In 2012 the Academy of Nutrition and Dietetics (Academy) and the American Society for Enteral and Parenteral Nutrition (ASPEN) published a consensus statement outlining the clinical characteristics recommended for the diagnosis of adult malnutrition, specifically undernutrition. The Academy and ASPEN recognized the need to standardize the approach to identify, diagnose and document malnutrition. There continues to be growing awareness that malnutrition plays a significant role on health outcomes and on the course of treatment for patients. The high prevalence of malnutrition at hospital admission identifies the need for more awareness, recognition and treatment at an earlier stage, such as primary care or an outpatient setting. The primary objective of this study was to assess the effectiveness of a malnutrition education program implemented in the outpatient clinics at James A. Haley Veterans’ Hospital and Clinics in Tampa, FL. The education program involved hands-on Nutrition Focused Physical Exam Workshop training for outpatient dietitians, education to outpatient dietitians regarding policies and procedures for improved identification and documentation of malnutrition, and education to primary care physicians at a formal staff meeting and team meetings and huddles. The Ambulatory Care Nutrition Section Chief recognized the need for further nutrition focused physical exam (NFPE) training for outpatient dietitians and general malnutrition training to outpatient providers. The interventions implemented as part of the malnutrition education program in the outpatient setting at James A. Haley Veterans’ Hospital and Clinics showed statistically significant, desired outcomes as indicated by improvements in outpatient dietitian confidence levels with performing NFPE and statistically significant associations between fiscal year and presence of malnutrition codes to evaluate effectiveness of training for both dietitians and primary care physicians.

Driving license can be taken from addictological patients by diagnosing substance abuse syndrome or driving a motor vehicle under the influence of an addictive substance. After that, drivers are often sent by specialists to the outpatient addictolocial care for examination by an addictologist. However, there is currently no uniform workflow and the role of addictologist is unclear in this process. The main aim of this thesis is to describe the role of addictologist in outpatient addictolgical care in the process of assessment of the return of driving license after its previous removal in patients diagnosed with substance abuse syndrome. Data obtained by semi-structured interview with staff of 9 outpatient addictological cares, which have practical experience with the given issue, was fixed by audio recording and then transcribed into text form. Analysis of this data was done by the method of creating clusters, linking them to larger units, and organizing data into groups based on their similarity. Furthermore, the method of pattern capture, the simple enumeration method describing the frequency of the examined phenomena and the method of contrasts and comparison were used. According to individual outpatient addictologival cares, the results are different and show the following basic roles of an...

Billions of mental health care dollars for millions of children and adolescents in need has garnered significant attention within the behavioral health industry to reduce costs while improving treatment efficacy through the identification and implementation of evidence based practices with youth populations requiring therapeutic services. This hermeneutic phenomenological qualitative research approach in the field of psychology is a consumer driven one in the world of business. Line by line context and discourse analyses, which included both a prior and inductive coding, of the verbiage and phraseology of 10 boys and 10 girls, aged 8-12, actively engaged in outpatient psychotherapy, formed the foundation for 31 themes that captured a shared experience or a consumer driven “view inside the therapist’s office.” These results are represented through 6 main themes indicating that a) “knowledge fosters investment” upon entry into and initiation of mental health services when therapists and parents recognize that b) “words have power to facilitate success,” only if, guided by childhood development but chosen thoughtfully for each child. Further, c) “therapy is therapy across the lifespan,” such that therapeutic care for minors deemed legally dependent reflected treatment for legally independent persons with implementation methods influenced by age. Lastly, age, as a definitive factor, impacted the means by which the youth in my study experienced d) “autonomy… and developed e) “therapeutic rapport…” in references to e) “boundaries…” that mitigate the entire treatment experience. The outcomes of this study offer the research and practice community opportunity to move children from the “object” of the treatment to “agents” in their treatment by respecting the ideas expressed by youth themselves.

