The use of herbal remedies (HR) as complementary and alternative medicines (CAM) appears to be popular despite the limited evidence of their safety and efficacy. The overall purposes of this investigation were to (1) investigate the relationship between regular use of HR and self-reported health status, (2) evaluate this relationship when the HR use was concomitant with pharmaceutical use, and (3) describe consumer beliefs, behaviors, and characteristics related to HR use. A national random-digit dialed telephone survey of 1,500 adult English- and Spanish-speaking Americans was conducted. The survey yielded a response rate of 40.4%. The prevalences of HR use and HR-pharmaceutical concomitant use were 17.1% and 7.9%, respectively. Multivariate modeling indicated that HR use was not associated with health status but was independently associated with race/ethnicity ("other" compared with White adjusted OR = 0.38, 95% CI 0.16-0.85), educational attainment (greater than high school diploma/GED compared with a high school diploma/GED or less adjusted OR = 2.05, 95% CI 1.47-2.87), and urbanicity (Metropolitan Statistical Area- [MSA]-4 compared with MSA-5 adjusted OR = 2.14, 95% CI 1.05-4.34). Among HR users, HR-pharmaceutical concomitant use was independently associated with health status (MCS-12 score adjusted OR = 0.95, 95% CI 0.92-0.99; PCS-12 score adjusted OR = 0.96, 95% CI 0.93-0.99), race/ethnicity (non-White compared with White adjusted OR = 0.26, 95% CI 0.11-0.62), and age (adjusted OR = 1.02, 95% CI 1.01-1.04). Over 45% of HR users reported that they were motivated to use HR for health maintenance. In contrast, HR non-users reported most commonly that the motive to not use HR was because they did not have any health problems that required their use (43.6%). Adult Americans were estimated to have spent between 7.9 and 15.7 billion per year out-of-pocket on HR. Respondents agreed that the government should become more involved in regulating HR safety and efficacy (p < 0.005). In conclusion, this investigation provided evidence that HR and HR-pharmaceutical concomitant use were prevalent across a variety of sociodemographic groups. Furthermore, the evidence indicated that consumers were willing to spend sizeable amounts out-of-pocket for largely unproven preventive agents/therapies, suggesting that the demand for these products would continue.

<p> This study was the result of a quantitative methods research design, which assessed: athletic training services, injury prevention at the time of the study, and intervention protocols for high schools within the Gateway Athletic Conference (GAC). This study explored the impact of injuries and concussions on student athletes. The study also examined the types of athletic training facilities, resources for rehabilitation, and procedures for athletic training programs available at the high school level in the GAC. The study uncovered some significant findings between the groups who were surveyed. The participants surveyed represented athletic trainers, athletic directors, and coaches. There were differences in how these groups viewed emergency care procedures, injury policies, and protocols. The differences ranged from views of job descriptions, written policies and procedures for emergency transportation, reporting and submitting accident reports, and regular review of the effectiveness of athletic training services. The groups did agree on most legal duties and responsibilities, general policies and procedures, injury management protocol and procedures, training room facilities, and operation questions. Blood-borne pathogens were an area in which notable improvement is needed, and there were some concerns with some of the data reporting injury statistics. Overall, the participants agreed with one another, but there were some differences throughout the study, as reported in this dissertation.</p>

Despite the time and resources focused on health care outcomes, few empirical links exist between healthcare activities, healthcare costs and outcomes of care. As a result, outcome evaluations that take into account the characteristics of the healthcare system as well as the desires of a number of stakeholders may have relevance to knowledge development as well as to implementation of needed changes in health care delivery. Using the framework of General Systems Theory (von Bertalanffy, 1968) and a modification of the model proposed by the American Academy of Nursing Expert Panel (Mitchell, Ferketich, Jennings, 1998), this investigation addressed broad categories of outcomes, including clinical and financial aspects, and examined the factors influencing them in a condition-specific population. Further, the contextual characteristics of the healthcare organization and the work group were examined and compared to the effects of the individual patient characteristics on cost, length of stay and morbidity/mortality outcomes. Organizational factors included structural characteristics such as volume and technology availability, work unit factors included perceived collaboration, access to power structures and control over nursing practice and individual patient factors included pre-hospital health conditions and socio-economic status. For this study outcomes consisted of adverse events, derived length of stay and direct costs. This study used a non-experimental, descriptive design. Contextual regression analysis indicated that organizational structure variables had a greater influence on cost and the work group-level variables had a greater influence on derived length of stay than did the individual-level variables. Total average costs for cardiac catheterization procedure and associated post-procedure hospitalization were 3758 (range 777-12,796). While the study has several limitations, the findings add to the body of knowledge that explains how the processes of nurses' work influence the outcomes of that work. The findings deserve consideration by nurse executives and others interested in enhancing work environments and patient care outcomes.

