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- Title
- The efficacy and feasibility of neuropsychological services in a primary care setting.
- Creator
-
Herring, Danielle, Paulson, Daniel, Sherod, Megan, Blaney, Cerissa, Cannarozzi, Maria, University of Central Florida
- Abstract / Description
-
Integrated primary care assimilates psychologists into the primary care setting, thus improving health outcomes and physician satisfaction. Neuropsychology has also begun to assimilate into primary care, as neurocognitive impairment is a correlate of many medical disorders. Subjective cognitive decline (SCD), a common complaint among older adults, is an increasingly recognized warning sign of non-normative cognitive aging. These patients typically present first to their primary care providers...
Show moreIntegrated primary care assimilates psychologists into the primary care setting, thus improving health outcomes and physician satisfaction. Neuropsychology has also begun to assimilate into primary care, as neurocognitive impairment is a correlate of many medical disorders. Subjective cognitive decline (SCD), a common complaint among older adults, is an increasingly recognized warning sign of non-normative cognitive aging. These patients typically present first to their primary care providers who may play a critical role in the early detection of cognitive impairment. Given the growing awareness about cognitive health and disability, the importance of neuropsychological assessment as a standard component of integrated care has been recognized by providers. Thus, the purpose of this study is to examine the efficacy and feasibility of neuropsychological services, for memory concerns, in a community primary care setting. The study also explored the relationship between SCD and performance on neurocognitive measures and satisfaction levels for both patient participants and medical providers. A total of 16 patient participants completed the study. On average, patients were in their late-60's and mostly female and Caucasian. Participants completed a brief interview, neurocognitive evaluation, self-report measures of SCD and mood, and satisfaction survey. Results did not reveal significant correlations between SCD and neurocognitive performance. Significantly more referrals were made to the onsite neurocognitive clinic, than were made for outside services in a nine-month period preceding the described program. Patients referred to the onsite clinic were also significantly more likely to have an accessible report located in their EMR than those referred offsite. Both participants and medical providers were reportedly satisfied with clinic services. Results suggest that a clinic of this nature has promising benefits and is well-liked by both patients and providers, though barriers related to full utilization of services remain a challenge. Further research with a larger, more diverse sample is recommended. ?
Show less - Date Issued
- 2019
- Identifier
- CFE0007653, ucf:52508
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007653
- Title
- Infection Control and Health Care Associated Infection (HCAI) in the Nursing Home: A Study to Determine the Impact of an Educational Video and Pamphlet About Infection Control on Knowledge and Perception of Hand Hygiene in Certified Nurse Assistants.
- Creator
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Hypes, Kathe, Blackwell, Christopher, Covelli, Maureen, Winton, Mark, University of Central Florida
- Abstract / Description
-
The impact of an education program on perception, knowledge, and infection rate was evaluated in this study. The educational intervention consisted of a video on infection control and a World Health Organization (WHO) pamphlet for hand hygiene. The study was conducted in one nursing home in the Southeastern United States. The survey sample consisted of 66 certified nurse assistants (CNAs). A pre- and post-intervention design was employed using the WHO's Hand Hygiene Knowledge Questionnaire...
Show moreThe impact of an education program on perception, knowledge, and infection rate was evaluated in this study. The educational intervention consisted of a video on infection control and a World Health Organization (WHO) pamphlet for hand hygiene. The study was conducted in one nursing home in the Southeastern United States. The survey sample consisted of 66 certified nurse assistants (CNAs). A pre- and post-intervention design was employed using the WHO's Hand Hygiene Knowledge Questionnaire and the WHO Perception Survey. Friedman's test and central tendencies showed no statistical relationship between the educational intervention and the overall knowledge scores of the sample. There also were no statistical differences in perception of hand hygiene in the CNA sample. Infection frequency was reduced with a percent change of -42%. While results of knowledge and perception surveys were not statistically significant, multiple conclusions were derived to suggest that educational opportunities may impact hand hygiene practice in CNAs and lead to a decrease in infection.
Show less - Date Issued
- 2012
- Identifier
- CFE0004551, ucf:49239
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004551
- Title
- DIGITAL RESEARCH CYCLES: HOW ATTITUDES TOWARD CONTENT, CULTURE AND TECHNOLOGY AFFECT WEB DEVELOPMENT.
- Creator
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Scott, Edward, Saper, Craig, University of Central Florida
- Abstract / Description
-
It has been estimated that one third of the world's population does not have access to "adequate" health care. Some 1.6 billion people live in countries experiencing "concentrated" acquired immune deficiency syndrome (AIDS) epidemics. Many countries in Africa -- and other low-income countries -- are in dire need of help providing adequate health care services to their citizens. They require more hands-on care from Western health workers -- and training so more African health workers can...
