Class of 2011 Absrtact / OBJECTIVES: To describe a pharmacy technician and student intern-driven medication reconciliation process and to evaluate medical provider acceptance of recommendations to reorder critical medications. METHODS: Patients admitted to Northwest Medical Center had medication histories taken on admission. A specially trained pharmacy technician or student intern reviewed these histories, with emphasis placed on critical medications as defined by the Pharmacy and Therapeutics Committee. Recommendations to re-order these critical medications were made to medical providers. All patients, excluding those under 18 years of age or current enrollment in the prison system, admitted during the months of May-June 2010 were reviewed for acceptance of critical medication recommendations through information recorded in the pharmacy electronic medical record system. RESULTS: One hundred seventy-eight (178) recommendations were made on 132 patients requiring recommendations. All medical providers accepted 102 (57%, p-value=0.008) of the recommendations made. Hospitalists were more likely than physician specialists or surgeons to accept recommendations made (62.5%, p-value<0.001). Recommendations made regarding thyroid products were accepted the greatest majority of the time (82.1%, p-value<0.001); antidepressants (54.8%, p-value=0.321), anticonvulsants (63.2%, p-value=0.194), and medications classified as other (55.6%, p-value=0.480) were also accepted a majority of the time. Vitamin K antagonists did not have recommendations accepted a majority of the time (31.8%, p-value=0.034). CONCLUSION: Medical providers accepted a majority of recommendations to reorder critical medications made by pharmacy technicians or student interns.

High prepaid subscriber churn impacts on the service provider's profitability, financial evaluation and resource utilisation. Simultaneously it deprives subscribers of improved service because service providers are committing resources to subscriber acquisition and the management of subscriber retention instead of committing these resources to improving the value propositions offered to subscribers. A prepaid churn rate of just less than 50% in South Africa (2009) highlights the need for research into the factors that influence churned prepaid subscribers' choice of mobile-service provider. This in turn will increase the knowledge of retention and acquisition of prepaid subscribers. Using a telephonic survey on a sample of 861 prepaid subscribers, quantitative research was conducted to determine those factors that churned prepaid subscribers consider important when choosing a mobile-service provider. By making use of Analysis of Variance 4 out of 11 factors that, prepaid subscribers considered very important were identified when choosing a mobile-service provider. These included, in order of importance, Customer service quality, Mobile tariffs, Prepaid airtime and Starter-pack availability and Promotions. Discriminant Analysis highlighted 9 factors to be used to predict and classify groups of subscribers based on average monthly spend. The discriminate equation coefficients highlighted how these two groups of subscribers view the 9 factors when choosing a mobile-service provider. / Dissertation (MBA)--University of Pretoria, 2011. / Gordon Institute of Business Science (GIBS) / unrestricted

