Class of 2009 Abstract / OBJECTIVES: To assess whether patients at University Medical Center (UMC) in Arizona who have indications for venous thromboembolism (VTE) prophylaxis receive treatment, determine whether appropriate pharmacologic VTE prophylaxis is implemented, and analyze the incidence of VTE associated with prescribed regimens. METHODS: Data were derived from a retrospective chart review on risk factors for VTE and prescription of pharmacological and non-pharmacological thromboprophylaxis. Two risk assessment models were used to evaluate adherence to treatment standards: the 2008 American College of Chest Physicians (ACCP) evidence-based consensus guidelines and the Caprini score. Clinical outcomes were evaluated with regard to proper thromboprophylaxis including assessment of appropriate time, type, intensity, and duration of treatment. RESULTS: A total of 366 patients met inclusion critera. Based on the Caprini score, 94% of patients were judged to be at risk for VTE. Of those at risk, 90% received thromboprophylaxis; however, only 35% of treated patients received proper thromboprophylaxis. Ten patients (2.7%) experienced a VTE during their hospital stay or within the following 6 months after discharge. There was not a significant difference in incidence of VTE with respect to treatment versus no treatment or proper versus improper prophylaxis (p=0.15 and 0.65, respectively); however, a favorable trend in incidence of VTE was observed for treated patients and patients treated with correct thromboprophylaxis based on risk assessment. CONCLUSIONS: Most patients at UMC who were indicated for VTE prophylaxis received treatment; however, the type, intensity, and duration of thromboprophylaxis were often inappropriate despite the existence of various guidelines.

Thesis (M.S.)--Boston University / That interpersonal relationships within the family may have a direct influence upon the development of schizophrenia is a fact well-recognized by authors. In recent years the exact role of the mother-child relationship in the etiology of schizophrenia has especially been the subject of a great deal of investigation. As a result of these investigations there has been developed the concept of the "schizophrenogenic mother." Tietze's findings are characteristic.

Class of 2005 Abstract / Objectives: The purpose was to describe the glycemic control of hospitalized patients treated with sliding scale insulin (SSI) and correlate glycemic episodes to other factors. Methods: The records of 315 patients admitted to a private, 166-bed hospital between August 25 and November 30, 2004 were identified from orders for antidiabetic medications then screened for inclusion and exclusion criteria. 135 of these patients met the criteria for inclusion in this study and their charts were reviewed for demographic data, medical history, medication regimens, blood glucose measurements and SSI use during hospitalization. Hypoglycemia was defined as less than or equal to 50 mg/dL and hyperglycemia greater than 250 mg/dL. Results: Orders for SSI were written for 93% of diabetic patients admitted. 2,904 blood glucose fingerstick measurements were recorded: 15.9% were greater than 250 mg/dL and 0.689% were under 50 mg/dL. The only statistically significant result was the correlation between increased numbers of hyperglycemic episodes and the consumption of the hospital’s “diabetic diet,” p<0.001. The small group of patients admitted for cellulitis (N=6) also experienced more hyperglycemic episodes. There was a trend approaching significance, p=0.055, for an increased number of hyperglycemic episodes in patients with admission blood glucose value over 200 mg/dL. Results based upon the hospital’s standard SSI regimen were not significantly different from other variations of SSI. Implications: SSI was almost always prescribed for hospitalized patients with type 2 diabetes and this regimen resulted in poor glucose control in approximately 17% of fingerstick measurements.

Ward environment as assessed by the Ward Atmosphere Scale was the focus of this exploratory study. The Ward Atmosphere scores of 110 patients hospitalized on two units for acute psychiatric care in a state hospital were analyzed for determining differences along the dimensions of population factors, sex and program change. Significant differences in attitude were obtained on certain of the ten scales for each of the three comparisons. The premise of ward atmosphere being a global entity as implied in the literature was not upheld in this population. Sex differences were noted and introduction of an individualized patient management program evoked significant changes in opinions concerning ward atmosphere. A number of interpretations for these results were offered and implication for future research was suggested.

