Background: It is well accepted that gestational weight gain (GWG) outside of the Institute of Medicine recommendations is a modifiable risk factor for pregnancy complications, regardless of a woman’s pre-pregnancy body mass index. Objectives: Given that not all prenatal healthcare providers (HCPs) are aware of these guidelines nor discuss them with their patients, this thesis sought to examine counselling practices and evaluate a pilot knowledge translation tool for the improvement of such counselling. Methods: 1) A literature review was conducted to assess current prenatal GWG counselling practices between patients and HCPs; 2) an electronic survey was conducted to determine patients’ perceptions of GWG counselling and whether certain patient characteristics increase chances of counselling; 3) a quasi-experimental study was implemented to evaluate the Canadian Obesity Network’s 5As of Healthy Pregnancy Weight Gain tool. Results: GWG counselling was often infrequent and inaccurate. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity and those categorized with overweight/obesity were more likely to receive GWG advice. The 5As of Healthy Pregnancy Weight Gain Tool is effective at initiating Ask and Advise components of HCP-mediated GWG counselling, but work is still needed to improve all other components of the 5As (Assess, Agree, Assist). Conclusions: Weight gain counselling is an essential component of prenatal healthcare, but discussions between HCPs and patients is inconsistent. Future steps include the development of GWG knowledge translation tools and improving GWG education for HCPs.

Class of 2012 Abstract / Specific Aims: The purpose of this study is to assess rural community members in Cochise County, Arizona, to determine if healthcare screenings and informational sessions are desired by the community members for chronic disease states, and from which healthcare providers the community members prefer to obtain these services. Identify which health professional rural members are most likely to seek for healthcare screening. Identify which health professional rural members are most likely to seek for healthcare informational sessions. Determine if rural community members are willing to pay for healthcare screening and informational sessions. Methods: This descriptive study obtained data through 350 questionnaires distributed during selected Cochise County community events in late 2011. Main Results: 341 surveys were completed. The majority of results favored physicians with 47.7% of the people stating they would very likely attend a health care screening conducted by a physician. 34.5% responded they would very likely attend an informational session conducted by a physician. Of the respondents willing to pay for health screenings, 63.9% would pay $30 or less. 70.9% stated they would not be willing to pay for an informational session. However, the majority of participants, 61.3%, indicated they would utilize pharmacists for OTC questions. Regarding questions about prescription medications, 43.4% would go to pharmacists, and similarly, 44% indicated they use physicians. Conclusions: As seen from the results, pharmacists are underutilized by rural community members; except for OTC questions. Respondents with higher levels of education were also more likely to prefer and attend events held by pharmacists.

No description available.

No description available.

Human papillomavirus (HPV) is one of the most common sexually transmitted infections in the United States, however vaccination uptake remains low. One of the known barriers of low vaccination rates is lack of a health care provider recommendation. The purpose of this project was to implement a practice change to increase the number of HPV vaccine recommendations provided by primary care providers (PCPs) to patients aged 9-26 years. The setting for this project was the Little Colorado Physician’s Office, a primary care clinic in rural northern Arizona. Four PCPs, including three family physicians and one family nurse practitioner, and members of the QI team participated in the project. The project was designed as a quality improvement project, guided by the Model for Improvement framework. The needs of the individual practice and their population were assessed by a quality improvement (QI) team using a fishbone diagram for root-cause analysis. A practice change was then implemented by the QI team and evaluated for its effectiveness in improving HPV vaccination recommendations. Outcome measures included the number of HPV vaccine recommendations made by a primary care provider to eligible patients and the number of HPV vaccines administered to patients. In a four-week period of practice change implementation, eight patients were considered eligible for the HPV vaccine. Of these patients, 100% were offered the HPV vaccine by their healthcare provider. The practice change was successful in promoting HPV vaccination recommendations by PCPs, and the QI team reported the change was beneficial to their practice.

This thesis deals with the design and implementation of an extensible provider for Windows PowerShell. This provider allows registering the adapters which provide access to various data stores. The thesis gives an introduction into PowerShell and outlines how to realize new extensions. It then elaborates the architecture of the provider in detail. Next part is devoted to the design and implementation of the adapter for compressed files. For this purpose, the SevenZip library is used which had to be adapted for the use from C# language. Therefore, the thesis also includes description of the wrapper allowing the library utilization from the managed code.

