A randomized clinical trial was undertaken to compare the effectiveness and direct costs of shock wave lithotripsy (ESWL) and laparoscopic cholecystectomy (LC) for the treatment of symptomatic gallbladder stones. Over a period of 24 months from a total of 468 patients screened, 35 patients were randomized to ESWL, and 25 to LC. 32 ESWL patients were treated, all as out-patients, with a mean convalescence post-ESWL of 0.5 $ pm$ 1.2 days. In contrast, all LC patients were admitted to hospital for a mean duration of 2.8 $ pm$ 1.5 days with a mean post-operative convalescence of 18.2 $ pm$ 16.8 days as measured by research nurses. The two patient groups did not differ with respect to McGill Pain scores administered immediately after treatment. Three Quality of Life (QOL) tools improved similarly in both groups within the month following treatment. The only differences in QOL questionnaire results between both groups when administered 3 months following treatment and at six monthly intervals thereafter occurred for LC as greater incremental improvements were noted at 6 and 12 months follow-up. The overall stone disappearance rate in the ESWL group after a median of 15 months was 38%. Direct costs to the Quebec Health Care system during the study period were determined by analysis of patients in both treatment groups. In 1993 canadian dollars, average costs and their range were 2,889$ (1,704 $-5,830$) for patients undergoing LC, and 3,936 $ (2,367$--6,243 $) for patients treated by ESWL. The cost effectiveness ratios using the incremental differences in direct costs and duration of disability favoured ESWL at a cost of 58.9$/day of disability saved over the 15--18 months follow-up period. (Abstract shortened by UMI.)

Functional disability assessments are recognized as being important for the diagnosis of Dementia of the Alzheimer's type (DAT) as well as for monitoring the impact of intervention and determining the need for home assistance or institutionalization. Existing instruments designed for the assessment of functional disability with this population are generally unsatisfactory with regards to their content or psychometric properties. The objective of this research project was to develop a more appropriate French and English assessment of functional disability for use with proxy-respondents of community-dwelling individuals who have DAT. The Disability Assessment for Dementia (DAD) was developed in several stages using three panels composed of health care professionals and caregivers of individuals with DAT. Forward-backward translation procedures were performed at each stage to ensure that the French and English versions of the scale were comparable. Content validity was verified by a fourth panel of experts. The DAD was then administered to 59 community-dwelling DAT subjects and their caregivers to determine internal consistency and the need to eliminate items. The instrument developed, which consisted of 46 items, was reduced to 40 items, 17 related to basic self-care and 23 to instrumental activities of daily living, as a result of this process. The content validity of the final version was established by a majority of members from the panel of experts. It also demonstrated a high degree of internal consistency (Cronbach's alpha = 0.96) and excellent interrater (N = 31) and test-retest (N = 45) reliability (Intraclass correlation coefficients of 0.95 and 0.96 respectively). In addition, it was found not to have gender bias. Estimates of its validity were determined in another study. The DAD represents a valid and reliable instrument which is short and easy to administer. This instrument should have a positive impact on geriatric rehabilitation, and on clinical and

This thesis presents the design and implementation of a Nursing Workload Manager module for a Patient Data Management System in an intensive care unit. The Nursing Workload Manager aids in the planning and documentation of the nurse's workload. It automates the generation of the nursing care plan and automatically assigns a score to the care plan based on a nursing workload measurement system. In the thesis a literature survey of patient data management systems, nursing workload measurement systems and system evaluation methods is presented. This is followed by an overview of the work environment of an intensive care unit. The functionality of the Nursing Workload Manager is described and details of the software environment and application implementation are discussed. Finally, the results of a user evaluation of the module are presented, and future work on the module is discussed.

<p> The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences were studied through an anonymous survey using a third party vendor. The data revealed that in spite of Internet and connectivity issues, clinicians at XYZ Home Care overlooked these issues because of the benefits in utilizing an electronic medical record system. These benefits include quick access to patient medical records and saving time. The data allowed for triangulation between describing, explaining, and exploring technology acceptance.</p>

This thesis presents the design and implementation of a speech interface for bedside data entry in an intensive care unit. A speech interface is a system comprised of a speech recognition system, for speech input, and a speech generation or speech synthesis system, for speech output. These interfaces allow the operation of a computer system using voice commands providing the user with feedback via speech output. Such systems permit users to perform "hands-free" and "eyes-free" data entry or system operation in circumstances where the use of traditional manual input devices, such as a keyboard, cannot be used. This thesis begins with a literature sampling of contemporary computerized medical information systems and speech interface systems followed by a description of the hardware and software architecture of the speech interface implemented. Test results are then presented and discussed followed by an outline of future extensions for the system.

