Made available in DSpace on 2014-10-09T12:50:30Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:58:54Z (GMT). No. of bitstreams: 1 00037.pdf: 763399 bytes, checksum: 3f408533971c20463f45c11f4a79d8b0 (MD5) / Dissertacao (Mestrado) / IEA/D / Instituto de Biociencias, Universidade de Sao Paulo - IB/USP

Made available in DSpace on 2014-10-09T12:50:30Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:58:54Z (GMT). No. of bitstreams: 1 00037.pdf: 763399 bytes, checksum: 3f408533971c20463f45c11f4a79d8b0 (MD5) / Dissertacao (Mestrado) / IEA/D / Instituto de Biociencias, Universidade de Sao Paulo - IB/USP

Class of 2012 Abstract / Specific Aims: To evaluate surgery, infectious disease, and nephrology consult documentation of antimicrobial content in bone cement within 30 days post-surgery; evaluate documentation of antimicrobial cement content by pharmacists in pharmacokinetic drug level evaluations within 6 months post-surgery; assess frequency and severity of adverse drug events associated with antimicrobials in bone cement. Methods: Retrospective chart review, which utilized a data collection form to evaluate the dose and type of antimicrobial agents prescribed, median and range antimicrobial doses per 40 grams of cement, documentation rates of antimicrobial content in clinical notes and incidence of potential adverse drug effects. Subjects were identified based on an ICD-9 code and their electronic medical records were accessed. Main Results: The sample size was 24 patients. The surgery notes had the highest rates of documentation with 96% naming the drug and 75% included the dose. The rates were the same in the infectious diseases consults and pharmacy pharmacokinetics notes with the drug name at 27% and the dose at 9%. No nephrology consult notes mentioned antimicrobials contained in the cement. Renal dysfunction (sCr≥2) developed in 13% of patients within 30 days and 25% of patients within 100 days. Approximately 17% of patients with renal dysfunction had the antimicrobial-laden cement removed. Conclusions: A variety of antimicrobial agents were embedded in bone cement at various concentrations and documentation from multiple sources was inconsistent. Likewise, adverse events associated with antimicrobial containing bone cement are not consistent.

Class of 2012 Abstract / Specific Aims: The primary aim of this study was to determine the incidence of posaconazole and voriconazole concentration monitoring that occurs in transplant patients receiving antifungal prophylaxis therapy. The secondary aim was to determine whether voriconazole and posaconazole serum concentrations were used for dose adjustments. Methods: Patients status post either a liquid or solid organ transplant over the age of 1 year who received invasive fungal infection prophylaxis with either posaconazole or voriconazole between the dates of February 1, 2010 through January 31, 2011 while admitted to academic medical center were included in this descriptive retrospective study. This study has been approved by the Institutional Review Board. Data collected on each subject included demographic information, type of transplant, posaconazole or voriconazole concentrations, and duration and dosage adjustments. Main Results: 54 subjects were identified who received either voriconazole or posaconazole for fungal prophylaxis after transplant. For subjects who were prescribed posaconazole (N = 8), concentration monitoring was performed in 50% of subjects and 0% of posaconazole dose adjustments were based on concentrations. For subjects who were prescribed voriconazole, concentration monitoring and dose adjustments based on voriconazole concentrations were performed in 20% and 78% of subjects respectively. Adverse outcomes associated with the use of antifungal therapy were reported in 0% of the posaconazole therapy group and 17% of the voriconazole therapy group. Conclusions: Both posaconazole and voriconazole concentrations were obtained from patients who were receiving antifungal therapy for invasive fungal infection prophylaxis. Adjustments of prophylactic doses are not well characterized.

