Class of 2011 Abstract / OBJECTIVES: To assess the outcomes of care for patients enrolled in a pharmacist-run anticoagulation clinic. METHODS: A retrospective chart review was conducted of patients who received warfarin anticoagulation therapy management at the pharmacist-managed clinic at a community health center. To be eligible for the study patients had to be between the ages of 18-80 and have at least 6 recorded INRs during the first 6 months of treatment in the clinic. The patient data were reviewed for a time period of 24 weeks from the initial visit. The primary dependent variable was whether or not a patient’s INR is within range. Secondary outcomes included frequency of adverse events (blood in urine or stool). A data extraction form was used to collect patient demographics and initial INR values from the patient charts. An odds ratio was used to compare the proportion of INRs in range upon entry into the clinic and after 6 months of care in the clinic. In addition, outcomes were evaluated for differences by gender and age. RESULTS: Sixty-six patients were included in the study; 50% (33) were men and the average age was 55.9 years old (SD = 12.9 years). At baseline, 24 patients had INRs within the therapeutic range. Patients were 5 times more likely to have INRs in range (N = 49; OR = 5.04; p < 0.001) after 6 months of treatment in the pharmacist-managed clinic than at baseline. About 59% of men and 54% of women had INRs in range during 6 months of therapy in the clinic (p=0.326). Patients under 55 were in range about 55% of the time over 6 months, while patients over 55 were in range about 59% of the time (p=0.366). CONCLUSION: Patients enrolled in the pharmacist-run anticoagulation clinic were more likely to have therapeutic INRs after 6 months of care in the clinic compared to baseline.

Magister Public Health - MPH / Background: Over the past decade, South Africa has scaled-up its antiretroviral treatment (ART) programme in an effort to control the HIV epidemic. Interventions to support the rollout of ART include task shifting ART initiation to nurses at primary health care level and ensuring HIV adherence counselling at every visit by lay counsellors. Furthermore, community-based outreach teams work at the community level to follow up on patients and ensure that patients remain in care and are adhering to ART. Despite all these efforts, poor adherence to ART remains a pertinent problem. In 2016, the national adherence to ART rate among adult patients was estimated at 35% compared to 39% in Pule Sefatsa clinic in Mangaung district, Free-state Province. Aim: The aim of the study was to explore the factors that influence poor adherence to ART among patients receiving ART at Pule Sefatsa primary health care clinic in Mangaung district, South Africa. Methodology: A descriptive qualitative research approach was used. Two focus group discussions were conducted with health workers and community caregivers and 16 in-depth interviews were conducted with ART patients who are in care and those who had defaulted on their treatment. Audio recorded data obtained from these sources were transcribed verbatim and prepared for analysis. Thematic analysis was used for data analysis and the results were classified under various categories. Findings: Adherence to ART in Pule Sefatsa clinic was found to be influenced by medical related factors, socio-economic factors, health system factors and individual factors. The medical-related factor was the side effects of the medication. The socio-economic factors were stigma and discrimination, lack of family support, poverty and food insecurity. Health system factors that hindered adherence to ART were medication stock-outs, long waiting times and poor service delivery. The final group of barriers to ART adherence was related to the individuals using ART and these include patients forgetting to take treatment and feeling depressed.

