abstract: Chronic illness can be a stressful experience that requires coping and support. In the last twenty years, Shared Medical Appointments (SMAs) were developed in U.S. healthcare as a response to the rising rates and challenges of chronic disease management. Due to the infancy of the SMA model, however, little is known or understood about the benefits of group medical care for patients. To date, scholars have not explored or systematically observed the communicative aspects of the SMA model. Communal coping, a theoretical framework that foregrounds group interaction and communication, offers a pragmatic lens for exploring how patients collectively cope with the stressors of chronic illness in the context of SMAs. Using qualitative methods, I conducted participant observation of SMAs at a Veterans Affairs hospital to analyze the communicative, transactional nature of communal coping as it unfolded among heart failure patients, family members, and providers in context. I also conducted interviews with SMA attendees. Analysis is based on 56 hours of fieldwork and 14 hours of interviews. Findings of this dissertation revealed group members who attended heart failure SMAs engaged in communal coping to manage the stressors of chronic illness. Group members moved through four primary phases of the communal coping process: (1) establish a communal coping orientation; (2) discuss shared stressors; (3) engage in cooperative action; and (4) practice communal reflexivity. Findings suggest patients become empowered by group interaction during SMAs as they move through each phase of the communal coping process. This dissertation also highlights various communicative strategies providers' use during SMAs to facilitate communal coping and group interaction. Theoretically, this dissertation expands upon existing knowledge of communal coping by exploring how individuals embody and socially construct the communal coping process. Specifically, this dissertation extends past models of communal coping with the addition of the communal reflexivity phase and through conceptualizing communal coping as a facilitated process of empowerment. Pragmatically, this research also offers insight to the benefits patients derive from attending SMAs, such as reduced feelings of stigma and isolation and improved motivation. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2015

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Appointment no-shows are a problem in healthcare organizations. It is important that appointment intake and scheduling processes are effective in both meeting client needs and efficient in meeting organizational business requirements. This study examined baseline levels of appointment keeping in a not-for-profit medical/behavioral pediatric services clinic, analyzed existing administrative processes, introduced additional appointment keeping reminders, and presented systematic, performance management tutorials for clinic employees. Results indicate an increase in percentage of appointments kept and a decrease in appointment lag time.

In order to complement existing empirical research on democratic consolidation in Kenya and the role of the judiciary in particular, this mini-­‐dissertation analyses the relationship between judicial appointment processes and judicial independence in Kenya. The escalation of corruption, centralisation and abuse of power by the executive, the lack of government accountability and post-­‐election conflict of 2007 is linked to the dominance of the executive and corresponding subservience of the judiciary. Historically, judicial appointments have been the ambit of the President. The powers given to the President to appoint and remove judges have resulted in judicial appointments premised on allegiance to the executive rather than on upholding justice and the Bill of Rights. To rectify this deficiency, the 2010 Constitution has introduced a merit based system of judicial appointments that meets international standards on judicial independence. The new process requires the President to limit his appointments to the recommendations of a Judicial Service Commission whose responsibility it is to shortlist candidates through a transparent public process. An analysis of the selection of Kenya’s sitting Chief Justice and Deputy Chief Justice demonstrates that the reformed judicial appointment process has delegitimised the executive’s dominance over the judiciary and by so doing has placed Kenya on the road restoring judicial independence. / Dissertation (MPhil)--University of Pretoria, 2012. / gm2014 / Centre for Human Rights / unrestricted

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Lower socioeconomic status, ethnicity, and race are associated with reduced health care use in the United States. Patients who continually miss their appointments suffer significant negative results, including a disruption in continuity of care, complications with their chronic illnesses, and an increase in hospital readmissions. The health belief model was used as the theoretical support for this project that investigated the underlying causes of no-shows at an urban hospital-based outpatient clinic in the United States. It used a quantitative, descriptive design and examined a minority, underserved, and underinsured population that was receiving care at the research site and had a fairly consistent 30% no-show rate. Data was collected by anonymous survey from 151 patients and 22 health care providers and analyzed via means, t tests, and an ANOVA. Female patients were significantly more likely than male patients to approve of the current scheduling system at the site, in which patients simply call the clinic for an appointment (p = 0.040). White (non-Hispanic) patients in general had a statistically lower interest in receiving appointment reminders via text compared to the rest of the population (p=0.024). Patients who were 29 years old and younger were significantly less likely than patients who were 30 years old and over to indicate that they did not show up to appointments due to a lack of insurance (p '? 0.001). This project promoted positive social change by increasing patient, staff, and stakeholder awareness of the reasons patients miss their appointments. The findings of this project can be used to improve appointment scheduling, reduce patient wait times, increase patient satisfaction, and increase cost savings to the clinic.

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Bakgrund: Övervikt och fetma är ett av samtidens största hot mot den globala folkhälsan. Människor med övervikt och fetma utsätts för stigmatisering och fördomar såväl i samhället som inom vården. Stigmat alstrar ohälsa och många patienter med övervikt och fetma uppger ett såväl fysiskt som psykiskt lidande. Sjuksköterskor inom primärvården har ett stort ansvar i arbetet mot övervikt och fetma då primärvården ofta är den första vårdinrättning patientgruppen kommer i kontakt med. Syfte: Att beskriva sjuksköterskors erfarenheter av att möta patienter med övervikt och fetma inom primärvården. Metod: En kvalitativ allmän litteraturöversikt med en induktiv ansats genomfördes. Resultatet består av 10 originalartiklar som analyserats utifrån kvalitativ innehållsanalys. Resultat: Resultatet genererade två huvudkategorier; 1) Möjligheter i möten samt 2) Hinder i möten. Fyra tillhörande underkategorier identifierades. Dessa påvisade hur sjuksköterskorna redogjorde för en bristande konsensus avseende bemötande och behandling av patientgruppen. Slutsatser: Mer kunskap avseende bemötande samt behandling av patienter med övervikt och fetma behövs bland sjuksköterskor inom primärvården. / Background: Overweight and obesity is one of today's greatest threats to global public health. People with overweight and obesity are exposed to stigma and prejudice both in society and in healthcare. The stigma generates ill health and many patients with overweight or obesity report both physical and mental suffering. Nurses in primary care have a responsibility in the work against overweight and obesity as primary care often is the first care facility the patient group meets. Purpose: To describe nurses' experiences of meeting patients with overweight and obesity in primary care. Method: A qualitative general literature review with an inductive approach was implemented. The result consists of 10 original articles analyzed based on qualitative content analysis. Results: The result generated two main categories; 1) Opportunities in meetings and 2) Obstacles in meetings. Four associated subcategories were identified. These showed how the nurses reported a lack of consensus regarding the treatment of the patient group. Conclusions: More knowledge regarding the treatment and treatment of patients with Overweight and obesity is needed among primary care nurses.

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The participant is a 61-year-old woman, diagnosed with a generalized anxiety disorder and profound intellectual disability who was referred to a behavior-disorders clinic, to increase cooperation with routine dental procedures. I used a behavioral treatment package consisting of stimulus fading, differential reinforcement, and extinction to establish tolerance of, and cooperation with, routine dental procedures. Results showed that cooperative responding varied throughout the progression of teaching the prerequisite steps (sitting in a chair, sitting in a variety of chairs, then working on sitting in the dental chair). However, by the end of the study, the participant engaged in the behavior of open mouth for 30 s and tolerated/cooperated with the experimenter using a plastic visual inspection tool for 30 s. Further research should evaluate the effectiveness of a similar treatment package to develop a more streamlined and systematic framework to improve compliance and tolerance.