The purpose of this investigation is to examine formal and informal resources available for teaching Spanish to health care professionals mainly in the Portland, Oregon area. Seventeen different Spanish-for-health-care-professionals texts are commented on by the author, some of which are the texts used in medical Spanish language classes. The majority of the texts contain little if any instruction on cultural aspects which affect the Latino patient population's health care behaviors and decision making. With the recent growth in the Latino population there is a greater demand for health care services by Spanish-speaking persons of the Latino community. The author discusses at length current information about the health status of this population, factors affecting access to health care, and language barrier. There is a lack of bicultural and bilingual health care professionals to provide needed health care services to Latinos. One factor is that the percentage of Latino medical and allied health providers is a small fraction of the percentage of Spanish-speaking patients in the U.S. Therefore, Spanish language instruction must be provided to medical personnel who do not have the cultural and language background to provide culturally relevant and efficient health care to Latinos. This language training must incorporate instruction on cultural issues that affect Latino patients' health care. At present very few Spanish-forhealth- care-providers texts and courses have this type of focus. Exemplary clinical programs specializing in the medical treatment of the Latino population, both inside and outside of the Portland Oregon area, are noted to highlight that effective and culturally relevant medical treatment is possible with adequate training of personnel. Outstanding courses integrating the instruction of both the Spanish language and culture are discussed. Often these courses are not offered as permanent parts of the curriculum. The author gives examples of some of the cultural issues that need to be addressed in language instruction, and makes suggestions for adapting this focus into Medical Spanish instruction.

Most medical students across the U.S. currently receive intubation skills training on low fidelity simulation (LFS) plastic mannequins. A limitation of these LFS models is that they do not allow students to attain complete familiarity and proficiency with intubation in a real-world clinical setting. For several years now, ETSU has been utilizing the Thiel embalming technique, which allows for greater joint flexibility and preservation of soft tissues compared to traditional embalming techniques. Our study set out to evaluate the efficacy of Thiel cadavers versus LFS plastic mannequins in assessing whether one model was more suitable in teaching intubation skills. After IRB approval, we exposed thirty-two first-and second-year medical students to both LFS models and Thiel embalmed cadavers in order to assess preparedness and confidence for performing intubations, and overall transference to patient care. Participants were shown an instructional video and given a brief lecture on the steps of a successful intubation by the primary investigators of the project before they were asked to practice intubation on both a Thiel cadaver as well as a LFS plastic mannequin. Participants were randomly assigned to note which teaching method to practice on first (Thiel cadaver or LFS model). Students were given written instructions during the procedure, and they completed a pre and post survey assessing preparedness, confidence, transference to patient care, and overall preference between the Thiel cadaver and LFS model for education. Our study significantly concluded that students felt better prepared and more confident by practicing on the Thiel cadaver and unanimously thought that it had better transference to clinical care. Overall, students also felt that the Thiel cadaver provided more knowledge, and close to two thirds of subjects preferred the Thiel cadaver over the LFS mannequin for learning intubation skills while a third of subjects said that both models should be used in training.

This thesis investigates the treatment quality of medical services in the hospital sector from different angles: theory, measures and application in China. This thesis includes three essays. The first essay (Chapter 2) is a critical review about the quality assessment. It shows that the environmental performance index is suitable for measuring treatment quality. The second essay (Chapter 3) introduces alternative approaches to environmental performance indices to solve the infeasibility problem of current measures. Environmental performance indices are measures to evaluate the production of undesirable outputs relative to desirable outputs. My new measures are more accurate using the sequential frontier and various reference vectors. The last essay (Chapter 4) is an empirical case study in the Chinese hospital sector that examines how the degree of government involvement and the degree of market competition affect the performance of treatment quality. Using the environmental performance indices of Essay 2 to evaluate treatment quality, I find that the performance of treatment quality of Chinese hospitals improved during the 2009-2014 period. Therefore, the marketisation of hospitals and government subsidies contribute to this sustained improvement

