The TC program, designed to decrease preventable readmissions and support patients who have chronic illnesses including HF, at BUMCP has had a low referral rate. This low referral rate results in the program being unable to make an impact to decrease readmission rates in the HF population and increase quality of life among this patient population. The purpose of this project was to identify current barriers to referral and develop interventions directed at the identified barriers. An online survey was sent to a hospitalist group employed at BUMCP. Results revealed perceived barriers include decreased accessibility, limited number of accepted patient diagnoses, and lack of involvement in launch of TC. Recommended interventions include increased accessibility through 24 hours day, seven days week availability, abolishment of current accepted patient diagnoses, and implementation of Lewin's Change Theory to increase buy-in from physicians.

Background: Fractures are a major health concern for older adults, especially for those with osteoporosis or low bone mineral density (BMD). Physical activity and exercise can be important self-management strategies for older adults with osteoporosis or low BMD to prevent fractures. Objectives: This study examined the physical activity and exercise levels of older adults with low BMD and determined the proportion of individuals meeting the Canadian Physical Activity Guidelines. As well, this study characterized perceived individuals’ barriers to exercise and their willingness to pay for different methods of delivering exercise information. Secondary goals of this study were to investigate correlates of aerobic exercise and factors associated with meeting moderate- to vigorous-intensity aerobic physical activity guidelines. Methods: Individuals aged 50 years or older with a self-reported diagnosis of low BMD were recruited from the Canadian Osteoporosis Patient Network (COPN) and an osteoporosis public education event. Questionnaires were distributed online and through mail to individuals interested in participating. Participants were asked about the amount of time they spent doing moderate- and vigorous-intensity physical activity (MVPA) and the frequency at which they did strength and balance training per week. Also, participants were asked about potential barriers to exercise that they perceive, the strength at which they perceived those barriers at, and their interest in and willingness to pay (WTP) for different methods of delivering exercise information. Information about different factors affecting exercise behaviour such as risk perception, intention to exercise, and exercise self-efficacy were collected as well. Results: The total number of participants included in this study was 130 (mean [SD] age 66.32 [8.81] years). The mean (SD) time spent doing MVPA per week reported by participants was 831.35 (1065.43) minutes. The mean (SD) days per week that participants reported doing strength and balance training were 1.90 (1.66) and 1.36 (1.84), respectively. Sixteen individuals (12.3%) did not meet the guideline of engaging in at least 150 minutes of MVPA per week. Forty-one participants (31.5%) did not report doing any strength training and sixty-five individuals (50%) did not report doing any balance training. The most prevalent barriers to exercise that were reported was having no enjoyment for exercise (51.2%) , having no company to exercise with (47.2%), and health-related problems (37.5%). Although a majority of participants expressed interest in all methods of delivering exercise information, the mean WTP for a group exercise class and for training one-on-one with a certified personal trainer was lower than the suggested amounts that they would normally cost. Factors associated with meeting MVPA recommendations were intention to exercise (p = 0.03), exercise self-efficacy (p = 0.03), and strength of perceived barriers (p = 0.02). Conclusion: Many older adults with low bone mineral density are not meeting established physical activity guidelines. Greater measures need to be taken in promoting strength and balance training among these individuals. Addressing barriers to exercise may be an effective strategy to encourage individuals with low bone mineral density to become more active.

Background – Every competent person in Ontario has the right to decide whether or not he or she will be admitted to long-term care. If your capacity to make such a decision is in doubt, then it is evaluated. The current evaluation process is inaccessible to people with aphasia or other communication barriers, and social work evaluators report significant problems in communicating with this population. Competent individuals have been found lacking in capacity because of communication barriers. Aims – To create a communicatively accessible capacity evaluation process with training in specialized communication techniques. Also, to test the validity and effectiveness of the Communication Aid to Capacity Evaluation (CACE) to reveal the inherent capacity of participants with aphasia using social work evaluators. Methods – 32 social workers were partnered with 32 competent participants with aphasia. They were randomly divided into an experimental and control group. Both groups administered the current ‘Capacity to Make Admissions Decisions’ questionnaire to establish a baseline measurement of capacity. The social workers in the experimental group were introduced to CACE and received communication training. Following a two-week interval they administered CACE and the control group re-administered the current capacity questionnaire. The 64 capacity evaluations were video recorded and 3 independent speech-language pathologists administered standardized assessment measures on the recordings. Finally, the participants completed surveys measuring confidence and communication abilities. Outcomes - Using the current capacity questionnaire, one social worker found a competent participant lacking in capacity and one third of social workers were unable to determine capacity. Following the introduction of CACE with communication training, analyses of the standardized measures and survey results showed a statistically significant difference between the participants in the experimental group and the control group. The social workers in the experimental group had significantly better communication skills, (‘Revealing Competence’ f (2, 29) = 12.03, p = 0.002), the participants with aphasia’ abilities to ‘Transfer Information’ increased, (f (2, 29) = 10.51, p < 0.003), and the evaluators’ confidence in their determinations of capacity improved (f (2, 29) = 13.511, p = .001). The use of CACE with communication training resulted in accurate determinations of capacity in competent participants with aphasia. Conclusions - CACE was an effective tool to evaluate the capacity to make a decision regarding admission to long-term care. It was communicatively accessible for this research population with aphasia, enhancing comprehension of the capacity process and enabling the person to communicate a response. Improved communication skills, transfer of information and confidence allowed the evaluators to accurately determine capacity.

