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<p> Falls are a serious issue for the elderly living in long-term care facilities, as falls contribute to significant health problems such as increased dependence, loss of autonomy, confusion, immobilization, depression, restriction in daily activities, and, in some cases, death. An estimated 424,000 fatal falls in elderly patients residing in long-term facilities occur annually in the United States costing $34 billion in direct medical costs. One way to reduce falls among elderly patients in long-term care is to assess for fall risk frequently and implement evidence-based strategies to prevent falls. Patients in this project site facility had been assessed for fall risk via the Briggs Fall Risk Assessment Tool with implementation of fall risk iinterventions only upon admission or when there was a fall. The purpose of this project was to assess whether changing to weekly use of the Briggs Fall Risk Assessment Tool with implementation of fall risk interventions by nursing staff could decrease fall rates in the elderly in long-term care in Harris County, Texas. The model of prevention served as the conceptual framework for this project. Thirty participants (20 females and 10 males) between the ages of 65-115 participated in the program. Pre-implementation data were collected for 1 month and post-implementation data were collected for 1 month. The total number of falls reported weekly was counted before and after the weekly implementation of the Briggs Fall Risk Assessment Tool. The number of falls decreased from 12(70.6%) before the implementation of the assessment tool to 5(29.4%) falls afterwards. A fall prevention program in long-term care may affect social change positively by reducing fall risk in long term care by reinforcing the importance of increased awareness of risk of falls to implement fall prevention strategies</p>

<p> The purpose of this study was to identify and measure trends in genetic counselor (GC) workforce supply in the United States from 2002 to 2016. Using data collected biennially from the National Society of Genetic Counselors&rsquo; Professional Status Survey (PSS), I calculated overall percent change in GC employment across specific work settings over the past 14 years. I also measured change in the relative percentage of GCs who provide direct patient counseling (i.e. clinical GCs) to determine if the percentage of clinical GCs decreased over time. Analyses were performed to determine if associations existed between GC work settings and 1) percentage of clinical GCs employed by those work settings, and 2) average number of new patient visits per week. </p><p> For several years, investigators have suggested that shortages of clinical GCs exist and that GC shortages could worsen, given increasing demand for genetic counseling and testing services. However, studies quantifying GC supply and demand are limited, and both must be measured and compared to confirm GC shortages. The goal of this study was to focus on measuring change in GC supply across work settings over time, and its impact on direct patient counseling. </p><p> From this study&rsquo;s results, I confirmed that there was a decrease in the percentage of GCs employed by University Medical Centers (UMCs), and an increase in GCs employed by Diagnostic Laboratories (DLs) from 2002 to 2016. I also showed that a greater percentage of GCs employed at UMCs counsel patients than GCs employed by DLs. An increase in DL GCs and a decrease in UMC GCs was temporally associated with a decrease in the percentage of clinical GCs. Although a significantly smaller percentage of DL GCs counseled patients than UMC GCs, clinical DL GCs, on average, counseled significantly more new patients per week than clinical UMC GCs. Evidence drawn from this study can help inform strategies to redistribute GC employment across specific work settings in order to increase the percentage of clinical GCs and increase the number of patients receiving genetic counseling services.</p>

Class of 2012 Abstract / Specific Aims: The purpose of this study was to assess the attitudes, beliefs and knowledge of pharmacy students regarding geriatric care. Methods: A questionnaire was administered to first, second and third year pharmacy students to assess the impact of geriatric curriculum on students at the University of Arizona College of Pharmacy. The primary grouping variable was whether or not students had previously taken a course focused on geriatrics. Main Results: A total of 193 pharmacy students completed the questionnaire which resulted in a response rate of 64.33%. There is no comparison group for the first year class as all students in this class had never taken a geriatric-focused course. Therefore, no tests for statistical significance could be performed for this class. Students in the second year class who have taken a geriatrics-focused course scored higher than those without course experience on all four of the attitude and beliefs questions (p = 0.104, p = 0.042, p = 0.045, p = 0.025). The same held true for the third year class (p = 0.006, p <0.001, p = 0.050, p = 0.653). Both classes showed a statistically significant increase in knowledge of geriatric care in those students who have previously taken a geriatrics-focused course (p = 0.032 for second years, p = 0.022 for third years). Conclusions: This study showed that pharmacy students at the University of Arizona College of Pharmacy who have previously taken a geriatrics- focused course have more positive attitudes and beliefs regarding geriatric care as well as a stronger knowledge base regarding geriatrics. With an aging population, it is important that pharmacists be knowledgeable and capable of caring for geriatric patients. Thus, we recommend that all pharmacy schools include a geriatrics-focused course as part of the standard curriculum for Pharm D. candidates.

