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THE EFFICACY OF ANTI-PSYCHOTIC MEDICATIONS IN TREATING THE BEHAVIOR, SOCIAL, AND COMMUNICATION DEFICITS ASSOCIATED WITH AUTISM SPECTRUM DISORDERS IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW
Title
THE EFFICACY OF ANTI-PSYCHOTIC MEDICATIONS IN TREATING THE BEHAVIOR, SOCIAL, AND COMMUNICATION DEFICITS ASSOCIATED WITH AUTISM SPECTRUM DISORDERS IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW.
Creator
Velazquez, Raquel, Ramirez, Bernardo, University of Central Florida
Abstract / Description
Background: Autism spectrum disorders (ASD) are a group of complex developmental disabilities which can cause behavior, social, and communication deficits. Anti-psychotic medications are often prescribed when symptoms such as aggression, irritability, hyperactivity, tantrums, and self-injurious behavior occur. Objective: To determine if anti-psychotic medications improve the behavior, social, and communication symptoms associated with ASD in children and adolescents. Search Strategy:...
Show moreBackground: Autism spectrum disorders (ASD) are a group of complex developmental disabilities which can cause behavior, social, and communication deficits. Anti-psychotic medications are often prescribed when symptoms such as aggression, irritability, hyperactivity, tantrums, and self-injurious behavior occur. Objective: To determine if anti-psychotic medications improve the behavior, social, and communication symptoms associated with ASD in children and adolescents. Search Strategy: Electronic literature searches were performed to find relevant studies and utilized the (1) Cochrane Database of Systematic Reviews, (2) Hispanic American Periodicals Index, (3) Medline, (4) PAIS International, (5) ProQuest Dissertations and Theses, (6) PsycInfo, (7) PubMed, (8) Springer LINK, (9) Taylor and Francis Journals, and (10) Sage Premier. Selection Criteria: Randomized controlled trials (RCTs) or quasi-experimental design (QED) studies of any dose of an anti-psychotic medication compared to a placebo or other prescription drug, in participants with autism spectrum disorder. Data Collection and Analysis: All studies which met the full-text level criteria were reviewed by a third party to validate the decision of inclusion. Meta-analyses in this review implemented both random and fixed-effects models. Main Results: Ten RCTs were included. Six studies evaluated a drug versus a placebo and four studies investigated the effects of two separate anti-psychotic medications or the efficacy of an additive medication to a drug and placebo group. Author's Conclusions: Limited evidence suggests the effectiveness of anti-psychotic medications in treating the behavioral symptoms associated with autism; however, further research is needed to determine the implications of long-term use.
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Date Issued
2012
Identifier
CFH0004197, ucf:44821
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004197
THE EFFECTIVENESS OF INTERVENTIONS AND BUNDLES FOR CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS IN THE NEONATAL INTENSIVE CARE UNIT
Title
THE EFFECTIVENESS OF INTERVENTIONS AND BUNDLES FOR CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS IN THE NEONATAL INTENSIVE CARE UNIT.
Creator
Alhamwi, Mohamad, Ramirez, Bernardo, Sole, Mary Lou, University of Central Florida
Abstract / Description
Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing...
Show moreIntroduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs. Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple search terms used and these included "neonate OR newborn OR infant", "CLABSI OR central line-associated bloodstream infection", "intervention OR prevention" and "bundle". The search solely focused on the outcome of infant patients. Therefore studies were excluded for the following criteria: being non-peer reviewed, being published before 2008, and being a case in which CLABSI was assessed in patients outside the NICU. See Table 4 and 5 for further information. Results: Eight articles were eligible for inclusion all of which CDC's guidelines were implemented in their strategy of intervention. The systematic review showed that adherence to care bundles decreases infection rates drastically. All eight articles reported a significant decrease in CLABSI rates following the implementation of the bundle set by CDC with two studies achieving a CLABSI rate of zero. Author's Conclusion: Implementation of care bundles showed a success in reducing CLABSI rates in the NICUs; however none of the studies endorsed a specific bundle application utilized to achieve its intended goal. Some practices adopted CDC's guidelines more than others and those showed a greater decrease in infection rate. In addition, it is evident that nurses deliver the best care when preventing an infection. Further research is needed to assess the effectiveness of a specific bundle element.
