Thesis (Ph.D.)--University of Central Florida, 2008. / Adviser: Myron Fottler. Includes bibliographical references (p. 112-119).

Thesis (Pharm.D.)--Butler University, 2007. / Includes bibliographical references (leaves 16-18).

Thesis (M.A.)--Rowan University, 2007. / Typescript. Includes bibliographical references.

Thesis (Ph. D.)--University of North Texas, Dec., 2009. / Title from title page display. Includes bibliographical references.

Thesis (Ph. D.)--Florida State University, 2006. / Advisor: C. Aaron McNeece, Florida State University, College of Social Work. Title and description from dissertation home page (viewed June 8, 2006). Document formatted into pages; contains xiv, 131 pages. Includes bibliographical references.

The Joint Commission in a joint effort with the Centers of Medicare and Medicaid Services (CMS) has established certain "core measures" by which hospital performance is measured. One of these is the measure for patients with ST-elevation myocardial infarction (STEMI) recommending percutaneous coronary intervention within 90 minutes of presentation to the Emergency Department in institutions that are able to provide this service. This recommendation does not take into account the long-term use of clopidogrel that is recommended by the American College of Cardiology and American Heart Association for patients that are treated with coronary stents. The purpose of this study was to evaluate outcomes of providing a short course of clopidogrel versus a prescription alone for clopidogrel to uninsured patients experiencing STEMI who were treated with a bare metal stent. After conducting a cost-benefit analysis, a policy was approved that provided uninsured STEMI patients with clopidogrel at discharge rather than a prescription. A social worker evaluated patients to determine if they met criteria and arranged for medication delivery to the patient’s bedside. A retrospective chart review for all patients who presented to the Emergency Department during two different time frames (before and after policy implementation) was conducted to evaluate if providing clopidogrel decreased readmissions. Data were collected on over a 15-month period of time before and after the clopidogrel policy implementation to allow for evaluation of 90-day readmissions with repeat STEMI. Data were analyzed using chi-square cross tabulation and T-test for independent samples. A total of 201 charts were reviewed: 100 from the pre-intervention group and 101 from the post-intervention group. Demographic characteristics of age, gender and insurance status iv were not statistically different between groups. The mean age for the control group was 59.1 (+ 13.8) years and 58.9 (+ 13.6) years for the intervention group. Twenty percent of the patients were uninsured. Five uninsured patients were readmitted with STEMI prior to the intervention compared to two patients in the intervention group (p = .191). The admissions for the preintervention patients occurred in the first 30 days after discharge compared to 31-60 days in the post-intervention group. All of the patients who were readmitted were assessed to be noncompliant with treatment. Additionally, a transition to increased use of bare metal stents in STEMI patients from 23.1% pre-intervention to 67.4% post-intervention was noted (p < .001). Although no differences were found in readmission rates, fewer readmissions for STEMI were noted after the intervention. The small number of patients who were readmitted with STEMI likely accounted for this finding, and additional monitoring of readmission rates is warranted. Despite provision of the clopidogrel, adherence remains an issue and needs to be addressed. During the intervention, physicians were encouraged to consider the financial and social resources of individual STEMI patients presenting to the Emergency Department to help identify patients that would be less likely to adhere to antiplatelet therapy. In those believed to be at high risk for non-adherence, primarily due to inability to purchase the relatively expensive medication clopidogrel, many physicians chose to insert bare metal stents rather than drugeluting stents to take advantage of the shorter course of clopidogrel required post procedure. Provision of a 30-day course of clopidogrel and aspirin was a major part of this effort to decrease recurrent myocardial infarction in this at-risk population. A few patients eligible for the clopidogrel were not provided the medication if they were admitted to a nursing unit where staff members were not familiar with the policy; revisions to the policy to ensure medication is provided to all eligible patients will be made. Providing clopidogrel to patients who experience v STEMI may improve adherence and thereby decrease readmissions as a result of repeat STEMI due to subacute thrombus formation. Patients who experience STEMI continue to be vulnerable after STEMI. Programs that provide medication to patients should be expanded within this facility and to other hospital systems to encompass all patients who are treated for STEMI. Multi-disciplinary collaboration is necessary in developing and implementing a program that will address care for this.

Thesis (M.A.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on September 3, 2008) Includes bibliographical references.

Thesis (M.S. Eco.)--Baylor University, 2006. / Includes bibliographical references (p. 48-50).

