<p> This quantitative study was an evaluation of the effectiveness of the online Training Home software program, designed for use with a national nonprofit business model. This study was undertaken because nonprofits have a difficult time resourcing training. If the Training Home program can deliver a comprehensive training program for minimal cost, then a nonprofit will be better able to deliver on the nonprofit&rsquo;s stated mission. For this study, six research questions centered on measuring the helpfulness of the program, the difference in job function training, improved knowledge of a national nonprofit, and perception of the Training Home program between those that had and or had not used the program. Additionally, cost per unit of training, the number of training vignettes delivered, time spent in training, ease of use by supervisors, and staff ratings of the effectiveness of the training home program. The population studied was the 450 staff at one affiliate of the national nonprofit. This staff group consisted of a mix of genders, ages, and education levels. This study used archival data gathered over the 2013, 2014, and 2015 calendar years and was analyzed using multivariate regression and descriptive analyses. The cost and number of training vignettes delivered in a 24-month period were compared to determine whether the Training Home program was a more cost-effective delivery model than the prior system for the year before the study. Analyses indicate that the Training Home program delivered more training to staff at a lower cost per unit of training when compared to the units of training delivered in the prior model. Supervisors and staff reported the program to be effective in knowledge management and tracking and the training of all staff. The study had positive results for the sample studied. It would be beneficial for any future studies to expand the sample size into other geographic regions.</p><p>

<p> <b>Rationale/Background:</b> Fall prevention is a paramount and lifesaving healthcare initiative. The investigation of interventions for the prevention of falls may lead to a decrease in injuries and promotion of superlative care for patients hospitalized in an acute healthcare environment. </p><p> <b>Purpose: </b>The purpose of this quantitative correlational direct practice improvement (DPI) project is to determine the relationship between the implementation of a fall prevention training program and changes in fall rates over a period over three months. </p><p> <b>Theoretical Framework:</b> The Neuman system model served as the theoretical foundation for this project. The model presents a holistic approach to patient at-risk for falling and guides bedside nursing care, assess stressors, safety needs, and environmental factors suggest potential indicators linked to fall-risk patients. </p><p> <b>Project Method and Design:</b> A quantitative method and correlational design was used to investigate the impact of the intervention. The intervention involved training for a total 28 nurses (N = 28) on two wards. The final data collection included fall rates for 56-patients (N = 56). </p><p> <b>Data Results:</b> The control ward had a fall rate of nearly twice as high than the ward who received the intervention. There is a statistically significant reduction in fall rates on the intervention ward (p = 0.04). </p><p> <b>Implications:</b> Based on the findings of this project, a fall education training program supported safety through a reduction of falls. The training program was adopted as a part of standard education for the site. </p><p>

Thesis (MPH) -- University of Limpopo, 2011. / Introduction STIs, including easily treatable bacterial infections such as syphilis and gonorrhoea, continue to cause a huge burden of ill health in both developing and developed countries. Syndromic management is currently the best approach for the management of sexually transmitted infections in developing countries, but its successful implementation is often questionable Objectives The overall aim of this study was to assess and compare the quality of STI services in the primary health care clinics in Leribe district, Lesotho. The specific objective of the study was to assess the availability of STI drugs, clinicians’ knowledge of STI management, and the availability of STI examination equipment Methods A descriptive cross-sectional quantitative study was conducted with 23 nurse clinicians in PHC clinics in Leribe district of Lesotho. This study explored the gaps and issues around the provision of syndromic management of STIs using the DISCA tool. Results Most of the facilities have inadequate and non reliable equipment and supplies as well poor and inadequate infrastructure. There is lack of continuous training on STI management, low complete treatment to STI clients with only a few of the health centres giving complete treatment and there was also poor contact tracing of partners. Almost all clinicians cited the correct treatment for managing male urethral syndrome. Conclusion The lack of continuous training compromised STI management because nurse clinicians lacked skills to provide quality services. In general, although the principles of syndromic management are well understood by most clinicians, there are no systems in place to support the use of these guidelines

Thesis (MPH) -- University of Limpopo, 2011. / Background: Health care workers (HCWs) are prone to occupational exposures to blood-borne viruses (BBVs), which include hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Post exposure prophylaxis (PEP) is available for both HBV and HIV, and if administered correctly can reduce the risk of HBV and HIV transmission by 80%. This study investigated the knowledge and practices of HCWs regarding PEP for BBVs at Medunsa Oral Health Care Centre (MOHC). Methods: This was a cross sectional study conducted among 166 HCWs at the MOHC using a self-administered, anonymous questionnaire on knowledge and practices of HCWs regarding PEP for BBVs. Binary logistic regression method was used to determine factors associated with reporting an occupational exposure and uptake of PEP. Results: The response rate was 67%. The mean age was 27yrs (SO =7.67yrs), and 68.7% of . respondents were female. The overall knowledge regarding PEP among the HCWs was inadequate as 46.9% had poor knowledge. The majority (77.7% [128/166]) of HCWs experienced occupational exposures and amongst them 39.0% (50/128) experienced it twice or more. Almost two-thirds (60.9%) of HCWs experienced an occupational exposure while performing scaling and polishing. Only 28.9% (37/128) of those who were potentially exposed to a BBV reported the incident to the authorities. Out of those who reported, 37% (14/37) took PEP for HIV, and 32.4% (12/37) took PEP for HBV. Among those taking HIV PEP, 21.4% (3/14) indicated that they completed the course. HCWs who haq five or more years of experience j were less likely (OR=0.138, p=0.043) to report compared to those who had less than five years of experience. Conclusion: Overall, participants' knowledge regarding PEP as well as reporting of an exposure was inadequate. The majority of HCWs experienced an occupational exposure while performing scaling and polishing.

