Thesis (M.S.) -- University of Texas Southwestern Medical Center at Dallas, 2006. / Not embargoed. Vita. Bibliography: 92-100.

Thesis (M.S.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 33 pages. Includes Vita. Includes bibliographical references.

Estudo de caso Ãnico com o objetivo geral de avaliar a estrutura, o processo e o resultado da atenÃÃo em diabetes no Centro Integrado de Diabetes e HipertensÃo de Barbalha-CearÃ. Da amostra constaram 108 prontuÃrios de saÃde de usuÃrios com diabetes mellitus tipo 2 e nove profissionais envolvidos na atenÃÃo em diabetes. A coleta de dados desenvolveu-se no perÃodo de julho a dezembro de 2011 utilizando-se de trÃs fontes de evidÃncias: prontuÃrios de saÃde, mapas e observaÃÃo direta. Para anÃlise adotou-se AvaliaÃÃo de Cuidados em SaÃde proposta por Donabedian (1980). Em relaÃÃo à caracterizaÃÃo dos usuÃrios, segundo se constatou ,85,2% eram do sexo feminino, mediana de idade de 67 anos, tempo de tratamento com mediana de 8 anos, 97,7% tinham hipertensÃo arterial, 91,6% estavam em acompanhamento com endocrinologista, 46,3% em uso de antidiabÃtico oral associado a anti-hipertensivo e insulina, 24,1% de aspirina e 23,1% de estatinas. Quanto ao componente estrutura, a estrutura fÃsica contraria em parte o preconizado pela AgÃncia Nacional de VigilÃncia SanitÃria, portanto, inadequada para atender plenamente as necessidades dos usuÃrios e dos profissionais. No tocante aos recursos materiais, medicamentos e insumos, suprem as necessidades quanto Ãs quantidades existentes. No referente ao componente processo, as consultas de enfermagem nÃo sÃo baseadas na metodologia da assistÃncia, as mÃdicas sÃo centradas na relaÃÃo queixa-conduta e as de nutriÃÃo na prescriÃÃo do plano e educaÃÃo alimentar. OrientaÃÃes quanto à alimentaÃÃo foram ofertadas aos usuÃrios pelo enfermeiro e mÃdico, com Ãnfase na restriÃÃo do sal, do aÃÃcar, das gorduras e na diminuiÃÃo dos carboidratos, enquanto os nutricionistas abordaram aspectos dos grupos alimentares, suas substituiÃÃes e regularidade dos horÃrios das refeiÃÃes. Apenas o endocrinologista orientou sobre atividade fÃsica. Quanto Ãs orientaÃÃes sobre medicamentos, o enfermeiro foi o principal responsÃvel. Evidenciaram-se lacunas no inerente à oferta de orientaÃÃes educativas grupais pelos profissionais de saÃde aos usuÃrios. O exame dos pÃs dos usuÃrios nÃo fazia parte do atendimento do endocrinologista e do enfermeiro. O auxiliar e o tÃcnico de enfermagem realizavam a verificaÃÃo da glicemia capilar, da pressÃo arterial, do peso corporal e da altura. Enquanto o recepcionista e o auxiliar de serviÃos gerais desempenharam parte das suas competÃncias tÃcnicas, o auxiliar e o tÃcnico de enfermagem apresentaram o maior nÃmero de registros nos prontuÃrios, seguidos pelo mÃdico. Embora o registro das consultas de nutriÃÃo tenha se revelado incipiente e as de enfermagem nÃo tenham atingido a totalidade dos prontuÃrios, o registro da aferiÃÃo da pressÃo arterial, da glicemia capilar e o do peso à prÃtica estabelecida na rotina do centro. Jà o registro da altura e do Ãndice de massa corpÃrea foi incipiente, enquanto o da circunferÃncia abdominal foi inexistente. No tocante ao exame do pà e do olho, os percentuais de registro foram baixos no perÃodo investigado. Segundo constatado, o registro de exames laboratoriais nÃo alcanÃou a totalidade dos prontuÃrios investigados, mas o registro de orientaÃÃes acerca da alimentaÃÃo e atividade fÃsica obteve percentuais expressivos no perÃodo estudado. Houve lacunas de registros quanto a estratÃgias educativas grupais referentes ao tratamento medicamentoso e nÃo medicamentoso. Quanto ao componente resultado, constatou-se no ano de 2007 que o serviÃo atendeu a exigÃncia do indicador LDL colesterol < 100mg/dl, em 2008 cumpriu o determinado para os indicadores hemoglobina A1c > 9%, A1c < 7% e o LDL < 100mg/dl. Contudo, no ano de 2009, o Ãnico indicador alcanÃado foi o LDL < 100 mg/dl. Diante dos resultados encontrados e compreendendo a avaliÃÃo em saÃde como instrumento para tomada de decisÃo, ressalta-se a importÃncia da atenÃÃo do gestor municipal, coordenaÃÃo e profissionais em reestruturar o referido centro em face das fragilidades constatadas. / This is a single case study that aimed to assess the structure, the process and the outcome of diabetes care in the Integrated Center for Diabetes and Hypertension of Barbalha-CE, Brazil. The sample consisted of 108 medical records of patients with diabetes mellitus type 2 and nine professionals involved in diabetes care. Data collection was carried out from July to December 2011, using three sources of evidence: medical records, maps and direct observation. For the analysis, we used the Health Care Evaluation proposed by Donabedian (1980). Regarding the characterization of users, we verified that 85.2% were female, median age of 67 years, with median treatment time of 8 years, 97.7% had hypertension, 91.6% were in endocrinology follow-up, 46.3% were using oral antidiabetic associated with antihypertensive and insulin, 24.1% aspirin and 23.1% statins. Regarding the component structure, the physical structure partly contradicts the recommendations of the National Agency