<p> <i>Introduction:</i> The purpose of this study was to examine the association of social determinants of health with 30-day rehospitalization among elderly patients who were discharged from an acute care hospital with an initial discharge destination of home with home health care support and to explore the social determinants' ability to accurately predict the odds of rehospitalization. </p><p> <i>Methods:</i> A secondary data analysis was performed on data obtained from the home healthcare agency. A total of 4,717 unique patients found in the data set. Some patients were represented in the data more than once during the observation period. To examine the relationship between socioeconomic factors and 30-day rehospitalization while controlling for select clinical factors, bivariate and multivariable analyses were performed using generalized linear mixed models (Proc GLIMMIX) and Cox proportional hazard models (Proc PHReg). A backward variable selection procedure was used to determine the best predictive model and a stepwise forward procedure was used to develop the survival model. </p><p> <i>Results:</i> Bivariate analyses of the variables used for predictive modeling showed that race (<i>p</i> = 0.0019), overall prognosis (<i>p</i> &lt; .0001), overall status (<i>p</i> &lt; .0001), multiple hospitali-zations (<i>p</i> &lt; .0001), multiple medications (<i>p</i> = .0001), multiple falls (<i>p</i> = 0.0004), mental disorder (<i>p</i> &lt; .0001), no risk of hospitalization (<i>p</i> = 0.002), no high risk factors (<i>p</i> = 0.03), and clinical classification (<i>p</i> &lt; .0001) were significantly associated with 30-day rehospi-talization. </p><p> Bivariate analyses of the variables used for survival modeling showed that race (<i>p</i> = 0.0029), living arrangement (<i>p</i> = 0.037), overall prognosis (<i>p</i> &lt; .0001), overall status (<i>p</i> &lt; .0001), multiple hospitalizations (<i>p</i> &lt; .0001), multiple medications (<i>p</i> &lt; .0001), multiple falls (<i>p</i> &lt; .0001), mental disorder (<i>p</i> &lt; .0001), no risk of hospitalization (<i>p</i> = 0.0017), no high risk factors (<i>p</i> = 0.02), smoking (<i>p</i> = 0.04), and clinical classification (<i>p</i> &lt; .0001) were significantly associated with 30-day rehospitalization. The predictive model was developed on 80% of the data and a random sample of 20% was used for independent validation of the predictive algorithm, Model sensitivity was 47% and specificity was 78% with a <i>C</i> statistic of 0.6 in the validation data. </p><p> <i>Conclusion:</i> While the variables in the final predictive model were statistically significantly associated with rehospitalization, the observed effect sizes were small to moderate and the model lacked sensitivity and was not very useful in correctly predicting which patients were rehospitalized. </p>

The health care burden associated with childhood injury is huge. Surveillance--the collection, analysis, interpretation, and dissemination of data--is seen as an important step towards understanding and controlling the injury problem. The usefulness of surveillance data, however, depends on their quality. Quality may be defined as the collection of reliable and valid data along with an unbiased capture of events. (An important issue in paediatric injury surveillance is that proxy respondents are often used to provide data on behalf of the child.) Previous evaluations of paediatric injury surveillance data, however, have not directly estimated the reliability and validity of proxy respondent information nor assessed the relative importance of factors associated with system capture. / Given these gaps in knowledge, this thesis examines the reliability and validity of proxy respondent information on childhood injuries. In addition, the importance of precise definition of the surveillance population of interest is described, along with identification of factors associated with failure of injury capture by a national paediatric injury surveillance system. The sensitivity, specificity, and representativeness of injury capture by this system is estimated for three different, but not mutually exclusive, populations of childhood injury. / The results from the proxy respondent studies provide important information on the utility of proxy data on childhood injury, while the studies on injury capture highlight the influence of process and health services utilization on surveillance system function. The implications of these findings for researchers and policy makers are discussed, with examination of the cautions necessary when drawing inferences from surveillance data.

<p> The purpose of this study was to determine if a cancer patient will experience less nausea and a better quality of life if a non-clinical caregiver is present with them while receiving chemotherapy. Primary data was collected at the oncology outpatient infusion center at Kaiser Permanente West Los Angeles Medical Center. Of the 39 participants, 23 had a caregiver with them and 16 came to receive treatment alone. Each participant was asked their nausea level 24 hours after they received chemotherapy. Seventy-two hours after receiving chemotherapy they were asked to complete the Functional Living Index-Emesis (FLIE) survey to evaluate their quality of life during the last 3 days. The data were analyzed by using descriptive and inferential statistics. </p><p> Although neither group of patients experienced less nausea or took less anti-nausea medication, those that did have a caregiver present with them did report that they had a better quality of life.</p>

