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Articles 181 - 210 of 290
Full-Text Articles in Medical Humanities
Towards An Understanding Of Patient Satisfaction In The Military Health System, Alan Alexander Jones
Towards An Understanding Of Patient Satisfaction In The Military Health System, Alan Alexander Jones
All ETDs from UAB
The Military Health System (MHS) is the most expansive health care system in the world. The MHS provides health care services to 9.7 million eligible beneficiaries spread across six continents. The MHS budget exceeded $52 billion in 2013 or 10 percent of the total 2013 Defense budget. The cost of health care in the MHS is of great concern to the Department of Defense and the US Congress. The MHS needs a strong framework to measure the value of the health care it provides. The purpose of this study was to develop a framework to better understand Patient Satisfaction in …
Examining The Interplay Of Diet Composition, Cardiometabolic Diseases, And Economics, Kenneth Patton Kell
Examining The Interplay Of Diet Composition, Cardiometabolic Diseases, And Economics, Kenneth Patton Kell
All ETDs from UAB
Despite the invaluable contributions that both randomized controlled trials and longitudinal studies have made to our understanding of the relationships between diet and cardiovascular disease (CVD), a comprehensive understanding of these relationships does not yet exist from birth to death. Furthermore, the longest running of these longitudinal studies have not included a representative portion of racial minority participants. Lastly, given the financial impacts of CVD, as well as how socioeconomic status (SES) can influence diet, the interplay between these three merits consideration. Therefore, the objective of this dissertation was to evaluate the associations between diet and cardiovascular disease (CVD): 1) …
The Impact Of Cultural Competency On Patient Experience Of Care, Emily Lane Koudelka
The Impact Of Cultural Competency On Patient Experience Of Care, Emily Lane Koudelka
All ETDs from UAB
The impact of hospitals’ cultural competency on inpatient experience of care will be examined. Enhanced patient experience of care may alter an individual’s willingness to use health services, thereby increasing access and decreasing health disparities. As a result, to the extent that cultural competency influences patient experience of care, the integration of cultural competency into healthcare organizations has emerged as a critical issue for researchers, industry leaders, and policymakers. Findings from this study will inform policies, practices, and processes across the broad spectrum of healthcare industry stakeholders.
Linking Adiponectin And Autophagy In The Regulation Of Breast Cancer Metastatic Potential, Emily Libby
Linking Adiponectin And Autophagy In The Regulation Of Breast Cancer Metastatic Potential, Emily Libby
All ETDs from UAB
Curative approaches for metastatic breast cancer remain elusive. Adiponectin is the most abundant of the adipocyte-secreted adipokines, and there is recent interest in development of adiponectin-based therapies for this disease. Yet, while multiple epidemiological studies have indicated that low levels of circulating plasma adiponectin portend poorer prognosis, recent work has reported that elevated adiponectin expression in breast tissue correlates with advanced disease. Further, isoform-specific roles of this molecule are not well understood. Thus, the overarching purpose of this work was to elucidate how adiponectin isoforms contribute to the microenvironmental regulation of the early steps of breast cancer metastasis. We show …
Intensivists And Organizational Performance, Glenn Barthwick Liddle
Intensivists And Organizational Performance, Glenn Barthwick Liddle
All ETDs from UAB
Because of the high intensity of care and the extremely complex medical conditions being treated, intensive care units (ICUs) represent one of the most significant units within a hospital. Despite the significance of the ICU, the majority of the care provided in the ICU has historically been managed and coordinated by referring or attending physicians, who often do not have the specialized training needed to effectively care for the exceedingly acute patients in the ICU. More recently, however, a growing number of hospitals have begun staffing the ICU with intensivists. Intensivists are uniquely trained physicians that specialize in providing care …
Patient Activation: An Examination Of The Relationship Between Care Management With Patient Activation-Customized Coaching And Patient Outcomes, Cindy L. Reistroffer
Patient Activation: An Examination Of The Relationship Between Care Management With Patient Activation-Customized Coaching And Patient Outcomes, Cindy L. Reistroffer
All ETDs from UAB