for Sanitary Vigilance, therefore inadequate to fully meet the needs of users and professionals. As for the material resources, medicines and supplies, they met the needs concerning the existing quantities. Regarding the component process, we verified that nursing consultations are not based on the assistance methodology; medical consultations are centered on the complaint-behavior relationship; and nutrition consultations in the plan prescription and nutrition education. Guidelines on eating were offered to the users by nurses and doctors, focusing on restriction of salt, sugar, fat and carbohydrates decrease, while nutritionists approached aspects of the food groups, their replacements and regularity of mealtimes. Only the endocrinologist advised about physical activity. Regarding the guidelines on medication, nurses were the main responsible. We identified gaps inherent to the offer of group educational guidelines to users by health professionals. The foot examination was not part of the assistance of endocrinologists and nurses. The nurse assistants and technicians performed the verification of blood glucose, blood pressure, body weight and height. The receptionist and general services assistant played part of their technical skills, while the nurse assistants and technicians presented the highest number of medical records, followed by doctors. Although the register of nutrition consultations has proved incipient and the nursing consultations have not fully reached the records, the register of blood pressure, blood glucose and weight measurements are established practices in the daily routine of the center. The register of height and body mass index was incipient, while waist circumference was nonexistent. Regarding the foot and eye examination, the registration rates were low in the investigated period. We found that the register of laboratory tests did not reach all the records investigated, but the register of guidelines on diet and physical activity presented significant percentage during the study period. There were gaps in records on the group educational strategies concerning the medical and non-medical treatment. Regarding the component outcome, we verified that in 2007 the service has met the requirement of the indicator LDL cholesterol < 100mg/dl, in 2008 it has met the specific indicators for A1c hemoglobin > 9%, A1c < 7% and LDL < 100 mg/dl. However, in 2009, the only indicator achieved was LDL < 100 mg/dl. Considering the results found and understanding the health services evaluation as a tool for decision-making, we highlight the importance of the attention of the city manager, coordination and professionals in order to restructure the center in study, given the weaknesses noted.

Patient safety culture (PSC) is a critical factor in creating high reliability healthcare organizations. However, few studies to date have correlated PSC measures with actual safety outcomes. In particular, nursing home studies have only recently appeared in the literature. Nursing homes differ from hospitals in that the vast majority of direct care is provided by certified nursing assistants (CNAs), not licensed nurses. Thus nursing home PSC could differ in important ways from PSC in acute care institutions. This dissertation was a secondary data analysis that examined whether CNAs’ perceptions of patient safety culture were correlated with clinical outcomes in a random sample of 74 nursing homes in five randomly selected states. This study matched CNA PSC survey data using the Hospital Survey of Patient Safety Culture (HSOPSC) with Minimum Data Set (MDS), Area Resource File (ARF) and Online Survey Certification and Reporting (OSCAR) data from those same homes during the first two quarters of 2005. In the original study, 1579 nurse aides out of 2872 completed the survey, for a 55% response rate. In addition to clinical outcomes, this study examined the relationship between CNA PSC scores and staff turnover. The relationship between certain demographic variables, such as level of education, tenure as a CNA, and PSC scores was evaluated. The relationship between certain facility characteristics, such as profit status and bed occupancy was also assessed. An exploratory factor analysis of the original HSOPSC instrument was re-run for this nursing home CNA sample. Data were analyzed using Poisson regression and multilevel techniques; descriptive statistics were compiled for demographic data. Major findings from the regression analyses and combined GEE models suggest that certain factors, such as CNA turnover and LPN staffing may predict CNA PSC scores. CNA PSC scores were associated with rates of falls and restraint use, but were not associated with differences in pressure ulcer rates in this sample. Few associations for CNA PSC with individual subscales were identified. The exploratory factor analysis revealed some potential differences in how items and subscales factored in this nursing home CNA population. This dissertation represents an important step in the evaluation of CNA PSC in nursing homes and the relationship of PSC to safety outcomes. Future work on nursing home PSC and clinical and workforce outcomes is described.