Class of 2012 Abstract / Specific Aims: The specific aim of this study was to assess the impact of public mental health benefit changes on patients with a serious mental illness. Methods: A comprehensive literature search was conducted using several databases. Articles that were included in the analysis met the following inclusion criteria: 1) Study conducted in the United States 2) Study population composed of adults (≥18) with a diagnosis indicative of a serious mental illness (psychotic disorders, bipolar disorders, major depressive disorder, anxiety disorders, dysthymic disorder, or a personality disorder) 3) Study evaluated a change or discontinuation of mental health services, 4) Study reported outcomes. Main Results: Of the 117 studies originally identified, 27 met all the inclusion criteria. Data was then extracted from each study regarding the design of the study, patient demographics, and impact of the various outcomes. Five studies looked at the implementation of prior authorizations required for psychiatric medications, which all showed increased rates of treatment discontinuation. Two of these five studies also looked at the impact on emergency department (ED) visits and hospitalizations with both studies showing increased ED visits, but no effect on hospitalizations. Three studies looked at the implementation of Medicare Part D, which all showed increased rates of medication access problems and increased rates of ED visits. Other studies that examined medication access issues found increased rates of suicide ideation or behavior, increased rates of treatment discontinuation, and increased rates of ED visits. Conclusions: Given the amount of variability among the studies, it is difficult to determine the impact specific benefit changes have on patients diagnosed with a serious mental illness. In order to draw conclusions regarding specific benefit changes, more studies looking at similar outcomes need to be conducted. This is critical as the studies examined, in general, showed negative outcomes for patients with a serious mental illness when mental health benefit changes were implemented.

Class of 2014 Abstract / Specific Aims: The purpose of this study is to compare frequency of pharmacy services available in ambulatory care practice between adult and pediatric populations and to identify factors that affect the availability of such practice settings between the two populations in the United States. Methods: This study was a descriptive survey study that was distributed nationally. Participants were recruited using two electronic listservs registered with the American College of Clinical Pharmacy (ACCP), the Pediatric PRN listserv and Ambulatory Care PRN listserv. A total of 126 participants completed and submitted the electronic questionnaire. This descriptive survey study collected data through an online questionnaire distributed to adult and pediatric ambulatory care pharmacists. Descriptive variables, demographic variables, categorical variables, and ordinal data were analyzed by calculating frequencies, percentages, and averages. Main Results: The majority of participants specialize in diabetes (n = 51, 40.5%), anticoagulation (n=42, 33.3%), hypertension (n=42, 33.3%), hyperlipidemia (n=40, 31.8%), and asthma (n=32, 25.4%). Adult care was greater than pediatric care in diabetes (Adult: n=54, 42.83%; Ped: n=14, 9.53%), anticoagulation (Adult: n=46, 43.66%; Ped: n=6, 4.76%), hypertension (Adult: n=44, 34.94%; Ped: n=8, 6.34%), hyperlipidemia (Adult: n=42, 33.34%; Ped: n=3, 2.39%), and asthma (Adult: n=35, 27.78%; Ped: n=28, 22.23%). Averages of 4.88 hours of hours per week and 5.21 years of experience were obtained for provision of pediatric care in the ambulatory care setting. Conclusion: In conclusion, availability of ambulatory care services for pediatric patients is dramatically less than those available for adults. Generalized structure for location of clinics, billing for services, and funding for positions may increase the opportunity for provision of adult and pediatric ambulatory care services.

M.Cur. / Tuberculosis is regarded as a global health problem as accelerated by the impact of the HIV/AIDS epidemic. In South Africa it is regarded as a top national health priority. Taking treatment regularly prevents multi-drug resistance TB. The introduction of Directly Observed Treatment Short-course (DOTS) ensures that treatment supporters observe TB patients swallow tablets under direct supervision. In the area of research, treatment supporters are trained by South African National Tuberculosis Association trainers to supervise treatment. It happened on a regular basis that patients complain about various aspects of the observational progress, resulting in change of treatment supporters, some preferred to be supervised from the clinic. The researcher developed interest to find out about the shortcomings in the observation of TB patients by treatment supporters, so as to address those shortcomings. A qualitative, exploratory, descriptive and contextual research study was conducted to identify the experience of treatment supporters in observing tuberculosis patients on TB treatment and also, the experience of TB patients as observed by treatment supporters. Permission was obtained from both treatment supporters and TB patients. A pilot phenomenological interview was conducted from one TB patient and one treatment supporter supervising TB treatment, who met the selection criteria. The phenomenological interviews were conducted in Northern Sotho (Pedi), Shangaan, Tswana, Xhosa, Zulu, Southern Sotho and Northern Sotho (Tlokwa) from both treatment supporters and TB patients. The samples comprises of 14 TB patients and 14 treatment supporters supervising those TB patients. Steps were taken to ensure trustworthiness. Tesch’s method of data-analysis was followed to analyze the data. Results indicated that there are interfering factors relating to the working relationship between the TB patients and the treatment supporter. From the findings, facilitative factors are used as proposals to promote the observation of TB patients by treatment supporters. Strategies are described from the rationale, which explain how the proposal can be reached. The strategies were based on the study findings and the literature reviewed.

