Class of 2015 Abstract / Objectives: Characterize all patients in the emergency room diagnosed with anxiety disorders from 11/01/2013 until 5/31/2014 to identify insurance coverage and demographic trends. Methods: Retrospective descriptive study of patients who present to the emergency department between 11/01/2013 – 05/31/2014 and discharged with a primary documented diagnosis of an anxiety disorder. Age, race, and gender were recorded in addition to insurance coverage. Results: 406 visits were reviewed: 212 (52.2%) males and 194 (47.8%) females. Average age per visit: 40.34 (SD=13.388). Race recorded with each visit: 189 (46.6%) white, 146 (36.0%) Hispanic, 42 (10.3%) African American, and 29 (2.2%) other. The most common insurance coverage was Medicaid at 63.3%, while 6.4% of visits had no insurance coverage. There was a significant difference in the distribution in number of ED visits between genders (Mann-Whitney U=17,407.5, p=0.007, sig ≥0.05). A Kruskal-Wallis Test showed a significant difference in the number of ED visits between racial groups X²=43.434, p=0.000 as well as a significant difference between Medicaid and other insurance groups X²=37.778, p=0.021. Conclusions: Men appear to have a higher frequency in anxiety symptoms requiring an ED visit than women do. White patients tend to have a greater frequency in anxiety symptoms followed by Hispanic patients. Medicaid tends to be the most prevalent insurance coverage used.

The thesis analyses the impact of Internet marketing tools on visits of the Lenovo Blog CZ, the official blog of the computer manufacturer Lenovo. It focuses evolution of visits of the blog over time, on the impact of social networks and Facebook posts paid promotion on visits. Finally, it observes to what extent the Internet marketing tools impact overall visits of the blog over the observed time.

Bakgrund: Barnmorskans bemötande är av stor betydelse för kvinnans upplevelse av att känna sig trygg och hantera smärtan under latensfasen och förlossningen. Målet är att kvinnan ska vara hemma under latensfasen då sjukhusmiljön kan ha en negativ inverkan på det fysiologiska förlossningsförloppet. Mödrahälsovården har en viktig roll genom att stötta och förbereda den gravida kvinnan inför förlossningen. Syfte: Att undersöka kvinnors upplevelse av att under latensfasen sökt vård på förlossningsavdelningen och sedan fått åka hem. Metod: En kvalitativ intervjustudie har gjorts och baseras på fem enskilda intervjuer med förstföderskor. Datamaterialet analyserades enligt innehållsanalys. Resultat: Kvinnorna kände sig oförberedda och uttryckte en okunskap om latensfasen. Bemötandet från barnmorskan på förlossningen var av betydelse för hur kvinnorna upplevde och kunde hantera latensfasen och förlossningen. Smärtsamma förvärkar och sömnbrist var de huvudfaktorer som gjorde att de besökte förlossningen. Slutsats: Studien visade att  informationen från barnmorskan på mödrahälsovården gällande latensfasen var bristfällig och behöver förbättras. Kvinnorna hade svårt att avgöra när de var i aktiv fas och skulle åka in till förlossningen. Barnmorskan på förlossningen behöver se den enskilda kvinnan och anpassa omhändertagandet individuellt. Även partner/närstående kan vara i behov av råd och stöd från barnmorskan för att lättare kunna hjälpa kvinnan under latensfasen. / Background: The midwife's attitudes are important for a woman’s experience of feeling secure and manage pain during latent phase and delivery. The goal is that the woman should be at home during latent phase, because of that the hospital environment can have a negative impact on the physiological delivery process during this phase. Maternal health care has an important role by supporting and preparing the pregnant woman for birth. Objective: To explore women's experiences of latent phase, sought care at the maternity ward, and then had to go home. Method: A qualitative study has been done and is based on five individual interviews with first-time mothers. The data were analyzed according to content analysis. Results: The women felt unprepared and expressed ignorance about latent phase. The treatment from the midwife at the maternity ward was important for the women and how they could handle their experience of latent phase and delivery. Painful contractions and sleep deprivation were the main factors that made the women visit the maternity ward. Conclusion: The study showed that the information about latent phase from the midwife at the maternal health care center was inadequate and need improvement. The women found it  difficult to determine when they were in active phase and would go into the maternity ward. The midwife at the maternity ward need to see the individual woman and adapt care individually. Partners / relatives may be in need of advice and support from the midwife to make it easier to help the woman in latent phase.

