The purpose of this study was to examine the decision-making process of individuals who use the energy healing modalities of homeopathy, reflexology, acupuncture, and Jin Shin Jyutsu. A qualitative design was selected because the personal nature of decision-making was best accessed through self account. Content analysis was used to examine the data because it both describes and quantifies phenomena. The study sample comprised nine volunteers who met study requirements. Data provided limited initial support of the motivating factors suggested in Astin's (1998) study. However, after consideration of all qualitative data, the original categorical definitions of dissatisfaction with conventional medicine, desire for personal control, and philosophical congruence were amplified or clarified. Additional motivating factors were also described and defined in this study. Therefore, this study identified healing system attributes, outcome, pleasure, timing, and recommendation as factors influencing the decision to use alternatives.

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>

<p> For African Americans kidney disease is the sixth leading cause of death (National Kidney Foundation (NKF) 2013). Compliance with a renal diet can help prevent the progression of kidney disease to kidney failure. The purpose of this study was to investigate compliance or non-compliance with renal dietary restrictions among older African American adults living in a nursing home setting. Twelve residents were interviewed. Six themes emerged including not appreciating being treated like a child, wanting options and independence, wanting the renal diet to respect cultural food traditions, the importance of food taste, more education about why certain foods are better than others, and re-framing diet education to emphasize the foods that can be eaten versus foods to avoid.</p><p> This research indicates a need for dietitians to discuss diet with an emphasis on what foods the patient can eat, not on restrictions, and to improve the taste of food.</p>

<p> There is limited information regarding physician satisfaction as it relates to the presence of a surgical pathology department in rural hospitals. Physician satisfaction directly influences the quality of patient care. The theoretical frameworks that informed this study included institutional theory and population ecology. The research questions addressed differences in levels of physician satisfaction between physicians who have access to an on-site surgical pathology department and physicians who do not have such access. The research also examined differences in satisfaction between physician specialties that have or do not have access to an on-site surgical pathology department services. A quantitative, cross-sectional study was employed utilizing three primary instruments: the Henry Ford Hospital Survey, Standardized (Synoptic) Pathology Reports, and PAR Medical Colleague Questionnaire. Statistical analyses including ANOVA, linear regression, and t tests were used to examine the relationships between the study&rsquo;s variables. The results revealed that there is statistically significant evidence to support that on-site surgical pathology department services influence physician satisfaction. Potential implications for positive social change from this study include a better understanding and awareness of the relationship between physician satisfaction and utilization of on-site pathology services, which may ultimately benefit healthcare facilities by more intently addressing quality of care and patient satisfaction.</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.