Background – Every competent person in Ontario has the right to decide whether or not he or she will be admitted to long-term care. If your capacity to make such a decision is in doubt, then it is evaluated. The current evaluation process is inaccessible to people with aphasia or other communication barriers, and social work evaluators report significant problems in communicating with this population. Competent individuals have been found lacking in capacity because of communication barriers. Aims – To create a communicatively accessible capacity evaluation process with training in specialized communication techniques. Also, to test the validity and effectiveness of the Communication Aid to Capacity Evaluation (CACE) to reveal the inherent capacity of participants with aphasia using social work evaluators. Methods – 32 social workers were partnered with 32 competent participants with aphasia. They were randomly divided into an experimental and control group. Both groups administered the current ‘Capacity to Make Admissions Decisions’ questionnaire to establish a baseline measurement of capacity. The social workers in the experimental group were introduced to CACE and received communication training. Following a two-week interval they administered CACE and the control group re-administered the current capacity questionnaire. The 64 capacity evaluations were video recorded and 3 independent speech-language pathologists administered standardized assessment measures on the recordings. Finally, the participants completed surveys measuring confidence and communication abilities. Outcomes - Using the current capacity questionnaire, one social worker found a competent participant lacking in capacity and one third of social workers were unable to determine capacity. Following the introduction of CACE with communication training, analyses of the standardized measures and survey results showed a statistically significant difference between the participants in the experimental group and the control group. The social workers in the experimental group had significantly better communication skills, (‘Revealing Competence’ f (2, 29) = 12.03, p = 0.002), the participants with aphasia’ abilities to ‘Transfer Information’ increased, (f (2, 29) = 10.51, p < 0.003), and the evaluators’ confidence in their determinations of capacity improved (f (2, 29) = 13.511, p = .001). The use of CACE with communication training resulted in accurate determinations of capacity in competent participants with aphasia. Conclusions - CACE was an effective tool to evaluate the capacity to make a decision regarding admission to long-term care. It was communicatively accessible for this research population with aphasia, enhancing comprehension of the capacity process and enabling the person to communicate a response. Improved communication skills, transfer of information and confidence allowed the evaluators to accurately determine capacity.

No description available.

As a way to broaden its offering Saab Support and Services started to implement a new ERP system in 2009. The main reasons were to be able to handle larger integrated solutions from its customers and achieve synergies between its many programmes; these benefits have only partially been achieved. ERP systems are a subject that has generated a lot of literature which describes how an implementation should be done and what benefits can be had, such as lowered costs, higher auto-mation and better communication. This thesis has attempted to answer what barriers have been present at Saab in the post-implementation phase and what can be done in order to move past these and achieve unrealised benefits. Since there are gaps in the literature regarding the post im-plementation phase an exploratory approach was used in this study with a case being studied at the Support and Services division at Saab. A literature study was performed in parallel with the collec-tion of empirical data in order to let the collected data steer the direction of the research.The three barriers to beneficial use that were identified were lack of vision for continuous improve-ments, lack of formal processes and lack of ease of use. Lack of vision for continuous improvement is a barrier since without it improvement measures will not be aligned and issues will persist. By com-municating common goals and using benchmarks to follow up on those goals improvement can be made and employees can see the importance of the system. The second barrier is lack of formal pro-cesses which has caused bad transparency, creating issues with invoices and resulting in limited knowledge sharing between programmes. By standardising routines they are easier to benchmark it also becomes clearer what issues exist and how they relate to each other. With formalised processes it is easier to assign roles and it becomes easier to understand why data is entered since it is more apparent how it used later on in the process. The last identified barrier is the lack of ease of use of the ERP system. Since the software is difficult to use, training is generally needed in order to be able to use it correctly, but since limited training has been carried out employees still lack a greater un-derstanding of how to adapt it into their workflow effectively. This barrier can be overcome either by further education and training users or by simplifying the interface and improving the usability. By having a well communicated vision, employees can work towards common goals, by standardising processes and simplifying the usability of the ERP system it is easier for new employees to learn, which means that employees can be shared easier within Saab.

Thesis (M.S.)--West Virginia University, 2005 / Title from document title page. Document formatted into pages; contains x, 59 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 55-56).

Thesis (Ph. D.)--Boston University, 1989. / Vita. Includes bibliographical references (leaves 185-188).

Thesis (Ph. D.)--University of Louisville, 2005. / Department of Civil and Environmental Engineering. Vita. "May 2005." Includes bibliographical references (leaves 183-190).

Thesis (Ph. D.)--University of Louisville, 2005. / Department of Civil and Environmental Engineering. Vita. Includes bibliographical references (leaves 183-190). Also available online via the University of Louisville website (http://etd.louisville.edu/).