This dissertation reports on the evolution of an observation instrument designed to examine a series of dyadic interactions between service providers and elderly clients. The encounters took place in the physical context of the client's home and under the auspices of two different kinds of urban service agencies. Staff members and elderly clients of In-home Nursing and Interaction agencies participated in the study. The coding system (Service Provider/Client Dyadic Interaction Coding System or SP/CDICS), is comprised of 28 carefully defined and described behavioral categories. The categories were developed through literature reviews and a series of preliminary observations conducted in agencies similar to but not included among the sampled agencies. A majority of the defined behavioral categories require moderate levels of observer judgment. A Field Manual was developed to train the five observers who collected the data. This was supplemented with a videotape constructed to further assist observers in the learning and subsequent use of the code, particularly with non-verbal and paralinquistic aspects of the behaviors. Fifty-one service providers and 147 clients comprised the sample of observed dyads. The coded observational data were examined in the expectation that there would be recurrent patterns of behavior. Factor analysis resulted in the delineation of ten client and five service provider behavioral patterns that appear to be interpersonally meaningful. The derived service provider and client behavioral factors were correlated with other measurements available on the same population. These included several service provider personality and attitude measures as well as observer and client evaluations of the encounter. The comparisons, in general, tended to confirm the interpretations given to the described factors, further supporting an assumption that the SP/CDICS is a useful and valid instrument.

The purpose for this study was to develop guidelines for the implementation of Goal Attainment Sealing (a mental health measurement technique) in the medical care setting. As a graduate student of social work, I have become involved in the delivery of medical care and am interested in the dynamics of psycho-social variables as they affect the structure, delivery, and outcome of medical services.

Lifetime incarceration within the United States has an incidence of 6.6%, thehighest globally. Within the United States, individuals experiencing incarceration are among the few citizens who have a protected right to healthcare, as outlined by the Eighth Amendment of the United States Constitution. Yet, despite the promise for adequate care, patients who are currently incarcerated or have previously experienced incarceration continue to be included in the most vulnerable and underserved populations. When bioethical principles, specifically autonomy and agency, are considered, it becomes clear that there is a convoluted relationship between the healthcare system, the correctional system, and the patient who must traverse both sides. Incarceration itself is often associated with poor short- and long-term health outcomes, and patients who currently or previously experienced incarceration can face bias when attempting to navigate the healthcare system. It is imperitive to evaluate healthcare provided in the prison systems as well as the associated outcomes because of the significant proportion of the U.S. population affected by incarceration. This thesis explores the current status of healthcare provided to individuals who are currently or previously incarcerated. In addition, this thesis aims to identify disparities that exist within the provision of this care. Lastly, it suggests potential solutions that would result in more ethical and humanistic care provided to this vulnerable population. / Urban Bioethics

No description available.

No description available.

Boerhaave syndrome is a spontaneous rupture of the esophagus. It results from a sudden increase in esophageal pressure combined with negative intrathoracic pressure as seen with severe straining or vomiting. Esophageal perforation is extremely rare with an incidence of approximately 3.1 per 1,000,000 per year with a mortality rate estimated to be 20-50%. The rare occurrence and fatal nature of an esophageal perforation makes this syndrome a difficult yet important diagnosis to consider in the clinical setting. This case presents a previously healthy 47-year-old gentleman who presented to a local emergency department with syncope, vomiting, and chest pain sequentially. He reported a 24-hour history of dark stools followed by syncope, and when he regained consciousness he had three bouts of retching and expulsion of coffee-ground vomitus. Shortly after emesis, the patient developed severe and continuous pain located in his central chest that radiated to his back. Upon arrival to the hospital he was tachycardic. Blood tests revealed metabolic acidosis, increased white blood cell count, elevated lactate, and significant anemia. The patient’s hemoglobin was 7.7 gm/dL, a significant drop from the patient’s baseline level of 14. The patient received 1 unit of packed red blood cells and was sent for imaging studies. Chest X-ray and CT imaging revealed free air in the mediastinum, and a subsequent Gastrografin esophagogram study revealed a lower esophageal perforation proximal to gastroesophageal junction. The patient was rushed to the operating room for emergency surgery. An esophagogastroduodenoscopy showed no active bleeds and confirmed a distal mucosal defect suggestive of perforation. The surgery team then performed a left thoracotomy with intercostal muscle harvest and esophageal repair, with the patient needing an additional 4 units of packed red blood cells during surgery. He tolerated the surgery well and received appropriate post-op care in the ICU. A repeat Gastrografin and barium swallow esophagogram revealed no evidence of leak, strictures, or complications from the operation. A follow up CT image of the chest, abdomen, and pelvis was performed one month after hospital discharge, and results showed complete resolution of mediastinal air without evidence of esophageal leak. This case demonstrates how a spontaneous esophageal perforation can occur in previously healthy, middle aged patients with no significant GI history or identifiable risk factors. Given this information, clinicians should consider Boerhaave Syndrome when a patient of any age presents with chest pain after an episode of emesis.

No description available.