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Title: THE INFLUENCE OF MEDICAL EDUCATION ON THE FREQUENCY AND TYPE OF MEDICAL BOARD DISCIPLINE RECEIVED BY LICENSED FLORIDA PHYSICIANS.
Creator: Bonnell, III, Richard, Fottler, Myron, University of Central Florida
Abstract / Description: It has been estimated that in the United States, between 44,000 to 98,000 patients succumb to medical errors each year. Due to a shortage of graduates of domestic medical schools, many graduates of foreign medical schools are practicing in the United States. The medical education received in foreign medical schools may not be equivalent to the medical education received in domestic medical schools, which are schools located in the United States, Puerto Rico and Canada. Differences due to the...
Show moreIt has been estimated that in the United States, between 44,000 to 98,000 patients succumb to medical errors each year. Due to a shortage of graduates of domestic medical schools, many graduates of foreign medical schools are practicing in the United States. The medical education received in foreign medical schools may not be equivalent to the medical education received in domestic medical schools, which are schools located in the United States, Puerto Rico and Canada. Differences due to the educational backgrounds of the foreign-schooled physicians may contribute to an increase in medical board disciplining. Furthermore, graduates of medical schools where the instruction is not conducted in the English language may receive increased medical board disciplining when compared to the graduates of medical schools where English is the language of instruction. Finally, domestic medical schools that are ranked low according to The Gourman Report, 8th Edition may provide a substandard medical education, causing their graduates to have increased rates of discipline when compared to peers who have graduated from higher ranked medical schools. This study examines the effects of undergoing foreign medical training as opposed to domestic medical training and receiving medical school instruction in the English language or another language, on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (N = 39,559). Also examined are the effects of attending domestic medical schools that are ranked lower than other domestic medical schools on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (n = 25,479). Control variables used in this logistic regression analysis include whether the medical doctor is specialty board certified or not, the specialty practiced and the medical doctor's race and gender. Archival data from the Florida Department of Health were used for this study. This study found that the graduates of medical schools where the instruction is not in the English language are more likely to receive discipline and are more likely to receive more severe types of discipline than graduates of medical schools where the instruction is in the English language. It was also found that medical doctors who are ABMS certified, are practicing either a surgical specialty, obstetrics, gynecology, psychiatry, emergency medicine, family medicine or diagnostic radiology, or are male have increased odds of being disciplined by the Florida Board of Medicine.
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Date Issued: 2008
Identifier: CFE0002392, ucf:47736
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002392

Title: THE USE OF DRUG THERAPY FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) IN THE MANAGEMENT OF OPPOSITIONAL DEFIANT DISORDER (ODD): A LITERATURE REVIEW.
Creator: Flowers, Shaina, D'Amato-Kubiet, Leslee, University of Central Florida
Abstract / Description: Children with oppositional defiant disorder (ODD) and a concurrent Axis I diagnosis are often prescribed drug therapy for attention deficit hyperactivity disorder (ADHD) to manage disruptive behavior. However, ODD symptoms tend to be poorly controlled, raising questions about the effectiveness of drug therapy in children with the condition. Safety and long term consequences of pharmacological agents for ODD are important factors clinicians must consider before initiating treatment. The...
Show moreChildren with oppositional defiant disorder (ODD) and a concurrent Axis I diagnosis are often prescribed drug therapy for attention deficit hyperactivity disorder (ADHD) to manage disruptive behavior. However, ODD symptoms tend to be poorly controlled, raising questions about the effectiveness of drug therapy in children with the condition. Safety and long term consequences of pharmacological agents for ODD are important factors clinicians must consider before initiating treatment. The purpose of this literature review is to examine the pharmacodynamics and efficacy of drug therapy used for ODD in school-age children and adolescents. Additionally, awareness of poor behavior patterns and recognition of symptoms associated with ODD in children among health care providers was explored. A literature review exploring ODD and drug therapy for ODD and related behavioral disorders was conducted from various online databases. Results from 15 reviewed studies suggest that pharmacologic therapy is typically prescribed for ODD symptoms when a comorbid condition such as ADHD, a mood disorder, or an anxiety disorder is present. Drug therapy for ADHD has demonstrated effective behavioral outcomes in reducing ODD symptom severity in children and tolerable side effects when used for short-term therapy. Studies have demonstrated success and better control of ODD symptoms with a focused drug therapy regimen. Overall, the benefits of drug therapy can potentially outweigh the risks of adverse effects, and improve the quality of life in children with ODD. In conclusion, uncovering the reasons for poorly controlled ODD in children can be of clinical significance to health care providers and can support decision making when considering drug therapy for children with this condition.
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Date Issued: 2014
Identifier: CFH0004673, ucf:45297
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004673