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<p>The aim of this study was to examine and analyze the experiences which social workers have of working with relatives of substance abusers. This included examining how they work with relatives who are in need of care and support and how the social workers identify their needs. We have also investigated how well informed the social workers are when it comes to approaches to helping relatives of substance abusers. A qualitative method has been used in this study in order to analyze the experiences of the social workers from a phenomenological point of view. This study was based on six semi-structured interviews. The results indicated that the relatives of substance abusers could receive help from a majority of the agencies but that most of the approaches to helping them were lacking in structure. Another result showed that relatives could not be accepted as clients at a majority of the agencies which presented a difficulty to working with relatives of substance abusers.</p>

The aim of this study was to examine and analyze the experiences which social workers have of working with relatives of substance abusers. This included examining how they work with relatives who are in need of care and support and how the social workers identify their needs. We have also investigated how well informed the social workers are when it comes to approaches to helping relatives of substance abusers. A qualitative method has been used in this study in order to analyze the experiences of the social workers from a phenomenological point of view. This study was based on six semi-structured interviews. The results indicated that the relatives of substance abusers could receive help from a majority of the agencies but that most of the approaches to helping them were lacking in structure. Another result showed that relatives could not be accepted as clients at a majority of the agencies which presented a difficulty to working with relatives of substance abusers.

Backround. Based of my personal observations when employed as a pharmacist in a Saudi hospital it was clear that there were problems with medicine supply to outpatients. This thesis was designed to scientifically investigate the types of shortages, the reason(s) for such problems and potential solutions to the problem. Methods . This study was undertaken using a variety of experimental techniques to determine the views and perceptions of patients, pharmacists, physicians and administrative staff of the hospital under examination. To establish the scale of the problem: focus groups (n=25), structured questionnaires, structured interviews/meetings for health care professionals and a national survey (n=650) were the research tools used to objectively determine the relevant data. The data were analyzed by appropriate statistical methods. Results and Discussion That there was a real problem was quickly established in the data obtained from patients. A similar finding was made for each of the 'professional groups'. The central problem was one of shortages of medicines for prescriptions presented by outpatients. It was not a case the medicines were simply not available because they were never stocked but rather a simple shortage in the dispensary stock. It was established the lack of medicines was not due to central budget arrangements but involved prescribing quantities outside of the hospital guidelines which no degree of planning could accommodate. There was also the very unexpected finding that a prescription could be filled in a variety of hospital dispensaries as individuals could access more than one hospital or they could consult more than one physician for the same condition and obtain effectively double the supplies. Communications between the hospital and patients and the health care professionals could all be improved by perhaps increasing the knowledge of the patient about the correct use of medicines. Recommendations. A series of recommendations for future work is provided

Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted. / Thesis (M.Med.)-University of Natal, Durban, 1987.

Renny Varghese Impact of an Electronic Medical Record Implementation on Drug Allergy Overrides in a Large Southeastern HMO Setting (Under the direction of Russell Toal, Associate Professor) Electronic medical records (EMRs) have become recognized as an important tool for improving patient safety and quality of care. Decision support tools such as alerting functions for patient medication allergies are a key part of reducing the frequency of serious medication problems. Kaiser Permanente Georgia (KPGA) implemented its EMR system in the primary care departments at Kaiser's twelve facilities in the greater metro Atlanta area over a six month period beginning in June 2005 and ending December 2005. The aim of this study is to analyze the impact of the EMR implementation on the number of drug allergy overrides within this large HMO outpatient setting. Research was conducted by comparing the rate of drug allergy overrides during pre and post EMR implementation. The timeline will be six months pre and post implementation. Observing the impact of the incidence rate of drug allergy alerts after the implementation provided insight into the effectiveness of EMRs in reducing contraindicated drug allergies. Results show that the incidence rate of drug allergy overrides per 1,000 filled prescriptions rose by a statistically significant 5.9% (ñ > 0.0002; 95% CI [-1.531, -0.767]) following the implementation. Although results were unexpected, several factors are discussed as to the reason for the increase. Further research is recommended to explore trends in provider behavior, KPGA specific facilities and departments, and in other KP regions and non-KP healthcare settings. INDEX WORDS: electronic medical records, drug allergy overrides, patient safety, medication errors, decision support tools, outpatient setting, primary care, computerized provider order entry

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