Show moreIt has been estimated that one third of the world's population does not have access to "adequate" health care. Some 1.6 billion people live in countries experiencing "concentrated" acquired immune deficiency syndrome (AIDS) epidemics. Many countries in Africa -- and other low-income countries -- are in dire need of help providing adequate health care services to their citizens. They require more hands-on care from Western health workers -- and training so more African health workers can eventually care for their own citizens. But these countries also need assistance acquiring and implementing both texts -- the body of medical information potentially available to them -- and technology -- the means by which that information can be conveyed. This dissertation looks at these issues and others from a multi-faceted approach. It combines a survey of the developers of Web sites designed for use by health workers in low-income countries and a proposal for a novel approach to communication theory, which could help improve health communication and other social marketing practices. It also includes an extensive review of literature regarding a number of topics related to these issues. To improve healthcare services in low-income countries, several things should occur. First, more health workers -- and others -- could visit African countries and other places to provide free, hands-on medical care, as this researcher's group did in Uganda. Such trips are ideal occasions for studying the cultural differences between "mzungu" (white man) and the Ugandan people. A number of useful medical texts have been written for health workers in low-income countries. Others will be published as new health information becomes available. But on what medium will they be published? Computers? Personal digital assistants? During the past 10 years the Internet became an ideal venue for conveying information. Unfortunately, people in target countries such as Uganda encounter cultural differences when such new technologies are diffused. This dissertation looks at cultural and technological difficulties encountered by people in low-income countries who attempt to diffuse information and communication technologies (ICT). Once a technology has been successfully adopted, someone will look for ways to use it to help others. There are hundreds of sites on the Internet -- built by Web developers in Western countries -- that are designed for use by health workers in low-income countries. However, these Web developers also experience cultural and technological differences, based on their knowledge of and attitudes toward best practices in their field. This research includes a survey of Web developers which determined their attitudes toward best practices in their field and tested this researcher's hypothesis that there is no significant difference among the developers' attitudes toward the content on their sites, their audience's cultural needs and the various technological needs their audience has. It was found that the Web developers agree with 17 of 18 perceived best practices and that there is a significant difference between Web developers' attitudes toward their audience's technological needs and their attitudes toward quality content and the audience's cultural needs. Creation of the survey herein resulted in this researcher generating a new way of thinking about communication theory -- called digital research cycles. The survey was based on a review of literature and is rooted in the belief that any successful communication of a computer-mediated message in the information age is a behavior which is influenced by the senders' and receivers' attitudes and knowledge about textual style, the audience, technology and the subject matter to which the message pertains.
Show less - Date Issued
- 2009
- Identifier
- CFE0002637, ucf:48218
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0002637
- Title
- THE EXPERIENCES OF HEALTH CARE PROVIDERS PROVIDING COMFORT FOR NURSING HOME PATIENTS AT THE END OF LIFE.
- Creator
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Baker, Herma, Rash, Elizabeth, University of Central Florida
- Abstract / Description
-
Research shows that healthcare providers (HCPs) are not adequately prepared to provide comfort care for patients who are at the end of life. Since the 1990s, numerous legislative, research, and clinical initiatives have addressed concerns about improving care at the end of life. The purpose of this study was to describe the experiences of HCPs providing comfort for patients in the nursing home who are at the end of life. This study focused on physicians, nurse practitioners, nurses and nurses...
Show moreResearch shows that healthcare providers (HCPs) are not adequately prepared to provide comfort care for patients who are at the end of life. Since the 1990s, numerous legislative, research, and clinical initiatives have addressed concerns about improving care at the end of life. The purpose of this study was to describe the experiences of HCPs providing comfort for patients in the nursing home who are at the end of life. This study focused on physicians, nurse practitioners, nurses and nursesÂÂÂÂ' aides at a central Florida nursing home. A descriptive qualitative design was done utilizing a focus group discussion, individual interviews, and a self-administered questionnaire. The findings indicated that a lack of facility support, inadequate staffing, inadequate end of life care education, family and patient denial of prognosis, as well as decreased primary care physician involvement affect the delivery of comfort care for patients at the end of life in the nursing home. This study supports the need for end of life education to HCPs and the need for adjustments in staffing to meet the complex needs of patients in the nursing home who are at the end of life. A new finding of this study reflects the use of an angel cart to aid in the provision of comfort care for patients at the end of life. Recommendations for future research were made based on study results
Show less - Date Issued
- 2010
- Identifier
- CFE0003305, ucf:48505
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0003305
- Title
- SPIRITUALITY AND EXPECTATIONS OF CARE PROVIDERS OF OLDER PATIENTS WITH CHRONIC ILLNES IN NORTH CENTRAL FLORIDA.
- Creator
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Sherman, Myra, Wink, Diane, University of Central Florida
- Abstract / Description
-
A qualitative design was used to explore the use of spirituality and prayer by older adults who have chronic illness and reside in a rural community. Thirteen individuals responded to a flyer soliciting participation in a study of the use of spirituality as part of health care. Participants were at least 60 years of age, had at least one chronic illness and resided in North Central Florida. Twelve participants then responded to six open-ended questions based on an adaption of an instrument...