Title: FACTORS THAT AFFECT ADHERENCE WITH LONG-TERM CONTROLLER MEDICATIONS USED TO MANAGE ASTHMA IN CHILDREN.
Creator: Bowks, Brittany, Draves , Krisann, University of Central Florida
Abstract / Description: Problem: Asthma affects one out of every ten children in the United States. It is recommended that children with persistent asthma take long-term controller (LTC) medications to achieve control. However, adherence varies, and many children do not take their LTC medication at all. The average cost for hospitalization of a child with asthma is $8,406. Asthma in children also contributes to school absenteeism and a decrease in quality of life. Objective: A literature review was performed to...
Show moreProblem: Asthma affects one out of every ten children in the United States. It is recommended that children with persistent asthma take long-term controller (LTC) medications to achieve control. However, adherence varies, and many children do not take their LTC medication at all. The average cost for hospitalization of a child with asthma is $8,406. Asthma in children also contributes to school absenteeism and a decrease in quality of life. Objective: A literature review was performed to examine factors that affect adherence to LTC medications used to control asthma in children. Method: A literature review was performed using the CINAHL, ERIC, Medline, Psych Info, and Academic Search Premier databases. Keywords included asthma AND child* OR pediatric* AND adherence OR compliance AND corticosteroid* OR "leukotriene modifier*" OR "mast cell stabilizer*" OR "monoclonal antibod*" OR "long-acting beta agonist.*" After applying exclusion criteria 35 articles were included in this review. Results: A variety of factors that affect adherence were identified. Internal factors included age, sex, and race/ethnicity. External factors included socioeconomic status, environment, health perception, lack of motivation, parental education, disease/medication beliefs, family dynamics and planning, responsibility, severity, and exacerbations. Interventional factors included caregiver-family communication, asthma knowledge, specialty care, white coat adherence, number of prescriptions, asthma action plans, medication regimens, and technology. Conclusion: It is recommended that healthcare providers use a four-step process during inpatient and outpatient asthma visits. The steps include assess and educate, collaborate, problem-solve, and follow-up. Collectively, this method can help healthcare providers overcome many of the barriers that were identified.
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Date Issued: 2015
Identifier: CFH0004809, ucf:45438
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004809

Title: THE EFFECTS OF MEDICAL CANNABIS USE AMONG ADULTS WITH CHRONIC PAIN: AN INTEGRATIVE REVIEW OF THE LITERATURE.
Creator: Asevedo, Bridget A, Bushy, Angeline, University of Central Florida
Abstract / Description: The purpose of this integrative literature review was to understand the effects of medical cannabis for chronic pain management in adults. Anecdotal reports suggest the use of medical marijuana as a pain management therapy could be an alternative to opioids and other medications which have long term consequences. Potential uses span the health care continuum, from prescribed outpatient symptom management, to acute care, extended care, home care, and hospice treatment settings. The methodology...
Show moreThe purpose of this integrative literature review was to understand the effects of medical cannabis for chronic pain management in adults. Anecdotal reports suggest the use of medical marijuana as a pain management therapy could be an alternative to opioids and other medications which have long term consequences. Potential uses span the health care continuum, from prescribed outpatient symptom management, to acute care, extended care, home care, and hospice treatment settings. The methodology included a review and synthesis of relevant research articles from 2012 to 2018, written in the English language. The findings suggest medical cannabis has the potential of effectively managing chronic pain in older adults. Adverse effects, if present, are mild and resolve without intervention. Lower doses of medical cannabis were reported to be more effective in treating chronic pain compared to higher doses. Inconsistencies in the efficacy of THC were noted compared to CBD for managing neuropathic pain. Implication for nursing practice, policy, education, and recommendation for future research were discussed along with study limitations.
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Date Issued: 2019
Identifier: CFH2000575, ucf:45620
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000575

