Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.

Thesis (M.A.)--Eastern Illinois University, 2009. / Includes bibliographical references (leaves 27-33).

In South Africa, the highest HIV prevalence is amongst young people, who may have the greatest potential to contribute to the country’s economy. South Africa has one of the world’s largest antiretroviral (ARV) rollout programs. Like all medications, ARVs need to be taken as prescribed to be safe and effective. Excellent adherence is necessary to ensure that drug resistance does not develop. HIV cannot be cured, and at present ARVs must be taken for the rest of the patient’s life. In the ARV clinic in Knysna, an unanticipated category of patients has been identified: those who “bounce” in and out of long term therapy. Not only do these patients put their own health at risk, but the development and transmission of drug resistant HIV threatens the potential treatment options of the whole community. One of the problems identified in recurrently defaulting patients, is the difficulty in maintaining long term adherence to an ARV treatment program, while in full time employment. This is because as time goes on, patients need to balance the need for ARV care, which has rigorous clinic attendance parameters, with work attendance. Many employees have only twelve days of paid sick leave per annum, and patients require an average of eleven clinic visits in the first six months of treatment. This qualitative study gauges whether the services provided to HIV positive people living in Knysna meets the needs of their employers. The study interviewed both employees and employers to gauge the effects of HIV on local businesses, and explored the knowledge and attitudes of employers towards services provided by the Knysna ARV program. Employers were asked to suggest ways in which the services could be improved to better meet their needs, and ultimately, the needs of their employees.

The literature on stroke reveals an increasing interest in the role played by social and emotional factors in rehabilitation after stroke. A comprehensive literature survey shows profiles of spontaneous recovery, the significance of a team approach to rehabilitation, patterns of prognostic significance for long-term recovery and adaptation and formulations of rehabilitation models for the Western world. The importance of depression as a major factor in demotivation to participate in rehabilitation and achieve long-term quality of life post-stroke emerges. From the literature survey a research design was formulated for the ecological study of a sample of 51 stroke patients at Ga-Rankuwa Hospital near Pretoria. The questionnaire was structured according to the Synchronous Systems Model, and data gathered from the biological, personal and environmental spheres of patients. Data was collected by a multidisciplinary team at three assessment times, three days, two weeks and three months post-stroke. These corresponded to the acute physical phase of stroke, the end of the hospitalisation period, and an assessment of patients once they had been discharged back into the community. Descriptive statistics were obtained on all variables and principle axis factor analysis was performed to verify the factorial structure of the tests. In order to establish whether group scores changed between assessments, t-tests for dependent measures were applied. Pearson Product Moment correlations were computed for the purpose of establishing relationships between variables. The results revealed dramatically differing biographical characteristics of the sample of stroke patients both premorbidly and at three months after the stroke. Significant recovery profiles emerged in both the physical and neuropsychological spheres at both the 14 day and 3 month assessments. Depression and the functioning at home and at work social sphere of role emerged as profiles of deterioration. At 14 days, depression was related to physical and cerebral functioning. This changed at three months, with depression also being significantly related to aspects of social functioning. On the basis of these results, depression after stroke was conceptualised as a severance of relational connectedness in the social ecological functioning of stroke patients. An ecological approach to rehabilitation is proposed that would seek to reframe the identity of stroke patients and establish relational connectedness post-stroke. / Psychology / D. Litt. et Phil. (Psychology)

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Class of 2012 Abstract / Specific Aims: To evaluate surgery, infectious disease, and nephrology consult documentation of antimicrobial content in bone cement within 30 days post-surgery; evaluate documentation of antimicrobial cement content by pharmacists in pharmacokinetic drug level evaluations within 6 months post-surgery; assess frequency and severity of adverse drug events associated with antimicrobials in bone cement. Methods: Retrospective chart review, which utilized a data collection form to evaluate the dose and type of antimicrobial agents prescribed, median and range antimicrobial doses per 40 grams of cement, documentation rates of antimicrobial content in clinical notes and incidence of potential adverse drug effects. Subjects were identified based on an ICD-9 code and their electronic medical records were accessed. Main Results: The sample size was 24 patients. The surgery notes had the highest rates of documentation with 96% naming the drug and 75% included the dose. The rates were the same in the infectious diseases consults and pharmacy pharmacokinetics notes with the drug name at 27% and the dose at 9%. No nephrology consult notes mentioned antimicrobials contained in the cement. Renal dysfunction (sCr≥2) developed in 13% of patients within 30 days and 25% of patients within 100 days. Approximately 17% of patients with renal dysfunction had the antimicrobial-laden cement removed. Conclusions: A variety of antimicrobial agents were embedded in bone cement at various concentrations and documentation from multiple sources was inconsistent. Likewise, adverse events associated with antimicrobial containing bone cement are not consistent.