Show moreA qualitative design was used to explore the use of spirituality and prayer by older adults who have chronic illness and reside in a rural community. Thirteen individuals responded to a flyer soliciting participation in a study of the use of spirituality as part of health care. Participants were at least 60 years of age, had at least one chronic illness and resided in North Central Florida. Twelve participants then responded to six open-ended questions based on an adaption of an instrument used by Dr. Shevon Harvey in her doctoral dissertation. The data was analyzed to identify themes and answer four research questions. The four research questions were 1) how do older adults living with chronic illness describe spirituality? 2) how do older adults use spirituality while living with chronic illness? 3) how can health care providers assist older individuals with chronic illness to meet their spiritual needs?, and 4) do patients feel that their spiritual needs are being addressed during their outpatient health care? The interview responses demonstrated that several different practices, including prayer and scripture readings as well as adherence to medication, diet, and exercise recommendations were used as coping mechanisms by study participants. The majority of participants want their health care providers to address spirituality and/or refer them to spiritual advisors for counseling. The study showed that some participants stated that their spiritual needs were met, but there were some who did not want spirituality addressed in the outpatient setting. Four themes were identified, which suggest that 1) spiritual practices were frequently used coping measure for these individual with chronic illness, 2) health care providers are supportive of their patients' spirituality, 3) participants with chronic illness consider adherence to medication, diet, and exercise a coping measure, and 4) participants with chronic illness want their health care providers to recognize their spiritual needs. The findings indicated that individuals who self identify as individuals from whom spiritual life is important and who have chronic illnesses and have spiritual needs that can be addressed in the outpatient setting. The findings also demonstrated use of non spiritual coping measures and the importance of health care provider's acceptance of spirituality in this specific population. Recommendations for further research are made.
Show less - Date Issued
- 2011
- Identifier
- CFE0003740, ucf:48794
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0003740
- Title
- NURSING HOMES' COMPLIANCE WITH STATE NURSE STAFFING STANDARDS AND ITS RELATION TO QUALITY-OF-CARE DEFICIENCIES.
- Creator
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Paek, Seung Chun, Wan, Thomas, University of Central Florida
- Abstract / Description
-
The purpose of this dissertation is to examine nursing homes' compliance with state minimum nurse staffing standards and its relation to quality-of-care deficiencies. Specifically, this study, reviewing staffing standards from 50 states and the District of Columbia for the year 2007, proposes a unique algorithm to calculate the states' expected nurse staffing levels for individual nursing homes in order to investigate their compliance with the state nurse staffing standards. By using...
Show moreThe purpose of this dissertation is to examine nursing homes' compliance with state minimum nurse staffing standards and its relation to quality-of-care deficiencies. Specifically, this study, reviewing staffing standards from 50 states and the District of Columbia for the year 2007, proposes a unique algorithm to calculate the states' expected nurse staffing levels for individual nursing homes in order to investigate their compliance with the state nurse staffing standards. By using hierarchical linear modeling method, this study attempts to capture the impact of the staffing standards on actual nurse staffing levels under resource dependence perspectives. Path analysis using structural equation modeling was conducted to investigate both direct and indirect effects of the staffing standards on nurse staffing levels and quality-of-care deficiencies. The major findings were as follows: (1) nursing homes in states with higher state staffing standards for the categories of RN, LN, and total nurse were found to have higher RN, LN, and total staffing levels, respectively; (2) higher nurse staffing levels resulting from higher state staffing standards were significantly associated with better quality of care (less quality-of-care deficiencies cited) in nursing homes; and (3) state staffing standards were found to have much stronger contribution to nurse staffing levels than any other organizational or contextual factors while nurse staffing levels, particularly licensed staff, were found to have stronger contribution to quality-of-care deficiencies than any other organizational factors. The study findings suggest that if the goal is to increase nurse staffing levels for better quality, increasing the stringency of both federal and state nurse staffing standards would be the most effective way. However, the staffing standards first need technical changes to reduce their ambiguity and ensure their fairness. If the goal is to achieve better quality, merely increasing nurse staffing levels may not be effective since the variation of the quality-of-care deficiencies explained by exogenous variables was smaller than random variation 5%. If state Medicaid reimbursements can be utilized for financial incentives for better performing nursing homes, nursing homes may improve their productivity by efficiently managing organizational personnel or increasing job satisfaction among nursing practitioners. Lastly, longitudinal analysis, considering variation in length of state staffing policy implementations, is encouraged to investigate the long-term effects of state staffing standards on nurse staffing levels and quality of care.
Show less - Date Issued
- 2011
- Identifier
- CFE0003754, ucf:48781
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0003754
- Title
- An Examination of the Florida Linking Individuals Needing Care Coordination Program for Racial and Ethnic Minority Females.
- Creator
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Vance, Michelle, Gryglewicz, Kimberley, Chapple, Reshawna, Lawrence, Shawn, Fisher, Kristina Childs, University of Central Florida
- Abstract / Description
-
Suicide accounts for close to 800,000 deaths each year, making it one of the leading causes of death in the United States. In the state of Florida, suicide is the 10th leading cause of death. Currently, it is the 2nd leading cause of death among young people ages 15-29, claiming more lives than homicide. Among Black and Hispanic youth (10 to 24), it is the 2nd and 3rd leading causes of death. This study aimed to examine the extent to which depression and suicidality outcomes change among...