A study on assessing communication challenges between clerks and deaf patients at Nelson Mandela Academic Hospital was conducted in 2010. The aim was to assess the existence of communication challenges, possible reasons and solutions to these. The literature reviewed identified a gap in the knowledge of communication between staff and deaf patients. A health systems’ study was conducted using a descriptive, cross sectional survey. The study population was made up of 33 clerks who worked at the registration and records area and deaf patients who stayed at Efata and received health services from the hospital. All clerks were interviewed and a random sample of 106 deaf patients was estimated using Epidat statistical software. Self administered questionnaires were used for data collection. Results confirmed the existence of communication challenges between the two groups. A majority of clerks were not trained in Sign Language. They used a combination of methods to communicate with deaf patients, and few clerks could use Sign Language. The patients also used a combination of methods due to the frustration of not having a common method of communication with clerks. The findings clearly showed that there are communication challenges between the two groups and Sign Language needed to be introduced to clerks in order to accommodate deaf patients. Further research may be done on all healthcare providers and to all deaf patients in the region served by Nelson Mandela Academic Hospital, and this could have a positive impact on the quality of service offered by the hospital to the deaf community.

Only in recent years have diagnostic and therapeutic advances lengthened the life expectancy for patients who have cystic fibrosis sufficiently to allow some of them to live into adulthood. Health care professionals have been focusing on survival issues and are only recently beginning to look at quality of life issues, such as sexuality, of these patients. The purpose of the study was to create a sexual profile of adults with cystic fibrosis which would describe their sexuality and sexual concerns. A questionnaire was developed and sent to all of the adult cystic fibrosis patients (19 years of age and older) in British Columbia (50 patients), all of whom attend the Shaughnessy Hospital Adult CF Clinic in Vancouver. The 62% response rate provided data for the sexual profile which indicated that 90% of the respondents were sexually active. Only a small number of subjects reported sexual difficulties in their relationships. Concerns about the impact of CF on their sexuality included: the effect of the potentially limited lifespan on their relationships, practical considerations such as fatigue and coughing during sexual activity, and poor body image. A major issue for CF males is that most of them are infertile due to CF. How and when men should be told about this issue was an important question for the CF Clinic staff. Responses indicated that men thought they should find out from either the physician in the pediatric CF clinic or the physician in the adult CF clinic. Furthermore, 100% of the men suggested that this issue be discussed with males before the age of 19 years. Limitations and recommendations of the research are discussed. A major recommendation is for physicians and other health care professionals in CF clinics to give patients the opportunity to discuss sexual issues. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

This study examines the relationships between three aspects of adjustment to hemodialysis (i.e. activity levels, mood states and severity of symptoms) and four demographic variables (i.e. age, occupation, education and length of time on dialysis). The sample consisted of 37 patients on hemodialysis. Activity levels, mood states and severity of symptoms were measured by the activity inventory, profile of mood states and symptom questionnaire, respectively. A personal history questionnaire was employed to assess the demographic variables. The data was analyzed using the Pearson Product-Moment Correlation Method with a one-tailed test of significance. Activity levels were found to be negatively correlated with age at a statistically significant level, but were not significantly correlated with occupation, education or length of time on dialysis. Total mood disturbance was not significantly correlated with any of the demographic variables. Total severity of symptoms were negatively correlated with education at a statistically significant level, but no significant correlations were discovered between this aspect of adjustment and the other demographic variables. A few supplemental findings were also deemed important. Total severity of symptoms were both negatively correlated with activity levels and positively correlated with mood states at statistically significant levels. However, mood states and activity levels were not significantly correlated. Finally, a significant positive correlation was found between education and occupational level. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate