Thesis (Ph.D.)--University of California, San Francisco, 2010. / Source: Dissertation Abstracts International, Volume: 71-05, Section: B, page: . Adviser: Robert H. Miller.

Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2009. / Title from PDF t.p. (viewed on Jul 15, 2010). Source: Dissertation Abstracts International, Volume: 70-12, Section: A, page: 4783. Adviser: Pravin K. Trivedi.

Thesis (Ed.D.)--Fairleigh Dickinson University, 1988. / Source: Dissertation Abstracts International, Volume: 49-05, Section: B, page: 1603. Adviser: David Rosen.

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2006. / Source: Dissertation Abstracts International, Volume: 67-11, Section: A, page: 4036. Adviser: John C. Lammers. Includes bibliographical references (leaves 77-91) Available on microfilm from Pro Quest Information and Learning.

<p> Japanese Americans comprise approximately 20% of the State of Hawaii&rsquo;s population and Japanese is the most common language used by first-generation Japanese Americans. As a result, delivering effective care to Hawaiian residents means that providers must deliver services in a culturally sensitive manner. Accomplishing this aim becomes increasingly difficult within elderly populations, when patients are dealing with physical and cognitive limitations as well as cultural and language barriers. This study examined the question: How can Hawaii eldercare professionals improve patient eldercare services to Japanese immigrants, taking into consideration Japanese language and cultural norms? </p><p> This study utilized a qualitative grounded theory design. One elder daycare facility and one hospice were selected as the setting for the study. From these settings, four participants were recruited from the hospice and three were recruited from the daycare. Participants&rsquo; job titles included nurse, massage therapist, grief counselor, daycare director, and activity aide. Participants were asked to provide their demographic information, report on the services they deliver and patient communication practices they utilize, and share their views about quality of care and desired patient outcomes. The interview data were analyzed using open coding and axial coding, culminating in the creation of an integrated theory. </p><p> Examination of the study data indicated that delivering culturally sensitive eldercare requires efforts to (a) understand patients&rsquo; history, beliefs, worries, goals, and diagnosis; (b) educate patients to ease concerns and elicit self-supportive behaviors; and (c) respect and adapt to patients&rsquo; characteristics and needs. Recommendations for eldercare professionals are to improve education and training of all eldercare staff, promote Japanese facilities and Japanese eldercare programming, and expand caregiver roles. Additionally, more research is needed to confirm and extend the present study&rsquo;s findings&mdash;specifically using a much larger sample size, including patient and family perspectives, and examining differences among Japanese immigrant subgroups.</p><p>

Clinical decisions should take into account the clinical risk and benefit of a new intervention compared to the reference treatment. A method was developed to compare multiple competing interventions using a clinical cost-effectiveness approach. A meta-analysis was conducted to estimate the clinical cost (major bleeding) and benefit (averted venous thromboembolism) of thromboprophylaxis with different anticoagulants in orthopedic surgery. The increment in cost and benefit of anticoagulants compared to placebo were calculated using replications of the values obtained through Monte Carlo simulations. Net clinical benefit was calculated for each replication across a range of risk acceptance values (risk-benefit acceptability threshold). Multiple anticoagulants were compared by calculating the probability that each agent had of achieving the highest net clinical benefit. The preferred anticoagulants varied depending on risk acceptance, type of surgery, bleeding and thrombosis definitions, and timing of anticoagulant initiation. This method allowed comparing multiple interventions in the absence of randomized trials.

The World Health Organization (WHO) Programme for International Drug Monitoring (PIDM) was developed for chemical rather than biological products. The ability of the PIDM to meet the needs of vaccine safety is of international public health importance. Three studies were conducted: (1) a survey of authorities responsible for reporting adverse events following immunizations (AEFIs); (2) an analysis of the WHO Adverse Reactions Database; and (3) a systematic review to identify and compare Bayesian methods used in drug and vaccine signaling. Communication between national surveillance authorities and lack of vaccine-specific terminologies are issues of concern. Many AEFI reports are not forwarded to the PIDM, and reporting timeliness and regularity should be improved. Few studies have examined the use of Bayesian methods in vaccine signaling. Vaccines should be recognized as a distinct group of drugs. Additional staff dedicated to AEFI reporting and vaccine signaling would be a valuable asset to the PIDM.

In 2001, the Ontario provincial government passed an act to minimize the use of physical and chemical restraints in hospitals. This study utilized data from the Ontario Chronic Care Patient System (OCCPS) from April 1998 to March 2004. Data were analyzed using a simple interrupted time series design with visual and ITSACORR analysis to evaluate whether the act has resulted in a change in prevalence rates of physical restraints among elderly patients in Ontario's complex continuing care beds, both province wide and by facility type (i.e., rural, urban, small, large, private or public). Provincial legislation to minimize the use of physical restraints was not effective. ITSACORR analysis coupled with visual analysis can be a useful combination of instruments to assess brief interrupted time series although neither method alone is without limitations.

This work presents doctors with a model of the estimated degree of risk of rare and important neonatal outcomes to aid in better decisions and improved allocation of equipment and resources. An extensive list of admission day parameters is reduced to minimum variable sets to create models for outcomes that are relevant to decision-making in the neonatal intensive care unit. Models are applied to a special collection of cases and compared to neonatologists' risk estimates. A comparative analysis of physician's predictions and the models' discrimination abilities highlights areas of success and areas that can be improved for future trials. Doctors responded positively to the prediction interface concept and to the estimated risk stratification models. Physicians' strengths identified outcomes that could benefit from increased sensitivity. A substantial effort was made to conduct the usability and performance evaluations within the ethical standards that are especially important for engineering healthcare management applications.

Allogeneic Hematopoietic Stem Cell Transplantation is applied in the management of cancer. It involves myeloablative chemoradiotherapy followed by infusion of donor stem cells. The characteristics of the donor stern cells influences transplant outcomes which itself, is dependent on the donor characteristics. The purpose of this thesis was to explore preferences over donor characteristics. A systematic review was performed to identify all donor characteristics associated with outcome. Eight traditional and 5 non-traditional characteristics were identified. The results of the review were used to inform a survey of the Canadian Bone Marrow Transplant Group which primarily includes transplant physicians. An online survey and conjoint analysis of Canadian Bone Marrow Transplant Group members was performed to define relative importance of donor characteristics. Canadian Bone Marrow Transplant Group members, including transplant physicians caring for adults strongly indicate preference for donors related to recipients (HR 2.97) over the donor's age, gender and cytomegalovirus compatibility.