Patients who are unable to comply with their health care regimen are almost 3 times more likely to have an adverse health outcome and are more likely to suffer irreversible progression of a chronic disease process. Increasing patient return clinic visits is essential, not only to curtail rapidly rising costs of health care but also to improve patient outcomes. This project focused on an uninsured patient population of a clinic in a rural community in the southeastern United States. The purpose of the project was to conduct a systematic review of the literature and identify the barriers and motivating factors for chronic care return primary care visits among uninsured patients. The theoretical models supporting the project were the health belief model and the chronic care model. A search of scholarly databases resulted in 366 articles meeting the inclusion criteria of peer-reviewed English-language literature published since 2014 that focused on outpatient care among uninsured populations. All identified articles were reviewed, and several interventions emerged as options to increase patient return rates: care transition and coordination services, patient education, patient follow up, pharmacy assistance programs, food assistance programs, and integration of computer-based literacy interventions. The clinic administrators determined that the best option for the site would be implementation of an on-site food program. The findings of this project have potential to create social change in clinics for uninsured in the community by addressing food insecurity and providing patients an incentive to return for care every 6 months.

Caregivers' compliance with polio vaccine regimens and timely receipt of the recommended 4 doses of polio vaccine are pivotal to eliminating polio. This cross sectional study, conducted in Lagos State, Nigeria, examined polio vaccine compliance and demographic attributes of caregivers' for statistically significant associations. Using an adapted health belief model theoretical framework, 1,200 participants were recruited from well-baby clinics in 8 local government areas in Lagos State. Participants completed a brief demographic survey providing data on caregivers' age, gender, residence (rural or urban), and their level of education as well as records from their children's immunization cards. Data obtained were tested for associations between caregiver's demographic information and their children's receipt of polio doses within specified timelines using chi-square and logistic regression analysis. Fisher's exact analysis were conducted for variables with frequencies less than 5. The only significant association recorded was between the receipt of Polio Dose A and location of caregivers' residence: Rural dwelling caregivers were less likely to receive the first dose of polio. Results showed Polio Dose D to be the dose most likely received in an untimely manner as well as most likely missed of the 4 doses. Logistic regression analysis did not show any variable to be of greater odds in predicting completion of the 4 doses or compliance with timelines of their receipt. Study's results may inspire polio program planners to develop interventions that broaden the immunization coverage for rural dwellers to include nontraditional maternity locations. Positive social change will ensue by the improvement caregivers' compliance with full polio dose receipts with timelines, maximizing immunity.

Community bank managers are struggling with the implementation of the many new regulations promulgated over the past several years. The purpose of this qualitative multiple case study was to explore strategies community bank managers in Pennsylvania use to implement new financial regulations. The population of interest included all community banks in Pennsylvania. For purposes of this study, a community bank was defined in terms of an asset size less than $500 million. Two community banks in Pennsylvania were selected, and 3 participants at each bank were interviewed. The participants included the chief executive officer, the compliance manager, and a mortgage lender. The transcribed interviews were analyzed using keyword frequency comparisons and cluster analysis. Member checking and triangulation of interview data and public company data (e.g., press releases) were employed to ensure trustworthy interpretation of data. Four major themes were identified, including leadership, training, collaboration, and organizational structure. Systems theory was the conceptual framework that guided this multiple case study. The board of directors, senior managers, and compliance managers can apply the recommendations to improve the approach to regulatory implementation in their organizations. The implication for positive social change includes the potential to sustain or increase the availability of loans to small businesses in the United States.

Thesis (M.Cur) --University of Limpopo, 2013 / Adherence to antipsychotic medication is very important to patients with schizophrenia. Therefore, if patients with schizophrenia are non-adherent to treatment, they are at risk of relapse and being re-admitted at a mental health care institution in the Limpopo Province. Despite the proven benefits of antipsychotic medications, half of the patients with schizophrenia do not take their prescribed drugs. The researcher has observed the following occurrences during practice: • Lack of adherence to antipsychotic medications of schizophrenic patients results in symptoms not being relieved, poor drug effectiveness and patients developed other serious or costly consequences, such as being violent and damaging property; • High rate of relapse; and • High rate of re-admissions. This research questions has guided the study: • What are the factors affecting adherence of mentally stable schizophrenic patients to antipsychotic medications at a mental health institution in the Limpopo Province? • Do mentally stable schizophrenic patients adhere to prescribed treatment? • Are there any guidelines used to promote adherence to antipsychotic treatment? The aim of the study has been to determine the level of adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental healthcare institution in the Limpopo Province. The objectives of the study have been to describe adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental health institution in the Limpopo Province. It implies that participants have been given the opportunity to describe their experience while on medication. vi Their responses have led to the development of guidelines to promote adherence of mentally stable schizophrenic patients to antipsychotic medication. The study site has been the Thabamoopo Mental Healthcare Institution in the Capricorn District of the Limpopo Province. A descriptive, exploratory and contextual qualitative research design has been used in this study. The population has consisted of all mentally stable schizophrenic patients and all the carers of such patients. Non-probability purposive sampling has been used to select participants in this study. The researcher has used a semi- structured interview with two schedule guides for the patient and carers/relatives, which have specified the issues and questions covered. It has assisted the researcher with gathering information about the problem studied (De Vos et al. 2005).A total of twenty (n = 20) participants, consisting of fourteen (n = 14) mentally stable schizophrenic patients and six (n = 6) carers/relatives has been included voluntarily in the semi-structured interview sessions. The steps of data analysis as described by Tesch (1990) in Cresswell (1994) have been followed in this study. The findings of this study reveal a central storyline which indicates that participants share the same point of view in connection with aspects of adherence to antipsychotic treatment and also knowledge about the causes of mental illness and its prognosis. The following four themes and their sub-themes have emerged during data analysis: Theme 1: Participants share the same point of view related to aspects of adherence to antipsychotic treatment; Theme 2: Knowledge related to mental illness; Theme 3: Health seeking behaviours of mentally ill patients; and Theme 4: Experiences of relatives caring for mentally stable patients on treatment. Guidelines and recommendations based on the findings of this study are described in Chapter 4. The criteria for establishing the trustworthiness of qualitative data maintained in this study have been: Credibility, dependability, confirmability and transferability. The following ethical principles have been adhered to: The principle of beneficence, justice, the principle of human respect and dignity, permission to conduct the study, informed consent and confidentiality, privacy and anonymity.