O objetivo principal desta pesquisa é investigar porque dois parques estaduais relativamente semelhantes (PETAR e PEI) apresentam graus de conservação tão distintos. As variáveis consideradas nesta análise foram: as formas de gestão das visitações, os recursos humanos disponíveis para esta atividade e os fluxos de visitação. A hipótese central é que as diferenças podem ser explicadas em função das gestões diferentes, ou seja, o PEI é mais conservado que o PETAR pois, sua gestão é conduzida pela Fundação Florestal com a participação da comunidade local através de uma cooperativa. Tal arranjo institucional acabaria, ao mesmo tempo, resolvendo um problema de responsabilidade estatal de conservação do meio ambiente natural e visitação pública com fins educacionais, com o interesse econômico da comunidade local. Por outro lado, no PETAR, a falta de coordenação entre o interesse público e o econômico teria levado a exploração descontrolada do parque. A análise dos dados e do resultado da pesquisa de campo nos leva a concluir que o PETAR está sofrendo um processo de deterioração de suas cavernas abertas a visitação e de seu entorno fruto da intensificação do turismo, configurando assim a incidência da tragédia dos comuns. Já no caso do PEI foi constatada uma visitação mais controlada e limitada e, portanto, um grau de preservação do complexo turístico bastante superior. Constatamos que dentre os diversos fatores que podem explicar as diferenças entre os parques, essencialmente, podem ser divididos entre diferenças em infra-estrutura turística e modelo jurídico de gestão dos parques. Sendo que o PEI tem um infra-estrutura turística limitada, o que naturalmente limita as visitações e ser submetido a Fundação Florestal, o que significa autonomia de gestão. Já o PETAR, tem assistido a um crescimento exploratório e sem planejamento da sua infra-estrutura turística, o que tem levado a deterioração de cavernas e do entorno do parque, além disso o gestor do parque tem pouca autonomia na sua gestão dada as amarras jurídicas de ligação com Instituto Florestal que, por sua vez, é controlado pela SMA e suas dotações orçamentárias. / The main objective of this research is to investigate why two similar state\'s parks (PETAR and PEI) presents different states of conservation. The variables took into consideration in this analysis were: the forms of management, the available human resources and the fluxes of visitation. The main hypothesis is that the differences in their state of preservation may be explained due to the differences in their form of visitors management. PEI is more preserved than PETAR since its management is conducted by Fundação Florestal within the participation of local communities through a cooperative. Such institutional arrangement, at the same time, solves a question of state responsibility of conservation of the natural environment and public visitations with educational purposes, together with the economic interests of the local community. On the other hand, at PETAR, the lack of coordination between the public interest and the economic interest has lead to a chaotic exploitation of the park. The analysis of the data and the results of the fields work make us to conclude that PETAR is suffering a deterioration process of its caves opens to visitation and its surrounds due this chaotic exploitation of tourism. Therefore, we clearly see the occurrence of the tragedy of commons. While at PEI we observed a controlled and limited visitation that may explains the higher level of preservation of this park. Among the many differences that can explain this situation we found mainly two: differences in the infra-structure of visitation and differences in the legal model of park\'s management. At PEI we can see a limited touristic infra-structure which contained the visitations. Moreover, the park is under the management of Fundação Florestal, which means more freedom to manage the park. On the other hand, PETAR, has faced a little planned growth of its tourist infra-structure which lead to a deterioration of the caves and surrounds. Furthermore, the park manager has little autonomy due to the legal restrictions imposed by the control of the Instituto Florestal that is also controlled by the SMA and its budget limitations.

Inledning: Barn i socioekonomiskt utsatta områden riskerar i större utsträckning att drabbas av psykisk ohälsa senare i livet. Kan utökade hembesök bidra till att stärka föräldraskap och tidigt upptäcka familjer i behov av stöd? Bakgrund: Barnhälsovården, mödrahälsovården och socialtjänsten i Sverige arbetar hälsofrämjande och förebyggande för att minska risken att familjer ska utveckla hälsoproblem. Mellan 2018 och 2019 genomfördes ett gemensamt projekt i två socioekonomiskt utsatta områden. Syfte: Att belysa vård-och omsorgspersonalens upplevelse av att arbeta med utökade hembesök genom projektet Förstärkt föräldraskap - utökade hembesök. Metod: Detta är en kvalitativ intervjustudie med induktiv ansats som analyserades med inspiration av kvalitativ innehållsanalys. Resultat: Resultatets tre kategorier är: Ett nytt arbetssätt som främjar samarbete och tidiga insatser, En möjlighet att fördjupa relationer och stärka föräldraskap genom hembesök samt En möjlighet att främja jämställdhet i föräldraskapet och delaktighet i familjecentralen. Diskussion: Deltagarna upplever att föräldraskapet stärkts på olika sätt genom tvärprofessionellt samarbete med utökade hembesök. Hembesöken har bidragit till stärkta relationer som givit goda förutsättningar för fortsatt samarbete och vidare kontakt med familjer. Konklusion: Deltagarna är positivt inställda och beskriver olika upplevelser i arbetet med projektet samt vad det bidragit till för verksamheterna. Kliniska implikationer: Vidare forskning rekommenderas om föräldrars upplevelser av projektet samt uppföljande studie när barnen blivit äldre.