As part of healthcare reform, patient engagement is becoming an important area of focus. Most recently, patient activation, as part of engagement, has been studied; however, interventions to improve activation are not well identified. The purpose of this dissertation was to empirically examine whether enrollment in care management with patient activation (PA)-customized coaching was associated with patient outcomes of utilization, medication adherence, and clinical outcomes. The study utilized the chronic care model framework and theoretical insights from social cognitive theory to examine the relationships among three hypotheses. Secondary data related to commercially-insured enrollees in Priority Health were used to test …
Bioavailability Of Dietary Oxalate, Mary Catherine Robertson
Bioavailability Of Dietary Oxalate, Mary Catherine Robertson
All ETDs from UAB
Urolithiasis, or kidney stone disease, is a costly and painful health problem affecting about 8.8% of Americans with prevalence on the rise. Calcium oxalate stones account for about 80% of all stones. Increased urinary excretion of calcium and oxalate is a risk factor and central feature of such stones; dietary oxalate contributes up to 50% of urinary oxalate. The purpose of our research is to determine if physical manipulation such as chewing or blending prior to ingestion may render some oxalate more accessible for absorption in spinach, a high-oxalate food. In this crossover, controlled trial we enrolled six healthy, non-stone …
Emergency Department Wait Time Communication Strategies And Patient Throughput Efficiency, Tom R. Mcdougal
Emergency Department Wait Time Communication Strategies And Patient Throughput Efficiency, Tom R. Mcdougal
All ETDs from UAB
This study investigates hospital strategies used to inform patients of anticipated wait times in the Emergency Department (ED) and the association of such strategies with patient throughput efficiency. When hospitals are inefficient in ED patient throughput, conditions of overcrowding often occur. Overcrowding of the ED is a problem for many hospitals. When such conditions exist, there is evidence in the literature that it leads to lower patient satisfaction, care quality, and financial position of the hospital. Therefore, improving patient throughput efficiency is a priority for hospitals. To improve patient throughput efficiency, hospitals use a variety of strategies. This study focuses …
The Interrelationships Among Obesity, Insulin Sensitivity, And Bone Phenotype In Pre-Pubertal Girls, Anna L. Newton
The Interrelationships Among Obesity, Insulin Sensitivity, And Bone Phenotype In Pre-Pubertal Girls, Anna L. Newton
All ETDs from UAB
Impaired insulin sensitivity as a consequence of childhood obesity has been implicated as a contributor to skeletal fragility. There is a need to understand the interrelationships among insulin sensitivity and skeletal parameters (i.e. cortical, trabecular, marrow) in obesity during the pubertal transition. Further, calorie restricted weight loss to stabilize these relationships warrants investigation as well. The goal of this project was to examine the relationships among body composition, skeletal parameters, and insulin sensitivity. The first aim was to evaluate the relationships among total body fat, bone mineral content (BMC) and femoral bone marrow adipose tissue (BMAT) during childhood and underlying …
Impact Of Medicare Part D Coverage Gap On Medicare Beneficiaries With Copd: Adherence, Healthcare Resource Use, And Cost, Yanni Fan Yu
Impact Of Medicare Part D Coverage Gap On Medicare Beneficiaries With Copd: Adherence, Healthcare Resource Use, And Cost, Yanni Fan Yu
All ETDs from UAB
Medicare Part D provides prescription drug coverage for beneficiaries to support their pharmacological treatment; however, the complex deductible structure within benefit plans creates a major coverage gap and unexpected consequences. Some evidence has demonstrated reduced adherence resulting from the coverage gap; however, little research has evaluated the effect on healthcare resource use (HRU) and cost, and no studies have been conducted for beneficiaries with chronic obstructive pulmonary disease (COPD). This study examined the impact of the coverage gap on medication adherence as well as healthcare resource use and medical cost among beneficiaries with COPD. Claims data based on a 5% …
The Effect Of Joining A Health System On Financial Performance, Kenneth Joseph Cochran
The Effect Of Joining A Health System On Financial Performance, Kenneth Joseph Cochran
All ETDs from UAB
The rate of hospitals merging has increased significantly over the last few years. The number of hospital mergers between 2003 and 2009 averaged 55 per year, while mergers for 2010 and 2011 were 72 and 90, respectfully. This research moved beyond anecdotal reports and by using publicly reported data to not only evaluate the financial success of mergers, but also to look at other factors such as size, ownership, geography, environment (urban vs. rural), and market competitiveness to assess impacts on financial outcomes of mergers. This study examined the effect of joining a hospital system based on financial performance. Further, …
Difference In Recommended-To-Actual Nurse Staffing And Patient Falls, Shawn Ulreich
Difference In Recommended-To-Actual Nurse Staffing And Patient Falls, Shawn Ulreich
All ETDs from UAB