Thesis (M Med (Family Medicine)) -- University of Limpopo,2011.

What constitutes quality of learning in primary care? A social systems view of that central question regards the relationships between dimensions of learning, purposes of primary care, and quality of practice. The question of learning quality was approached in three ways. First, perceptions of learning quality were elicited through recorded interviews with fifteen participants representing diverse roles in a primary care medical clinic. Analysis of the interviews indicated learning sources, factors, and functional dimensions of learning. Second, because learning is constituted in a social practice, the social context of learning in primary care clinics was modeled with qualitative systems diagrams. This exposed systemic barriers and facilitators of learning in practice. Third, learning is directed toward fulfilling the purposes of primary care. The nature of those purposes is not well articulated. A framework of seven core purposes was developed from the perspective of systems phenomenology. This framework extends the biopsychosocial framework in several regards. Perceptions of learning quality, the structural situation of learning in clinical practice, and the core purposes of primary care, all contribute to a social systems understanding of what constitutes learning quality, and how primary care organizations might procure it and assess it. Systems phenomenology represents a significant innovation in social systems science methods. / Graduation date: 2002

The U.S. pharmaceutical industry has been remarkably successful in developing new treatments for many of the leading causes of morbidity and mortality. These new treatments and their high prices lead government and private parties to increase spending and raise the issue of access. Price and cost increases have stimulated insurance costs, raising questions about the value of new technologies. A key way to address the increase in pharmaceutical prices is to investigate the impact of newer therapies on overall health expenditure. There is a conflict among researchers about the benefits and costs of newer and better drugs. Some researchers argue that newer and better drugs keep people out of hospitals and provide significant cost savings. Another group of researchers argue in their work that newer drugs do not really provide significant cost savings. This dissertation investigates the impacts of break-through drug classes on overall health care expenditures. Empirical evidence presented in this dissertation shows that drugs belonging to new drug classes provide significant advances in treatment of conditions compared to other drugs. The results indicate that all new drug classes except Fluoroquinolones provide substantial cost savings on overall health care expenditures. This dissertation also explores the relations between FDA Therapeutic Drug Classification and total health care expenditures. It offers a better methodology by incorporating both the quality and the age of the drugs to capture their effects on total health care expenditures. It studies the impacts of the quality and the age of the drugs on the diseases of following therapeutic classes: musculoskeletal system and connective tissue, skin and subcutaneous tissue, neoplasm, mental disorders, nervous system and sense organs, circulatory system, respiratory system, digestive system, genitourinary system. The nature of therapeutic conditions coupled with their duration lead us to conclude that for some therapeutic categories newer priority drugs are preferable, for others newer standard drugs are better. The results suggest that there is no general rule to state that newer priority drugs decrease health care expenditures.

The U.S. pharmaceutical industry has been remarkably successful in developing new treatments for many of the leading causes of morbidity and mortality. These new treatments and their high prices lead government and private parties to increase spending and raise the issue of access. Price and cost increases have stimulated insurance costs, raising questions about the value of new technologies. A key way to address the increase in pharmaceutical prices is to investigate the impact of newer therapies on overall health expenditure. There is a conflict among researchers about the benefits and costs of newer and better drugs. Some researchers argue that newer and better drugs keep people out of hospitals and provide significant cost savings. Another group of researchers argue in their work that newer drugs do not really provide significant cost savings. This dissertation investigates the impacts of break-through drug classes on overall health care expenditures. Empirical evidence presented in this dissertation shows that drugs belonging to new drug classes provide significant advances in treatment of conditions compared to other drugs. The results indicate that all new drug classes except Fluoroquinolones provide substantial cost savings on overall health care expenditures. This dissertation also explores the relations between FDA Therapeutic Drug Classification and total health care expenditures. It offers a better methodology by incorporating both the quality and the age of the drugs to capture their effects on total health care expenditures. It studies the impacts of the quality and the age of the drugs on the diseases of following therapeutic classes: musculoskeletal system and connective tissue, skin and subcutaneous tissue, neoplasm, mental disorders, nervous system and sense organs, circulatory system, respiratory system, digestive system, genitourinary system. The nature of therapeutic conditions coupled with their duration lead us to conclude that for some therapeutic categories newer priority drugs are preferable, for others newer standard drugs are better. The results suggest that there is no general rule to state that newer priority drugs decrease health care expenditures.

In the provision of public goods such as health care for the uninsured, nonprofit organizations serve important functions in society. Because they often rely on volunteer labor, and funding is frequently unstable, their survival depends on factors not present in either private enterprise or state agencies. This comparison case study examines three clinics, one surviving clinic and two that did not survive, to find patterns that characterize organizational success and survival. Theories about public goods, volunteering, and organizational coordination and communication provide insight into different aspects of the case study. Data was gathered from 19 in-depth interviews with individuals connected to the three clinics. The analysis employs Ostrom’s characterization of eight principles of longstanding common-pool resource organizations, with slight adjustments for the public goods setting. As expected, the successful clinic reflects more of the characteristics, or possesses them to a greater degree, than the unsuccessful ones. Specifically, the successful clinic reflects a greater degree of congruence between organizational rules and local conditions (as evidenced by community support), and collective-choice arrangements (as indicated by the presence of an actively engaged board of directors). In addition, the successful clinic is loosely nested with other organizations, whereas the nonsurviving clinics were more tightly nested within local organizations; the looser nesting allows for greater autonomy in decision-making. Finally, an unexpected finding drawn from the interviews concerns the manner in which the clinics framed their message and mission. The successful clinic framed its mission in terms of serving the “working poor,” whereas the nonsurviving clinics stated their mission as charity for the poor and needy. This variance may have contributed to greater community support for the successful clinic.

Thesis (MSc (Epidemiology, School of Health Systems and Public Health))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.