Strategies to optimize birth outcomes are a top priority in the current health care delivery system, where the examination and elimination of health disparities in childbearing women remain an important public health objective. Several studies have examined the relationships between socioeconomic status (SES), occupational status, ethnicity, insurance status, health care utilization, and educational level on birth outcomes, all known to influence gestational age and newborn mortality. Lesser-known variables are the influence of provider practice and hospital characteristics on birth outcomes.The purpose of this study was to evaluate several dimensions of birth outcomes employing birth certificate records and information available from provider licensing surveys for a one year period to calculate how much variation was due to differences in; a) hospital organizational characteristics; b) provider characteristics; and c) patient socio-demographic characteristics.The Quality Health Outcomes Model by Mitchell et al. (1998) provided a valuable framework which allowed the analysis of the interplay between intervention, client, and system characteristics, and their impact on birth outcomes for Maricopa County in 2005.The study design was a retrospective descriptive study using secondary data analysis with a dataset (Arizona HealthQuery, housed at the Center for Health Information and Research at Arizona State University) that included birth certificate information and the physician licensing renewal surveys.Secondary data analysis of this large administrative dataset provided the advantage of having a large sample size (62,816) of demographically diverse cases, thus minimizing concerns related to sample size and generalizability. Multiple regression and non-linear estimation models were deployed to control for confounding and effect modifying variables that could influence the relationship of labor induction on birth outcomes, including prolonged labor, use of forceps or vacuum extractors, cesarean births, Apgar scores, and newborn intensive care unit (NICU) admission.

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In Botswana, nurses play a major role in the provision of healthcare. Most of the time it is the professional nurses who frequently discover patients with cardiac arrests and it is necessary for them to be trained to perform CPR as efficiently as possible. The aim of this study is to describe and explore the perceptions, barriers and needs as experienced by nurses in Botswana during the provision of CPR. For this study, the researcher utilised both quantitative and qualitative research designs in four phases. Phase one assessed and audited the existing available facilities in the provision of CPR. Phase two investigated the existing knowledge and skills of registered nurses in the performance of CPR. Focus groups discussions and semi-structured interviews were held during phase three to identify the perceived barriers, needs in the performance of CPR. In phase four, the researcher made recommendation to improve the provision of CPR in relation to system, nurse and patient. Convenience sampling and purposive sampling were used in this study respectively. The auditing of the equipment in the two referral hospitals showed that the availability of equipment was below 50%. The CPR knowledge and skills demonstrated by the nurses in the pre-test were inadequate. Following CPR training with the help of a manikin, the knowledge and skills among registered nurses improved substantially. The focus group discussions and semi-structured interviews among registered nurses and senior nurse mangers revealed that there was a lack of organisational support and resources, lack of knowledge and skills among registered nurses, inadequate policies and protocols are the major contributory factors affecting the registered nurses performance in the provision of CPR. In order to enhance the performance of the registered nurses while providing CPR, the researcher recommends the two referral hospitals to • have adequate provision of equipment • introduce regular BLS training program for registered nurses • have clearly defined policies regarding the nurses’ role on end-of-life care / Health Studies

Σκοπός της εργασίας είναι να μελετηθεί κατά πόσο εξοικιωμένοι είναι οι Έλληνες με την εναλλακτική ιατρική και ποια χαρακτηριστικά της προσωπικότητάς τους οδηγούν στο να διαλέξουν κάποια εναλλακτική θεραπεία έναντι της κλασικής ιατρικής. / This essay wants to show us how alternative medicine is believed to heal, versus classical medicine.

In Botswana, nurses play a major role in the provision of healthcare. Most of the time it is the professional nurses who frequently discover patients with cardiac arrests and it is necessary for them to be trained to perform CPR as efficiently as possible. The aim of this study is to describe and explore the perceptions, barriers and needs as experienced by nurses in Botswana during the provision of CPR. For this study, the researcher utilised both quantitative and qualitative research designs in four phases. Phase one assessed and audited the existing available facilities in the provision of CPR. Phase two investigated the existing knowledge and skills of registered nurses in the performance of CPR. Focus groups discussions and semi-structured interviews were held during phase three to identify the perceived barriers, needs in the performance of CPR. In phase four, the researcher made recommendation to improve the provision of CPR in relation to system, nurse and patient. Convenience sampling and purposive sampling were used in this study respectively. The auditing of the equipment in the two referral hospitals showed that the availability of equipment was below 50%. The CPR knowledge and skills demonstrated by the nurses in the pre-test were inadequate. Following CPR training with the help of a manikin, the knowledge and skills among registered nurses improved substantially. The focus group discussions and semi-structured interviews among registered nurses and senior nurse mangers revealed that there was a lack of organisational support and resources, lack of knowledge and skills among registered nurses, inadequate policies and protocols are the major contributory factors affecting the registered nurses performance in the provision of CPR. In order to enhance the performance of the registered nurses while providing CPR, the researcher recommends the two referral hospitals to • have adequate provision of equipment • introduce regular BLS training program for registered nurses • have clearly defined policies regarding the nurses’ role on end-of-life care / Health Studies