Title: MEDICATE TO EXECUTE: CONSTITUTIONAL AND ETHICAL CONSIDERATIONS.
Creator: Schultz, Adam, Cronon, Chad, University of Central Florida
Abstract / Description: The United States Supreme Court has not yet examined several aspects of the death penalty. One aspect is the ability for the state to forcefully medicate an incompetent inmate, which may result in the inmate appearing competent for execution. While the Supreme Court' ruled that it is unconstitutional to execute an inmate who is incompetent, inmates who would have had their executions vacated due to mental illness are executed because the state can put them on an involuntary medication regimen...
Show moreThe United States Supreme Court has not yet examined several aspects of the death penalty. One aspect is the ability for the state to forcefully medicate an incompetent inmate, which may result in the inmate appearing competent for execution. While the Supreme Court' ruled that it is unconstitutional to execute an inmate who is incompetent, inmates who would have had their executions vacated due to mental illness are executed because the state can put them on an involuntary medication regimen. According to many experts, involuntary medication regimens mask the affects of their illness instead of providing a cure. Experts often refer to this practice as the "chemical straitjacket." Because the effects of antipsychotic medication, inmates may be sedated to a point where they appear competent, but in reality, they are sedated to a point where their mental illness is still present yet undetectable. As a result, placing condemned inmates on involuntary medication regimens has the possibility to violate the inmate's Fifth, Sixth, Eighth and Fourteenth Amendment rights. The intent of this thesis is to examine whether the Supreme Court has successfully upheld its duty to promote a fair judicial system by allowing the medicate to execute scheme to continue. Through the analysis of case law, law review articles, and the American Constitution, this thesis will evaluate the treatment of condemned inmates who show signs of incompetence. Through analysis, this thesis aims to raise awareness to an issue that, in the opinion of this writer, deserves the attention of American courts and other governing bodies.
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Date Issued: 2012
Identifier: CFH0004227, ucf:44960
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004227

Title: FLORIDA'S MEDICAL MALPRACTICE TORT REFORM: A COGNITIVE ANALYSIS OF LITIGIOUS, LEGISLATIVE PROMULGATION AND JURISPRUDENCE.
Creator: Formoso, Joseph, Milon, Abby, University of Central Florida
Abstract / Description: Public opinion in recent years has been seemingly manipulated by superfluous stories, bad press, and negative commentaries regarding the perceived "Medical Malpractice Crisis." It has initiated a political attack on Florida's tort system which has resulted in making valid medical malpractice claims even more so difficult for victimized plaintiffs to pursue. After months of diligent research, and with the loyal aid of my university advisors and the dedicated law librarians I've had the honor...
Show morePublic opinion in recent years has been seemingly manipulated by superfluous stories, bad press, and negative commentaries regarding the perceived "Medical Malpractice Crisis." It has initiated a political attack on Florida's tort system which has resulted in making valid medical malpractice claims even more so difficult for victimized plaintiffs to pursue. After months of diligent research, and with the loyal aid of my university advisors and the dedicated law librarians I've had the honor to work with, I have thoroughly analyzed Florida's past and present medical malpractice tort reforms and governing procedural laws; in addition to arguing, by virtue of this thesis, why these reforms were truly enacted, how traditional tort reforms have egregiously compromised public interests, why Florida's future - with regard to legislative change - is grim, and how new, innovative tort reforms - such as those established overseas - could genuinely benefit Floridians. The premise of the conclusion reached in this research is partially iterated in a quote by the critically acclaimed "Insurance Law Expert," Tom Baker: "...the medical malpractice myth. Built on a foundation of urban legend mixed with the occasional true story, supported by selective references to academic studies, and repeated so often that even the mythmakers forget the exaggeration, half truth, and outright misinformation employed in the service of their greater good, the medical malpractice myth has filled doctors, patients, legislators, and voters with the kind of fear that short circuits critical thinking." -Baker, T. (2005). The medical malpractice myth. Chicago: University of Chicago Press.
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Date Issued: 2012
Identifier: CFH0004207, ucf:44972
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004207