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Date Issued
2018
Identifier
CFH2000407, ucf:45736
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH2000407
Influence of Personal and State Level Variables on Perception of State Emergency Management Network Resilience In 47 States
Title
Influence of Personal and State Level Variables on Perception of State Emergency Management Network Resilience In 47 States.
Creator
Jennison, Victoria, Wan, Thomas, Zhang, Ning, Ramirez, Bernardo, Kapucu, Naim, University of Central Florida
Abstract / Description
Emergency management coordination in the United States has fallen victim to over a century of strategies to organize, reorganize, consolidate, or decentralize disaster preparedness, planning and response. Regardless of the agency in charge at the federal level, individual citizens have been responsible for their own well-being immediately after any disaster or emergency event for more than 100 years because it takes time to mobilize and deliver aid. The system most often charged with managing...
Show moreEmergency management coordination in the United States has fallen victim to over a century of strategies to organize, reorganize, consolidate, or decentralize disaster preparedness, planning and response. Regardless of the agency in charge at the federal level, individual citizens have been responsible for their own well-being immediately after any disaster or emergency event for more than 100 years because it takes time to mobilize and deliver aid. The system most often charged with managing that mobilization during an emergency event that exceeds the response capacity of local public safety agencies is the state emergency management network. Many entities in a state emergency management network have different responsibilities during disaster states vs. non-disaster states. Regardless of their role and function, entities need to be able to exchange resources and information with each other, often under time, economic, or other constraints during disasters. This resource exchange generates trust, an essential element of a resilient network. Resilient networks suffer fewer negative impacts from disaster related loss and are more likely to retain collective capacity to respond and help communities recover.The purpose of this study is to explore the ability of individual and state level attributes to explain variability in perception of network resilience. One-hundred fifty one state emergency management agency employees were surveyed regarding their perception of 5 constructs of network resilience (rapidity, redundancy, relationships, resourcefulness, and robustness) and individual level attributes. State level indicators from FEMA, NEMA, American Human Development Index, and Social Vulnerability Index were also analyzed. Overall, it was found that the individual attribute of perception of network integrity had the most influence on perception of network resilience, followed by perception of community resilience and state level attributes including disaster experience, state well-being, and number of full time state emergency management agency employees. These findings can improve network resilience by informing state emergency management network development activity. Networks that increase member opportunities to develop relationships of resource and information exchange will increase their resilience. That increased network resilience impacts community resilience because, as Winston Churchill's wise words during World War II reconstruction advise, (")We shape our communities and then they shape us(").?
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Date Issued
2015
Identifier
CFE0005812, ucf:50040
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005812
A formative evaluation of a technology-mediated alternative to traditional study abroad
Title
A formative evaluation of a technology-mediated alternative to traditional study abroad.
Creator
Howard, Wendy, Gunter, Glenda, Ramirez, Bernardo, Vitale, Thomas, Moskal, Patsy, University of Central Florida
Abstract / Description
Purpose: The purpose of this study was to determine if a proposed technology-mediated intervention is a viable alternative to traditional study abroad for those who are unable to travel. While technology cannot reproduce the same experience of traveling abroad, the primary objective of this study was to determine if there is value in using Web conferencing technology to provide students with access to the same opportunity to interact with international experts in the field as their...