The aim of this study was to measure the effects of audiologic intervention on self-perceived quality of life in the elderly hearing-impaired population. The tested hypothesis was that hearing aid use would result in improved quality of life as measured by utilities. In this study, utilities were obtained using the U-Titer II, an interactive software program designed to measure an individual's health state preference or utility. This study also examined the issue of numeracy, which is described as an understanding of basic probability, and its effect with an individual's ability to accurately complete utilities. Data from 54 individuals fit with hearing aids in this randomized, controlled, pre-test/post-test experimental design study were analyzed. The participants completed the U-Titer II, a test of numeracy and the International Outcome Inventory for hearing Aids (IOI-HA). Three utility approaches were used in this study: Time Trade-Off (TTO), Standard Gamble (SG) and Rating Scale (RS). With each of the utility approaches, disease-specific (e.g., deafness vs. perfect hearing) and generic (death vs. perfect health) anchors were incorporated. Several research questions were posed to examine the sensitivity of utilities to hearing aid intervention. Question 1: Can the effects of hearing aid intervention be determined with a utility approach? Statistically significant differences between pre- and post-intervention utility scores were measured with disease-specific and generic anchors for only the TTO and RS approaches. These findings suggest that hearing aid intervention outcomes can be measured using either the TTO or RS utility approaches. Question 2: Is numeracy ability a factor in the usefulness of a utility approach for assessing the effects of hearing aid intervention? Statistical analysis showed that mean utility scores changed very little as a function of numeracy ability. These findings suggest that numeracy ability does not appear to affect utility scores. Question 3: What, if any, are the relationships between hearing aid benefit as measured by a utility approach and hearing aid benefit as measured by the IOI-HA? Spearman Rho correlations were conducted on the benefit data obtained from the two self-report measures (IOI-HA and utilities). The major findings from these analyses determined that the IOI-HA total scores were significantly correlated with utility outcomes as measured by TTO generic, TTO disease-specific, and RS disease-specific anchors. In general, correlations between the measures were higher with the disease-specific anchors than the generic anchors. Also, none of the correlations between any IOI-HA outcome domains and utility change scores with generic anchors obtained with the RS scale were significant. For utilities measured with disease-specific anchors, significant correlations were found with two IOI-HA outcome domains (benefit and satisfaction) and utility change scores as measured by the TTO technique. When the RS technique was utilized, significant correlations were found for four of the seven outcome domains (benefit, satisfaction, participation and impact of others). Thus, if the IOI-HA is used as a measure against which to validate the utility approach as a measure of hearing aid outcomes, the measure with the most face validity is a RS method with disease-specific anchors. However, if one wished to compare hearing aid intervention to intervention in other areas of health care, these data support the use of a TTO approach.

In 2014 Bodenheimer and Sinsky published the Quadruple Aim model, which argued that healthcare provider wellbeing was the missing link to improving patient and population health outcomes, as well as cost containment. Rather than treating burnout, however, experts in fields outside healthcare are finding validity in promoting thriving at work as a means to prevent burnout and improve employee satisfaction, engagement, and productivity. The purposes of this study were to investigate the relationship between thriving and emotional exhaustion (which is widely considered a core element of burnout) in healthcare providers, and the impact thriving had on primary care population health outcomes as measured by quantifiable value-based quality performance metrics. Using Georges' (2013) Emancipatory Theory of Compassion and Bodenheimer and Sinsky's Quadruple Aim as conceptual frameworks, this descriptive, non-experimental study used advanced applied biostatistical techniques to analyze archival data from the December 2018 UCHealth Physician and Advanced Practice Provider Voice Survey as well as provider performance scores from the same time period. Results of the study were mixed, showing that while there is an inverse relationship between thriving and emotional exhaustion in healthcare providers, thriving did not predict population health outcomes. By evaluating thriving in healthcare providers in relation to emotional exhaustion and in context of value-based health care delivery systems, this study was the first of its kind. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

No description available.