Show moreSuicide accounts for close to 800,000 deaths each year, making it one of the leading causes of death in the United States. In the state of Florida, suicide is the 10th leading cause of death. Currently, it is the 2nd leading cause of death among young people ages 15-29, claiming more lives than homicide. Among Black and Hispanic youth (10 to 24), it is the 2nd and 3rd leading causes of death. This study aimed to examine the extent to which depression and suicidality outcomes change among racial and ethnic minority females (i.e., Black and African American, Hispanic) who participated in a care coordination intervention. These subpopulations were chosen due to limited suicide prevention research on at-risk racial and ethnic minority females and to address health disparities. To examine these outcomes, the study employed a one-group pretest-posttest design utilizing secondary data from 76 youth participants enrolled in the care coordination program from three crisis stabilization units (CSU) in Florida. Key findings included significant decreases in depression symptomology (54%) and suicidality (82%). Among participants enrolled in the program, 84% did not have a readmission to the CSU. Length of stay was a predictor or readmission in that a one unit (one day) increase lead to a 3% increase in odds of readmission to the CSU. Results of this study can help guide social work and mental health practitioners in designing and implementing community-based suicide prevention programs for racial and ethnic minority females.
Show less - Date Issued
- 2019
- Identifier
- CFE0007548, ucf:52594
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007548
- Title
- Rapid Response Teams versus Critical Care Outreach Teams: Unplanned Escalations in Care and Associated Outcomes.
- Creator
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Danesh, Valerie, Neff, Donna, Aroian, Karen, Andrews, Diane, Unruh, Lynn, University of Central Florida
- Abstract / Description
-
The incidence of unplanned escalations during hospitalization is undocumented, but estimates may be as high as 1.2 million occurrences per year in the United States. Rapid Response Teams (RRT) were developed for the early recognition and treatment of deteriorating patients to deliver time-sensitive interventions, but evidence related to optimal activation criteria and structure is limited. The purpose of this study is to determine if an Early Warning Score-based Critical Care Outreach (CCO)...
Show moreThe incidence of unplanned escalations during hospitalization is undocumented, but estimates may be as high as 1.2 million occurrences per year in the United States. Rapid Response Teams (RRT) were developed for the early recognition and treatment of deteriorating patients to deliver time-sensitive interventions, but evidence related to optimal activation criteria and structure is limited. The purpose of this study is to determine if an Early Warning Score-based Critical Care Outreach (CCO) model is related to the frequency of unplanned intra-hospital escalations in care compared to a RRT system based on staff nurse identification of vital sign derangements and physical assessments. The RRT model, in which staff nurses identified vital sign derangements to active the system, was compared with the addition of a CCO model, in which rapid response nurses activated the system based on Early Warning Score line graphs of patient condition over time. Logistic regressions were used to examine retrospective data from administrative datasets at a 237-bed community non-teaching hospital during two periods: 1) baseline period, RRT model (n=5,875) (Phase 1: October 1, 2010 (-) March 31, 2011), and; 2) intervention period, RRT/CCO model (n=6,273). (Phase 2: October 1, 2011 (-) March 31, 2012). The strongest predictor of unplanned escalations to the Intensive Care Unit was the type of rapid response system model. Unplanned ICU transfers were 1.4 times more likely to occur during the Phase 1 RRT period. In contrast, the type of rapid response model was not a significant predictor when all unplanned escalations (any type) were grouped together (medical-surgical-to-intermediate, medical-surgical-to-ICU and intermediate-to-ICU). This is the first study to report a relationship between unplanned escalations and different rapid response models. Based on the findings of fewer unplanned ICU transfers in the setting of a CCO model, health services researchers and clinicians should consider using automated Early Warning score graphs for hospital-wide surveillance of patient condition as a safety strategy.
Show less - Date Issued
- 2015
- Identifier
- CFE0006212, ucf:51093
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006212
- Title
- Perceived readiness to transition to adult health care for youth with cystic fibrosis and congruence with their caregivers' views.
- Creator
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Lapp, Valerie, Chase, Susan, Aroian, Karen, Weiss, Josie, Yan, Xin, Robinson, Patricia, University of Central Florida
- Abstract / Description
-
Youth with cystic fibrosis must gradually assume considerable self-care management skills in order to optimize longevity and quality of life, and healthcare providers and caregivers play a role in youth gradually assuming these skills. The purpose of this study was to determine how youth with cystic fibrosis perceive their self-care management skills required for transition to adult healthcare, the relationship between age and skill acquisition, youth and caregiver congruence on perceived...
Show moreYouth with cystic fibrosis must gradually assume considerable self-care management skills in order to optimize longevity and quality of life, and healthcare providers and caregivers play a role in youth gradually assuming these skills. The purpose of this study was to determine how youth with cystic fibrosis perceive their self-care management skills required for transition to adult healthcare, the relationship between age and skill acquisition, youth and caregiver congruence on perceived transition readiness, and frequency of transition discussion with provider. In this descriptive, correlational, cross-sectional design, 58 youth ages 14-22 rated their skill ability in managing cystic fibrosis using the Transition Readiness Assessment Questionnaire (TRAQ) during visits to the cystic fibrosis clinic. Using an adapted version of the questionnaire, the TRAQ-C, 52 caregivers also rated youth readiness to transition to determine congruence in self-care management ability. Five simple regressions were calculated to determine age effects for the self-care management skills. Independent t-tests were used to compare mean scores of youth and caregiver perceptions of self-care management skills. Age predicted youth perception of readiness for self-care management skills. Youth scored significantly higher than their caregivers did in perception of self-care skill management. Study findings suggest that preparation for transition to adult care should begin at an earlier age to prepare youth to assume self-care. Including transition discussion with youth and caregiver assessments using questionnaires such as the TRAQ and TRAQ-C may guide learning of skills and timing of transition to adult health care.