Background. Factors such as the shortage of personnel, hospital closures and mergers, the ageing of the population combined with the evolution of medical technologies have all added pressure to the health care system. These pressures have had an impact on current work environments and health care workers' satisfaction. In light of the evidence on the influence of job satisfaction and retention on the quality of tare and patient safety, interventions are needed to address these issues. / Objective. The objective were to examine the effect of Appreciative Inquiry on: (1) the development of innovative ideas regarding work organization; (2) changes in health care professionals' and particularly nurses' job satisfaction and intent to stay; and, (3) levels of empowerment, social network and perceived organizational support. / Research design. The study used a multiple embedded case study design to access the multifaceted aspects relating to retention and innovation and examine the changes engendered by an AI intervention. / Participants and setting. Two oncology ambulatory clinics constituted the cases; the embedded units were the health care and the management teams (N = 47 and 5) of an adult oncology division in a multi-site university affiliated health care centre in a large Canadian city. / Methods. Multiple sources of evidence were used. They consisted of participant observation, questionnaires providing quantitative and qualitative evidence, interviews, direct observation and documentation. / Results. AI provided a way to involve health care professionals in change processes by creating the opportunity and the conditions that promoted the emergent of innovative ideas. Some of these ideas were implemented during the study period. AI did not result in improved psychological empowerment, perceived organizational support, support network or decreased intent to stay. Job satisfaction decreased over time. Perceptions of organizational support and psychological empowerment were found to influence job satisfaction and intent to stay. / Conclusion. This study makes a contribution to micro-systems examination of change processes and reveals how ideas evolve and are developed in a multidisciplinary context. AI represents a way to tap into the innovative potential of individuals within an organization. The findings suggest that upper and middle management support is required throughout change processes and that multilevel interventions need to be pursued to facilitate the implementation of innovative ideas and subsequently improve work environments.

<p> The purpose of this correlational, quantitative research study was to determine if a relationship existed between employee perceived levels of servant leadership in healthcare leaders and employee satisfaction in New York City public hospital emergency rooms. The effect of servant leadership on improving employee satisfaction in New York City public hospital emergency rooms (ER) was unknown. The theoretical foundation of the study, servant leadership, supported the premise that employee perceptions of servant leadership characteristics influenced employee job satisfaction within public hospital settings in New York City. One hundred and seventeen employees completed the Organizational Leadership Assessment and the Minnesota Survey Questionnaire, and the data were analyzed through the utility of SPSS v. 19. The results revealed a statistically significant relationship between servant leadership and employee general job satisfaction (<i>r</i> = .191; <i>p</i> &lt; 0.05). The findings of this research study are important with regard to the following areas: (a) providing information to healthcare administrators regarding the usefulness of servant leadership in the improvement of employee and patient satisfaction, (b) creating a positive working environment for employees, (c) creating satisfied employees and patients, and (d) improving organizational performance.. The study adds to the research in the area of servant leadership and its potential to impact healthcare organizations and people. </p><p> <i>Keywords:</i> servant leadership, employee satisfaction, patient satisfaction.</p>

<p> Hypovitaminosis D is associated with a variety of health conditions. Understanding the effects of low vitamin D levels on children and adolescents with sickle cell disease (SCD) remain limited. The project&rsquo;s aim was to determine hypovitaminosis D prevalence in children and adolescents with SCD and explore correlates to improve current screening and treatment strategies. A retrospective, electronic health record (EHR) review was conducted on 104 children and adolescents with SCD who attended a non-profit tertiary children&rsquo;s hospital in southwestern Pennsylvania. A descriptive, cross-sectional, correlational design was used to examine hypovitaminosis D prevalence and correlate vitamin D levels with comorbidities, medications, biological and environmental factors in this sample. Results demonstrated the hypovitaminosis D prevalence rate was 88.5% (&lt; 30 ng/mL); deficiency occurred among 39% (&lt; 20 ng/mL); subjects were 6.9 times as likely to have lower vitamin D levels in fall versus summer (p = 0.0007). Underweight subjects were 6.2 times (p = 0.0056) as likely to have lower vitamin D levels compared to healthy weight subjects. Sufficient vitamin D levels only occurred among subjects &lt; 10. Higher probability of hypovitaminosis D was noted in subjects reporting liking milk &ldquo;sometimes&rdquo; versus &ldquo;yes&rdquo; (p = 0.0001). Hospitalizations for acute chest syndrome (ACS) had an association with vitamin D severity (p = 0.0497). The conclusion is hypovitaminosis D is prevalent among children and adolescents with SCD living in southwestern Pennsylvania. To promote future positive patient outcomes, continued identification of correlates associated with hypovitaminosis D will assist in developing well-designed prevention and treatment programs. </p>

<p> In today's health care reformation, called ObamaCare, patient satisfaction plays a prominent role. When facing the increased demand for quality patient care and safety, quality medical service must be improved in various ways by medical professionals and ancillary staff, including clinical laboratory personnel. From the perspective of laboratory medicine, patient satisfaction can be achieved by consistently delivering accurate and reliable laboratory results in a timely manner. This study examines the correlation between patient satisfaction and laboratory personnel job satisfaction levels. Process observation by utilizing root cause analysis and Lean tools is used to investigate whether implemented process improvements promote the efficiency of laboratory service. Statistical data analysis is used to draw conclusions on whether the implemented process improvement has a significant impact on employee and patient satisfaction. This thesis highlights the importance of maintaining continuous process improvement over an extended period of time to achieve and sustain patient satisfaction. </p>

<p> Mobile medical applications are emerging as a significant part of the healthcare industry. Despite this popularity, mobile medical application development has proven difficult due to several factors. Moreover, the U.S. Food and Drug Administration's (FDA) 2013 publishing of strict regulatory requirements has further complicated development efforts.</p><p> Consequently, this thesis addresses the market need to design mobile medical applications in a manner that simultaneously ensures conformance to regulatory requirements and facilitates commercial success. Thoroughly analyzed as a solution is the integration of Agile tools, practices, and principles with the Waterfall model for software development to develop a quality system that delivers safe and effective mobile medical applications in a manner that promotes commercial success.</p><p> Specifically, this thesis provides an Agile augmented Waterfall model for mobile medical application development that ensures conformance with regulatory requirements and responds to unique market development needs, thus orienting the organization towards commercial success.</p>