The dissertation is on the impact of information technology (IT) on the economy. Theoretical and empirical analyses are reported in order to explain the productivity "paradox" surrounding IT. The techniques used in the study cover a wide range from simple deterministic production functions to panel data techniques and data envelopment analysis. The empirical study is set in the health care industry. A hospital, which is the the unit of analysis, is an organizational entity that provides an appropriate context for the study of the interactions between information technology, technological advancements, organizational factors and regulation. Overall, it was found that IT contributes in a positive manner to the production of healthcare services. However, measurement problems including "quality" of IT capital due to technological developments can lead to the underestimation of IT productivity. It is also seen that regulation plays a major role in the manner in which costs are allocated to input factors. In particular, the effect of the Prospective Payment System (PPS) legislated in 1983 is investigated. One of the findings of the cost function analysis is that, since PPS, hospitals have been moving toward cost containment. Non-parametric analyses is used to determine the allocative inefficiency in IT with respect to other inputs. The different techniques serve as means to triangulate the measure of IT impact on productivity and efficiency, and in addition, develop the theory underlying production techniques.

As an exciting information technology-based innovation, telemedicine has potential to enhance physicians' patient care and management, improve healthcare organizations' operations and performance, and cause a paradigmatic shift in health care toward a progressively emerging digital practice. Previous research has concentrated on technology developments and clinical applications and therefore offers limited discussion of technology management. Managing telemedicine technology in healthcare organizations is so complex and dynamic that it has been an important factor in the failure of many early telemedicine attempts. This dissertation research directly addressed organizational management of telemedicine technology. To deal with complexity and dynamism, the research took a multi-phase approach, using a research framework built upon a well-established theoretical foundation. Case study was used in the exploratory phase to provide detailed understanding of the underlying technology implementation process and to generate specific research questions or models for the subsequent descriptive/explanatory phase. Systematic linkage of these investigations was safeguarded by desired methodological triangulation. Findings from the case study and substantiating interviews identified technology acceptance, adoption and evaluation as problematic areas in organizational technology management. Findings of a survey study administered to most physicians practicing in public tertiary hospitals in Hong Kong suggested that perceived usefulness and ease of use, self-efficacy, and subjective norms were important to their accepting telemedicine technology. Similarly, a survey conducted with hospital executive officers, chiefs of service and center directors of all Hong Kong public healthcare establishments indicated that service needs, attitudes of medical staff, and the technology's benefits, risks and compatibility were essential to organizational technology adoption. In addition, results of an evaluative experimental study showed that the clinical decision- making of physicians can be improved through use of appropriate telemedicine technology. The combined findings suggested that these separate technology management issues were closely interrelated rather than isolated. Effects of a technology on physicians' patient care and management practice have important impacts on their technology acceptance, which, in turn, needs to be considered by their affiliating organization when making an adoption decision.

This research investigated the question of whether automatic or system-generated information classification methods can help humans better manage information. A series of four experiments were conducted; they investigated the usability (i.e., usefulness) of two automatic approaches to information classification, the concept space approach and a Kohonen-based SOM approach in the context of information retrieval. The concept space approach was evaluated in three different domains: Electronic Brainstorming (EBS) sessions, the Internet, and medical literature (the CancerLit collection). The Kohonen-based SOM approach was evaluated in the Internet and medical literature (CancerLit) domains only. In each case, the approach under investigation was compared with existing systems in order to demonstrate performance viability. The basic premise that information management, in particular information retrieval, can be successfully supported by system-based information classification techniques and that humans would find such techniques viable and useful was supported by the experiments. The concept space approach was more successful than the Kohonen-based SOM approach. After modifications to the algorithms based on user feedback from the EBS experiments had been made, users found the concept space approach results to be comparable (in the Internet study) or superior (in the CancerLit study) to existing information classification systems. The key future enhancement will be incorporation of better ways to identify document descriptors through syntactic and semantic front-end processing. The Kohonen-based SOM approach was considered difficult to use in all but one specialized case (the dynamic SOM created as part of the CancerLit prototype). This can probably be attributed to the fact that its associative organization does not match with the standard mental models (hierarchical and alphabetic) for information classification.