There is a dearth of studies investigating methods by which parental compliance may be enhanced. The primary purpose of this study was to investigate the relative efficacy of four conditions--high information, prompting, incentive , and comparison control--in increasing parental compliance. The self-help recommendation was to obtain a book or video from a local library. Parents were from a small, rural, northern Utah community; their children were diagnosed with externalizing behavior problems. Chi-square analyses were utilized to assess statistically significant differences, and effect sizes were computed to assess magnitude of association. The incentive intervention influenced parental compliance to a greater degree than either the comparison control or other intervention conditions. A secondary purpose of the study was to investigate the association of certain sociodemographic variables with parental compliance. Results of a logistic regression were indicative of no contribution of sociodemographic variables to the prediction of parental compliance. The relationship of current results with previous studies is discussed, as well as implications for clinical practice and future research.

A growing body of research suggests that cross-examination may be detrimental to the accuracy of children�s event reports. The primary goal of the present research was to investigate three specific ways in which the negative effect of cross-examination could be reduced. Experiment 1 examined the effect of reducing the delay between the collection of the primary evidence and cross-examination. Five- and 6-year-old children (N = 76) took part in a staged event and were interviewed 1 to 2 days later. In this interview, children were asked to recall everything they could remember about the event. Children were then asked specific yes/no questions. Next, either 1 to 3 days or 8 months later, all children were interviewed for a second time in a cross-examination format. The 8-month delay was equivalent to the average delay experienced by children in New Zealand courts (Lash, 1995). The aim of the cross-examination interview was to talk the children out of their original responses, irrespective of the accuracy of their original account. Cross-examination questioning had a significant negative effect on the accuracy of children�s reports, regardless of timing. That is, children cross-examined soon after the memory event performed no better than those who were cross-examined after an 8-month delay. Furthermore, one week after cross-examination, children were interviewed again. The purpose of this interview was to establish whether children actually believed the responses they had given during cross-examination. During this interview, many children reversed what they had said during cross-examination, indicating that the responses they had given during cross-examination were due primarily to compliance to authority. Given the finding that compliance to authority played a significant role in children�s cross-examination performance in Experiment 1, Experiment 2 addressed whether a pre-interview intervention aimed to decrease compliance would reduce the negative impact of cross-examination. Five- and 6-year-old children (n = 59) and 9- and 10-year-old children (n = 62) participated in the same staged event and were interviewed for their primary evidence as in Experiment 1. Prior to the cross-examination interview, however, some children were warned that the interviewer might ask some questions which were tricky and that it was okay to tell her that she was wrong. Warning children prior to the cross-examination interview did not reduce the negative impact of cross-examination for either age group, even when the warning was delivered by the cross-examining interviewer. Experiment 3 addressed whether a more intensive pre-interview intervention could reduce the negative impact of cross-examination. Using the same experimental procedures as Experiment 2, half of the 5- and 6-year-old children (n = 77) and 9- and 10-year-old children (n = 87) received a practice and feedback session with cross-examination type questions prior to the target interview. While cross-examination still resulted in a decrease in children�s accuracy, children in the preparation condition performed significantly better than the control children. Taken together, these findings demonstrate that the negative effect of cross-examination is highly robust and that compliance appears to be the underlying mechanism responsible for this. A practice and feedback session targeting the factors that contribute to compliance reduced, but did not eliminate, the negative effect of this questioning style. Therefore, children�s accuracy may be facilitated to some extent by cross-examination preparation prior to testifying.

Thesis (MCur. (Faculty of Health Sciences))--University of Pretoria, 2006. / Summary in English. Includes bibliographical references.