Title: GREEN CHAIRS, FICTIONAL PHALLUSES, INFILTRATION, AND LOVE ON THE ROCKS: MEDICAL IMAGING ARTIFACTS BLOWN UP.
Creator: Koller, Lynn, Bowdon, Melody, University of Central Florida
Abstract / Description: This text outlines and applies a methodology for deciphering problems and producing new information by analyzing the artifacts produced by medical imaging technologies – text and images – using practices gleaned from Surrealists, semiologists, and visual artists, emphasizing its own form as being the product of the apparatuses that produce it and therefore untrustworthy. Its basic assumption is that every text contains the information necessary to solve problems of all sorts, though...
Show moreThis text outlines and applies a methodology for deciphering problems and producing new information by analyzing the artifacts produced by medical imaging technologies – text and images – using practices gleaned from Surrealists, semiologists, and visual artists, emphasizing its own form as being the product of the apparatuses that produce it and therefore untrustworthy. Its basic assumption is that every text contains the information necessary to solve problems of all sorts, though because of the limitations of this text in both form and authorial intellect, we may only reach a starting point for a solution herein. In this regard, we are deciphering rather than solving. Further, this text illustrates primarily through narratives how digital imaging technologies mediate our relationship with our doctors, illnesses, and our bodies. It explores how the artifacts produced by medical imaging technologies create a data stream that replaces the corporal patient, shifting the physician's focus from the whole body to pieces and parts. It is a study of texts and technologies. The method evolved from a rhetorical approach to examining the medical imaging artifacts and the processes by which those artifacts come into existence, with the method and form becoming part of the story, producing a wide array of new information that transcends disciplinary constraints.
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Date Issued: 2008
Identifier: CFE0002193, ucf:47916
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002193

Title: Simulating Human Pleura Performance in Medical Training Using Measured Tissue Mechanical Properties.
Creator: Norfleet, Jack, Bai, Yuanli, Kassab, Alain, Metcalf, David, Cendan, Juan, University of Central Florida
Abstract / Description: Medical simulations provide hands-on training at various levels of medical expertise. Yet these simulators fail to accurately mimic the look, feel and behavior of human tissue. Applying measured mechanical properties from human cadaver tissues promises to improve the fidelity of simulated tissue behaviors when subjected to medical procedures. Samples of human parietal pleura were tested under uniaxial tension to failure and measured characteristics were replicated in synthetic pleura. Context...
Show moreMedical simulations provide hands-on training at various levels of medical expertise. Yet these simulators fail to accurately mimic the look, feel and behavior of human tissue. Applying measured mechanical properties from human cadaver tissues promises to improve the fidelity of simulated tissue behaviors when subjected to medical procedures. Samples of human parietal pleura were tested under uniaxial tension to failure and measured characteristics were replicated in synthetic pleura. Context specific parameters were then collected and compared between human pleura and the new synthetics. These comparisons tested the hypothesis; H1 Gaps exist between synthetic and human pleura performance, H2: Human tissue fracture mechanics define desired performance of synthetic tissues, H3: Synthetic and human tissues with similar stress/strain parameters will behave similarly when blunt punctured. The results promote the future development of high fidelity tissue simulants for medical training.The studied tissue is parietal pleura which contributes the critical haptic (")pop(") indicating access to the proper anatomic space during the tube thoracostomy procedure. Once accessed through blunt puncture, tube is then inserted to drain air and fluid from around the lungs.Stress/strain based hyper-elastic and fracture properties calibrated from fresh human cadaver pleura were used to define performance requirements. Synthetic pleura were then prototyped and their mechanical properties were characterized. Commercial pleura simulants were puncture tested and compared to compliant custom and off-the-shelf formulations. A non-compliant but commonly used pleura substitute was also tested. Blunt puncture force and displacement were compared for each of the materials to test the stated hypotheses.
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Date Issued: 2018
Identifier: CFE0007065, ucf:52023
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007065