No description available.

High blood pressure (BP) is the most significant risk factor for cardiovascular disease and a major contributor to chronic disease burden in the United States. Chronic conditions are the most common reason for office-based physician visits among adults, accounting for 37% of all visits. Home BP monitoring when combined with clinical support may help engagement with care and improve condition control. This study examines the extent to which home BP measurement is associated with total office visits among Medicare beneficiaries with self-reported high BP and the influence by other related factors. The 2018 Medicare Current Beneficiary Survey (MCBS) was used in the study. The study population consists of Medicare beneficiaries (n=4,456) with self-reported high BP who had at least one total office visit in the year. Total office visits served as the outcome and were dichotomized to low (1-5 visits) and high (greater than 5 visits), while self-reported home BP measurement was the primary independent variable. Andersen’s conceptual framework was used to establish the co-variates [Predisposing factors: age, gender, race, education; Enabling factors: insurance plan (Medicare Advantage, MA), income, patients’ satisfaction (a. quality, b. information); Individual needs: smoking, BMI; Environment: region]. Bivariate analysis using a chi-square test for independence, unadjusted and adjusted logistic regression was conducted using SAS v 9.4. Of the study population, 57.9% reported measuring blood pressure at home. Approximately 95.6% and 94.2% of beneficiaries were satisfied with the quality of care received and information about their symptoms respectively. Bivariate analysis showed a significant relationship between total office visits and home BP measurement (p<0.05). Unadjusted logistic regression results noted that those who reported home BP measurement had increased odds of high total office visits [uOR: 1.17 (1.02-1.33)]. This relationship was slightly increased in the adjusted analysis when accounting for other factors of interest [aOR:1.22 (1.06- 1.40)]. Those aged 65-74 years had reduced odds [aOR: 0.77 (0.61 -0.98)], females had increased odds [aOR: 1.38 (1.19 – 1.61)], and those with higher education had increased odds [aOR: 1.41 (1.14 -1.75)] of high total office visits. Those not enrolled in MA [aOR: 3.37 (2.31- 4.90)] and those who earn $25,000 or more [aOR: 1.23 (1.04 -1.45)] had increased odds of high total office visits. Those who have never smoked [aOR: 0.81 (0.69-0.94)] and those from the non-metro region [aOR: 0.65 (0.56-0.76)] had reduced odds of high total office visits. We conclude that those who engage in home BP monitoring are more likely to have a high number of total office visits. The use of home BP monitoring could reflect the severity of high BP suggesting the need for regular follow-up and frequent use of services. Further studies that explore this association are recommended.

Bakgrund: Digitaliseringen syftar till att underlätta en god och jämlik vård. Information- och kommunikationstekniken (IKT) är under snabb utveckling där Covid- 19 pandemin bidragit till ökad användning av digitala verktyg inom primärvården, där ett exempel är videobesök. Syfte: Att undersöka patienters, läkares och sjuksköterskors uppfattningar och upplevelser av digitala videobesök inom primärvården.  Design: Systematisk litteraturstudie med kvalitativ design. Metod: I studien inkluderades 13 kvalitativa artiklar. Materialet analyserades via innehållsanalys med induktiv ansats. Resultat: Presenteras i fyra kategorier; Digitala aspekter där tekniska förutsättningar är väsentliga för adekvata videobesök och att konfidentialiteten bevaras. Praktiska möjligheter och utmaningar innebär för patienter ökad tillgänglighet samt tidsbesparing och för vårdpersonal förbättrad interprofessionell samverkan. Däremot finns olika åsikter avseende arbetsbördan. Möjligheter och utmaningar i interaktionen mellan patient och vårdgivare där videobesök kunde underlättas vid etablerad vårdrelation. Fler fördelar än telefonsamtal, möjliggör icke verbal kommunikation. Tillämpbara kontexter är bland annat lättare sjukdomstillstånd utan behov av fysisk undersökning och uppföljningsbesök. Videobesök kan lämpas för patienter boende på landsbygden, begränsade till hemmet, yngre eller med adekvat digital litteracitet.  Konklusion: Det är av stor vikt att videobesök används till “rätt” patienter vid “rätt” tillfällen för att uppnå en effektiv och säker användning. Nyckelord: läkare, patienter, primärvård, sjuksköterskor, videobesök / Background: Digitalization aims to facilitate good and equal care. Information and communication technology (ICT) is under rapid development, where the Covid-19 pandemic has contributed to increased use of digital tools in primary care, where an example is video visits. Aim: To investigate patients', doctors' and nurses' perceptions and experiences of digital video visits in primary care. Design: Systematic literature review with qualitative design. Method: The study included 13 qualitative articles. The material was analyzed with content analysis with an inductive approach. Results: Presented in four categories; Digital aspects where technical conditions are essential for adequate video visits and that confidentiality is maintained. Practical opportunities and challenges for patients increased accessibility as well as time savings and for healthcare staff improved interprofessional collaboration. There are different opinions regarding the workload. Opportunities and challenges in the interaction between patient and caregiver where video visits could be facilitated with an established care relationship. More benefits than phone calls, enables non-verbal communication. Applicable contexts include mild medical conditions without the need for a physical examination and follow-up visit. Video visits can be suitable for patients living in rural areas, the housebound, younger or with adequate digital literacy. Conclusion: It is of great importance that video visits are used to the "right" patients at the "right" occasions to achieve an effective and safe application. Keywords: nurses, patients, physicians, primary care, video visits