Do atendimento a cardiopatas internados, criou-se a categoria vivência de perdas, desencadeada por evento(s) significativo(s) que implica no processo do luto. Segundo Freud (1916), o luto é um trabalho psíquico que requer um tempo para elaboração da perda e de transformação da realidade psíquica, desestruturada pela falta do objeto perdido. Entende-se que o luto é o correlato psicodinâmico da reação manifesta de depressão. Com estes fundamentos, esta pesquisa teve por objetivo geral: investigar vivência de perdas, estados de luto e de depressão. Foram avaliados 44 pacientes com os diagnósticos médicos de infarto agudo do miocárdio e angina, de 33 a 65 anos, 50% mulheres e 50% homens. Utilizados três instrumentos: entrevista semi-estruturada, para avaliação do luto; Inventário de Depressão de Beck, para depressão; Escala de Avaliação e Reajustamento Social de Holmes e Rahe, que avalia porcentagem de probabilidade de apresentar problemas de saúde. Os resultados foram relacionados através do programa Statistical Package for Social Sciences, versão 11.0. Apresenta estado de luto 65,9%, sendo significativas as relações entre: luto e depressão (p<0,05); luto e gênero (p=0,000); presente em 90,9% das mulheres; depressão e gênero (p<0,05). Os eventos significativos relatados com maior freqüência foram: morte de familiares, 47% ou de pessoa próxima, 13%. Também é significativa a relação estatística entre luto e quantidade de mortes relatadas por participante como evento significativo (p<0,05). Sugere vivência de perdas como indicativo de risco psicológico para doença arterial coronariana, apontando para a associação entre luto e depressão / Since the attendance of hospitalized cardiac patients was created the category experience of losses caused by significative(s) event(s) that implicated in the mourning process. According to Freud (1916), mourning is a psychic process that requires time for the loss elaboration and changing of the psychic reality, shaped by the lost object missing. Mourning is understood as a psychodynamic correlation of the manifested depression reaction. On this basis, this research aimed: investigate experience of losses, mourning and depression. 44 patients with medical diagnosis of severe heart attack and angina were evaluated, from 33 to 65 years old, 50% women and 50 % men. Three instruments were used: semi-structured interview for mourning evaluation; Beck Depression Inventory, for depression; Holmes and Rahe Social Readjustment Rating Scale, which evaluates the probability of presenting health problems. The results were treated by the software Statistical Package for Social Sciences version 11.0 . 65,9% presented state of mourning and the association between : mourning and depression were significative (p<0,05); mourning and gender (p=0,000), presented in 90,9% of the women; depression and gender (p<0,05). The significative events more frequently reported were: death of a relative 47%, or closer person 13%. It is also significative the statistical relation between mourning and deaths related by the participants as significative event (p<0,05). Experience of losses is suggested as indicative of psychological risk for coronary artery disease, highlighting the association with mourning and depression

The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. Literature review shows that there have been many different methods utilized to halt obesity's progression, however rates continue to increase. The United States Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other agencies recommend obesity screening and counseling at every patient encounter, but most hospitals do not have a current obesity policy in place to accomplish this task. The purpose of this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A's framework to increase screening and referrals of obese, adult patients ages 18 and over. The logic model was utilized to guide the program development, implementation, evaluation, and dissemination. The program was accepted by the hospitalist group and nurse leaders for full development and evaluation. Key stakeholders and content experts were convened to create a proposal and algorithm to guide the project. The obesity program will increase screenings and referrals upon full adoption. Increase in screenings and referrals will improve care, quality of life, weight status, and decrease health care expenditure. The results of dissemination of the program may stimulate other facilities to adopt the program to combat obesity and contribute to social change The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. Literature review shows that there have been many different methods utilized to halt obesity's progression, however rates continue to increase. The United States Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other agencies recommend obesity screening and counseling at every patient encounter, but most hospitals do not have a current obesity policy in place to accomplish this task. The purpose of this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A's framework to increase screening and referrals of obese, adult patients ages 18 and over. The logic model was utilized to guide the program development, implementation, evaluation, and dissemination. The program was accepted by the hospitalist group and nurse leaders for full development and evaluation. Key stakeholders and content experts were convened to create a proposal and algorithm to guide the project. The obesity program will increase screenings and referrals upon full adoption. Increase in screenings and referrals will improve care, quality of life, weight status, and decrease health care expenditure. The results of dissemination of the program may stimulate other facilities to adopt the program to combat obesity and contribute to social change The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity-related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. A review of the literature showed that multiple methods have been used to address the rate of progression; however, obesity rates continue to increase. The U.S. Preventative Services Task Force, American Heart Association, and other agencies recommend obesity screening and counseling at every patient encounter; most hospitals do not have a policy to accomplish this task. The purpose of this project was to develop an obesity screening and referral tool for the hospital setting. The resulting tool was based on the 5 As framework to increase screening and referrals of obese patients. The logic model was used to guide program development, implementation, evaluation, and dissemination. Results of the obesity screening and referral program showed an increase in screenings and referrals upon a trial adoption, raising the number of identified referrals to 23, compared to 2 patients identified for referral prior to program implementation (p = 0.035). An increase in screenings and referrals can bring about positive change by improving care, quality of life, and weight status of patients and decreasing health care expenditure.