It is common for clinicians to implant medical devices, such as permanent pacemakers and implantable defibrillators, for cardiac diseases. These medical devices require follow-up care at regular intervals to ensure proper device function and optimal outcomes. Currently, many individuals without insurance or financial resources lack access to recommended follow-up care after implantation of a cardiac device. The purpose of this project was to determine the number of individuals who have had a medical device implanted without insurance coverage over a 3-year period, and then to establish a clinic that provides this service. The standard of care and operating procedure for the pacemaker clinic was established using evidence-based guidelines from the Heart Rhythm Society and the American Heart Association. Complexity science was the theoretical model used to guide this project's design and implementation. This quality improvement initiative was non-experimental, descriptive, and quantitative. Data were extracted from the ICD Registry and United States Census Bureau to determine the number of residents, insurance status, and number of implants over a 3-year period. These data were used to estimate the number of individuals with devices. The data revealed that 40 individuals with low power cardiac devices and 15 individuals with high power devices lacked access to care. The model developed estimates a growth rate of 7 to 10% annually. The pacemaker clinic will provide access to over 70 individuals lacking care for their pacemakers, thereby resulting in improved healthcare outcomes, fewer preventable complications, and optimal device performance.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background: The Durban University of Technology (DUT) chiropractic teaching clinic (CTC) represents a training facility for future chiropractors as well as providing a healthcare service to the local population. It is important to measure the demographic characteristics and presenting complaints of patients attending the DUT CTC as this information prepares the student interns for private practice. It also provides an insight into the popularity of chiropractic in the community. Objectives: This study sought to measure certain demographic variables and presenting conditions of patients attending DUT CTC and to assess whether these have changed over time. Method: A retrospective, cross-sectional descriptive study was performed by drawing patient files of new patients presenting to the DUT CTC for the months of February through April, during 2000, 2006 and 2011 (data from a 1994 study was included for analysis). The files had the following information regarding the patient collected: age, gender, ethnicity, occupation, medical aid, main presenting complaint, as well the duration of the most recent complaint. The data was analysed for trends using statistical software (SPSS v19). Results: Data from 1 311 patient files were analyzed. The number of patients attending the DUT CTC had reduced significantly since 2000. The mean age ranged from 37.0 – 39.7yrs across the samples with a trend of increasing age occurring between 1994 and 2006. Ages ranged from 2 weeks – 89yrs, with 20 – 29yrs being the most common group. Females formed 50.5 – 51.2% of the samples with no significant change over time. White (46.3 – 64.2%) and Indian patients (27.2 – 40.9%) formed the majority, with Black patients showing a trend of increasing representation (from 6.4% in 2000 to 15.8% in 2011). The most common occupations were student (19.7 – 26.8%) and clerical (17 – 23%), with a trend noted between 1994 and 2006 of a decreasing student proportion. This trend reversed from 2006 – 2011. Medical aid subscription among patients reduced significantly (p<0.05) from 56.2% in 1994 to 41.6% in 2011. The main presenting complaints were spinal (68.2 – 84.1%), with low back (30.7 – 40.7%) and neck/head (27.8 – 33.8%) being the most common. Most main complaints were of a chronic nature (45.8 – 61.7%), though a trend of reducing chronicity was noted between 1994 and 2006. A trend of increasing sub-acute complaints was seen between 1994 and 2011. Conclusions: The patients attending DUT CTC are similar to most international CTC’s in terms of patients’ age, gender, occupation, and main presenting complaint. Compared to existing data on South African private practice, the patients at DUT CTC are generally younger, less likely to be female, less likely to be White, more likely to be Indian or Black, less likely to have medical aid, more likely to present with low back pain as appose to neck/head pain, and more likely to present in the acute/sub-acute phase. Between 1994 and 2006, the trend shows that patients at DUT CTC were older, less likely to be White, less likely to be students, less likely to have medical aid, and less likely to present in the chronic phase.

Background: Two current growing health care trends in the United States are the escalating rates of obesity and the use of retail health care clinics. Poorly controlled diabetes can lead to long lasting health complications including renal and cardiac disease. Little is known about the recent trend of retail clinics expanding their scope and providing care for chronic diseases. The purpose of this project is to assess a baseline knowledge and personal attitudes of diabetes management of retail health providers at a specific chain of retail health clinics in Arizona. Purpose: This needs assessment will explore the intersection of these trends, as retail health care clinics expand beyond delivering urgent care, to providing comprehensive diabetes care. The purpose of this project is to assess provider knowledge of diabetes and personal attitudes towards diabetes in a retail health setting. Methods: Participants will complete an on-line diabetes knowledge questionnaire based upon the current standards of care for patients with diabetes from the American Diabetes Association and the Diabetes Attitude Survey (DAS-3). Results: Twenty-eight health care providers participated and results showed that 62% of the diabetes knowledge questions were answered correctly. The data also indicated that providers attitudes towards diabetes was generally supportive and positive for the patient. Participants generally agreed about the importance of special training for health care professionals who care for diabetic patients, understanding the seriousness of diabetes mellitus, recognizing the importance of glucose control. Participants valued patient autonomy and acknowledge the psychosocial role of diabetes mellitus in patients. Conclusion: This needs assessment indicated that 62% of the diabetes knowledge questions were answered correctly. The results of this study indicated that diabetes management education for retail health providers could be one approach to increase their knowledge. The results from the attitudes survey indicated that most providers agreed on the importance of managing diabetes and including the patient in their healthcare decisions. This assessment identified the need for further education for health care providers. Future studies may include assessment of an educational program for providers or assessing the quality of the diabetes management delivered in a retail health setting.