Title: CULTURAL RELEVANCE IN MEDICINE: AN EVALUATION OF CULTURAL COMPETENCE CURRICULUM INTEGRATION IN SOUTHEASTERN MEDICAL SCHOOLS.
Creator: Gannon, Leslie, Mishtal, Joanna, University of Central Florida
Abstract / Description: Cultural competence in health care provision has been broadly identified as the need for providers to acknowledge, address, or incorporate an understanding of the cultural and social context of patients' lives into the process of treating and managing patient's illnesses. However, how cultural competence can be incorporated has been the subject of debates in biomedicine and anthropology, and has often been met with difficulties in physician practice. These challenges arise from differing...
Show moreCultural competence in health care provision has been broadly identified as the need for providers to acknowledge, address, or incorporate an understanding of the cultural and social context of patients' lives into the process of treating and managing patient's illnesses. However, how cultural competence can be incorporated has been the subject of debates in biomedicine and anthropology, and has often been met with difficulties in physician practice. These challenges arise from differing perspectives about how cultural competence is understood and institutional neglect of culturally relevant education. While the need for cultural competence integration into health care practitioner training during medical school education has been discussed for over six decades, effective incorporation of cultural competence into medical curriculum remains a multifaceted topic of interdisciplinary debate and a challenging task. The purpose of this project is to evaluate cultural competence integration in Southeastern medical school curriculum. Theoretically, this research utilizes critical medical anthropology as developed by anthropologists Arthur Kleinman, Janelle Taylor and Nancy Sheper-Hughes as a theoretical lens through which cultural competency implementation in Southeastern medical school curricula can be examined curricula Southeastern. This research also fills an interdisciplinary gap in both anthropological and medical scholarly knowledge bases. Methodologically, multiple project parameters have been explored utilizing qualitative data collection methods of cultural competence background and evaluation. This research combines primary data collection and secondary data analysis. Primary data collection involved interviewing individuals from Florida medical institutions concerning their experience and personal views of the benefit of cultural competence integration. The analysis of secondary data explored the integration of cultural competence into medical school curricula. These analyses include an examination of the content, format, and language of Southeastern medical school curricula, demographic trends as related to cultural competence in health care, federal grant allocation as related to cultural competence in health care, and institutional perspectives on incorporating social science concepts in medical education. This thesis makes three distinct but interrelated claims: (1) I argue that based on the provided descriptions of medical institution curriculum guides, there is a substantial discrepancy between the cultural competency incorporation claims made by the schools and what is actually integrated into their curriculum; (2) I argue that cultural competence integration must be delivered vertically across disciplines and horizontally across the entire four year span of medical education, and (3) Available ethnographic guides are presented with too narrow of a focus to apply to all medical school curricula. Understanding the shortcomings of medical school curricula in incorporating cultural competence training is significant because it draws attention to the need to develop more effective and systematic ways to train future health care providers to address the needs of an increasingly diverse patient population.
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Date Issued: 2014
Identifier: CFH0004717, ucf:45370
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004717

Title: VOICE TRACK COMPUTER BASED SIMULATION FOR MEDICAL TRAINING.
Creator: Makwana, Alpesh, Kincaid, J. Peter, University of Central Florida
Abstract / Description: Varying the delivery rate of audio-based text within web-based training increases the effectiveness of the learning process and improves retention when compared with a fixed audio-based text delivery rate. To answer this question, two groups of 20 participants and one group of 10 participants were tested using the Web-based Anatomy & Physiology course modules developed by Medsn, Inc. The control group received the static speed of 128 words per minute while the experimental group received the...
Show moreVarying the delivery rate of audio-based text within web-based training increases the effectiveness of the learning process and improves retention when compared with a fixed audio-based text delivery rate. To answer this question, two groups of 20 participants and one group of 10 participants were tested using the Web-based Anatomy & Physiology course modules developed by Medsn, Inc. The control group received the static speed of 128 words per minute while the experimental group received the initial speed of 128 words per minute with the option to change the speed of the audio-based text. An additional experimental group received the initial speed of 148 words per minute also having the option to vary the speed of the audio-based text. A three way single variable Analysis of Variance (ANOVA) was utilized to examine speed of voice presentation differences. The results were significant, F (2, 47) = 4.67, p=0.014, ç2 = 0.166. The mean for the control group was (M = 7.2, SD = 1.69) with the experimental groups at, (M = 8.4, SD = 1.31) and with extra groups at (M = 8.6, SD = 1.26).
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Date Issued: 2005
Identifier: CFE0000639, ucf:46533
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0000639

Title: NURSING ATTITUDES TOWARD THE USE OF REPROCESSED SINGLE-USE MEDICAL DEVICES.
Creator: Maben-Tenney, Laura, Loerzel, Victoria, University of Central Florida
Abstract / Description: BACKGROUND: Before the implementation of single-use devices (SUD) in health care, medical equipment was sterilized and reused. Now many medical devices are used once and then thrown away, contributing to the 5.9 million tons of medical waste produced yearly. This project explores nursing attitudes toward single-use medical devices, evaluates current recycling practices and examines whether student nurses would be likely to use reprocessed SUDs in their practice if given the option....
Show moreBACKGROUND: Before the implementation of single-use devices (SUD) in health care, medical equipment was sterilized and reused. Now many medical devices are used once and then thrown away, contributing to the 5.9 million tons of medical waste produced yearly. This project explores nursing attitudes toward single-use medical devices, evaluates current recycling practices and examines whether student nurses would be likely to use reprocessed SUDs in their practice if given the option. METHODOLOGY: After obtaining IRB approval, students enrolled in nursing research courses were invited to participate in this exploratory study. 157 undergraduate nursing students completed the 46-question survey. Descriptive statistics were used to analyze the survey results, independent t-tests were used to compare groups and content analysis was used to analyze open-ended responses. RESULTS: The typical student was female, age 30, licensed as a registered nurse and enrolled in the RN to BSN program. Most students (84.7%) viewed themselves as environmentally conscious, and most recycle at home (75.5%) and at work (54.7%). Most agreed (96.8%) that hospitals produce a lot of hazardous waste and that it is the hospitals responsibility for environmentally friendly waste disposal. The majority also agreed (80%) that nurses have the ability to impact waste production at a hospital. More than half (67.7%) agreed that SUD disposal contributes to environmental pollution and many (76.6%) felt that nurses should be responsible for environmental health concepts. Most (81.6%) felt that SUDs should be thrown out after one use and few (28.5%) felt that SUDs can be reused if sterilized. Most (74.0%) also believed that SUD reuse contributes to hospital acquired infections, but a little more than half (56.3%) were willing to reuse a SUD that had only touched intact skin if sterilized for reuse. Additionally, most respondents (79.1%) would consider joining a green team at work. Those who recycle at home were more likely to identify as environmentally conscious than those who do not recycle at home. No generational differences existed when considering environmental consciousness. Generation X was more likely to recycle at home than Generation Y, but no generational differences existed when analyzing work recycling habits. Generation X was also more likely to see single-use device disposal as contributing to environmental pollution than Generation Y. Home recyclers were more likely to agree that nurses have the ability to decrease the amount of hospital trash production, and more likely to join a green team than non-recyclers. They also believed that SUD disposal contributes to environmental pollution, SUDs can be reused if sterilized, and disagreed that SUD reuse contributes to hospital acquired infections when compared to those who do not recycle at home. Discussion: While most students agree that hospitals produce large amounts of waste and should be responsible for the disposal of it in an environmentally friendly manner, most are hesitant to use reprocessed SUDs as a means to make the hospital more environmentally friendly. Student responses indicated the largest perceived barriers to SUD reuse were fears of inadequate sterilization and fears of the spread of disease. CONCLUSIONS: Most students, especially home recyclers, believe themselves to be environmentally conscious and most were willing to consider reusing some SUDs. Translating this belief into action can happen through education in line with the Scope and Standards of practice for nursing, as well as establishing the safety of SUDs through further research.
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Date Issued: 2012
Identifier: CFH0004243, ucf:44939
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004243

Title: INDUCED HYPOTHERMIA AND ITS EFFECTS ON CARDIAC ARRHYTHMIAS.
Creator: Barlow, Shatoyia, Desmarais, Paul, University of Central Florida
Abstract / Description: The purpose of this integrated review of the literature was to determine the relationship between therapeutic hypothermia and cardiac arrhythmias. The reviewed literatures were English based articles from year 2003-2013. Relevant information from the American Heart Association and the International Liaison Committee on Resuscitation was used to further enhance research results. The results of this literature review showed hypothermia treatment propensity to prolong QT interval without...
Show moreThe purpose of this integrated review of the literature was to determine the relationship between therapeutic hypothermia and cardiac arrhythmias. The reviewed literatures were English based articles from year 2003-2013. Relevant information from the American Heart Association and the International Liaison Committee on Resuscitation was used to further enhance research results. The results of this literature review showed hypothermia treatment propensity to prolong QT interval without precipitating life-threatening arrhythmias. Although arrhythmias can be potentially increased under induced hypothermia, it has been shown that treatment is easier while under hypothermic conditions. The reviewed research also shows that hypothermia treatment should be expanded to include more circumstance besides ventricular cardiac arrest. It was suggested that the reason for lack of use of hypothermia treatment under the suggested conditions was due to the restricted circumstances in which it is suggested to be used. Other recommendations include increased monitoring for cardiac rhythms during cardiac arrhythmias and protocols for arrhythmia treatment.
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Date Issued: 2014
Identifier: CFH0004653, ucf:45256
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004653