Patient falls are a serious safety concern in hospitals. Injuries from falls can be devastating to patients and are now subject to reimbursement penalties from the Center for Medicare and Medicaid Services. Patient falls have been identified by the American Nurses Association as a nursing sensitive indictor suggesting that improvements in the quality or quantity of nurses may impact this outcome. Moreover, the literature suggests that nurse staffing levels have an impact on various patient outcomes such as patient falls. Therefore, identifying appropriate nurse staffing levels to minimize patient falls is critically important to hospitals. A variety of staffing metrics …
Effectiveness Of Functional Electrical Stimulation Assisted Rowing To Improve Shoulder Pain And Aerobic Fitness In Manual Wheelchair Users With Spinal Cord Injury, Susan Wilbanks
All ETDs from UAB
Exercise is beneficial to adults with spinal cord injury (SCI) because of its ability to improve function and increase life expectancy. The goal of this dissertation was to determine an effective intervention for increasing aerobic fitness and decreasing shoulder pain in manual wheelchair users with SCI by identifying underlying mechanisms for shoulder pain, optimizing training and utilizing appropriate outcome measures. Three studies were conducted. The first study indicated that exercise interventions for adults with SCI are of low to moderate methodological quality, frequently using outcome measures associated with changes in body structures and functions, and not frequently examining effects on …
Chief Executive Officer Characteristics In Relationship With Patient Experience Scores Of Hospital Value Based Purchasing, Christina Galstian
Chief Executive Officer Characteristics In Relationship With Patient Experience Scores Of Hospital Value Based Purchasing, Christina Galstian
All ETDs from UAB
ABSTRACT Patient experience scores have become important indicators of value in healthcare. This study was the first of its kind to examine CEO gender, tenure, and education in relationship with patient experience scores and all other value based purchasing scores, such as outcome, efficiency, clinical process of care, and total performance scores. This study suggested that hospitals with certain types of CEOs may perform better with respect to patient experiences and other value based purchasing scores. The primary analysis of this study was to examine the impact of hospital CEO characteristics (tenure, education, gender) on patient experience scores. A supplementary …
Safety Culture And Patient Harm, Alfonso Gatmaitan
Safety Culture And Patient Harm, Alfonso Gatmaitan
All ETDs from UAB
SAFETY CULTURE AND PATIENT HARM EVENTS: A CONTINGENCY THEORY PERSPECTIVE IN THE CONTEXT OF COMPLEX ADAPTIVE SYSTEMS ALFONSO GATMAITAN ADMINISTRATION-HEALTH SERVICES ABSTRACT This study examines the correlation between a Culture of Patient Safety as measured by hospital staff surveys and actual patient harm attributed to hospital performance. It is generally accepted by health care management leaders that the presence of a strong culture of patient safety has become a critical component in reducing patient harm. However, little empirical evidence within multiple hospitals over time exists to support this belief. Healthcare managers can utilize this evidence in formulating patient safety improvement …
Hospital-Based Skilled Nursing Facilities: Predictors Of Survival And Performance, Shivani Gupta
Hospital-Based Skilled Nursing Facilities: Predictors Of Survival And Performance, Shivani Gupta
All ETDs from UAB
This three-paper dissertation examined the organizational and market factors predicting the response of hospital-based skilled nursing facilities (HBSNFs) to the changes in their environment such as the implementation of prospective payment system in 1998 and their role in coordination of care for patients in transition from acute care to home or a post-acute care facility. In the first study, population ecology of organizations framework was used to evaluate the organizational and market factors associated with HBSNFs’ closure after 1998. The event histories of all acute-care hospitals which had an open HBSNF in 1998 were examined across 15 years (1998-2012) to …
Associations Of Gestational Weight Gain And Breastfeeding With Postpartum Weight Change Among African American Women, Camille Schneider
Associations Of Gestational Weight Gain And Breastfeeding With Postpartum Weight Change Among African American Women, Camille Schneider
All ETDs from UAB
Objective: To examine the associations of gestational weight gain (GWG) and breastfeeding (BF) with postpartum (PP) weight change among African American women. Methods: Healthy, low-income African American women (n=32) were enrolled in a prospective observational cohort study of early life origins of obesity. GWG was calculated using data retrieved from medical records. Women were stratified according to the 2009 Institute of Medicine (IOM) GWG guidelines. Investigators measured maternal body weight at 2-weeks and 3-months PP, with the difference reflecting PP weight change. BF status at 2-weeks PP was self-reported. Analysis of covariance with Bonferroni post hoc testing was used to …