Architecture, as the art of making a building, consists of an assemblage of elements that interact and interlock to create something whole—from an assembly of parts, emerges a unified composition. In this thesis exploration, I strive to take this simple idea, fundamental to all buildings—to the very process of building itself—and utilize it as a driving force. This proposal was conceived both as a response to the site and program,as well as an effort to control an arrangement of parts in order to create an integrated, functioning whole that is greater than the sum of its parts. The resulting architecture derives its existence and identity from the articulation of these individual elements and the manner in which they interact and connect. Furthermore, this choreography generates a certain sequence of spaces creating moments of pause, compression, and release. There is a certain level of complexity that results from the formal play of setting elements into motion against the site and each other. Accepting this condition, the designer's will must be exerted in an effort to gain/maintain control of this composition. As such, this architecture explores the possibilities of complexity generated through the formal arrangement of parts. / Master of Architecture

This thesis is an exploration of architecture as an active participant in human life, not just as a stage. When architecture is considered a participant it contributes to the improvement of our quality of life as well as aiding  the healing process when we fall ill. As more people are diagnosed with anxiety and sleep disorders, the thesis considered questions of how the places in which we carry out our day-to-day lives improve the prognosis and, further, can architecture be used as a powerful tool for healing? It is possible that our disconnection from nature is partially responsible for our disrupted sleep patterns and misplaced anxieties. Perhaps natural elements and rhythms are too absent in our daily urban lives. But as more of us move into cities and our urban centers become denser, designers must find clever ways to help city owls reset their circadian rhythm. Architecture can help reestablish that bond with nature. This thesis explores an architecture of healing by proposing a program and design that follows the day and night circadian rhythm of our bodies, which in turn follow the sun and other natural phenomena. Located in a tricky triangular site in one of the busiest nighttime neighborhoods of Washington DC, a wellness center and sleep clinic would allow city dwellers to find a peaceful oasis for healing. In parallel, this thesis is also a study of collage as a design tool, as well as designing from details and the human scale. / Master of Architecture

Class of 2009 Abstract / OBJECTIVES: The purpose of this study is to describe clinical pharmacist services in a nurse practitioner (NP) run clinic and how clinical pharmacists might influence prescribing. METHODS: The description of the clinical pharmacist services is based on a 12-week experience of a clinical pharmacist and senior student pharmacist working with the nurse practitioner and nurse practitioner students. A questionaire was developed and consisted of items relating to the nurse practitioners ability to identify possible interactions of OTC medications, herbals and prescription medications. In addition, the questionnare assessed the comfort level of NP’s taking a prescription medication history, checking a patient’s prescription formulary, and selecting appropriate medication therapies. The questionaire uses a retrospective pretest format and was tested as a method of collecting data on how a pharmacist influenced NP prescribing. The site selected for this study was the Arizona State University Center for Healthcare Innovation (ASU Center) located in the heart of Downtown Phoenix (3rd Ave and Van Buren). RESULTS: Only one nurse practitioner worked at the ASU Center. The facility is new to the neighborhood and does not see many patients. The nurse practitioner partner in this project responded that working with a clinical pharmacist on a regular basis, with more patients would definitely help her hone skills necessary to identify interactions and prescribe according to a patients formulary. CONCLUSIONS: Pharmacists provide value-added services in an ambulatory care clinic run by nurse practitioners and provide valuable education and consultation on drug interactions. Pharmacist influence can be measured successfully to using a questionnaire in a retrospective pretest-posttest study design.

The Southern Arizona Veterans Affairs Health Care System (SAVAHCS) Chronic Pain Rehabilitation Clinic (CPRC) is an interdisciplinary pain management team. The team consists of physicians, a psychologist, a kinesiotherapist, a nurse and a pharmacist, who work together, to manage pain. In order to monitor and improve the effectiveness of treatment at SAVAHCS CPRC, the team created a pain outcomes measure collection program. A pilot study of the pain outcomes data collection process was conducted. The purpose of this project was to evaluate the data collection procedure and identify areas for improvement. The program planned to collect outcomes data at a new patient education/orientation class using an intake questionnaire. After three months, a follow-up questionnaire was to be mailed to the patient. The patient would then return the questionnaire, by mail, to the clinic where responses would be entered into an electronic database. Eight items in the data collection process were recognized as needing improvement. Three of the most important items follow. (1) Mailing out questionnaires had a low response rate, which could be solved by administering the intake questionnaire during the pharmacist medication evaluation, and the follow-up questionnaire, 6 months later, during a provider appointment. (2) The investigational review board approval process took longer than anticipated but could be corrected through enforcement of a submission time line. (3) Data entry required a large amount of time but could be rectified through the use of volunteers. Overall, the data collection program could gather outcome measures, but procedural adjustments need to occur.

MSc, Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2007