Die vorliegende Arbeit zur Logistik,verstanden als eine anwendungsorientierte Wissenschaftsdisziplin, verfolgt eine wissenschaftliche sowie praxisorientierte Zielsetzung. Als übergeordnetes Ziel ist die Feststellung des Status quo und der Entwicklungsperspektiven des 4PL-Ansatzes anzuführen. Durch die Verwendung von etablierten Forschungsmethoden wird die wissenschaftliche Rigorosität sichergestellt. Zur Erfüllung der praxisorientierten Zielsetzung wurden Fallstudien und Experteninterviews im Rahmen des Forschungsprozesses verwendet, um zum einen das Wissen aus der Praxis einzubinden und zum anderen eine Relevanz für die Praxis sicherzustellen. Für eine konsistente Praxis-Orientierung wurde die Branche der landwirtschaftlichen Schüttgutlogistik als exemplarisches Anwendungsfeld zur Untersuchung des 4PL-Ansatzes gewählt. Die Schüttgutlogistik beschreibt das Bindeglied zwischen der Landwirtschaft, dem Handel und der Ernährungsindustrie und somit einen Teil eines Netzwerkes. Das Transportvolumen betrug im Jahr 2010 ca. 3,5 Mrd. t, wobei 76 % (2,7 Mrd. t) auf den Straßenverkehr entfielen (Bundesministerium für Ernährung, Landwirtschaft und Verbraucherschutz 2010). In Anlehnung an die Trends der Logistik konnten gefestigte und klassische Strukturen vorgefunden werden, weshalb der 4PL-Ansatz als wahre Innovation untersucht werden konnte. Dies ist dadurch begründet, dass die Branche über genossenschaftliche Strukturen verfügt und neue technologische Trends eher zurückhaltend verfolgt. Dennoch sind die logistischen Herausforderungen wie die Reduzierung von Leerkilometern, die Optimierung der Frachtraumkapazitäten sowie die CO2-Reduzierung laut den befragten Akteuren der Branche von hoher Bedeutung (Müller 2010). Im Rahmen dieser Arbeit wurden daher Methoden, Modelle, Applikationen und Vorgehensweisen entwickelt, welche zur Beantwortung der folgenden übergeordneten Forschungsfragen herangezogen werden: 1. Was ist der Status quo des 4PL-Ansatzes sowie das Anforderungsprofil der landwirtschaftlichen Schüttgutlogistik an den 4PL? 2. Was sind die wichtigsten Diffusionsfaktoren des 4PL-Ansatzes in der deutschen landwirtschaftlichen Schüttgutlogistik? 3. Was sind die Potenziale innerhalb einer Branche durch Einführung eines 4PL? 4. Wie können eine Implementierung sowie die organisatorische Einordnung des 4PL-Ansatzes für eine Branche erfolgen? 5. Welche Trends der Zukunft zeigen Parallelen zum 4PL-Ansatz auf? Die vorliegende kumulative Dissertation zeigt Potenziale für die Branche auf und trägt zum Verständnis einer zukünftigen Entwicklung des 4PL-Ansatzes bei. Zur Zielerreichung wird ein Mixed-Methods-Ansatz verfolgt.

Millard County, Utah, rural and sparsely populated, continues to experience challenges in recruiting and retaining primary health care providers. My study addressed the lack of a rigorous and systemic analysis of this problem by collecting and analyzing data from a series of semi-structured interviews conducted between January and March 2019. These interviews were with nineteen of the twenty-four known health care providers who began practice in the county from the mid1980s to 2018, as well as with four administrators. The study, taking advantage of this comprehensive analysis, provided a more extensive understanding of the root causes underlying the recruitment and retention shortcomings. Findings showed that decisions to stop practice in the county were not typically made for a single over-riding reason but occurred when the cumulative effect of negative experiences reached a tipping point, prompting the provider to seek another practice venue. Providers who left reached this tipping point in spite of most having a rural background. The study recommended implementing a comprehensive and on-going support program aimed at addressing providers concerns. The stressors associated with rural health care practices need to be regularly assessed and resolved in a timely fashion.

Provider-based stigma is defined as the negative attitudes, beliefs, and behaviors of mental health providers toward clients they serve. Often unintentional and unknowingly conveyed, this phenomenon has been indicated in previous research (e.g. Lauber, Nordt, Braunschweig, & Rössler, 2006; Nordt, Rössler, & Lauber, 2006; Hugo, 2001; Schulze, 2007). Other instruments crafted to measure provider stigma have utilized theory in their development, without incorporating the voice of the client (e.g. Wilkins & Abell, 2010; Kennedy, Abell, & Mennicke 2014). To better address the social injustice posed by provider stigma, the profession requires a valid and reliable measure, guided by theory, which also reflects the client and family experience. This study attempts to do so, referencing the five themes of the experience-based model (Charles, 2013) to guide item development. These themes include: blame & shame; disinterest, annoyance, and/or irritation; degradation & dehumanization; poor prognosis/fostering dependence; coercion/lack of ‘real’ choice. The measure’s item pool was generated following Nunnally and Bernstein’s (1994) domain sampling method, in reflection of the experience-based model, and reviewed by a series of focus groups. The electronically hosted survey was distributed to a purposive sample of mental health service providers employed at Virginia’s public mental health agencies. Using a final sample of N = 220, factor analysis indicated a four factor solution, accounting for 32.454% of the items’ variance. Refinement resulted in a scale of 20-items demonstrating adequate internal consistency, measured by Cronbach’s alpha = 0.817. The four factors of the Mental Health Provider Self-Assessment of Stigma Scale (MHPSASS) were labeled: Irritation & Impatience (eight items); Choice & Capacity (five items); Adherence & Dependence (four items); Devalue & Depersonalize (three items). Hypothesized relationships were found between provider self-rating of burnout and MHPSASS score (Pearson’s r = 0.235, p = 0.001) as well as social desirability level and MHPSASS score (r = -0.169, p = 0.015), supporting the MHPSASS’ construct validity. As a measure of provider-based stigma, the MHPSASS displays adequate reliability and validity. Future studies are indicated, including replication. Limitations include agency response rate, unknowable individual level-response rate, social desirability, and the potentially burdensome length of the survey package.

