคียงกัน ในส่วนการประเมินคุณค่าและความรู้สึกพบว่าความรู้สึกทางบวก ได้แก่ ความเข้าอกเข้าใจเห็นใจ ความรู้สึกทางลบมักเกี่ยวกับความหงุดหงิดที่เด็กออทิสติกไม่ตอบสนองหรือกลัวพฤติกรรมที่ควบคุมไม่ได้ ซึ่งอาจสัมพันธ์กับแนวโน้มพฤติกรรม ทั้งเข้าหา ถอยห่าง และไม่ตอบสนองสรุป : เจตคติต่อการเป็นเพื่อนกับนักเรียนออทิสติกเรียนร่วมบางเวลานั้นมีทั้งด้านบวกและลบ การเข้าใจจะเป็นประโยชน์ต่อการจัดกิจกรรมต่าง ๆ เพื่อส่งเสริมนักเรียนปกติสามารถปรับตัวและมีปฏิสัมพันธ์กับเด็กออทิสติกได้อย่างเหมาะสมยิ่งขึ้น.