Show morePurpose: The purpose of this study was to determine if a proposed technology-mediated intervention is a viable alternative to traditional study abroad for those who are unable to travel. While technology cannot reproduce the same experience of traveling abroad, the primary objective of this study was to determine if there is value in using Web conferencing technology to provide students with access to the same opportunity to interact with international experts in the field as their counterparts who were able to travel. This formative evaluation is the first in a series of iterative studies aimed at developing a viable, sustainable, technology-based solution through design-based research (Reeves, 2006).Methodology/Design: Two guiding questions drove the focus of this formative evaluation: Did the program accomplish what was intended and was it implemented effectively? These generated a set of evaluation questions using the Online Learning Consortium (OLC) Quality Framework, which were used to evaluate the quality of a joint study abroad program in Brazil with students and instructors from the University of Central Florida and the University of Scranton. While studying global health management in Brazil, the group in the field broadcasted their site visits live to online participants back in the United States. Web conferencing tools allowed the online attendees to see and hear the group in Brazil and interact in real time through the audio or text chat. Evaluation data was compiled from multiple sources including an anonymous student survey, instructor interviews, session recordings, financial budgets, and online facilitator observations in order to triangulate and evaluate the effectiveness of this Web-based intervention.Findings: Web conferencing technology appears to be a viable alternative that is not necessarily as immersive as traveling abroad, but it does provide its own set of benefits to higher education students. This formative evaluation revealed clear areas for improvement, including technical and procedural elements, but instructors and online participants did find value in the experience. Was it perfect? No. Was it successful? Yes. Was it encouraging? Definitely. Exploration of the evaluation questions under each of the five pillars of the OLC Quality Framework revealed both success factors and areas for improvement in each of the following categories: learning effectiveness, scale (commitment (&) cost), access, faculty satisfaction, and student satisfaction.Implications: Overall, this was a successful proof of concept that justifies future improvements and subsequent further evaluation in an iterative design-based research program. In addition to repeating this study with the joint global health management course in Brazil, this intervention could also be implemented and evaluated in other contexts, disciplines, and countries around the world. This formative evaluation produced a set of recommendations for the next study based on the success factors as well as the areas for improvement identified in this initial implementation in addition to a list of suggestions for future research.
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Date Issued
2015
Identifier
CFE0005808, ucf:50041
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005808
Predictors of hospital quality and efficiency
Title
Predictors of hospital quality and efficiency.
Creator
Fotovvat, Hoda, Wan, Thomas, Liu, Albert Xinliang, Ramirez, Bernardo, Yu, Chia-Yuan, University of Central Florida
Abstract / Description
American hospitals have made serious efforts to implement and expand their health information technology capabilities and to integrate different specialized care or high-tech services in order to maximize the efficiency and quality of care. In providing a variety of HIT-related services, these hospitals expanded their national reputation in line with integrated care goals. As a result, hospitals are encouraged to establish effective communication channels to facilitate patient-physician...
Show moreAmerican hospitals have made serious efforts to implement and expand their health information technology capabilities and to integrate different specialized care or high-tech services in order to maximize the efficiency and quality of care. In providing a variety of HIT-related services, these hospitals expanded their national reputation in line with integrated care goals. As a result, hospitals are encouraged to establish effective communication channels to facilitate patient-physician sharing of the patient care experience, to enhance effective pain management, and to transform patient-centered care modalities to solidify the adequacy of patient care processes. By analyzing national data sets publicly available, this investigation explored the relationship of acute-care hospitals' performance to the contextual, organizational and patient characteristics, using a cross-sectional study design. This study developed and evaluated the quality and efficiency of hospitals with respects to the structural complexity, process adequacy, efficiency, and quality of care. The structure-process-outcome theory in quality of care developed by Donabedian (1980), is adopted for this investigation. Statistical methods such as confirmatory factor analysis (CFA) and covariance structure model are employed. The population surveyed by the American Hospital Association (AHA) are acute care hospitals throughout the United States, including more than 3000 acute care hospitals of all types of ownership. The data provided by HIMSS Analytics and AHA are available for 2015 and the data provided CMS quality indicators are available for 2016. The key finding of this research is that process adequacy mediates the relationship between hospital structure and performance variables. The efficiency variable played an important role in shaping quality. The location and hospital teaching status have a moderate impact in determining hospital performance by affecting the structure and process of hospitals.
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Date Issued
2019
Identifier
CFE0007888, ucf:52796
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0007888
Factors Influencing Hypoglycemia Care Utilization and Outcomes Among Adult Diabetic Patients Admitted to Hospitals: A Predictive Model
Title
Factors Influencing Hypoglycemia Care Utilization and Outcomes Among Adult Diabetic Patients Admitted to Hospitals: A Predictive Model.
