There is growing evidence that the way patients and families relate to healthcare professionals influences their experience of illness and healthcare, and may affect their psychological and physical wellbeing. Relationships between professional groups may also have a significant impact on healthcare provision to children and families. Previous research has focused on dyadic relationships within paediatric healthcare (mother and child, nurse and parents, doctors and nurses), but little has been published concerning the complex inter-relationships and roles of family members, doctors and nurses. The aim of this research was to undertake a systemic analysis of the roles and relationships of nurses and doctors with children, adolescents and families. A qualitative methodology was used to explore how the three groups (nurses, doctors and families) understand their respective roles and relationships in the care of ill children within a tertiary paediatric hospital. While systemic and social constructionist theory informed the overall conception of the study, grounded theory was the method used for structuring data collection and analysis. Data collection involved semi-structured interviews with doctors, nurses and families. These were audio-taped and each set of transcripts analysed according to grounded theory principles. Theoretical coding then allowed comparisons to be made across each set of data. Two theoretical categories describing key processes involved in the care of ill children emerged from the analysis. These were: “Building emotional connections and focusing on medical goals: complementary or contradictory relationship discourses for families and staff?” and “Shifting relationships around expertise and power: the gains and losses associated with new positionings” The first category highlights that both professionals and families appear to draw on particular societal discourses to inform their roles and relationships. These discourses (about the therapeutic value of emotional connections between staff and families and the need for ‘medical professionalism’) can appear at odds with each other. creating tensions and dilemmas for each group. The second theoretical category highlights that power relationships between nurses, doctors and families are in a process of change. Fundamental change may be hard to achieve however, as each group may experience losses and well as gains in their emerging positions. It is further argued that changes in government policy relating to these core processes creates challenges for each participant group as they struggle to balance positive working relationships, the medical care of the child and status and power issues. Change in any one aspect of these professional and family roles and relationships may have both adverse and beneficial effects, which need to be recognised. These findings raise important questions about the feasibility and desirability of family centred care. The implications of this research for training, consultation and future research are explored. The research adds to a small but growing body of literature focusing on the interface between professionals, patients and families in healthcare settings.

Class of 2016 Abstract / Objectives: Analyze electronic prescription errors made by a community health center. Determine the time it takes to correct electronic prescription errors in a community pharmacy. Ascertain whether or not a collaborative practice agreement would be beneficial. Methods: The store computer system was used to generate a report of all prescriptions received at a community pharmacy from a community health center during a 6-month period. Using an Excel sheet, one author kept track of how many electronic prescriptions were received, the number and type of errors, and the time it took to get an error corrected. Results: There were 1896 electronic prescriptions sent from a community health center to a community pharmacy; 61 contained an error (3.24%). On average, it took the doctor’s office 111.7 hours to call back and clarify the mistake. Conclusions: There was not a significant amount of prescribing errors that occurred during the data collection period. However, the time it took for the doctor’s office to call back was significant and translates to patients not being able to get their medications on time.

Class of 2011 Abstract / OBJECTIVES: To examine the effects of pharmacist-provided direct patient care with consideration to the patients’ socioeconomic status as determined by the patients’ health insurance. METHODS: A meta-analysis was conducted to evaluate the effects of pharmacist-provided direct patient care on different socioeconomic populations as determined by the patients’ health insurance by including results from several independent randomized control trials. A standardized and tested data extraction form was used to collect primary data on outcome category (therapeutic, safety, and humanistic), disease category (diabetes, hypertension, cardiovascular, dyslipidemia, asthma, and other), insurance status (Medicaid, Medicare, Veterans Affairs/ Department of Defense, private and uninsured), and outcome measures. The potential for bias data were analyzed by calculating a total potential for bias score and by construction a forest plot ordered by bias score. RESULTS: Twenty-two studies were included in the meta-analysis. The insurances most often reported were Medicaid (13.6%), Medicare (18.2%), the Veterans Affairs/ Department of Defense (VA/DoD) (41%), and private insurance (27.2%). All insurance groups benefited from pharmacist intervention (p<0.01). The Medicare patients benefited the least from the pharmacist interventions [standard mean difference (SMD) = 0.21], and the benefit of intervention was significantly less than the benefit for subjects having Medicaid, Private Insurance or VA/DoD coverage (p<0.02). CONCLUSION: While patients in all insurance type benefited from pharmacist intervention, Medicare patients seemed to benefit the least; further studies are needed to verify the findings and to explore why the benefit is less than for other groups.