Show less - Date Issued
- 2016
- Identifier
- CFE0006133, ucf:51185
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006133
- Title
- Early and Intermediate Hospital-to-Home Transition Outcomes of Older Adults Diagnosed with Diabetes.
- Creator
-
Lamanna, Jacqueline, Bushy, Angeline, Norris, Anne, Wink, Diane, Gammonley, Denise, University of Central Florida
- Abstract / Description
-
Over 5 million older adults with diabetes are hospitalized each year. Though typically not the index condition that leads to hospitalization, diabetes control often decompensates during the course of an admission and necessitates changes in home self-management plans. The specific transitional care needs of older adults with diabetes have been largely unstudied. Transition theory provided the guiding framework for this research and proposes that each transition is a complex process created by...
Show moreOver 5 million older adults with diabetes are hospitalized each year. Though typically not the index condition that leads to hospitalization, diabetes control often decompensates during the course of an admission and necessitates changes in home self-management plans. The specific transitional care needs of older adults with diabetes have been largely unstudied. Transition theory provided the guiding framework for this research and proposes that each transition is a complex process created by the continuous interaction of personal, community, and societal-level conditions that facilitate or inhibit the health of a transition. Hospitalization has been described as a series of three successive, interrelated transitions. The aims of this study were to determine whether personal and community transition conditions impacted the early and intermediate post-discharge outcomes in a sample of older adults with diabetes. A simultaneous quantitative/qualitative mixed method design was used to identify factors that impacted the home recovery transition experiences in a sample of 96 older adults with a mean age of 75 years. A supplementary content analysis of free-response data gathered during administration of the Post-Discharge Coping Difficulty Scale (PDCDS) clarified difficulties encountered by elders and caregivers during in the first 30 days following discharge. Four overarching themes emerged: (")the daily stuff is difficult("); (")engineering care at home is difficult("); (")life is stressful(") and (")difficulty managing complex health problems(").Difficulties managing a complex medication regimen, regulating blood glucose, and managing a non-diabetes chronic health problem such as hypertension and chronic lung disease were subthemes that emerged during qualitative data analyses. These subthemes were transposed into discrete nominal level variables and served as additional indicators of post-discharge coping difficulty in the descriptive correlational core component of the research project.Participants in this study who experienced an event of recidivism had lower pre-discharge assessments of readiness on the Readiness for Hospital Discharge Scale (RHDS) (t = 2.274,df = 48, p =.028). Higher PDCDS scores were observed in patients who experienced an event of recidivism within 30 days of discharge (t = -3.363, df=24.7, p = .003) and also in respondents who described difficulties with managing medications, controlling diabetes, and managing a chronic illness. Binary logistic regression was used to identify factors that may predict recidivism risk. No condition-specific predictor variables were identified. A statistically significant three-variable model (X2 = 26.737, df = 3, p (<) .001) revealed that PDCDS scores at 7 days (Wald X2 =3.671, df = 1, p =.050), PDCDS scores at 30 days (Wald X2 = 6.723, df = 1, p =.010), and difficulty managing a chronic health condition (Wald X2 = 8.200, df = 1, p =.004) were predictive of an event of recidivism within 30 days of discharge. Difficulty managing a chronic health problem other than diabetes was particularly predictive of recidivism. The nurse's skill in delivering discharge education was a factor in limiting early post-discharge difficulties. Elders with residual information needs on the day of discharge as measured by scores the Quality of Discharge Teaching Scale (QDTS) reported a lower readiness for discharge (r = -.314, p = .003) and experienced greater difficulties with early post-discharge coping (r =. 288, p = .023). Greater satisfaction with the post-discharge transition was noted in participants with higher QDTS scores (r = .444, p (<).001). Outcomes of the hospital-to-home transition experience were impacted by a variety of personal, hospital, and community factors. Findings of this study suggest that there is a need to better understand the sequential nature of the home recovery transition and the fluid needs of older adults during this high-risk phase of care. The environments in which older adults receive post-discharge care are complex and need to be thoroughly considered when planning the post-discharge transition. Metrics of institutional performance of transitional care practices need to extend beyond events to recidivism and include evaluations of post-discharge coping and transition satisfaction. The nurse as the primary provider of discharge education has the potential to significantly promote positive transition outcomes for older adults and their family care providers.
Show less - Date Issued
- 2013
- Identifier
- CFE0004875, ucf:49652
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004875
- Title
- Down in the Mouth: Homelessness and Oral Health.