<p>Bakgrund: Bristande följsamhet till behandling leder till sämre behandlingsresultat och står för en stor kostnad för samhället. Individens egen kunskap, erfarenhet och tro på området har betydelse för de beslut denne fattar rörande sin behandling. Syfte: Litteraturstudiens syfte var att belysa patientens syn på mediciner, medicinering och livsstilsförändringar. Metod: Studien baserades på 17 vetenskapliga artiklar som analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Patienternas syn på sina mediciner berodde på faktorer som sjukdomsacceptans, bedömning av medicinerna samt tillgång till och syn på information. När det gäller synen på livsstilsförändringar så var motivation till förändring den avgörande faktorn. Diskussion: Sjukdomsacceptans var en viktig faktor när patienterna fattade beslut om följsamhet till behandling och frånvaron av symtom kunde leda till sjukdomsförnekelse. Rädsla för negativa effekter hade stor betydelse för bedömningen av medicinerna. Livsstilsförändringar påverkade identiteten kraftigare än medicinering och upplevdes därför svårare att vara adherent till. Slutsats: Att få tillgång till patienternas åsikter på området är en grundläggande faktor för att kunna få till stånd en dialog om behandlingen.</p>

Cette thèse a pour contexte la micromanipulation en milieu liquide. Cette thématique scientifique vise à comprendre les phénomènes qui interviennent lors de la manipulation dans un liquide de microcomposants, dont la taille peut varier entre 1µm et quelques millimètres. Les travaux de cette thèse se sont focalisés sur l'étude des forces de tension de surface en milieu immergé. L'idée est d'utiliser des bulles de gaz comme un moyen d'actionnement dans les milieux liquides, et nécessite d'étudier les propriétés mécaniques de ces bulles. L'originalité de l'approche repose sur la combinaison de deux effets : la tension de surface et la compressibilité du gaz. La première étape a été l'étude d'un moyen pour générer une unique bulle de gaz de taille voulue. Le contrôle en volume étant une méthode prometteuse, nous avons développé un modèle permettant de prédire la taille d'une bulle, et mis en évidence la possible existence d'une instabilité de la croissance de ces bulles. Une étude analytique adimensionnelle nous a permis de définir un critère pour prédire l'existence de cette instabilité. La seconde étape a porté sur la caractérisation mécanique d'une bulle de gaz en contact avec deux solides. Le modèle implémenté a permis de déduire des propriétés intéressantes des bulles de gaz, notamment une grande compliance dont la valeur peut être contrôlée par des paramètres fluidiques. Un démonstrateur exploitant les bulles de gaz a été conçu : une microtable compliante actionnée par trois bulles. Ces travaux ouvrent la voie vers de nouveaux modes d'actionnement ou de capteur utilisant la transduction entre une énergie fluidique et mécanique opérée par un ménisque capillaire.

<p>Examensarbete  vårdvetenskap 15 hp</p><p>TITEL: Sjuksköterskans omvårdnadsinterventioners påverkan på kroniska hjärtsviktspatienters egenvård</p><p> Författare: Julia Halt och Anna Jonsson</p><p>SAMMANFATTNING:<strong> </strong></p><p>Bakgrund:<strong> </strong>Kronisk hjärtsvikt är en av de vanligaste sjukdomarna hos äldre. En stor och viktig del av behandlingen utgörs av egenvård och då patienterna är införstådda med vikten av denna.<strong> </strong></p><p>Syfte:<strong> </strong>Att belysa sjuksköterskans påverkan på kroniska hjärtsviktspatienters egenvård, med fokus på patientundervisning.  </p><p>Metod:<strong> </strong>Systematisk<strong> </strong>litteraturstudie där åtta artiklar valdes ut, kvalitetsgranskades och sedan analyserades till ett resultat.<strong> </strong></p><p>Resultat:<strong> </strong>Det huvudsakliga resultatet visar att de viktigaste interventionerna för att påverka hjärtsviktspatienters egenvård är kontinuerlig utbildning där patient och sjuksköterska närvarar. En viktig del efter att ha informerat patienterna är att kontrollera deras förståelse för egenvården. Centralt är även sjuksköterskans bemötande och patientens medverkan. Stor vikt läggs vid att patienterna ska motiveras till egenvården och därmed öka följsamheten. Resultatet ger ny kunskap om hur viktig sjuksköterskans påverkan är för egenvården och har hjälpt oss att förstå vilka delar som är väsentligast för att stötta patienter i egenvården.</p><p>Slutsatser: Sjuksköterskan har en stor påverkan på patientens egenvård. Relationen mellan sjuksköterska och patient bör grundas på en ömsesidig kommunikation, förtroende och engagemang. Patientundervisningen kan med fördel individanpassas för att öka förståelse och förmåga till egenvård.</p><p><strong> </strong>Nyckelord:<strong> </strong>Kronisk hjärtsvikt, egenvård, omvårdnad, patientutbildning, compliance<strong></strong></p>