In this thesis, we propose architecture for a SaaS model in Cloud that would provide service to the financial investors who are not familiar with various mathematical models. Such finance models are used to evaluate financial instruments, for example, to price a derivative that is currently being traded before entering into a contact. An investor may approach CSP to price a particular derivative and specify the time, budget and accuracy constraints. Based on these constraints specified by investors, the service provider will compute the option value using our proposed FSM. To evaluate our proposed model, we compared pricing results with the classical model that provides a closed-form solution for option pricing to meet the accuracy constraints. After establishing the accuracy of our pricing results, we further ensured that the SLA between the FSP and the investors is honoured by meeting the constraints put forth by the investor who uses the Cloud service.

In this thesis, we propose architecture for a SaaS model in Cloud that would provide service to the financial investors who are not familiar with various mathematical models. Such finance models are used to evaluate financial instruments, for example, to price a derivative that is currently being traded before entering into a contact. An investor may approach CSP to price a particular derivative and specify the time, budget and accuracy constraints. Based on these constraints specified by investors, the service provider will compute the option value using our proposed FSM. To evaluate our proposed model, we compared pricing results with the classical model that provides a closed-form solution for option pricing to meet the accuracy constraints. After establishing the accuracy of our pricing results, we further ensured that the SLA between the FSP and the investors is honoured by meeting the constraints put forth by the investor who uses the Cloud service.

Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings:  Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.

Universiẗat, Diss.--Freiburg (Breisgau), 2008.

Indiana University-Purdue University Indianapolis (IUPUI) / Within the mental health field, provider burnout is widespread and associated with far-reaching negative outcomes for providers, consumers, and organizations. Over the past four decades, various burnout interventions have been tested and found to be minimally effective, leading several researchers to suggest an increased focus on targeted recruitment (i.e., targeting providers who are most likely to benefit from a particular burnout intervention approach) and/or modifications to the interventions (e.g., format and content). Accordingly, the present study examined several person-related and intervention-related variables that were hypothesized to be predictive of response to BREATHE, a burnout intervention for mental health providers. Data from four prior studies that assessed the effectiveness of the BREATHE intervention were amalgamated. For the primary analyses, hierarchical linear regression was used to determine whether the person-related and/or intervention-related variables were predictive of treatment response. Additionally, the BREATHE studies were examined to determine whether the intervention became less effective at reducing burnout with each subsequent iteration. With respect to person-related predictors of response to the BREATHE intervention, age and turnover intentions were significant. Specifically, younger participants had higher post-intervention levels of depersonalization than older participants (β = -.13, p = .023), and higher baseline intentions to turnover were associated with greater post-intervention levels of emotional exhaustion (β = .11 p = .041) and depersonalization (β = .12, p = .023). In terms of intervention-related predictors of treatment response, participants who received the BREATHE intervention in a multi-session format had higher post-treatment levels of emotional exhaustion than those who received the BREATHE intervention in a single session format (β = .13, p = .015). Notably, across these primary analyses, baseline levels of burnout (i.e., emotional exhaustion, depersonalization, and personal accomplishment) were consistently the strongest predictors of post-intervention levels of burnout. Lastly, the data suggests that the BREATHE intervention became less effective with subsequent iterations. For example, earlier BREATHE studies had larger effect sizes than more recent studies. Additionally, there was a significant difference between the studies with respect to the change in emotional exhaustion (F(3, 230) = 4.86, p = .001, η2 = .06), such that participants in the first BREATHE study had a significantly larger reduction in emotional exhaustion than participants in the three subsequent studies. The present study was the first to examine potential predictors of response to the BREATHE intervention. Although the hypotheses were not supported, the implications of these findings are discussed and suggestions for future research directions are provided.