- Creator
-
Kleinberger, Jessica, Wright, James, Rivera, Fernando, Donley, Amy, University of Central Florida
- Abstract / Description
-
The burden of dental disease in American has been termed a (")silent epidemic,(") affecting the most vulnerable populations in society. Poor oral health has been linked with general health issues, such as diabetes and cardiovascular disease, as well as decreased mental health and impairments in social functioning. This burden weighs particularly heavy on the homeless, who are not only denied access to private systems of care, but are further rejected by an inadequately supported public safety...
Show moreThe burden of dental disease in American has been termed a (")silent epidemic,(") affecting the most vulnerable populations in society. Poor oral health has been linked with general health issues, such as diabetes and cardiovascular disease, as well as decreased mental health and impairments in social functioning. This burden weighs particularly heavy on the homeless, who are not only denied access to private systems of care, but are further rejected by an inadequately supported public safety net. Despite the recognition of social inequalities and the call for further scientific research, oral health care has not been extensively recognized within sociology. The aim of this research was to uncover how Central Florida's homeless adults cope with oral health issues in the face of barriers. This study intends to begin closing the gap by exploring the ways in which structural inequalities are embodied in the teeth of the homeless. Twenty-five semi-structured interviews were conducted with homeless individuals in the Central Florida area in regards to their oral health and coping mechanisms. Results indicate that without conventional access to dental care, homeless are forced to rely on emergency departments, alcohol, illegal drugs, home remedies, and over-the-counter medications. When treatment was received, only emergency services were provided. This led to an extraction-denture treatment model which left many homeless individuals edentulous, with continued complications in their ability to eat, work, and talk.
Show less - Date Issued
- 2014
- Identifier
- CFE0005192, ucf:50640
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005192
- Title
- TRAUMA-FOCUSED MODELS FOR CAREGIVERS: A SYSTEMATIC REVIEW OF EMPIRICAL RESEARCH.
- Creator
-
Paul, Wesley, Lawrence, Shawn, University of Central Florida
- Abstract / Description
-
Child and Adolescent caregivers are rarely the focus of research and/or trauma-focused or informed models when working with traumatized children (Baynard, Englund, & Rozelle, 2001; Chapman, Dube, & Anda, 2007). It has been shown that use of caregivers in the treatment of children who have suffered trauma can have a significant impact on not only the child, but also reduce the trauma symptoms of the caregivers themselves (Cohen, Mannarino, & Staron, 2006). The purpose of this study is to...
Show moreChild and Adolescent caregivers are rarely the focus of research and/or trauma-focused or informed models when working with traumatized children (Baynard, Englund, & Rozelle, 2001; Chapman, Dube, & Anda, 2007). It has been shown that use of caregivers in the treatment of children who have suffered trauma can have a significant impact on not only the child, but also reduce the trauma symptoms of the caregivers themselves (Cohen, Mannarino, & Staron, 2006). The purpose of this study is to critically review the empirical research of trauma-focused and trauma-informed trainings and treatment models for children who have suffered some form of trauma and whose caregiver is included in the treatment. The outcomes of trauma-focused models will be examined in terms of its purpose, intervention, facilitation, adaptability and modification. Implications for further research and application are drawn.
Show less - Date Issued
- 2013
- Identifier
- CFH0004369, ucf:45026
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH0004369
- Title
- Examining the influence of personal and environmental factors on treatment outcomes in opioid dependent medication-assisted treatment patients.
- Creator
-
Placide, Vierne, Unruh, Lynn, Atkins, Danielle, Chisholm, Latarsha, Scott, Blake, University of Central Florida
- Abstract / Description
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Opioid abuse has become a global epidemic and is now a huge public health concern here in the US. Non-medicinal use of opioid prescription drugs is at the forefront of the epidemic and considered the (")gateway(") drug to other illicit opioid use. As opioid prescribing has increased over the last decade in the US, so has opioid-related deaths, surpassing car accidents and suicide as the leading cause of injury-related deaths. Medication assisted treatment (MAT) is fundamental in decreasing...
Show moreOpioid abuse has become a global epidemic and is now a huge public health concern here in the US. Non-medicinal use of opioid prescription drugs is at the forefront of the epidemic and considered the (")gateway(") drug to other illicit opioid use. As opioid prescribing has increased over the last decade in the US, so has opioid-related deaths, surpassing car accidents and suicide as the leading cause of injury-related deaths. Medication assisted treatment (MAT) is fundamental in decreasing opioid abuse overdose and mortality. Therefore, the research study aims to determine if counseling adherence, opioid abstinence, and retention in MATs are influenced by personal characteristics, socio-economic factors, readiness to change, social support, and integrated care. Guided by social cognitive theory, transtheoretical model, and theory of reasoned action, the study will employ a retrospective cohort design utilizing opioid dependent patients from a MAT Program in West Florida. Analysis of three cox regression models indicated for personal factors: an increase in age was associated with patients being more likely to adhere to counseling (p=.001) and retention (p=.034), full-time employment (p=.043) was positively associated with opioid abstinence, whereas part-time employment (p=.037) was positively associated with retention, having insurance (public: p=.000) was positively associated with counseling adherence, opioid abstinence (public: p=.000, private: p=.035) and retention (public: p=.000, private: p=.000). With regards to environmental influences, social support was positively associated with opioid abstinence (p=.022) and integrated care was positively associated with opioid abstinence (p=.027) and retention (p=.000). Examining these factors are necessary to improve treatment adherence and expand MAT programs. Additionally, providing funding is crucial for practitioners to continually create educational intervention strategies to engage patients in treatment, thereby reducing the opioid overdose epidemic. This study extends the literature contributing to understanding personal factors and environmental influences in MATs.
Show less - Date Issued
- 2018
- Identifier
- CFE0007074, ucf:52018
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007074
- Title
- Treatment of Leachate Organic Matter through Sunlight Driven Processes.
- Creator
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Lozinski, Duncan, Reinhart, Debra, Lee, Woo Hyoung, Bolyard, Stephanie, University of Central Florida
- Abstract / Description
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The ability to manage leachate during post-closure care (PCC) of a landfill may be increasingly difficult as leachate organic matter (LOM) becomes recalcitrant when a landfill ages, requiring advanced and costly treatment technologies. This research investigated the ability to treat LOM through sunlight driven processes, with a focus on photolysis, to provide insight to landfill owners and operators on the potential of wetlands treatment as a means for reducing long-term risks and costs...
Show moreThe ability to manage leachate during post-closure care (PCC) of a landfill may be increasingly difficult as leachate organic matter (LOM) becomes recalcitrant when a landfill ages, requiring advanced and costly treatment technologies. This research investigated the ability to treat LOM through sunlight driven processes, with a focus on photolysis, to provide insight to landfill owners and operators on the potential of wetlands treatment as a means for reducing long-term risks and costs associated with leachate treatment during PCC. The study was completed in eight batch tests, where leachate was exposed to natural sunlight in central Florida for a period of 90 days. It was hypothesized that through photolytic reactions, in particular photolysis, high molecular weight recalcitrant LOM would be degraded to labile, low molecular weight material. To identify the treatment mechanisms, transformation processes were measured using ultraviolet-visible (UV-Vis) spectroscopy, fluorescence excitation-emission matrix spectroscopy (EEMs), size-exclusion chromatography (SEC), and chemical oxygen demand (COD) from the beginning to the end of the test period. Additionally, the ability for nitrogen species to become bioavailable when exposed to sunlight was evaluated for two of the leachate samples using solid-phase extraction (SPE) to fractionate recalcitrant dissolved organic nitrogen (rDON) and bioavailable dissolved organic nitrogen (bDON). Results suggest that treatment of LOM through sunlight driven processes is possible. Treatment is dependent upon the dilution of leachate and characteristics of the LOM. Dilution must be high enough to allow sunlight to penetrate the depth of the liquid. UV-Vis, EEMs, and SEC show that high molecular weight recalcitrant material is undergoing transformation into lower molecular weight material as a result of photolytic and likely biological reactions promoted by sunlight. The ability for nitrogen to become bioavailable when exposed to sunlight was shown to be dependent upon nitrogen concentrations in the sample.
Show less - Date Issued
- 2018
- Identifier
- CFE0007044, ucf:51987
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007044
- Title
- LOW-INCOME HEALTH CARE NETWORKS: INITIAL CONDITIONS, EXTENT, AND INTENSITY RELEVANT TO COUNTY GOVERNMENT PARTICIPATION.
- Creator
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Knepper, Hillary, Feldheim, Mary Ann, University of Central Florida
- Abstract / Description
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Contemporary health care systems in the United States are not equitable. Indeed, as the literature indicates, there are substantial differences in the variety and scope of service delivery based on age, income, and other socio-economic indicators. The recent passage of health care reform in the United States illustrates that Americans are seeking to bring balance and equity to health care. However, as learned in this study, county governments across the country have been working in their...
Show moreContemporary health care systems in the United States are not equitable. Indeed, as the literature indicates, there are substantial differences in the variety and scope of service delivery based on age, income, and other socio-economic indicators. The recent passage of health care reform in the United States illustrates that Americans are seeking to bring balance and equity to health care. However, as learned in this study, county governments across the country have been working in their communities to ensure some balance and equity, by making a safety net available for those citizens who are unable to access health care. Perhaps this is because health care quickly becomes a local government problem. In this current economic climate, county governments are being pinched between declining revenues and rising demands for services (Eaton, 2009; Phaup, 2009). The Orange County Primary Care Access Network is one example studied here that provides clear evidence of how organizations can work together to develop and maintain a sustainable health care safety net for the underinsured and uninsured. This study is the first of its kind to examine county government influences, environmental pressures, and community resources in the context of health care network performance. The methodological research question for this study is what determinants (exogenous constructs) contribute to a health care network and its performance (endogenous construct) within the framework of county government participation? Further, is the model supported by the data and can prediction, direction, and strength of relationships among the variables be identified? The simple answer is yes. For this study, the responses from 123 counties were analyzed with a variety of statistical techniques, culminating in structural equation modeling. The outcome of these analyses provided a reasonable explanation for the variation among the variables leading to network performance improvement in meeting the health care needs of uninsured and underinsured people. These quantitative data were also supported in their results with the inclusion of a case study analysis of a particular health care safety-net, the Orange County Primary Care Access Network in Orange County, Florida. Ultimately, this study learned three valuable lessons that can be used by county government decision-makers and health care providers alike. First, county involvement in community based health care networks results in a benefit that reverberates during economic stress- the leveraging of resources. Second, public-private initiatives are fundamental to reducing disparities in health care access. Third, health care networks improve access to health care for uninsured and underinsured people. Ultimately, county government participation is the largest predictor of network performance in this study.