This paper investigates the multiskilled health practitioner (i.e., imaging specialist) how they are trained for what they do and the way their traditional role as a generalist in radiologic technology has been impacted by advancing technologies. This dissertation consists of multiple case studies, which is primarily qualitative and exploratory in nature. It does not test a hypothesis in a strict sense and is grounded in analytical categories and theories derived from the literature on technology, work, occupations, and organizations. The data analysis section consists of four sections: perceptions of the MSHPs' work, the impact of technology (i.e., incentive structures, wages, issues of autonomy/authority, task difficulty/responsibility and patterns of interaction), the enskilling/deskilling findings for all MSHPs in general and each hospital subgroup, and the MSHPs perceptions about the effectiveness of their formal education programs. With regards to a cultural examination of the workplace, the most significant sociological perspective identified were in the patterns of interaction. Specifically, three primary stylistic differences are noted. In relation to the effects of technology, an institutionalized practice of the incentive structure and the homogeneity of three broad skills were noted among our cohort. Additionally, three contextual factors that condition social action and thereby affect a technology's tendency to enskill or deskill are revealed. In light of the attributes and deficiencies noted by the interviewees regarding their formal educational programs and skills required for their new roles, the researcher provides five recommendations for strengthening technology transfer programs in which to better prepare the MSHP.

The EQ-5D is a brief, multi-attribute, preference-based health status measure. This dissertation describes the development of a statistical model for estimating U.S. population-based preference weights for the EQ-5D health states. A multistage probability sample was selected from the adult U.S. population. Using the time trade-off (TTO) method, each respondent valued 13 of the 243 health states described by the EQ-5D. The valuations were linearly transformed to lie on the interval [-1, 1]. Numerous model specifications were investigated, and a modified split-sample approach was used to evaluate the predictive accuracy of the models. All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design. The best model proved to be one based on a conceptual notion of the effect of movements away from perfect health. This model, which we have named D1, included ordinal terms to capture the effect of departures from perfect health as well as interaction effects due to increasing health problems. Relative to other models tested, a random effects specification of the D1 model provided a good fit for the observed TTO data. This model yielded an overall R² of 0.38, a mean absolute error of 0.02, and a correlation between mean observed and predicted valuations of 0.99. We also examined differences in health state valuations among the three major racial/ethnic groups in the U.S., i.e., Hispanics, non-Hispanic blacks, and others. In general, non-Hispanic blacks valued health states more highly than Hispanics or non-Hispanic non-blacks. Non-Hispanic blacks appeared to perceive extreme health problems to be associated with less disutility than did members of the other racial/ethnic groups. Differences in valuations did not appear to be related to differences between groups in education, income, or self-reported chronic conditions. The D1 model predicts the values for observed health states with a high degree of accuracy. This model's predictions provide a set of EQ-5D preference weights specifically developed for use in the U.S. population. Within the U.S. population, there exist differences among the major racial/ethnic groups in the perceived desirability of the EQ-5D health states. These differences cannot be readily explained by socioeconomic disparities.

A self-administered, mail questionnaire was used to assess the current state of hospital drug-use evaluation (DUE) programs within short-term, general U.S. hospitals. During February-March 1992, two mailings were sent to pharmacy directors at 491 randomly selected institutions. A net response rate of 66.6% (327/491) was achieved. The level of pharmacist participation in DUE program activities was found to be very high and to have a significant, positive correlation with the rated effectiveness of current DUE programs and the rated importance of pharmacist participation in DUE program activities. Pharmacists were members on 97.9% of responders' DUE (sub)committees, while 65.5% of pharmacist members held voting privileges. Pharmacists devoted an average of 11.27 hours per week to DUE-related tasks. Wide variation was demonstrated in rationale used to select DUE study drugs, interventions employed, use of DUE study results, and methods selected to evaluate DUE program effectiveness.

In a descriptive study, Lutzen's Moral Sensitivity Questionnaire (MSQ) was used to describe nurse case managers' perception of ethical decision making. Both community-based and hospital-based case managers responded. Research questions addressed (a) relationship between respondent's age and patient autonomy and between length of experience as case manager and benevolence; and (b) difference in conflict in ethical decision-making by level of education and difference in rules in ethical decision-making by type of setting. No significant correlations were found between the respondent age and patient autonomy nor between the respondents' length of experience as case manager and benevolence. There was a statistically significant difference in perception of conflict by educational level. Difference in rules in ethical decision making by type of setting approached statistical significance.