A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

Class of 2009 Abstract / OBJECTIVES: The purpose of this study is to determine if a pharmacist run diabetes management clinic assists patients in the successful management of type 1 or type 2 diabetes. METHODS: Patients must have been enrolled and participated in at least one visit to the pharmacist run diabetes management program at North Country Health Care Clinic (“NCHCC”). A retrospective chart review was completed to determine patient outcomes. RESULTS: A total of 82 charts were reviewed and 49 patients were qualified for the study. A total of 19 men (mean age 42.1; SD 12.1) and 30 females (mean age 55.0; SD 14.4) completed at least one visit to the pharmacist run diabetes management program. HbA1c levels were significantly lower after one or more visits to the pharmacist run diabetes clinic (p=<0.001) for all patients. CONCLUSIONS: Patients who participate in the pharmacist run diabetes management clinic appear to successfully lower HbA1c values after at least one visit to the program.

Muslim Charitable Clinics are free healthcare clinics that provide healthcare services to uninsured patients of all faiths, free of charge, and publicly identify as Muslim. This study seeks to better understand Muslim Charitable Clinics’ potential to provide vital healthcare services to communities in need while promoting mutual understanding between Muslim and Non-Muslim Americans. The data consists of a case study of one Muslim Charitable Clinic in Longwood, Florida, the American Muslim Community Clinic, and a national survey of Muslim Charitable Clinics. The American Muslim Community Clinic operates a uniquely flexible model with profound benefits for underserved residents in the surrounding Longwood community. The study will explore how the clinic's Muslim identity may also help promote mutual understanding between Muslim and non-Muslim Americans by providing the Muslim American community with positive exposure and visibility. Comparing the findings from this case study to data reported in a national survey of Muslim Charitable Clinics, this thesis finds that the American Muslim Community Clinic was in many respects representative of many other Muslim Clinics across the country, as the survey demonstrates.

This investigation is an attempt to apply the principles of the experimental analysis of behavior to the stuttering behavior of two clinical subjects. The experimental manipulations were performed in order to bring about a decrement in the stuttering rate of the two subjects.

The study aimed to assess and improve the quality of care for Opuwo District Hospital HIV/AIDS clinic in Namibia. Currently, there is no literature available on the quality of care for the HIV/AIDS clinic at primary level in Namibia. Opuwo District has one of the lowest prevalence rates of HIV/AIDS in Namibia with 8.8% among ANC patients. A total of 1714 HIV positive patients are enrolled at Opuwo District Hospital HIV/AIDS clinic and 109 (6.36%) of them are defaulting treatment. Based on these statistics, I decided to do a quality improvement cycle of the HIV clinic system to see if it would improve adherence. Adherence will improve if the quality of care rendered to patients is standard (18). Aim and Objectives The aim of the research is to improve the quality of care for patients on ARVs, with concern for factors influencing adherence in Opuwo district Hospital. The objectives are as follow: 1) To evaluate the quality of care that was given to patient registered at Opuwo HIV/AIDS clinic since 2007 2) To correct inadequacies discovered during initial evaluation of the clinic to improve the quality of care 3) To evaluate if corrected inadequacies have led to improved quality Method The study design is a quality improvement cycle The quality improvement cycle done was a teamwork that involved trained nurses in HIV, data clerk, counsellors, trained pharmacist in ARV therapy and a doctor. This team audited care rendered by looking at the structure, process and outcome of the care given at the clinic; then inadequacies discovered were corrected and the whole system was re-audited to see if there is improvement. The study population was patients attending HIV/AIDS clinic since 2007 until date and the sample size was fifty with selection made by random sample using simple proportion (HIVQUAL system that was automatically programmed to calculate sample size based on the population of patients entered into the system). Data on structure was carried out prospectively by observing what is on the ground in term of equipment, staff, tools etc. Data for proper documentation, weight checked at every visit, clinical staging at every visit, counselling at every visit, TB screening etc and outcome (regular in clinic attendance, viral load below 1000 after 6months on HAART, etc) were audited retrospectively using patient’s file. Results Using chi-square test to analyse the data, the intervention was successful because the P-values were less than 0.05 in most of the indicators audited for process and outcome. It was found that after the intervention (in-service training, re-enforce proper documentation, re-enforce health education by all staff not limit it to counsellors alone, wall poster to remind staff on ordering investigation for CD4, viral load when due and follow up results by doctor or nurses, weigh check for all patients before starting consultation, doctor and nurses should prescribe IPT, Co-trimoxazole and multivitamins) was made, adherence improved from 46% to 82% and opportunistic infection declined below 15%. Conclusion The quality improvement cycle enabled simple changes like in-service training, re-enforcement of health education by all staff, etc to be made at the clinic, which lead to appreciable quality improvement over a short period.

how does a structure signal change? in the absence of conformational alteration, of opening or closing, a dynamic must develop as a temporal function of the participant's experience. in a place where change is sought after, the mask of the skin is lifted. renewal is found. / Master of Architecture

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University / The intent of this paper is to study by case analysis and follow-up interviews how social workers approached the treatment of six patients who applied to Briggs Clinic in 1950. Their cases were closed as improved but they later returned to the clinic for further treatment. The similarities and differences in the initial and subsequent treatment periods shall be considered, The follow-up interviews were structured to determine what the patients themselves thought of the treatment they had received.

Thesis (M.S.)--Boston University

Class of 2011 Abstract / OBJECTIVES: To identify the pharmacy service needs of providers and staff at the San Luis Walk-In Clinic, and to evaluate whether the addition of a dispensing pharmacy to the clinic will benefit the community of San Luis. METHODS: Two focus groups were conducted with employees of the clinic: one with providers and another with supportive staff. Subjects discussed included major health issues at the clinic, where patients received health care products and information, barriers to receiving health care, beneficial pharmacy services and products, and the role of pharmacists in health care. Data was collected regarding whether participants were providers or staff members and whether they lived within or outside of San Luis. These sessions were audio-recorded, transcribed, and analyzed for recurrent themes and patterns. RESULTS: The first focus group consisted of three providers, one of whom was living within San Luis, and the second group was comprised of six supportive staff members, five of whom were from the community. In regards to pharmacy service needs, providers cited medication management, patient education, and treatment recommendations as beneficial resources. Both groups identified the top four major health problems seen in their clinic as hypertension, diabetes, allergies, and dyslipidemia, and barriers to adequate healthcare included financial issues, time constraints, transportation, and lack of education. CONCLUSION: There is a need for pharmacy services, including medication therapy management and disease state education, at the San Luis Walk-In Clinic. This need likely extends to many rural communities throughout the nation.