Show less - Date Issued
- 2010
- Identifier
- CFE0003341, ucf:48475
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0003341
- Title
- Factors Influencing Hypoglycemia Care Utilization and Outcomes Among Adult Diabetic Patients Admitted to Hospitals: A Predictive Model.
- Creator
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Kattan, Waleed, Wan, Thomas, Ramirez, Bernardo, Gurupur, Varadraj, Stevenson, Robyne, Pratley, Richard, University of Central Florida
- Abstract / Description
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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.
Show less - Date Issued
- 2017
- Identifier
- CFE0006611, ucf:51304
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006611
- Title
- A Simulation-Based Evaluation Of Efficiency Strategies For A Primary Care Clinic With Unscheduled Visits.
- Creator
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Bobbie, Afrifah, Karwowski, Waldemar, Thompson, William, Elshennawy, Ahmad, Mikusinski, Piotr, University of Central Florida
- Abstract / Description
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In the health care industry, there are strategies to remove inefficiencies from the health delivery process called efficiency strategies. This dissertation proposed a simulation model to evaluate the impact of the efficiency strategies on a primary care clinic with unscheduled "walk-in" patient visits. The simulation model captures the complex characteristics of the Orlando Veteran's Affairs Medical Center (VAMC) primary care clinic. This clinic system includes different types of patients,...
Show moreIn the health care industry, there are strategies to remove inefficiencies from the health delivery process called efficiency strategies. This dissertation proposed a simulation model to evaluate the impact of the efficiency strategies on a primary care clinic with unscheduled "walk-in" patient visits. The simulation model captures the complex characteristics of the Orlando Veteran's Affairs Medical Center (VAMC) primary care clinic. This clinic system includes different types of patients, patient paths, and multiple resources that serve them. Added to the problem complexity is the presence of patient no-shows characteristics and unscheduled patient arrivals, a problem which has been until recently, largely neglected. The main objectives of this research were to develop a model that captures the complexities of the Orlando VAMC, evaluate alternative scenarios to work in unscheduled patient visits, and examine the impact of patient flow, appointment scheduling, and capacity management decisions on the performance of the primary care clinic system. The main results show that only a joint policy of appointment scheduling rules and patient flow decisions has a significant impact on the wait time of scheduled patients. It is recommended that in the future the clinic addresses the problem of serving additional walk-in patients from an integrated scheduling and patient flow viewpoint.
Show less - Date Issued
- 2016
- Identifier
- CFE0006443, ucf:51462
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006443
- Title
- Unicondylar Knee Arthroplasty in the Inpatient vs Outpatient Setting: Impact on Process Time, Quality Outcomes, and Patient Satisfaction.
- Creator
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Zeini, Ibrahim, Ramirez, Bernardo, Noblin, Alice, Liu, Albert Xinliang, Sivo, Stephen, University of Central Florida
- Abstract / Description
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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.
Show less - Date Issued
- 2015
- Identifier
- CFE0006427, ucf:51489
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0006427
- Title
- AN INVESTIGATION OF THE ECONOMIC VIABILITY AND ETHICAL RAMIFICATIONS OF VIDEO SURVEILLANCE IN THE ICU.
- Creator
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Bagge, Laura, Heglund, Stephen, University of Central Florida
- Abstract / Description
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The purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely...
Show moreThe purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely increase, which may burden hospital with additional costs.. Because of increasing economic pressures, more hospitals are using video surveillance to enhance quality care and reduce ICU costs (Goran, 2012). Research shows that VS enhances positive outcomes among patients and best practice compliance among hospital staff. The results are fewer reports of patient complications and days spent in the ICU, and an increase in reported hospital savings. In addition, VS is becoming an important tool for the families of newborns in the neonatal ICU (NICU). The belief is that the VS can facilitate parent-baby bonding. In the United States of America, privacy rights impose legal restrictions on VS. These rights come from the U.S. Constitution, Statutory law, Regulatory law, and State law. HIPPA authorizes the patient to control the use and disclosure of his or her health information. Accordingly, hospitals are under obligation to inform patients on their right to protected health information. It is appropriate that hospitals use VS for diagnostic purposes as long as they have obtained patient consent. According to modern day privacy experts Charles Fried and Alan Westin, a violation of a person's privacy equates a violation on their liberty and morality. However, if a physician suspects that a third party person is causing harm to the patient, than the use of covert VS is justifiable.
Show less - Date Issued
- 2013
- Identifier
- CFH0004475, ucf:45138
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH0004475
- Title
- An economic analysis of child care and low-income mothers.
- Creator
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Donnan, Brenda C., Hosni, Djehane, Business Administration
- Abstract / Description
-
University of Central Florida College of Business Administration Thesis
- Date Issued
- 1979
- Identifier
- CFR0011947, ucf:53102
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFR0011947