This study involves an investigation of the relationship between dependency and work resumption of patients with myocardial infarction. In the process of studying this problem, information concerning the different levels of dependency during the convalescence through employment continuum v/as gathered. The purposes of the study are to add to the body of knowledge concerning the concept of dependency and to make nurses and other members of the health team aware of the implications of dependency behaviour in the process of resuming normal function of patients with myocardial infarction. Its long range purpose is to increase the sense of well-being and achieving of the patient with myocardial infarction by helping him resume his productive role, both through the help of members of the health team and members of his family. The study was planned to test the following hypotheses: 1. The employed patients with myocardial infarction will show lower dependency ratings than the unemployed patients in the Navran Dy Scale. 2. The employed patients with myocardial infarction will show progressive decrease in the D-I Scale dependency ratings along the convalescence to employment period continuum, while the unemployed patients with myocardial infarction will maintain a constant level of dependency ratings in the D-I Scale along the convalescence to employment period continuum. 3. Low trait dependents with myocardial infarction will show progressive decrease in the D-I Scale dependency ratings along the convalescence to employment period continuum, while high trait dependent patients with myocardial infarction will continue to show steady dependency ratings in the D-I Scale along the convalescence to employment period continuum. Two structured questionnaires were constructed following a review of the literature to obtain information regarding the research problem. The Navran Dy and the dependency portion of the D-I Scale were also administered. The study population consisted of 21 men. The study population was restricted to men who were confined in the hospital for their first myocardial infarction, who were 64 years of age or younger, who could read and write English, and who had been employed for the 6 months immediately prior to the confinement. Analysis of the data included Frequency tables, T test and the Two-Factor Analysis of Variance. The findings of the study showed that patients with myocardial infarction showed different degrees of dependency, both trait and state. The findings failed to support the three hypotheses even though during the data analysis of the individual hypothesis, the group means showed leaning towards the direction of the hypothesis. The study suggests that steps should be taken to make nurses and family more aware of the varying degrees of dependency in patients. / Applied Science, Faculty of / Nursing, School of / Graduate

Background: Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in noninfected populations suggests that knowledge of CVD risk factors significantly influences perception of risk. Understanding the level of risk factor knowledge and risk perception can inform the development of innovative interventions to reduce risk. The purpose of this study was to describe cardiovascular risk factor knowledge and risk perception in a cohort of HIV-infected adults. Specific aims included (a) describing the estimated risk of CVD, the perceived risk of CVD, and the level of CVD risk factor knowledge; (b) describing the relationship between estimated and perceived risk, and (c) examining the influence of risk factor knowledge on perceived risk of CVD. The Health Belief Model was the theoretical framework that guided the study. Methods: A prospective observational cohort; cross-sectional design. A convenience sample of 130 HIV-infected adults was recruited from two hospital-based HIV clinics. Each participant had one study visit in which all data were collected by direct interview. Results: Results: Mean age of enrollees was 48 years (SD 8.4); 62% were male; 41.5% White, 32% Black, 23% Hispanic; 56% current smokers; mean years since HIV diagnosis were 14.7; mean BMI 27 (SD 5.5); 48.5% had prehypertension. Higher scores on the Heart Disease Fact Questionnaire indicate a higher degree of knowledge. In this sample, the Mean was 19, (S.D. 3.5; range 6–25), indicating a fair degree of knowledge. Estimated and perceived risk were significantly, though weakly, correlated r (126) = .24, p = .01. Controlling for age, risk factor knowledge was not predictive of perceived risk (F[1,117] = 0.13, p > .05). Conclusions: HIV-infected adults are at increased risk for cardiovascular disease. Traditional CVD risk factors such as smoking, prehypertension, and being overweight are highly prevalent. Despite having a fair level of risk factor knowledge, knowledge did not influence perception of risk for CVD. Research to improve risk perception and to develop innovative interventions that reduce CVD risk is needed for this population.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Management of very low rectal cancer is one of the most challenging issues faced by colorectal surgeons. For tumors in the mid and upper rectum, procedures can be done to resect the cancer while maintaining continence, a major determinant of post-operative quality of life. In the low rectum, however, to optimize oncologic outcomes, many surgeons feel compelled to pursue abdominoperineal (APR) over low anterior resection (LAR), a sphincter-preserving procedure. It was hypothesized that after robust adjustment, procedure choice will not be associated with a difference in disease-free survival in the resection of tumors in the low rectum. To analyze this, the US Rectal Cancer Collaborative Database, a comprehensive, multi-center dataset obtained from six institutions between 2010 and 2016, was queried. Patients undergoing TME resection for Stage I-III very low rectal cancers (involvement) were selected for this study. Patients were categorized by procedure- LAR vs APR. Primary outcome was five-year disease-free survival. Secondary outcomes included overall survival, recurrence, length of stay, and complications. An adjusted analysis was performed to account for all known potential confounders. 431 patients with very low rectal cancer treated by either APR or LAR were identified. 154 (35.7%) underwent APR. The overall recurrence rate was 19.6%. Median follow-up time was 42.5 months. An analysis adjusted for age, gender, BMI, ASA class, and pathologic stage observed no difference in disease free survival between operative types (HR=0.90, 95% CI [0.53-1.52], p=0.70). Similarly, secondary outcomes demonstrated no significant difference between operation types, including length of stay (Beta: 0.04, Std. error = 0.25, p = 0.54), overall survival (HR=1.29, 95% CI [0.71-2.32], p=0.39), or complications (OR = 1.53, 95% CI [0.94 - 2.50], p=0.09). In this analysis, no significant difference in disease-free survival or overall survival was observed between patients undergoing APR or LAR for very low rectal cancer. This comprehensive study supports the treatment of very low rectal cancer, less than 5cm from the anorectal ring with no sphincter involvement, by either abdominal perineal or low anterior resection. Further studies may focus on patient-reported and quality of life outcomes which may influence decision-making.