Background: Tertiary hospitals have multiple specialist outpatient clinics attended by patients suffering from various comorbid diseases. This results in individuals attending more than one clinic per month, since dedicated clinic days are seldom on the same day. As patients attend discrete clinics, they have separate encounters with various prescribers, increasing the potential for irrational drug use. In addition, multiple clinic visits have a negative socio-economic impact on health care users from poorer communities where financial resources are limited due to transport expenses and days of work missed. The aim of this study was to determine the prescribing pattern of drugs to chronic disease outpatients, and find possible solutions to provide a system that would reduce overprescribing of chronic medication at Steve Biko Academic Hospital (SBAH) in one measure namely drug duplication. Methods: A retrospective descriptive cross-sectional study with the use of convenience sampling was employed to determine the medication prescribing practises to comorbid chronic disease patients attending multiple specialist clinics at SBAH from February 1, 2018-May 31, 2018. Participants were selected according to their appearance in the hospital records, with sample saturation reached when each participant had visited all the different clinics. Chronic disease outpatients attending the SBAH clinics had reviews every three months. The reviews were controlled by issuing patients with medication for a three-month period, where after a follow up visit was mandatory in order to ensure prescription and medication renewal. Therefore, each patient visited all the clinics rendering a service relating to a specific chronic condition within a four-month period that determined the study period chosen. Hospital records of patients attending the most frequently visited clinics as reported by the SBAH Pharmacy and Therapeutics committee (PTC) were evaluated. These clinics included outpatient departments of diabetes, haematology, internal medicine, neurology, oncology and psychiatry. Each drug prescription observed was evaluated using guidelines of World Health Organization (WHO) titled, “How to investigate drug use in health facilities: selected drug use indicators.” Prescribing indicators relevant to this study were used from the WHO guidelines. Results: One hundred and six patients were multiple clinic-attendees during the study period. Of the 106 patients retained, 103 (97.17%) patients attended two clinics and three (2.83%) patients attended three clinics. Regarding the WHO prescribing indicators, the average number of visits to SBAH by the comorbid chronic disease outpatients observed was 3.03 visits during the four-month study period. Prescription analysis included 80 (75.47%) patients out of 106 patients attending multiple clinics at the same time. The average number of drugs prescribed per encounter was 4.97. The results also showed that 45.45% of the 187 prescriptions observed contained five or more drugs. Most frequently prescribed drugs were tramadol 51 (5.49%), followed by simvastatin 48 (5.17%) and enalapril 45 (4.84%). Drug duplication occurred in 68 individual cases in the 80 patients observed. In total, drug duplication affected 39 patients (48.75%) [95% CI = 37.80%: 59.70%]. The most duplicated drug classes were analgesics 18 (26.47%), followed by anti-depressants 14 (20.59%) cases recorded. Conclusion: The results from this study support findings from similar studies at different institutions. The study confirmed multiple clinic visits are prevalent in the medical disciplines, often prescribing drugs from the same class. Clinical implications from these frequent and separate encounters may result in irrational prescribing, adverse drug events, drug-drug interactions and polypharmacy. The establishment of polypharmacy to comorbid chronic disease patients indicates the high risk of drug-drug interactions and adverse drug events. A prospective study would have provided more data for analysis to determine the level of polypharmacy and drug duplication. Thus, supplementation of this study with further studies could provide conclusions on whether the patients suffered from problematic or had appropriate polypharmacy. Physicians treating multiple clinicattendees should be equipped to monitor rationality of prescribing encounters. Installation of an advanced electronic Hospital Information System (HIS) could aid in improving drug prescribing in tertiary hospitals. Use of electronic prescribing tools as shown in previous studies is a requirement to improve tertiary hospitals in developing countries such as SBAH. The incidence of drug duplication at SBAH builds on existing evidence of unnecessary healthcare costs because of medication errors. / Dissertation (MSc)--University of Pretoria, 2020. / Pharmacology / MSc (Pharmacology) / Unrestricted

No description available.