<p> The abstract is not available for copy and paste.</p>

<p> The abstract is not available for copy and paste.</p>

While the concept of medical futility has existed for as long as medicine has been practiced, it remains a controversial issue that has become more clouded as medicine has advanced. This thesis will explore futility in the most technologically rich and emotionally charged of settings, the intensive care unit. The complex interactions of biology, ethics and the law, with their competing and sometimes conflicting interests will be explored. Disputes between patients, families and health care workers over life-sustaining interventions occur most often in the ICU, and the factors that influence this dynamic, such as lack of communication, time constraints, media-driven misconceptions and value-conflicts, will be examined. Attempts to address futility through advance health directives and conflict resolution policies will be critiqued. But most importantly, this thesis will explain, by appealing to the proper goals of medicine, why limitations should be placed on end-of-life care, and why physicians have an important role to play in making these determinations.

The purpose of this prospective cohort study was to describe the profile and outcomes of geriatric trauma care patients treated in level I trauma centers in Quebec. The study also evaluated the quality of care provided to geriatric trauma patients and identified predictors of outcomes which focused on mortality. / A total of 4934 trauma patients over the age of 65 were admitted for the treatment of injuries in three level I trauma centers in Quebec. The majority of the patients were injured in falls and had a low injury severity score. Male gender, older age, thoracic and abdominal injuries, burns, and delayed emergency room stays were identified as significant predictors of mortality. Inferior quality of care was observed with increased age and fall-related injuries. / The observed association between longer emergency room stay and falls with increased risk of mortality along with inferior care for patients injured in falls would suggest that level I trauma centers are inefficient and potentially harmful in treating elderly trauma patients. Further studies would be helpful in confirming these conclusions.

<p> This retrospective study was conducted to evaluate whether culturally competent resources, such as Vietnamese-speaking healthcare providers, one-on-one public health nurse (PHN) education session(s), and free healthcare services would affect the results of the following questions: (a) Will the 114 study subjects achieve HbAIC reduction at 6-month and 12-month periods? (b) Is there a correlation between HbA1C reduction and the number of the provider visits? and (c) Is there a significant HbA1C reduction for the one-on-one PHN education participants compared to the non-participants? The result findings were analyzed using the Chi-Square tests and the two-sample <i>t</i>-tests. On average, the 114 subjects achieved HbA1C reductions of0.57% and 0.63% at 6-month and 12-month periods, respectively. However, there was no direct correlation between the HbA1C reductions and the frequency of provider visits. Furthermore, the PHN education session(s) did not significantly affect the rate of HbA1C reduction for the attendees. In conclusion, future studies on culturally competent interventions should be studied in the Vietnamese patients diagnosed with diabetes mellitus.</p>

<p> Research has shown that people with mental illness who seek treatment from mental health services have improved quality of life. The objective of the study was to evaluate the influence of stigma on people with mental illness, and how stigma can affect the person's decision to seek treatment for his or her mental condition.</p><p> The objected was assessed using secondary data from the 2009 Adult California Health Interview Survey. The initial filtering of the respondents was unable to be performed because Human Subjects Protection laws protect sensitive information from being released in public use data files. I redeveloped my study, focusing primarily on the association between respondents with feelings of depression and whether or not they have health insurance coverage for mental health services.</p><p> The results of the analysis proved to be statistically significant, which led to speculation that, even with mental health insurance coverage, the low rates of mental health service utilization was most likely attributed to the impact of stigma. Future research should be conducted on the effects of primary care mental health integration, and how this increased parity impacts the utilization of mental health treatment options.</p>

<p> The purpose of this qualitative study was to discover strategies that hospital administrators can use to obtain support from physicians as they pertain to corporate compliance, while still remaining accountable and loyal to healthcare organizations. By interviewing eight physicians and eight hospital administrators, the study sample was used to gather information on behaviors that influence and affect physician participation in corporate compliance programs. Using the grounded theory design of qualitative research was most appropriate for this study. The use of purposive sampling was most appropriate for this study and produced data for a comparative analysis. The comparative analysis allowed for the generation of a grounded theory by first extracting primary themes for the collected data. Twelve primary themes emerged from the content analysis, which produced four categories, producing a grounded theory, The Hospital Compliance Leader Theory. The hospital compliance leader theory indicates that hospital administrators can engage physicians in corporate compliance programs, while maintaining physician loyalty. To accomplish this, the healthcare leaders must incorporate each of the following: (a) use appropriate training programs while understanding the challenges the physicians face; (b) bridge the artificial gap between hospitals and physicians by educating physicians on the potential consequences the hospital faces because of noncompliance; (c) training physicians on corporate compliance, emphasizing the benefits to patient care with full support from the administrative leadership team; and (d) mandating physician compliance training and focusing the training on the greatest compliance risk areas.</p>