The Roles Of Mammalian Tribbles Homolog 3 (Trib3) In Coordinating Energy Metabolism And Development Of Insulin Resistance, Wei Zhang
All ETDs from UAB
Insulin resistance in diabetics comprises of a reversible component treatable with intensive glycemic control and a non-reversible component present in pre-diabetes that may lead to the development of overt diabetes. The reversible component is induced and exacerbated by hyperglycemia in both uncontrolled type 1 and type 2 diabetes, a process known as glucose-induced insulin resistance (GIIR) or glucose toxicity. The tribbles homolog 3 (TRIB3) has been identified as a pseudokinase that inhibits Akt activity by physically blocking its phosphorylation site. Expression of TRIB3 has been associated with various signals such as endoplasmic reticulum (ER) stress and nutrient availability in pancreatic …
A Longitudinal Study Relating Patient Care Outcomes To Nurse Magnet Designation In United States Academic Medical Centers, Thomas R. Hunt
A Longitudinal Study Relating Patient Care Outcomes To Nurse Magnet Designation In United States Academic Medical Centers, Thomas R. Hunt
All ETDs from UAB
The purpose of this investigation is to determine whether the addition of the structural and process elements necessary for an academic medical center to garner its initial Magnet designation is associated with improved patient care. Donabedian's linear structure-process-outcome theory serves as the framework to empirically assess the relationship between Magnet status and patient care outcomes. The influence of such organizational factors as hospital size, clinical activity, and complexity of care is investigated. Secondary data from the American Nurse Credentialing Center (ANCC) and the University HealthSystem Consortium (UHC) is used as the basis of this empirical study. This investigation identified two …
The Relationship Between Patient Complaints And Surgical Complications, Joseph Francis John
The Relationship Between Patient Complaints And Surgical Complications, Joseph Francis John
All ETDs from UAB
THE RELATIONSHIP BETWEEN PATIENT COMPLAINTS AND SURGICAL COMPLICATIONS JOSEPH F. JOHN ADMINISTRATION - HEALTH SERVICES ABSTRACT Background: Patient complaints are viewed as indications of dissatisfaction with the service received or experience at a health care institution. The prediction of patient complaints is not clearly understood, and to date, very little quantitative research has evaluated the relationship between patient complaints and health care quality. Objective: The objective of this study was to examine whether (1) surgeons that operate on patients with higher perioperative surgical risk are associated with higher levels of patient complaints and (2) surgeons with higher levels of patient …
Freestanding Emergency Departments: Strategic And Policy Implications, Nitish Patidar
Freestanding Emergency Departments: Strategic And Policy Implications, Nitish Patidar
All ETDs from UAB
The dissertation examined the role of Freestanding Emergency Departments (FSEDs) in the current United State health care system. The study collected the primary data on FSEDs in the United States and analyzed the factors associated with the hospitals operating FSEDs and its effect on hospital financial performance. The relationship of presence of FSEDs in the market and Medicare expenditure per person was also studied. The Resource Dependency Theory was used to study the effect of market and organizational factors on the hospital decision to operate an FSED. Panel data from 2002 to 2011 was analyzed using logistic multivariate regression with …
Dietary Pattern Adherence Of Adults With Diabetes In The Reasons For Geographic And Racial Differences In Stroke (Regards) Study 2003-2007, Keith Pearson
All ETDs from UAB
The objective of this study was to determine if adults with diabetes engage in different dietary practices compared to adults without diabetes in a national cohort of adults 45 years of age or older. Dietary practices were evaluated using five dietary patterns derived previously using factor analysis in a sample of 21,636 African American and European American participants who completed the Block 98 Food Frequency Questionnaire in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) measuring dietary pattern adherence of adults with diabetes …
Glycine Supplementation To Improve Insulin Sensitivity In Humans, Marie-Hippolyte Boni Epse Attobla
Glycine Supplementation To Improve Insulin Sensitivity In Humans, Marie-Hippolyte Boni Epse Attobla
All ETDs from UAB
The main purpose of this pilot study was to investigate the insulin sensitizing effect of glycine as a dietary supplement in insulin resistant (IR) normoglycemic subjects (N= 10), and to determine significant changes in insulin sensitivity and lipid profile after four weeks of glycine supplementation. Descriptive statistics were used to describe the basic characteristics of the study population. A paired t-test was used to determine differences between insulin sensitivity and lipid profile pre- and post- intervention, considering the estimation of HOMA-IR and Matsuda- index scores. Results showed that glycine supplementation might improve triglyceride (TG) levels in European Americans; and low-density …