<p>This dissertation aimed to investigate the use of electronic nursing documentation as a strategy to improve the quality of care provided to hospitalized patients. The literature to support the use of electronic nursing documentation on the quality of care delivered to patients is limited to date. Additionally, the literature describing the use of information for the delivery of care on paper-based nursing documentation is limited. This dissertation reviews the current literature, investigated the knowledge needed for nurses to know their patients and established categories of nurses' information needs as preliminary work to be able to descriptively compare the use of paper with electronic nursing documentation on inpatient care units within a hospital setting. The main study conducted for this investigation used a mixed-methods multiple case study design, to describe the processes of information use on two inpatient care units, while first using paper and subsequently electronic nursing documentation. Findings revealed the importance of the categories of nurses' information needs for both cases in addition to the use of verbal, paper-based and electronic information sources for the collection, communication and temporary storage of information needs. Additionally, the conversion to electronic nursing documentation introduced new challenges related to three quality metrics: efficiency, timeliness and safety. Recommendations are provided for further evaluation of electronic health records with additional consideration for appropriate hardware devices in the context of the care environment.</p> / Dissertation

Do atendimento a cardiopatas internados, criou-se a categoria vivência de perdas, desencadeada por evento(s) significativo(s) que implica no processo do luto. Segundo Freud (1916), o luto é um trabalho psíquico que requer um tempo para elaboração da perda e de transformação da realidade psíquica, desestruturada pela falta do objeto perdido. Entende-se que o luto é o correlato psicodinâmico da reação manifesta de depressão. Com estes fundamentos, esta pesquisa teve por objetivo geral: investigar vivência de perdas, estados de luto e de depressão. Foram avaliados 44 pacientes com os diagnósticos médicos de infarto agudo do miocárdio e angina, de 33 a 65 anos, 50% mulheres e 50% homens. Utilizados três instrumentos: entrevista semi-estruturada, para avaliação do luto; Inventário de Depressão de Beck, para depressão; Escala de Avaliação e Reajustamento Social de Holmes e Rahe, que avalia porcentagem de probabilidade de apresentar problemas de saúde. Os resultados foram relacionados através do programa Statistical Package for Social Sciences, versão 11.0. Apresenta estado de luto 65,9%, sendo significativas as relações entre: luto e depressão (p<0,05); luto e gênero (p=0,000); presente em 90,9% das mulheres; depressão e gênero (p<0,05). Os eventos significativos relatados com maior freqüência foram: morte de familiares, 47% ou de pessoa próxima, 13%. Também é significativa a relação estatística entre luto e quantidade de mortes relatadas por participante como evento significativo (p<0,05). Sugere vivência de perdas como indicativo de risco psicológico para doença arterial coronariana, apontando para a associação entre luto e depressão / Since the attendance of hospitalized cardiac patients was created the category experience of losses caused by significative(s) event(s) that implicated in the mourning process. According to Freud (1916), mourning is a psychic process that requires time for the loss elaboration and changing of the psychic reality, shaped by the lost object missing. Mourning is understood as a psychodynamic correlation of the manifested depression reaction. On this basis, this research aimed: investigate experience of losses, mourning and depression. 44 patients with medical diagnosis of severe heart attack and angina were evaluated, from 33 to 65 years old, 50% women and 50 % men. Three instruments were used: semi-structured interview for mourning evaluation; Beck Depression Inventory, for depression; Holmes and Rahe Social Readjustment Rating Scale, which evaluates the probability of presenting health problems. The results were treated by the software Statistical Package for Social Sciences version 11.0 . 65,9% presented state of mourning and the association between : mourning and depression were significative (p<0,05); mourning and gender (p=0,000), presented in 90,9% of the women; depression and gender (p<0,05). The significative events more frequently reported were: death of a relative 47%, or closer person 13%. It is also significative the statistical relation between mourning and deaths related by the participants as significative event (p<0,05). Experience of losses is suggested as indicative of psychological risk for coronary artery disease, highlighting the association with mourning and depression