Creator
Kattan, Waleed, Wan, Thomas, Ramirez, Bernardo, Gurupur, Varadraj, Stevenson, Robyne, Pratley, Richard, University of Central Florida
Abstract / Description
Diabetes Miletus (DM) is one of the major health problems in the United States. Despite all efforts made to combat this disease, its incidence and prevalence are steadily increasing. One of the common and serious side effects of treatment among people with diabetes is hypoglycemia (HG), where the level of blood glucose falls below the optimum level. Episodes of HG vary in their severity. Nevertheless, many require medical assistance and are usually associated with higher utilization of...
Show moreDiabetes Miletus (DM) is one of the major health problems in the United States. Despite all efforts made to combat this disease, its incidence and prevalence are steadily increasing. One of the common and serious side effects of treatment among people with diabetes is hypoglycemia (HG), where the level of blood glucose falls below the optimum level. Episodes of HG vary in their severity. Nevertheless, many require medical assistance and are usually associated with higher utilization of healthcare resources such as frequent emergency department visits and physician visits. Additionally, patients who experience HG frequently have poor outcomes such as higher rates for morbidities and mortality.Although many studies have been conducted to explore the risk factors associated with HG as well as others that looked into the level of healthcare utilization and outcomes among patients with HG, most of these studies failed to establish a theoretical foundation and integrate a comprehensive list of personal risk factors. Therefore, this study aimed to employ Andersen's health Behavior Model of health care utilization (BM) as a framework to examine the problems of HG. This holistic approach facilitates enumerating predictors and examining differential risks of the predisposing (P), enabling (E) and need-for-care (N) factors influencing HG and their effects on utilization (U) and outcomes (O). The population derived from the national inpatient sample of the Healthcare Cost and Utilization Project (HCUP) database and included all non-pregnant adult diabetic patients admitted to hospitals' Emergency Departments (EDs) with a diagnosis of HG from 2012-2014. Based on the BM framework, different factors influencing HG utilization and outcome were grouped under the P, E, or N component. Utilization was measured by patients' length of stay (LoS) in the hospital and the total charges incurred for the stay. Outcome was assessed based on the severity ranging from mortality (the worst), severe complications, mild complications, to no complications (the best). Structural Equation Modeling (SEM) followed by Decision Tree Regression (DTREG) were performed. SEM helped in testing multiple hypotheses developed in the study as well as exploring the direct and indirect impact of different risk factors on utilization and outcome. The results of the analysis show that N is the most influential component of predictors of U and O. This is parallel to what was repeatedly found in different studies that employed the BM. Regarding the other two components, P was found to have some effect on O, while E influences the total charge. Interaction effects of predictors were noted between some components, which indicate the indirect effect of these components on U and O. Subsequently, DTREG analysis was conducted to further explore the probability of the different predictor variables on LoS, total charge, and outcome. Results of this study revealed that the presence of renal disease and DM complications among HG patients play a key role in predicting U and O. Furthermore, age, socio-economic status (SES), and the geographical location of the patients were also found to be vital factors in determining the variability in U and O among HG patients.In conclusion, findings of this study lend support to the use of the BM approach to health services use and outcomes and provide some practical applications for healthcare providers in terms of using the predictive model for targeting patient subgroups (HG patients) for interventions among diabetic patients. Moreover, policy implications, particularly related to the Central Florida area, for decision makers regarding how to approach the growing problem of DM can be drawn from the study results.
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Date Issued
2017
Identifier
CFE0006611, ucf:51304
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0006611
Unicondylar Knee Arthroplasty in the Inpatient vs Outpatient Setting: Impact on Process Time, Quality Outcomes, and Patient Satisfaction
Title
Unicondylar Knee Arthroplasty in the Inpatient vs Outpatient Setting: Impact on Process Time, Quality Outcomes, and Patient Satisfaction.