An Economic Evaluation Of A Peer Support Intervention For Diabetes Self-Management, Caresse Campbell
An Economic Evaluation Of A Peer Support Intervention For Diabetes Self-Management, Caresse Campbell
All ETDs from UAB
Appropriate management of diabetes has the potential to affect not only health outcomes associated with diabetes, but also its economic burden. Peer support has emerged as a promising intervention to improve diabetes self-management, with demonstrated effects on improving clinical outcomes. Whether the health improvements obtained with peer support are worth its implementation cost, has not been established. This dissertation sought to close the gap in the literature by conducting an economic evaluation of a peer support intervention for diabetes self-management. We conducted analyses of secondary data from Encourage, a randomized trial testing a peer advisor intervention conducted in rural Alabama. …
Gut Microbiome And Its Role In Obesity And Aging In C57bl/6j Mice, Yongbin Yang
Gut Microbiome And Its Role In Obesity And Aging In C57bl/6j Mice, Yongbin Yang
All ETDs from UAB
turtles and its’ ecological and evolutionary significance regarding certain aspects of
The Relationship Between Emergency Department Wait Times And Inpatient Satisfaction, Polly Jean Davenport
The Relationship Between Emergency Department Wait Times And Inpatient Satisfaction, Polly Jean Davenport
All ETDs from UAB
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Development And Testing Of The Primary Care Homeless Organizational Assessment Tool (Pc-Hoat) To Evaluate Primary Care Services For The Homeless, Jocelyn Louise Steward
Development And Testing Of The Primary Care Homeless Organizational Assessment Tool (Pc-Hoat) To Evaluate Primary Care Services For The Homeless, Jocelyn Louise Steward
All ETDs from UAB
The purpose of this dissertation is to develop and test an organizational assessment tool that can used to evaluate primary care services for the homeless. The research evaluates the importance, feasibility, reliability, and validity of organizational processes and structures of primary care services for the homeless. The final product is the validated Primary Care Homeless Organizational Assessment Tool (PC-HOAT). This tool provides stakeholders with information regarding the organizational structures and processes associated with greater quality of primary care for the homeless. This tool will help managers better understand their organization's strengths and weaknesses, guide discussions regarding operations, and provide information …
Employer-Based Wellness Programs; Financial Value To The Organization, Ricky D. Wallace
Employer-Based Wellness Programs; Financial Value To The Organization, Ricky D. Wallace
All ETDs from UAB
The health and wellness of employees is of strategic importance for healthcare organizations to achieve leadership in accountable care and health reform. This study sought to discover whether an organizational program, focused on health promotion and wellness for employees, has a value to the organization. This quantitative evaluation study examines variables of a wellness program implemented at a medical facility in the United States by determining the medical costs among participants and non-participants of the facility sponsored wellness program. The results of the study provide valuation evidence concerning the program's value to the organization.
Syndecan Knockdown In The Insulin Producing Cells Of Drosophila Melanogaster Affects Energy Metabolism And Life Span, Jonathan Lund Warren
Syndecan Knockdown In The Insulin Producing Cells Of Drosophila Melanogaster Affects Energy Metabolism And Life Span, Jonathan Lund Warren
All ETDs from UAB
Drosophila melanogaster is a powerful model organism for studying human metabolic disease due to the conservation of various signaling processes and pathways. The insulin producing cells (IPCs) in the brain of adult flies sense circulating nutrients and respond by producing three insulin-like peptides (dILP2, dILP3, and dILP5). Several studies have shown that dILPs play a major role in Drosophila reproduction, metabolism, growth, and longevity. Previous data showed that flies homozygous for a hypomorphic mutation in the Drosophila syndecan (dSdc) gene had defects in energy metabolism and lower expression of brain dilp2-3 and dilp5 genes. Syndecan is a transmembrane proteoglycan that …
Employment Of Physician Administrators (Ceos) In Acute Care Hospitals And Their Impact On Hospital Performance, Muhammad H. Al-Midani
Employment Of Physician Administrators (Ceos) In Acute Care Hospitals And Their Impact On Hospital Performance, Muhammad H. Al-Midani
All ETDs from UAB
that arribada nesting enhances the survival of eggs and hatchlings through the confusing