Class of 2012 Abstract / Specific Aims: The primary aim of this study was to determine the incidence of posaconazole and voriconazole concentration monitoring that occurs in transplant patients receiving antifungal prophylaxis therapy. The secondary aim was to determine whether voriconazole and posaconazole serum concentrations were used for dose adjustments. Methods: Patients status post either a liquid or solid organ transplant over the age of 1 year who received invasive fungal infection prophylaxis with either posaconazole or voriconazole between the dates of February 1, 2010 through January 31, 2011 while admitted to academic medical center were included in this descriptive retrospective study. This study has been approved by the Institutional Review Board. Data collected on each subject included demographic information, type of transplant, posaconazole or voriconazole concentrations, and duration and dosage adjustments. Main Results: 54 subjects were identified who received either voriconazole or posaconazole for fungal prophylaxis after transplant. For subjects who were prescribed posaconazole (N = 8), concentration monitoring was performed in 50% of subjects and 0% of posaconazole dose adjustments were based on concentrations. For subjects who were prescribed voriconazole, concentration monitoring and dose adjustments based on voriconazole concentrations were performed in 20% and 78% of subjects respectively. Adverse outcomes associated with the use of antifungal therapy were reported in 0% of the posaconazole therapy group and 17% of the voriconazole therapy group. Conclusions: Both posaconazole and voriconazole concentrations were obtained from patients who were receiving antifungal therapy for invasive fungal infection prophylaxis. Adjustments of prophylactic doses are not well characterized.

Class of 2012 Abstract / Specific Aims: The specific aim of this study was to assess the impact of public mental health benefit changes on patients with a serious mental illness. Methods: A comprehensive literature search was conducted using several databases. Articles that were included in the analysis met the following inclusion criteria: 1) Study conducted in the United States 2) Study population composed of adults (≥18) with a diagnosis indicative of a serious mental illness (psychotic disorders, bipolar disorders, major depressive disorder, anxiety disorders, dysthymic disorder, or a personality disorder) 3) Study evaluated a change or discontinuation of mental health services, 4) Study reported outcomes. Main Results: Of the 117 studies originally identified, 27 met all the inclusion criteria. Data was then extracted from each study regarding the design of the study, patient demographics, and impact of the various outcomes. Five studies looked at the implementation of prior authorizations required for psychiatric medications, which all showed increased rates of treatment discontinuation. Two of these five studies also looked at the impact on emergency department (ED) visits and hospitalizations with both studies showing increased ED visits, but no effect on hospitalizations. Three studies looked at the implementation of Medicare Part D, which all showed increased rates of medication access problems and increased rates of ED visits. Other studies that examined medication access issues found increased rates of suicide ideation or behavior, increased rates of treatment discontinuation, and increased rates of ED visits. Conclusions: Given the amount of variability among the studies, it is difficult to determine the impact specific benefit changes have on patients diagnosed with a serious mental illness. In order to draw conclusions regarding specific benefit changes, more studies looking at similar outcomes need to be conducted. This is critical as the studies examined, in general, showed negative outcomes for patients with a serious mental illness when mental health benefit changes were implemented.

Class of 2014 Abstract / Specific Aims: The purpose of this study is to compare frequency of pharmacy services available in ambulatory care practice between adult and pediatric populations and to identify factors that affect the availability of such practice settings between the two populations in the United States. Methods: This study was a descriptive survey study that was distributed nationally. Participants were recruited using two electronic listservs registered with the American College of Clinical Pharmacy (ACCP), the Pediatric PRN listserv and Ambulatory Care PRN listserv. A total of 126 participants completed and submitted the electronic questionnaire. This descriptive survey study collected data through an online questionnaire distributed to adult and pediatric ambulatory care pharmacists. Descriptive variables, demographic variables, categorical variables, and ordinal data were analyzed by calculating frequencies, percentages, and averages. Main Results: The majority of participants specialize in diabetes (n = 51, 40.5%), anticoagulation (n=42, 33.3%), hypertension (n=42, 33.3%), hyperlipidemia (n=40, 31.8%), and asthma (n=32, 25.4%). Adult care was greater than pediatric care in diabetes (Adult: n=54, 42.83%; Ped: n=14, 9.53%), anticoagulation (Adult: n=46, 43.66%; Ped: n=6, 4.76%), hypertension (Adult: n=44, 34.94%; Ped: n=8, 6.34%), hyperlipidemia (Adult: n=42, 33.34%; Ped: n=3, 2.39%), and asthma (Adult: n=35, 27.78%; Ped: n=28, 22.23%). Averages of 4.88 hours of hours per week and 5.21 years of experience were obtained for provision of pediatric care in the ambulatory care setting. Conclusion: In conclusion, availability of ambulatory care services for pediatric patients is dramatically less than those available for adults. Generalized structure for location of clinics, billing for services, and funding for positions may increase the opportunity for provision of adult and pediatric ambulatory care services.