<p> La Vang is a non-profit adult day care facility specifically designed to provide health, nutritional, spiritual, and social care for retired Vietnamese adults during the day time throughout Orange County, CA. From Monday-Friday, clients may arrive in La Vang at 7:00am, and return to their homes at 7:00pm. La Vang will greatly relieve the stress of family caregivers who cannot adequately care for their elderly parents/relatives while also working full-time to support their immediate family. Currently, there are no other adult day care facilities in Orange County that can offer full services in Vietnamese. Ultimately, La Vang will be the only adult day care facility in Orange County that Vietnamese caregivers can confidently entrust their loved ones to during the day. Clients and their families can rest assured that La Vang will not only provide basic day care for its clients, but will also provide comprehensive care that will be culturally sensitive, and appropriate for the elderly Vietnamese population as well.</p>

<p> As each year passes the number of female veterans within the United States is expected to increase; as this population increases there will be a greater need for specialized healthcare services directed at this group. One issue that affects this population and has gained more attention within the past 20 years is military sexual trauma (MST) and the effect it has on mental health. Victor Echo Tango (VET) Support Services Inc. is a proposed counseling center that focuses on providing counseling services to female veterans that have experienced military sexual trauma. VET Support Services Inc. offers various counseling services that will help teach our female veterans how to live through their trauma. The organization combines traditional counseling services, such as individual counseling and relationship counseling, with new-age counseling techniques such as group mindfulness training to offer a comprehensive care model.</p>

<p> This business plan proposes a mobile app, MyMark, that will form in partnership with grocery stores nationwide to promote healthy behaviors in the form of nutritional consumption. The app will take on its initial pilot testing at a Ralphs grocery store located in San Diego, California. It will cater to grocery store shoppers by synthesizing custom grocery lists based on the app user&rsquo;s personally input health information. The app is intended to serve as a convenient replacement to shopping in the moment and aimlessly walking up and down the grocery store aisles. It is also a conventional solution to bringing a nutritious grocery list to the store. This business proposal delivers the market analysis, feasibility analysis, legal and regulatory considerations, and financial overview that will allow MyMark to successfully pilot and nationally expand.</p>

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Currently few studies have investigated the accuracy of using transcutaneous bilirubinometry after phototherapy especially in the outpatient setting. The purpose of this study was to evaluate the accuracy of transcutaneous bilirubin measurements (TCB) after phototherapy for neonates with jaundice. At the Maricopa Integrated Health System, neonates who undergo phototherapy for hyperbilirubinemia come in for outpatient follow‐up at the Comprehensive Health Center following their discharge. For those neonates, current protocol calls for serum bilirubin (TSB) to be measured to properly monitor bilirubin levels, however transcutaneous measurements were made and recorded as well. In this study, we compared the values of total serum bilirubin and transcutaneous bilirubin in jaundiced neonates who underwent phototherapy. From October 2013‐April 2015, a total 67 healthy infants were seen in the Pediatric Clinic who had received phototherapy in our hospital, only 36 (54%) of those met minimum data criteria to be included in the study. The absolute difference between mean serum bilirubin and transcutaneous bilirubinometry in healthy outpatient newborns who received inpatient phototherapy was 0.4 and is clinically insignificant. The average time from hospital discharge to return to clinic was 47 hours. We conclude that for the outpatient physician, transcutaneous bilirubinometry can be used following phototherapy, which facilitates faster, more convenient, and painless follow‐up visits.

This thesis describes the model-based development and validation of an advisor for the maintenance of artificially ventilated patients in the intensive care unit (ICU). The advisor employs fuzzy logic to represent an anaesthetist's decision making process when adjusting ventilator settings to safely maintain a patient's blood-gases and airway pressures within desired limits. Fuzzy logic was chosen for its ability to process both quantitative and qualitative data. The advisor estimates the changes in inspired O2 fraction (FI02), peak inspiratory pressure (PEEP), respiratory rate (RR), tidal volume (VT) and inspiratory time (TIN), based upon observations of the patient state and the current ventilator settings. The advisor rules only considered the ventilation of patients on volume control (VC) and pressure regulated volume control (PRVC) modes. The fuzzy rules were handcrafted using known physiological relationships and from tacit knowledge elicited during dialogue with anaesthetists. The resulting rules were validated using a computer-based model of human respiration during artificial ventilation. This model was able to simulate a wide range of patho-physiology, and using data collected from ICU it was shown that it could be matched to real clinical data to predict the patient's response to ventilator changes. Using the model, five simulated patient scenarios were constructed via discussion with an anaesthetist. These were used to test the closed-loop performance of the prototype advisor and successfully highlighted divergent behaviour in the rules. By comparing the closed-loop responses against those produced by an anaesthetist (using the patient-model), rapid rule refinement was possible. The modified advisor demonstrated better decision matching than the prototype rules, when compared against the decisions made by the anaesthetist. The modified advisor was also tested using data collected from ICU. Direct comparisons were made between the decisions given by an anaesthetist and those produced by the advisor. Good decision matching was observed in patients with well behaved physiology but soon ran into difficulties if a patients state was changing rapidly or if the patient observations contained large measurement errors.

<p>The purpose of this directed project was to develop a four-hour workshop for Gerontologists and associated health professionals to assist older adults in understanding the Medicare products available to them. The workshop was specifically developed for delivery through a non-profit called ?In Transition Planning,? which is an educational platform to assist aging individuals with the aging process through education, community involvement and training. The four-hour workshop was based on the ?Medicare and You? booklet developed by the Centers for Medicare and Medicaid Services (CMS) sent to older adults prior to turning 65 years old and annually. This workshop covers the basics of Medicare planning, which includes elections on basic Medicare, Medicare Advantage, and Medicare Supplemental Plans that a senior receiving Medicare needs to consider. Workshop materials were sent to three expert reviewers, who gave suggestions for revision. General suggestions included adding material about Medicaid and rules for dual eligibles, discussing identity theft as it relates to one?s Social Security card, including breaks in the presentation, and condensing some of the material for the time allotted. The workshop will educate Gerontologists and associated health professionals about the different components of Medicare and insurance coverage available to older adults.