Creator
Zeini, Ibrahim, Ramirez, Bernardo, Noblin, Alice, Liu, Albert Xinliang, Sivo, Stephen, University of Central Florida
Abstract / Description
The implications of rising healthcare expenditures are of great concern nationally and internationally. Performing procedures in the outpatient setting can be one solution to this crisis. However, there is a lack of research on systematic approaches for transitioning procedures to the outpatient setting. Unicondylar knee arthroplasty (UKA) presents an opportunity, as it is already in the early stages of transitioning to the outpatient setting. The key step in facilitating an effective...
Show moreThe implications of rising healthcare expenditures are of great concern nationally and internationally. Performing procedures in the outpatient setting can be one solution to this crisis. However, there is a lack of research on systematic approaches for transitioning procedures to the outpatient setting. Unicondylar knee arthroplasty (UKA) presents an opportunity, as it is already in the early stages of transitioning to the outpatient setting. The key step in facilitating an effective transition to the outpatient setting is comparing outpatient UKAs with inpatient UKAs with a focus on process time, quality outcomes, and patient satisfaction. This study retrospectively compares 400 UKA patients in the outpatient setting with 675 UKA patients in the inpatient setting. The primary analytical tools for this study are Ordinary Least Squares Regression, Logistic Regression, and Ordinal Regression adjusting for comorbidity, social history, demographics, and surgery related characteristics. Outpatient UKAs outperformed inpatient UKAs across 11 of 18 variables analyzed. Process Time will be less for outpatient UKAs in all phases with the exception of Surgery Breakdown Time. The risk-adjusted quality outcomes of UKAs in the outpatient setting were better across Non-Surgery Related Complications, Follow-Up Pain, and Follow-Up Functional Range of Motion Limitation. Patient Satisfaction was higher for outpatient UKAs. There was a lack of consistent and appropriate information to conduct a substantial statistical analysis of the costs. These findings point towards outpatient UKAs being a viable option in the future. This research serves as a platform to launch a system-wide effort of transitioning procedures to the outpatient setting across different specialties.
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Date Issued
2015
Identifier
CFE0006427, ucf:51489
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0006427
Is Conflict a Factor in a Population's Quality of Life? A Comparative Study of University Students in the Palestinian Territories and Jordan
Title
Is Conflict a Factor in a Population's Quality of Life? A Comparative Study of University Students in the Palestinian Territories and Jordan.
Creator
Asi, Yara, Unruh, Lynn, Ramirez, Bernardo, Liu, Albert/Xinliang, Sadri, Houman, University of Central Florida
Abstract / Description
As nearly one third of the world's population lives in an area that is in some way touched by war, researchers have long been interested in the varied impacts of conflict on civilians. Many indicators, measuring both physical and mental constructs, have been assessed in war-torn populations from around the world, one of which is health-related quality of life (HRQoL). The occupied Palestinian Territories (oPt) are one region in which copious research on health indicators has been undertaken...
Show moreAs nearly one third of the world's population lives in an area that is in some way touched by war, researchers have long been interested in the varied impacts of conflict on civilians. Many indicators, measuring both physical and mental constructs, have been assessed in war-torn populations from around the world, one of which is health-related quality of life (HRQoL). The occupied Palestinian Territories (oPt) are one region in which copious research on health indicators has been undertaken in an effort to understand how long-term conflict manifests itself in noncombatant populations. However, existing studies focus primarily on indicators within the Palestinian population itself that impact HRQoL, and not on the extent to which the presence of the conflict and its consequences disturb physical and mental health outcomes compared to areas without conflict. The purpose of this study is to evaluate the impact of long-term conflict by comparing HRQoL in the oPt and the neighboring country of Jordan, as well as to assess how demographic factors such as socioeconomic status and household size can moderate or aggravate this impact. The potential mediating factors of insecurity and perceived stress will also be assessed. This study found that the presence of conflict was not the most significant predictor of low HRQoL. The mitigating factor of a traditional foundation of mental resilience in Palestinian culture is addressed as a potential explanation for this result. The implications of this study are wide-ranging, particularly in their ability to contribute to healthcare policy recommendations in war-affected areas, and to bolster our understanding of the health status and needs of those living in these areas.
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Date Issued
2015
Identifier
CFE0005574, ucf:50233
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005574