Thesis (M.S.)--University of Delaware, 2006. / Principal faculty advisor: Lynn Snyder-Mackler, Dept. of Physical Therapy. Includes bibliographical references.

Thesis (Ph. D.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains xv. 191 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 166-183).

BACKGROUND: Treatment of left-sided Infective Endocarditis (IE) is challenging due to the presence of both surgical and medical interventions. The choice typically depends on the patient’s surgical risk and severity of infection. Our aim is to compare outcomes of IE patients who undergo valve replacement surgery with patients who are treated with solely antibiotics. METHODS: Patients undergoing valve surgery at our institution from 1995 to 2014 (n=196) and patients who were treated medically for IE from 2001 to 2014 (n=120) were included in this study. In total, 316 patients were included and clinical data was retrospectively collected from chart review. Society of Thoracic Surgeons (STS) Scores were calculated to assess for surgical risk and data for preoperative fever, angina, and abscess was collected to assess for severity of infection. The primary outcome of interest was mortality at 30 days and 1 year post-treatment and secondary outcomes included post-treatment development of septic shock, MI, embolic events, recurrence of infection, stroke, and renal dysfunction. Cox regression analyses were performed to assess the likelihood of mortality based on the patient’s pre-intervention comorbidities and characteristics. A Kaplan-Meier Analysis was also conducted to assess for survival at both 30 days and 1 year. RESULTS: Pre-operative fever (68.88% surgical vs 52.50% medical, p=0.002), angina (13.78% surgical vs 2.50% medical, p<0.05), and presence of abscess (33.37% surgical vs 6.67% medical, p<0.05) were significantly higher in the surgical population. Mortality at both 30-days (7.65% surgical vs 29.17% medical, p<0.05) and 1 year (17.35% surgical vs 46.67% medical, p<0.05) was significantly higher in the medical cohort. Mortality in patients presenting with valvular abscess was significantly higher in the surgical population at 30 days (4.5% surgical vs 62.5% medical, p<0.05) and 1 year (15.15% surgical vs. 75.00% medical, p<0.05). Surgical risk was significantly higher in medical patients overall (p<0.05), but not significantly higher in the pathogen specific subgroups. By individual pathogen, medical mortality was significantly higher at both 30 days and 1 year in the MRSA (p=0.0004 and p=0.0002) and Staphylococcus population (p=0.001 and p=0.0005) but only significantly higher in the Streptococcus population at 1 year (p=0.032). CONCLUSION: Valve Replacement Surgery in patients with left-sided MRSA and non-MRSA Staphylococcus IE leads to significantly better mortality outcomes at 30 days and 1 year than medical management. Specifically, we suggest that patients with preoperative valvular abscess undergo valve replacement surgery, regardless of pathogen, and that patients with MRSA and non-MRSA Staphylococcus IE be strongly considered for surgical intervention.

The annual incidence of knee replacement (KR) procedures in the United States is predicted to reach over 3.5 million by the year 2030. KR is the current definitive treatment for debilitating knee osteoarthritis (KOA). There has yet to be substantial research regarding the impact of KR on participation in community activities and quality of life. The hypotheses evaluated in this dissertation were that persons following KR will have 1) faster gait speed and 2) lower risk of participation restrictions than persons without KR; and 3) a decreased risk of all-cause mortality compared to persons without KR. To address the first two hypotheses, we collected data from subjects with KOA from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative, large cohorts of older adults with or at risk of KOA at the time of enrollment. In the first study, KR did not have an effect on gait speed overall and among most subgroups, however subjects with a slow gait speed prior to KR did have an 80% increased risk (RR 1.8, 95% CI 1.1, 3.0) of having a healthy gait speed compared with non-KR subjects. In the second study, KR was associated with a small decreased risk of having participation restriction (RR 0.82, 95% CI 0.67, 0.99). The third study used data on patients with KOA from the Clinical Practice Research Datalink, a database of clinical information on > 8 million people throughout the United Kingdom. There was a decrease in the death rate among KOA subjects who had a KR compared to those who did not, and the hazard of death was reduced by over one half in the first five years after the procedure (HR 0.46 (95% CI 0.43, 0.51). For most subjects, this benefit did not extend longer than five years, and patients least likely to have KR (due to clinical and medical presentation) showed an increased hazard of death compared to the non-KR subjects. In conclusion, the results of this dissertation support the hypotheses that KR confers a positive benefit to activity and participation related pursuits which may extend to survival in the short term for some people.

Thesis (M. Phil.)--University of Hong Kong, 1997. / Includes bibliographical references (leaf 254-261).

BACKGROUND: There has been an enormous rise in total joint arthroplasties (TJA) in the United States over the past several years. Researchers have documented the increase in healthcare costs associated with unplanned hospital readmissions among patients post-TJA, specifically total hip and total knee arthroplasties. Additionally, researchers have reported the burden that these costs place on the healthcare system, private payers and on patients and their caregivers. Social routines, quality of life and occupational functioning are often interrupted because of a patient’s unplanned hospital readmission after receiving a total hip or total knee arthroplasty. Investigators have identified the major causes of costly unexpected hospital readmissions among patients with a TJA; they include surgical site infections, blood clots, joint dislocations and periprosthetic fractures. The Occupational Therapy Practice Framework: Domain and Process describes the practice of occupational therapy as promoting health, well-being, and engagement in meaningful occupation. Nonetheless, there is limited literature in the occupational therapy field directed towards reducing hospital readmissions among patients with a total hip or knee arthroplasty, thus suggesting an area that is well-positioned for intervention development and testing. PURPOSE: This Occupational Therapy Doctoral Project entitled Teaching Intervention to Reduce Readmissions-Post Surgery (TIRR-PS) is a proposed program for an acute care hospital setting which: (a) described the problem of hospital readmissions among patients with a total hip or total knee arthroplasty, (b) investigated evidence and best practices for imparting knowledge and/or teaching skills to hospital administrators, healthcare professionals, occupational therapy staff, patients, and caregivers, (c) proposed an intervention based on empirically supported strategies and theoretical frameworks, (d) recommended activities to include as part of the program evaluation, the funding plan and the dissemination plan to promote this multi-level, multi-component pilot program. TIRR-PS will aim to reduce unplanned 30-day hospital readmissions and their associated healthcare costs. Unplanned readmissions are in part caused by inadequate education of hospital administrators, occupational therapy staff, patients, and caregivers. The TIRR-PS program will raise awareness about how to address common medical complication risks and promote the support of hospital administration for the education and skill building activities directed towards healthcare professionals with an emphasis on occupational therapy. CONCLUSION: TIRR-PS was designed for an acute care setting to reduce hospital readmission rates, to reduce healthcare costs, to improve patient quality of life, and to reduce the societal burden of unplanned hospital care. TIRR-PS is an innovative program designed to be comprehensive and to impart knowledge and skills to all relevant professionals in an acute care setting with a particular emphasis on the contribution of the OT profession. TIRR-PS, once evaluated, will provide a standardized, systematic approach to reducing unexpected hospitalizations post-TJA and shows promise for contributing to routine orthopaedic rehabilitative practice in acute care hospitals. This in turn will not only reduce healthcare costs, but will improve the post-surgery quality of life for patients with a recent total hip or total knee arthroplasty.

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published_or_final_version / Business Administration / Master / Master of Business Administration

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