Title: Improving Diabetes Self-Management Education and Support (DSMES) Referrals in the Primary Care Setting Authors: Stephanie Sossong and Dr. Jean Hemphill, College of Nursing, East Tennessee State University, Johnson City, TN. Purpose: The purpose of this quality improvement project is to implement a standardized referral process to DSMES in primary care. DSMES decreases complications from T2DM and reduces healthcare costs. However, patients diagnosed with T2DM are referred <7% of the time. Aim: To assure that patients diagnosed with T2DM receive referrals to an accredited DSMES program. Processes: Baseline data of the number of patients with T2DM referred to DSMES was collected from a primary care clinic for 4 weeks. An educational in-service highlighting the benefits of DSMES, guidelines for referrals, and the process improvement was presented to providers and medical assistants. Data regarding referrals to DSMES after the process implementation will be collected for 4 weeks, numbers will be compared to pre-implementation data and reported using percent frequency. The IRB determined that the activities of this project are not defined as research involving human subjects. Results: The results of this project have not been determined yet, however; the expected outcome is an increased number of referrals to DSMES. Limitations: The limitations of this project include a small sample size and a short length of study. Conclusions: Implementing a standardized referral process in primary care increases referral rates to DSMES. This is important because DSMES has been proven to reduce diabetes related complications, healthcare spending, and prevalence of other comorbidities.

Thesis (M.S.)--Boston University / Anxiety is a common reponse in patients undergoing cardiac surgery. The source of this anxiety is attributed to a multitude of factors. Research findings support the relationship between preoperative preparation and a reduction in anxiety. However, a lack of information exists as to the role of critical care nurses in this process. This purpose of this study was to examine the effect of a structured preoperative education/orientation visit by the critical care nurse on the level of patient anxiety. A sample of 21 patients were drawn from the population of cardiac surgical patients and randomly assigned to the experimental or control group. Subjects in the experimental group received a structured preoperative education/orientation visit by a critical care nurse the evening prior to surgery. Subjects in the control group did not receive the visit. Subjects in both groups completed the State-Trait Anxiety Inventory preoperatively and the A-State Scale plus an additional questionaire postoperatively. Data were analyzed using analysis of covariance on repeated measures and a t-test comparison of mean anxiety scores. Findings revealed no significant differences in postoperative state anxiety scores between the experimental and control group. Results from the second questionaire indicated that subjects in the experimental group felt the preoperative visit was helpful. Furthennore, those patients who had the continuity of the same nurse conducting the preoperative visit and assuming primary care postoperatively in the intensive care unit responded more favorably on the questionaires. There were however, significant pre-existing differences in age and trait anxiety scores between the groups. This fact, in addition to the small sample size limit the ability to evaluate the effectiveness of the experimental intervention. Thus, further research is warranted to determine the effect of a preoperative education/orientation visit by critical care nurses utilizing a larger sample size.

Magister Scientiae Dentium - MSc(Dent) / The purpose of this study was to compare the accuracy of direct versus indirect bracket placement in orthodontics in a controlled setting. The more accurate the initial bracket placement is the less time will be required in terms of treatment. Accurate bracket placement can reduce the envelope of error in the three dimensions of vertical (incisal height, height of tooth), horizontal (mesial-distal) and angular (degrees incisal to root apex causing rotational irregularities) based on Andrews’ six keys to normal occlusion (Andrews, 1979). In this comparative experimental study, 10 Class I molar relation study models were selected from the researcher’s practice archives. Only the MBT pre-adjusted or angulated orthodontic brackets were used on manikins, followed by the use of 3D CAD CAM technology to evaluate the results against a pre-determined golden standard.