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Rehabilitation is recognised as important in helping stroke survivors achieve their highest levels of functional independence and best quality of life. Conversely, a lack of rehabilitation services, and other environmental barriers, can prevent the attainment of optimal levels of functioning and advanced outcomes, such as community integration and employment. Aim of the study: To determine if uninsured stroke survivors living in the Helderberg Basin (Western Cape) reached their optimal rehabilitation outcome levels and if not, what environmental barriers contributed to this. Methods: A descriptive study was conducted. Quantitative data was obtained from 53 participants, who were selected through proportional stratified random sampling. Demographic information and the health status of participants were recorded. Other instruments utilised were the Stroke Impact Scale (SIS3), Modified Barthel Index (MBI), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), language screening test and the ICF Core Set for Stroke (Environmental Factors). Outcome levels were categorised as described by Landrum, Schmidt and McLean, 1995. Data was subjected to statistical analysis. Qualitative data was obtained from five participants, who were chosen by means of purposive sampling. Data were analysed according to predetermined themes. Results: Six (11%) participants were classified as being on rehabilitation level 1; 21 (40%) on level 2; 16 (30%) on level 3; 8 (15%) on level 4; 2 (4%) on level 5. According to the MBI, 65% of participants required assistance with activities of daily living LOTCA scores showed that most difficulty was experienced with tests for visuomotor organization and thinking skills. Participants experienced varying degrees of difficulty with the speech and language test. A mean score of 50.84 for questions related to feelings on the SIS3 is indicative of underlying depression. Stroke survivors received limited physiotherapy and occupational therapy and even less speech therapy and dietary counselling. Occupational therapy had a significant impact on MBI (<0.01) and SIS3.6 (community mobility) (0.02) scores. Six (12%) reported assistance from a social worker. No psychological counselling was reported by any participant. A limited number of assistive devices, focussing mainly on mobility appliances had been issued. Participants regarded the most significant environmental barriers as being lack of assets (89%), transportation (88%) and general social support services, systems and policies (87%). Qualitative data showed a lack of counselling, education and training by health professionals regarding primary and secondary prevention of stroke and rehabilitation. Conclusion: Numerous environmental barriers impacted on the achievement of advanced rehabilitation outcomes. In addition to shortcomings in the primary and secondary prevention of stroke, many of the minimum standards for rehabilitation, as stipulated in the Western Cape Comprehensive Service Plan for the Implementation of Healthcare 2010, were not being met. Recommendations include establishing a designated stroke unit at Helderberg Hospital, ensuring transport, and improving the referral system to existing rehabilitation services. Increased input from core disciplines essential to stroke rehabilitation has the potential to improve outcomes. A concerted effort by health professionals is required in terms of counselling, education and training with regards to primary and secondary prevention of stroke and rehabilitation. / AFRIKAANSE OPSOMMING: Inleiding: Daar word algemeen aanvaar dat rehabilitasie na 'n beroerte uiters belangrik is, want dit kan beroerte oorlewendes help om die hoogste moontlike vlak van onafhanklikheid te bereik. Daarenteen kan‘n gebrek aan rehabilitasiedienste en omgewingsstruikelblokke verhoed dat ‘n oorlewende weer sy volwaardige plek in die samelewing en werksplek inneem. Doel van die projek: Om vas te stel of beroerte oorlewendes, woonagtig in die Helderberg Kom (Weskaap), sonder mediese versekering, wel hulle hoogste vlak van funksionering bereik het, en indien nie, om vas te stel watter omgewingsstruikelblokke bydraende faktore was. Metode: ‘n Beskrywende studie is uitgevoer. Kwantitatiewe data is verkry van 53 deelnemers wat lukraak gekies is deur gestratifiseerde, ewekansige steekproefneming. Demografiese inligting en die gesondheidstatus van deelnemers is aangeteken. Ander toetse wat gebruik is, is die Stroke Impak Skaal (SIS3), Gewysigde Barthel Indeks, Loewenstein Arbeidsterapie Kognitiewe Bepaling (LOTCA), taalsiftingstoets en die ICF kern stel vir beroerte (omgewingsfaktore). Uitkomsvlakke was bepaal, soos beskryf deur Landrum, Schmidt en McClean, 1995. Die data is statisties geanaliseer. Kwalitatiewe data was verkry van vyf deelnemers wat deur middel van doelgerigte steekproeftrekking gekies is. Tydens data analise is voorafbepaalde temas geidentifiseer. Resultate: Ses (11%) deelnemers was geklassifiseer as op rehabilitasie vlak 1; 21 (40%) op vlak 2; 16 (30%) op vlak 3; ag (15%) op vlak 4; twee (4%) op vlak 5. Volgens die MBI het 65% van die deelnemers bystand nodig vir daaglikse aktiwiteite. LOTCA uitslae toon dat die grootste probleme ondervind is met toetse vir visumotoriese organisasie en denkvermoëns. Deelnemers het verskillende grade van probleme ondervind met die spraak en taaltoets. ‘n Gemiddelde telling van 50.84 vir vrae met betrekking tot gevoelens in die SIS3, mag aanduidend wees van onderliggende depressie. Beroerte oorlewendes het min fisioterapie en arbeidsterapie ontvang en nog minder spraakterapie en raad van dieetkundiges. Arbeidsterapie insette het 'n beduidende impak op MBI telling (<0.01) en SIS3.6 (mobiliteit in die gemeenskap) (0.02) gehad. Ses (12%) het aangedui dat hulle hulp van maatskaplike werkers ontvang het. Nie een van die deelnemers het sielkundige berading ontvang nie. Beperkte hoeveelhede en tipes hulpmiddels is uitgereik, en was meesal om mobiliteit te verbeter. Volgens deelnemers was die grootste struikelblokke 'n gebrek aan bates (89%); vervoer (88%) en algemene sosiale ondersteuningsdienste, stelsels en beleid (87%). Kwalitatiewe data het 'n gebrek aan berading, onderrig en opleiding by gesondheidswerkers in terme van primêre en sekondêre voorkoming van beroerte en rehabilitasiedienste getoon.

Thesis (Ph.D.)--Bowling Green State University, 2007. / Document formatted into pages; contains xiv, 166 p. Includes bibliographical references.