Introduction Studies have shown that a proportion of patients admitted to hospital do not require the intensity of services they provide. Also, the admission of patients can be for an inappropriate duration. Methods Three studies were conducted. The first study was a record review to determine the appropriateness of patient admissions and inpatient stays. The second examined the wider causes of inappropriate admissions/inpatient stays as perceived by clinicians, and identified interventions to reduce such admissions/stays. Data were collected using focus groups. The final study explored barriers to service use from the perspectives of clinicians and patients. Data were collected from clinicians via an online questionnaire and from both clinicians and patients using semi structured in-depth interviews. Results Of 119 patients, 32 were admitted inappropriately and 83 were admitted for an inappropriate duration. Risk factors for an inappropriate admission included living in the community compared to a nursing/residential home, and for an inappropriate length of stay included the number of presenting complaints, number of long term neurological conditions and whether the participant lived alone in their own home or with others. In the second study, the limited knowledge and a lack of health and social care resources in the community, were perceived as causes of inappropriate admission/lengths of stay. Interventions to prevent inappropriate admissions/lengths of stay included: sub-acute care facilities and patient held summaries of specialist consultations, among others. The final study found that the main barriers to use of services were out of hour's access and unfamiliarity of clinicians with local service provision. Conclusions The causes of inappropriate admissions/lengths of stay related, in main, to communication problems and accessibility of services. Interventions to improve transference of information and knowledge regarding long term condition management and service provision may be warranted.

This study involved the development and implementation of a model for providing structured on-the-job training (SOJT) in a healthcare foodservice operation. The model was developed to provide a structured method for conducting SOJT Events, the process when an incumbent employee trainer teaches another employee to perform his/her job. The model was composed of four components, each serving to support the Event. An SOJT Event Process established a series of steps to follow when conducting SOJT. A Training Manual and Training Checksheet were Support Documents used to assure the consistency of each Event and to document standard procedures. Trainers were prepared to conduct Events during the Trainer Preparation Workshop. Finally, the last component was the SOJT Event Performance Support System, a set of guidelines devised to create the support network necessary for Events to be carried out in the work setting. The model was implemented as each Trainer was scheduled to conduct two SOJT Events over a three month period. It was tested by measuring Trainee knowledge, performance and assessment of the SOJT Events. Other employees, who had been trained with unstructured training in the past served as control groups. Subjective observations of the applicability and acceptability of the model among employees were also noted. The model was successful in producing knowledge gains among Trainees. Trainees who were recipients of SOJT assigned higher assessment scores to SOJT than control group employees assigned to unstructured on-the job training. There was no difference in performance among employees trained using structured or unstructured on-the-job training. Employees that were directly involved in the SOJT Events were positive about supporting the model. Modifications for the model and the components are suggested. It was concluded that the model components that were developed and the use of a consultant with experience in training and instructional design are necessary for implementation of structured on-the-job training in foodservice operations. / Graduation date: 1992

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. / Since inmates are a population disproportionately affected by HIV, correctional settings are important sites for delivering HIV services. The Maricopa county (Phoenix Area) jail system is the 4th largest in the nation. In 2011, the Maricopa County Correctional Health Service implemented an opt‐out HIV screening program for individuals booked into the Maricopa County Jails (MCJ). The aims of this study were to determine for the years 2012‐2014: • The number of inmates screened for HIV • The HIV positivity rate • The number of newly diagnosed patients • The clinical characteristics of the newly diagnosed HIV positive patients Five to seven days after booking, inmates are offered HIV screening. These laboratory records were used to determine the number of inmates tested and positivity. Prior history of previous HIV diagnosis was obtained from Maricopa public health records. Retrospective chart review of the MCJ health and case management records, including Ryan White forms, was performed to gather gender, age, race/ethnicity, sexual orientation, drug use, homelessness and co‐morbidities of newly HIV‐infected persons, such as Hepatitis C and prior STDs. Categorical factors were compared between groups with the Chi‐square test. Means were compared using a standard t test. P values ≤0.05 were considered significant. A total of 319,575 persons were booked and 46,346 were screened (14.5%) for HIV during the study period. The majority of booked inmates were male (76.9%) and Caucasian (50.8%). The mean age of inmates was 36 years. There were 70 newly HIV‐diagnosed patients. Chi squared and t tests comparing newly diagnosed individuals to the general jail population revealed statistical significance for male gender (p=0.02), African American race (p=0.04), and age (p=0.003). Undiagnosed HIV, including AIDS (CD4 counts <200), is an important issue among individuals booked into the MCJ. Compared to the general jail population, HIV is more likely to be diagnosed in males rather than females, younger patients, and African‐American patients. Additionally, IV drug use, polysubstance abuse, other STDs (particularly syphilis), high risk sexual activity, Hepatitis C and homelessness were common among HIV positive patients. Surveillance should be continued and include more patient education on the importance of screening. Furthermore, targeting high‐risk populations may result in even greater numbers of individuals being diagnosed and treated. Within the next year, all patients at the MCJ will also be offered screening for Hepatitis C, chlamydia, gonorrhea and syphilis. This may also result in more patients agreeing to be screened, and subsequently diagnosed with HIV.