Background: Multiple studies have shown that people who have experienced a serious health problem such as an injury tend to overrate the quality of health they had before that event. The main objective of this study was to test whether the phenomenon of respondents overrating their past health can also be observed in people from the general population. A second aim was to test whether habitual optimism is indeed focused on events in the future. Method: A representatively selected community sample from Leipzig, Germany (n = 2282, age range: 40–75 years) was examined. Respondents were asked to assess their current health, their past health (5 years before), and their expected future health (in 5 years) on a 0–100 scale. In addition, the study participants completed several questionnaires on specific aspects of physical and mental health. Results: Respondents of all age groups assessed their health as having been better in the past than it was at present. Moreover, they also assessed their earlier state of health more positively than people 5 years younger did their current state. Habitual optimism was associated with respondents having more positive expectations of how healthy they will be in 5 years time (r = 0.37), but the correlation with their assessments of their current health was nearly as high (r = 0.36). Conclusion: Highly positive scores of retrospectively assessed health among people who have experienced a health problem cannot totally be accounted for by a response to that health problem.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-21T18:42:47Z No. of bitstreams: 1 elaineamaraldepaula.pdf: 1460978 bytes, checksum: ff78f9b1f4676773753eff8e58c634ed (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T18:48:39Z (GMT) No. of bitstreams: 1 elaineamaraldepaula.pdf: 1460978 bytes, checksum: ff78f9b1f4676773753eff8e58c634ed (MD5) / Made available in DSpace on 2016-01-25T18:48:39Z (GMT). No. of bitstreams: 1 elaineamaraldepaula.pdf: 1460978 bytes, checksum: ff78f9b1f4676773753eff8e58c634ed (MD5) Previous issue date: 2014-12-11 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / INTRODUÇÃO: O Centro HIPERDIA Minas do município de Juiz de Fora (CHDM/JF) se caracteriza pela oferta de atenção compartilhada em nível especializado para hipertensos, diabéticos e renais crônicos encaminhados a partir Atenção Primária à Saúde (APS). Nesse modelo de atenção, a APS deve atuar como centro coordenador do cuidado acompanhando toda a trajetória do usuário na rede por meio de ferramentas específicas e de estratégias de comunicação entre profissionais da APS e da atenção secundária a saúde. O CHDM/JF oferece atendimento interdisciplinar e exames específicos, para usuário com doença renal crônica (DRC) secundária a hipertensão arterial ou diabetes mellitus, nos estágios 3-B, 4 e 5 e / ou com o declínio da taxa de filtração glomerular ≥ 5 mL/min/ano. Por sua vez a APS representa o primeiro contato do usuário com DRC na rede de atenção à saúde, evidenciando a importância da participação dos profissionais da APS na detecção precoce dessa condição. OBJETIVO: Avaliar a estrutura das unidades de atenção primária (UAPS), os processos de trabalho e os resultados da atenção aos grupos de risco para DRC. MÉTODOS: Estudo avaliativo, de abordagem quantitativa, realizado em 14 pontos da APS e um centro de atenção secundária do município de Juiz de Fora, MG, no período de 2010 a 2012. As informações de “Estrutura” e “Processo” foram obtidas através de questionário semiestruturado aplicado a médicos, supervisores e agentes comunitários. Os resultados da atenção foram avaliados por meio de indicadores clínicos obtidos em prontuários. As UAPS foram classificadas de acordo com o grau de implantação dos critérios de “Estrutura” e “Processo” direcionados à atenção à DRC. RESULTADOS: A classificação do grau de implantação das UAPS revelou que 36% eram “implantadas” e 64% “parcialmente implantadas” ou “não implantadas”. As UAPS “implantadas” apresentaram melhores taxas de estabilização da taxa de filtração glomerular estimada (51%) quando comparadas às UAPS “parcialmente implantadas” (36%) e “não implantadas” (44%) (p=0,046). Além disso, as UAPS “implantadas” encaminharam os usuários à atenção secundária em estágios mais precoces da DRC (estágio 3B) quando comparadas as UAPS “não implantadas” (58% vs 36%) (p=0,049). CONCLUSÃO: As UAPS com pontuação mais elevada em critérios de “Estrutura” e “Processo” para atenção à DRC apresentaram melhores desfechos clínicos. / INTRODUCTION: The HIPERDIA Minas Center Juiz de Fora (CHDM/JF) is characterized by primary care and specialist collaboration in the care of patients with hypertension, diabetes and chronic kidney disease (CKD). In this model of care, the primary health care (PHC) should serve as the coordinating care center throughout the trajectory of the user on the network through specific tools and strategies for communication between professionals in PHC and secondary health care. The CHDM/JF offers interdisciplinary care and specific tests for chronic kidney disease