The purposes of this study were: (1) to determine which characteristics of male alcoholics are related to treatment success and length of stay in long-term treatment, and (2) to assess the efficacy of predicting outcome and length of stay on the basis of patient characteristics, The study was performed post hoc on 265 patients discharged from a 6- to 12-month residential alcoholism program on the grounds of a state hospital. After an extensive literature review, 19 predictor variables were selected which were most consistently related to outcome and length of stay in previous studies of shorter rehabilitation programs. Data for predictor variables were obtained from psychological testing, admission interview notes, anamneses, and symptom ratings, Treatment outcome at 6-month follow-up was assessed dichotomously (success - failure) and numerically (number of abstinence and social adjustment criteria met) based on questionnaire responses and second-hand information. Sample size varied across analyses, as cases were deleted for missing data. Compared to patients who failed to benefit, treatment successes were less antisocial (p < .01) and reported fewer alcoholic withdrawal symptoms (p < .05, n = 131). The results also suggest that successes were less angry than failures (this variable reached significance in the analyses which were given the most consideration, and showed consistent trends in other analyses). Patient characteristics unrelated to treatment outcome were age, socioeconomic status, social stability, number of arrests, age at onset of drinking problem, problematic drinking by patients' parents, length of longest previous period of sobriety, number of previous alcoholism treatments, previous regular A.A. attendance, overall mental health, neuroticism, depression, obsessive compulsive traits, latent schizophrenia, IQ, and defensiveness. A four-variable discriminant function produced 70.23% correct classification of outcome (r = .34, p < .01, n = 131), but the 33.3% false negative rate raises a question about using the function as an acceptance criterion. The pattern of results implies that the longterm program fosters social integration, but does not overcome the effects of severe personality disorders or physical addictions. Only IQ was related to length of stay, with more intelligent subjects remaining in treatment longer (p < .05, n = 233). Weak but statistically significant prediction of length of stay was obtained with a nine-variable regression equation (r = .34, p < .01, n = 199).

Made available in DSpace on 2016-03-22T17:27:22Z (GMT). No. of bitstreams: 1 Camila.pdf: 315174 bytes, checksum: 7f3cebe0af3e1a677f9c659d6402963b (MD5) Previous issue date: 2006-07-11 / Objective: to assess the impact of symptom severity on the development of the therapeutic alliance in women with postpartum depression undergoing brief cognitive psychotherapy. Method: this study is part of a randomised controlled trial that investigated the effectiveness of psychotherapy in the treatment of postpartum depression. Women were between 30 and 60 days postpartum and had a positive screen for mild to moderate depression. To assess depressive symptom severity, the Beck Depression Inventory was employed at the beginning and at the completion of treatment. The client and therapist forms of the Working Alliance Inventory (WAI) were used to evaluate the therapeutic alliance after the session 1, 4, 7. Data was analyzed with correlations and chi-square tests. Results: correlation analysis pointed to associations of the total WAI score (r = -0,35) and subscale task (r = -0,31) and bond (r = -0,57). Chi-squares tests were significant in the fourth session for the total WAI score (p &#8804; 0,050) and the bond subscale (p. &#8804; 0,037). Conclusion: the association of the investigated variables during the intermediary phase of the treatment was insufficient to indicate that depressive symptom severity had influence on the development of the therapeutic alliance. / Puerpério, Características do paciente, Relação terapêutica. 21 ABSTRACT Objective: to assess the impact of symptom severity on the development of the therapeutic alliance in women with postpartum depression undergoing brief cognitive psychotherapy. Method: this study is part of a randomised controlled trial that investigated the effectiveness of psychotherapy in the treatment of postpartum depression. Women were between 30 and 60 days postpartum and had a positive screen for mild to moderate depression. To assess depressive symptom severity, the Beck Depression Inventory was employed at the beginning and at the completion of treatment. The client and therapist forms of the Working Alliance Inventory (WAI) were used to evaluate the therapeutic alliance after the session 1, 4, 7. Data was analyzed with correlations and chi-square tests. Results: correlation analysis pointed to associations of the total WAI score (r = -0,35) and subscale task (r = -0,31) and bond (r = -0,57). Chi-squares tests were significant in the fourth session for the total WAI score (p &#8804; 0,050) and the bond subscale (p. &#8804; 0,037). Conclusion: the association of the investigated variables during the intermediary phase of the treatment was insufficient to indicate that depressive symptom severity had influence on the development of the therapeutic alliance.