Class of 2009 Abstract / OBJECTIVES: To assess a student pharmacist administered osteoporosis education program given to assisted living facility staff members in order to evaluate the impact of the program on the staffs’ knowledge and attitudes about osteoporosis treatment and prevention. METHODS: The study consisted of a pre-test/post-test design to evaluate data obtained through surveys administered at assisted living facilities in the Phoenix, Arizona area. The primary dependent variables were knowledge and confidence levels of the staff in regards to osteoporosis management. The surveys included multiple choice questions that measured knowledge of osteoporosis prevention and treatment, as well as Likert-scale questions to measure confidence levels. Mean scores were calculated and paired t- tests were used to compare scores of pre-test versus post-test answers. RESULTS: Surveys were completed by 5 participants. Sixty percent of the staff members were female and the mean age was 36 years old (SD 9.90). Eighty percent of the sample were certified nurse assistants. The mean pre-test score for the knowledge portion of the survey was 3.6 and the mean post-test score was 4.8 (p=0.18). The mean pre-test score on the participants confidence levels was 11.2 and the mean post-test score was 11.8 (p=0.37). Overall, the participants rated the value of the program a mean of 7.6 out of 8 possible points. CONCLUSIONS: Although not statistically significant, knowledge and confidence levels of osteoporosis management were raised in assisted living facility staff members after a student pharmacist administered presentation on the subject.

Class of 2009 Abstract / OBJECTIVES: The objective of this study was to determine the effect of an education program in regards to pharmacy students’ knowledge and confidence regarding osteoporosis management. METHODS: This was a pretest/posttest study of data obtained through surveys given to pharmacy students’ at the Phoenix and Tucson campuses. The education program administered was generated by the Arizona Osteoporosis Coalition. RESULTS: A total of 19 pharmacy students were surveyed in Tucson and Phoenix, AZ. When the knowledge questions were analyzed (questions 1 through 7), the t-score obtained was 4.7914 (p<0.05). This score was larger than the t-critical value for a 95% confidence interval. When the confidence questions were analyzed (questions 8 through 10), the t-scores obtained were 0.6849, 0.5945, and 0.2287, respectively. These scores did not reach statistical significance (p>0.05). The intervention proved to increase knowledge but did not increase confidence. CONCLUSIONS: The education program on osteoporosis management increased pharmacy students’ knowledge on this disease state. Other education programs targeting various disease states may also increase students knowledge, further preparing them to provide quality patient care.

M.Phil. / The study identifies the needs and interests of the community in Mamelodi Extension 5 with regard to sport and recreation facilities. There is a need to determine the role of sport in society to fulfil the sport-related needs and to find out how these needs can be addressed by the social facilitation of sport. The study offers an understanding of aspects of sport and recreation in the area. A review was done of relevant literature dealing with sport and recreation. The sources used to gather information embodied books, magazines, articles, newspapers, media reports, government reports and information from the internet. Stratified random sampling was used to collect data from the residents of Mamelodi East Extension 5. A questionnaire served as the main data collection tool. It was piloted on thirty (30) residents who did not serve in the final sample of respondents. This assisted to gauge the validity of the questionnaire. The empirical study was done with three hundred (300) questionnaires that were filled in by the respondents to get their views relating to sport and recreation. Face-to-face interviews were used to collect data, which were analysed using SPSS spreadsheets. The study found that sport and recreation facilities were scarce in the area, that only few facilities were available but mostly ill equipped and that most residents did not participate in sport and recreation. The main recommendation was that management of clubs and institutions that deal with sport and recreation be involved in encouraging and assisting residents to use the facilities in their localities. / Prof. C. Singh

The problem of this study was to determine what are the maintenance practices and to what extent are they being used by industrial arts teachers in the subject areas of woodworking, metalworking, and drafting at the secondary level in the state of Texas.