patients (CKD) secondary to hypertension or diabetes mellitus, from the stages 3b to 5 and/or with a decline of estimated glomerular filtration rate ≥5 mL/min/year. In turn PHC represents the first contact of the user with chronic kidney disease on the health care network, highlighting the importance of the participation of PHC professionals in the early detection of this condition. AIM: To evaluate the structure of primary care units (PCU), the work processes and outcomes of care for at risk groups for CKD. METHODS: Evaluative study with a quantitative approach, performed in 14 points of primary care and one center of secondary care in the city of Juiz de Fora - MG, Brazil, in the period ranging from 2010 to 2012. The information of "structure" and "process" were obtained by a semistructured questionnaire applied to physicians, administrators and community workers. The clinical parameters were assessed using clinical indicators obtained from medical records. The PCU were classified according to the degree of implantation of the “Structure” and “Process” criteria directed to the attention of the CKD. RESULTS: The classification of the degree of implantation of the PCU showed that 36% were “implanted” and 64% “partially implanted” or “not implanted”. The “implanted” PCU showed better stabilization rates of the glomerular filtration rate (51%) than the “partially implanted” (36%) and “not implanted” (44%) PCU (p=0,046). Moreover, the "implanted" UAPS forwarded users to secondary care at earlier stages of CKD (stage 3B) than the "not implanted" PCU (58% vs. 36%) (p=0.049). CONCLUSION: PCU with higher grades in the criteria of "structure" and "process" for attention to CKD showed better clinical outcomes.

Bakgrund: Patienter med svår smärtproblematik utsätts för ett stort lidande och risken för psykiska- och fysiska komplikationer ökar. För att behandla dessa patienter på bästa sätt krävs adekvat smärtbehandling. För att kunna följa upp och utvärdera både smärtan och smärtbehandlingen är det viktigt med en god smärtdokumentation. Syfte: Att studera smärtdokumentationen hos tidigare inneliggande patienter med smärtproblematik som under denna tid blivit konsulterade av Smärtcentrum på Akademiska sjukhuset, samt jämföra dokumentationen mellan de avdelningar som studerats. Metod: Studiens forskningsdesign är en kvantitativ retrospektiv empirisk studie där journaler för patienter vars vård Smärtcentrum har varit delaktiga i under 2015 utgjorde datan för studien. Det var 30 ortopedjournaler och 28 onkologjournaler som granskades. Resultat: Resultatet visade att patienterna fick sin smärta dokumenterad två gånger eller färre under en period på tretton dagar. Smärtskattning dokumenterades mest frekvent. Något signifikant samband mellan längden på patienternas vårdtid och frekvens i smärtdokumentation kunde inte konstateras. Det fanns en skillnad i frekvensen av smärtdokumentationen mellan onkologavdelningarna och ortopedavdelningarna. Slutsats: Frekvensen av smärtdokumentationen på de granskade avdelningarna visade sig vara undermålig och följer därmed inte de riktlinjer som finns. Detta försvårar arbetet för både konsultverksamheten samt personal på berörda avdelningar att få en helhetsbild kring patienternas smärtproblematik.  Risken ökar för både komplikationer och lidande hos patienterna. Ytterligare forskning krävs för att undersöka vad anledningen till den bristande dokumentationen är. / Background: Patients with severe pain are subjected to great suffering and the risk of psychological- and physical complications increases. To treat these patients optimally it requires adequate pain management. In order to monitor and evaluate both the pain and the pain treatment it is important with pain documentation. Objective: To study the documentation of pain on previously hospitalized patients with pain problems who during that time were consulted by the Pain Centre at Akademiska hospital, as well as compare the documentation between the included wards. Method: The design is a quantitative retrospective empirical study of medical records of patients consulted by Pain Centre at Akademiska hospital during 2015. The final sample consisted of 30 records from the orthopedic clinic and 28 from oncology clinic. Results: The results showed that the hospitalized patients had their pain documented less than twice during a period of thirteen days. Pain Measurment was documented most frequently. No significant correlation between the length of care and frequency of pain documentation could be found. There was a difference in the frequency of pain documentation between the included wards. Conclusion: The frequency of pain documentation for the consulted patients in the included wards at Akademiska hospital proved to be deficient and does not follow the guidelines. This complicates the work of the health care staff, and the monitoring and evaluation of the treatment. This also increases the risk of complications and suffering of the patients. Further research is required to investigate the reason of the lack of documentation.