The Institute of Medicine reported seven thousand deaths annually due to medication errors. It is estimated that two out of one hundred admissions experience a preventable adverse medication event resulting in an average cost of $4,700 per admission, which is $2.8 million dollars annually for a 700 bed hospital (Institute of Medicine, 1999). In Canada, medication related errors were identified as the most common adverse event (Canadian Institute for Health Information, 2007). A medication error is “any error that occurs during the process of history taking, ordering, dispensing, administering and surveillance of a medication regardless of whether harm occurred to the patient or if there was potential harm (Eslami, Abu Hanna, & de Keizer, 2007; Ong, 2007). Computerized provider order entry (CPOE) can play a vital role in the prevention of medication errors in the drug ordering stage. It was reported that the occurrence of Adverse Drug Events (ADE) was decreased by fifty-five percent with the addition of CPOE system (Berger & Kichak, 2004). However, the literature review on CPOE impact is heavily focused on the physicians’ perspective (Eslami et al., 2007; Reckmann, Westbrook, Koh, Lo, & Day, 2009; ). Nurses play a significant role in the medication process, as traditionally, nurses are involved in all the medication process stages. Research on the impact of CPOE in the entire medication process is still lacking (Househ, Ahmad, Alshaikh, & Alsuweed, 2013). Understanding the perspective of nurses on the impact of CPOE in their work will increase awareness and understanding of CPOE use among health care professionals and health informaticians. This research adopts a grounded theory approach to explore the question of “how do nurses perceive the impact of CPOE on the medication process and on collaborative practice?” Ten participants were interviewed and out of the ten, eight participants were observed during a portion of their work. The information collected was analyzed using a constant comparative method. Participants described that the CPOE supported legible order communication between care providers and departments. CPOE use removed the requirement to transcribe orders to the medication administration record, as well as, the necessity to fax the order sheet to the pharmacy. However, in the ordering stage the nurse is also involved in providing information for order decision-making. Nurses discuss probable medication orders in cases of urgent situations, or nursing assessments of the patient. In this decision-making, the information requirements of nurses involve not only the medication information, but also information about other orders such as diagnostics, laboratory, and patient care orders. Future CPOE design and CPOE implementations should consider including mobile devices, alerts, and workflow modeling with the nursing information needs. / Graduate / 0710 / 0569 / vitor@uvic.ca

Thesis advisor: Peter Gottschalk / Thesis advisor: Thomas McGuire / Thesis advisor: Donald Cox / Does managed care send expectant mothers to hospitals they would choose even if their choice of hospital was not limited? I find that Medicaid managed care patients are redirected to hospitals that enrollees of more generous insurance payers with the same personal characteristics do not go to. However, Medicare managed care enrollees do not face an increased risk of having a cesarean delivery at the hospital they attend, which is interpreted as evidence that they are redirected to high quality hospitals. / Thesis (PhD) — Boston College, 2003. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

The theoretical part of the master's thesis provides a wide range of information about outsourcing as such -- it covers it's history, definitions and specifications of the basic terms and a legal view on the issue. It also includes a list of services which could be outsourced and divides outsourcing according to the subject. The practical part of the master's thesis analyses the Czech market. It is based on a survey, which deals with many issues already mentioned in the theoretical part. The analysis is performed by both parties to the contract, which means both the user (recipient) and the provider of outsourcing services.

Adult literature has shown that quality of patient-physician relationships is associated with better patient adherence to treatment recommendations across chronic illnesses. However, few studies have examined this in youth with type 1 diabetes, particularly those of Hispanic origin. Evidence indicates that minority youth with type 1 diabetes are at higher risk for poorer metabolic control and experience less satisfaction in patient-provider relationships compared to their white, non-Hispanic counterparts. This study examined the association between satisfaction with the physician-patient relationship and regimen adherence and glycemic control in 120 Hispanic youth with type 1 diabetes. Most caregivers who participated were mothers (82.5%) and youths were primarily female (51.7%). Children ranged in age from 10 to 17 (M age = 13.63 ± 2.18 years). Mean duration of diabetes was 6.26 ± 3.72 years. Most caregivers were married (64.7%). Mothers? highest level of education included 35.3% who had a high school education or less, 34.5% who had some college, and 30.2% who completed college. Mean HbA1c level on recruitment date was 7.68 ± 3.56. Adolescents and their parents independently completed an adapted version of the Medical Interview Satisfaction Scale (MISS-21) (Meakin & Weinman, 2002), which assessed their personal satisfaction with their endocrinologist?s consultation, and the Diabetes Self Management Profile (DSMP) (Harris et al., 2000), which measures adherence over the past 3 months across multiple self-care domains. Spanish translations of both forms were used when appropriate in obtaining caregiver report. Also, physicians rated their patients? regimen adherence using an average of eight items concerning patient adherence. Youth and parents shared similar perceptions concerning youth regimen adherence, as measured by the DSMP (r=.68, p<.001). Youth and parent report of their relationship with their endocrinologist was modestly correlated (r=.27, p<.01). Due to high concordance between parent and child adherence scores, further analyses used a combined DSMP score, while separate scores were used for parent and child reports of satisfaction. Age, mother?s education, and single parent status were used as control variables and were correlated with parent and child satisfaction and a combined DSMP score. Including control variables, parent and child satisfaction did not significantly predict glycemic control (R2∆=.02, p<.10). Parent and child satisfaction also did not significantly predict adherence (R2∆=.02, p=.06). Due to these unexpected findings, further exploratory analyses were conducted. Parent and child satisfaction did not predict physician report of adherence. Interestingly, parent and child report of satisfaction with communication comfort with the physician predicted physician report of adherence (R2∆=.05, p<.01). More specifically, child report of communication comfort predicted physician report of adherence (ß=.26, p<.01), while parent report did not. No subscales of the satisfaction measure (MISS) or the adherence measure (DSMP) predicted glycemic control. Findings suggested that more positive patient-physician relationships are associated with better physician-reported regimen adherence, but not with family report of adherence. However, it is unclear whether better patient-physician relationships enhance adherence or whether more adherent patients are likely to be satisfied with their provider. Further studies are needed to prospectively examine the directionality of these relationships, as well as examine methods to improve the quality of physician-patient relationships in order to increase positive health outcomes.