If there are to be more and improved recreational facilities for the handicapped, recreation planners, landscape architects, and architects must collect, analyze, and project pertinent data into comprehensive criteria for facility development. To develop the criteria, personal notes from site investigations and project developments were correlated with information from the Department of Health, Education, and Welfare; the National Therapeutic Recreation Association; the American Association on Mental Deficiency; and the National Recreation and Park Association.

This study explores women's experiences of critical illness in Jordanian intensive care units. A narrative approach was employed to access Jordanian women's stories of their critical illness and to study how these accounts changed during the period following their discharge from intensive care. The study was conducted in two hospitals in a major Jordanian city. A purposive sample of 16 women who had spent at least 48 hours in intensive care was recruited over a period of six months, with each woman taking part in between one and three interviews during the six month period. Two focus group discussions were also conducted with 13 ICU nurses drawn from the hospitals in which the women had been patients. These had the aim of encouraging discussion about the development of new supportive care strategies for critically ill women in Jordanian intensive care units. The study findings revealed three main areas: the women's experiences of suffering and pain; their experience of body care; and the impact of the ICU experiences on their lives after discharge home. Experiences of suffering were pervaded with physical, emotional, social and temporal dimensions, interlinked with pain that was often severe, overwhelming, and disturbing to their sleep. The notion of 'nafsi' suffering was employed to describe emotional and social losses, such as loss of family support, which the women experienced. The notion of 'vicarious death' was used to explain the mortal fear women experienced in witnessing the death of others. Loss of body control, the unfamiliar ICU environment, and the sudden onset of illness made it difficult for the women to make sense of their experiences. This study shows that cultural norms and religious beliefs shape the ways in which these Muslim women made sense of their bodies. An analysis of the concept of 'bodywork' is presented: the 'dependent body' captures the women's experiences of changes of their physical status, which meant that from being care providers, they became those in need of care. This involved the experience of a sense of paralysis or disablement, and a complete dependence on their family or nurses. The 'social body' describes the women's feelings and emotions toward their family members. The latter assisted in the care of the women's bodies, but distress, frustration and a sense of loneliness were experienced by the women as a result of the loss of verbal communication with their relatives. The 'cultural body' describes the effect of cultural norms and Islamic religious beliefs on the women's interpretation of their experiences, and the interpretation of male nursing care in the ICU. The 'mechanical body' describes the women's experiences of the ICU machines as extensions of their bodies, and the senses of limbo and ambiguity they encountered during their ICU stay. The recovery period raised many physical, emotional, social, and spiritual issues, which in turn impacted on the women's experiences of their everyday lives. Weakness and tiredness accompanied with difficulties in eating and sleeping made some women feel frustrated and uncertain about their health. Some felt they were a burden upon their families. The meaning of the critical illness experiences were interpreted by some women as an opportunity to value family unity and neighbours' support. For other women, the illness experiences gave them lessons which strengthened their role as mothers and helped them to think positively about their future. This study highlights the importance of considering the cultural and religious preferences among Muslim women in critical care settings. The study recommendations focus on the need to base nursing care on an understanding of the physical, emotional, social, and religious elements of suffering, by exploring the potential of a palliative care approach for nursing critically ill people.

MSc, Occupational Therapy, Faculty of Health Sciences, University of the Witwatersrand / Infants and toddlers living in residential care facilities are at risk of developmental delay. Environmental factors contributing to this risk are the temporal context (how children spend their time) and social context (how and when caregivers interact with children). This study compared time-use patterns of children living in residential care facilities where caregiver training had previously taken place versus those in facilities where caregiver training had not taken place using a non-experimental, cross-sectional static group comparison study design. Spot observations were used to estimate time-use patterns of infants and toddlers living in residential care in Johannesburg. Results show that caregiver training increased the quantity of time infants spent with their caregivers (temporal context) and the quality of time toddlers spent with their caregivers (social context). Thus caregiver training has the potential to improve the environment in residential care facilities and can be used as an intervention strategy by occupational therapists.