Despite decades of the implementation of the directly observed therapy short-course (DOTS), Sierra Leone is ranked among the 30 highest TB-burdened countries. Several factors account for unfavorable treatment outcomes, among which are patient characteristics. Previous studies have only focused on treatment compliance without any consideration for the factors that lead to noncompliance to treatment. The purpose of this study was to investigate patient characteristics that are associated with treatment noncompliance (treatment not completed) among TB patients undergoing the DOTS program in Sierra Leone. A retrospective longitudinal quantitative design was used to analyze secondary data from the completed records of 1,633 TB patients, using the Andersen's behavioral model of health services utilization as a theoretical framework work. Descriptive statistics and bivariate and multivariate logistic regressions were used to analyze the data. The results show that there was no significant association between treatment completion and age, gender, and TB-case category. On the other hand, being HIV-positive decreases the odds of treatment completion. Also, the educational level, geographic location, and year of treatment were significantly associated with treatment completion. Overall, program performance improved as the number of dropouts decreased significantly between 2013 and 2015. The social change implication of this study was that it identified HIV-positive patients and rural communities as areas needing specific attention such as the assignment of case managers to ensure compliance thereby improve DOTS program performance, thereby reducing the incidence and transmission of TB

The purpose of this cross-sectional correlational study was to examine the effects of patient and nursing unit characteristics on nursing-sensitive patient outcomes. The conceptual framework for this study is generated from the Quality Health Outcomes Model. The patient characteristics were patient age, gender, education, duration of illness, severity of illness, and illness representation. The nursing unit characteristics were nurse experience, nurse staffing, nursing unit competency, and group cohesion. Nursing-sensitive patient outcomes were patient’s confidence in self-care and patient’s perception of being well-cared for. Stratified sampling was employed to recruit a sample of 130 hospitalized chronically ill patients in 8 medical care units of 4 hospitals in Thailand. A face-to-face questionnaire interview was used to collect data from patients. A self-administered questionnaire was used to collect data from 90. Nurse staffing data were obtained from nursing administrative data for each unit. Multiple regression analyses were used to examine the relationships, test a mediator, and analyze the contextual effect of the study variables. Severity of illness (β = -.315, p <.01) and illness representation (β = -.234, p < .05) were significant predictors of patient’s confidence in self-care, when controlling for nursing unit characteristics. Illness representation partially mediated the relationship between severity of illness and patient’s confidence in self-care. Nursing unit characteristics were not significant predictors of patient’s confidence in self-care, when controlling for patient characteristics. There was a significant individual effect on patient’s confidence in self-care. Severity of illness (r = -.199, p < .05) and group cohesion (r = -.195, p < .05) were correlated with patient’s perception of being well-cared for. The findings of this study reinforce the need for acute care nurses to be aware of how chronically ill patients perceive health threats since illness representation directly affects patient’s confidence in self-care. Through understanding the role of illness representation as a mediator between severity of illness and confidence in self-care, it is suggested that nurses can improve patient’s confidence in self-care in severely ill patients by providing nursing interventions that promote positive illness representation.

This research focused on experiences of dying patients and hospice nurses in a hospice unit. The research objectives were to (i) acquire more extensive knowledge about how dying patients and hospice nurses experience life and death and (ii) describe patients who were cared for during a 10-year period in an inpatient hospice ward. Data were gathered via interviews with 19 nurses and 11 patients. An interpretive description method was used to analyze interview results. Data were also gathered from institutional care records that included gender, age, marital status, diagnosis, referral source, and length of stay (666 women and 555 men). Descriptive statistics were used to describe basic features of the study's data and to compare differences between women and men. The main finding from interviewing the nurses was that they were struggling to acknowledge and unveil the person within the weakening body. In doing so, they used various strategies such as (i) striving to understand patients’ experiences of body function loss; (ii) encouraging patients to uphold body functions and daily habits; (iii) acknowledging and balancing patients’ need for body control; and (iv) providing tender care for the body. After 2 years of work in hospice care, nurses described that facing the dying and death of many patients had an impact on daily work and private life. The close relationship with the dying patient led to existential issues concerning the meaning of life and death, which were conceptualized into this theme: death as an agent of change. Eleven years later, the presence of death took a less dominant place in the nurses’ lives, and the theme became: death as a companion in life. In the long-term, nurses emphasized that their relationships with dying patients fostered their professional and personal growth. The findings from interviewing the patients revealed that when death became a reality, life took on new meaning, and they acquired new values that were important to preserve or protect; this triggered need for feeling secure within this situation. These revelations were manifest in three sub-themes: (i) when possible death becomes a reality; (ii) living with death as a reality, and (iii) a need for a feeling of security. And this main theme was conceptualized: making sense of life close to death. Results regarding patients in hospice ward care over a 10-year period revealed significant differences between women and men. More women than men were single, had cancer with relatively short trajectories, and were referred from the oncology department. More men than women were diagnosed with types of cancer with somewhat longer trajectories. Despite longer trajectories, length of stay was shorter for men than for women. The most frequent referral source was the hospital. But compared to women, men (particularly younger men) were more often referred from home-based hospice care. The findings expand knowledge about dying and its various configurations; consequently, care and support needs will vary. For the dying person, it is important to know that care is provided according to the person’s preferences and given when needed.