The present study investigated (a) the effects of group therapy ix on values and behavioral adjustment of hospitalized psychiatric patients, and (b) differential effects of directive versus non-directive group therapy in effecting desired therapy outcomes. Thirty subjects selected from among patients at Wyoming State Hospital were matched on age and sex and then randomly assigned to two experimental groups and one control group. Experimental group I received directive group therapy, experimental group II received non-directive group therapy and the control group participated in recreational activities. Both experimental groups and the control group participated in 12 weekly sessions, which were structured according to the respective objectives, mode of leadership style and/or activity intended for each group. All subjects were administered the Rokeach Value Survey prior to, and following the 12 group sessions. Each subject was also rated on the MACC Behavioral Adjustment Scale by two independent raters (hospital ward attendants) both before and after the experimental period. Porter's (1950, pp. 180-182) "counseling categories" were used to measure directiveness and non-directiveness of the group therapy leaders. Pretest comparisons among the experimental and control groups showed the groups to be essentially comparable (not significantly different) either in median rankings of values on the Rokeach Value Survey or in ward attendant ratings of the subjects on the MACC Behavioral Adjustment Scale. Posttest comparisons on the same variables (i.e., value rankings and ratings of behavior) indicated significant differences among the experimental and control groups on two of the 18 instrumental values of the Rokeach Value Survey, but no differences on any of Rokeach's 18 terminal values. Posttest changes over pretest value rankings occurred as much in the control group as in the experimental groups and the direction of changes varied with each group. Thus, no definitive benefits of one type of group procedure over another occurred. Further, the limited number of values for which posttest differences were observed between the experimental and control groups were well within the amount of normal change that could be expected from chance probabilities alone. It was therefore concluded that these particular changes in value rankings were essentially negligible and thus not attributable to either of the treatment modalities. Possible effects of group therapy in general, as well as any differential effects of directive versus non-directive group therapy were also studied in terms of behavioral ratings of subjects by hospital ward attendants. Statistically significant results on this variable clearly supported the value of both therapy groups over the control group for effecting positive changes in post-treatment behavioral ratings of the study's hospitalized subjects. However, the results did not demonstrate sufficient differences between the two experimental groups to conclude superiority of one leadership style over the other. A descriptive analysis of individual movement (direction and amount of change) from pretest to posttest ratings of behavioral adjustment was presented, and posttest differences between subjects subgrouped according to psychiatric diagnosis and number of psychiatric hospitalizations were discussed in terms of clinical rather than statistical inferences. The results of the study were discussed in reference to previous research related to human values, and Rokeach's viewpoint with regard to personal values and value changes was considered in light of the findings of the present study. Some possible implications of the study results were suggested, with particular reference to some of the unique characteristics of the study sample, including differing psychiatric diagnoses and chronicity of subgroups of the subjects, and a possible lack of motivation on the part of some subjects for participation in therapy groups. Several delimitations of the study were discussed, and recommendations for further research of this nature were offered.

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