Title: Optimization Algorithms for Deep Learning Based Medical Image Segmentations.
Creator: Mortazi, Aliasghar, Bagci, Ulas, Shah, Mubarak, Mahalanobis, Abhijit, Pensky, Marianna, University of Central Florida
Abstract / Description: Medical image segmentation is one of the fundamental processes to understand and assess the functionality of different organs and tissues as well as quantifying diseases and helping treatmentplanning. With ever increasing number of medical scans, the automated, accurate, and efficient medical image segmentation is as unmet need for improving healthcare. Recently, deep learn-ing has emerged as one the most powerful methods for almost all image analysis tasks such as segmentation, detection,...
Show moreMedical image segmentation is one of the fundamental processes to understand and assess the functionality of different organs and tissues as well as quantifying diseases and helping treatmentplanning. With ever increasing number of medical scans, the automated, accurate, and efficient medical image segmentation is as unmet need for improving healthcare. Recently, deep learn-ing has emerged as one the most powerful methods for almost all image analysis tasks such as segmentation, detection, and classification and so in medical imaging. In this regard, this dissertation introduces new algorithms to perform medical image segmentation for different (a) imaging modalities, (b) number of objects, (c) dimensionality of images, and (d) under varying labelingconditions. First, we study dimensionality problem by introducing a new 2.5D segmentation engine that can be used in single and multi-object settings. We propose new fusion strategies and loss functions for deep neural networks to generate improved delineations. Later, we expand the proposed idea into 3D and 4D medical images and develop a "budget (computational) friendly"architecture search algorithm to make this process self-contained and fully automated without scarifying accuracy. Instead of manual architecture design, which is often based on plug-in and out and expert experience, the new algorithm provides an automated search of successful segmentation architecture within a short period of time. Finally, we study further optimization algorithms on label noise issue and improve overall segmentation problem by incorporating prior information about label noise and object shape information. We conclude the thesis work by studying different network and hyperparameter optimization settings that are fine-tuned for varying conditions for medical images. Applications are chosen from cardiac scans (images) and efficacy of the proposed algorithms are demonstrated on several data sets publicly available, and independently validated by blind evaluations.
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Date Issued: 2019
Identifier: CFE0007841, ucf:52825
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007841

Title: RISK OF MEDICATION ERRORS IN THE HOME: AN INTEGRATIVE LITERATURE REVIEW.
Creator: Crescenzi, Maria M, Bushy, Angeline, University of Central Florida
Abstract / Description: Regardless of the setting, medication errors are of great concern when associated with an individual's health outcomes, along with the increased costs to society, healthcare institutions, and providers. Current research focuses on medication error data primarily in acute and extended care facilities. However, there is a paucity of research examining the causes of medication errors that occur post hospital discharge when individuals transition to the home. The purpose of this integrative...
Show moreRegardless of the setting, medication errors are of great concern when associated with an individual's health outcomes, along with the increased costs to society, healthcare institutions, and providers. Current research focuses on medication error data primarily in acute and extended care facilities. However, there is a paucity of research examining the causes of medication errors that occur post hospital discharge when individuals transition to the home. The purpose of this integrative literature review is to examine risk factors for medication errors outside of these settings, specifically in the home. A systematic literature search was conducted using multiple databases for relevant articles in the English language between 2006 to 2017, including CINAHL, MEDLINE, PubMed, and PsycINFO. Search terms included 'medication errors', 'home care', 'post-discharge', 'hospital readmission', and 'medication error risks in the home'. Exclusion criteria included medication errors in acute and extended care settings. The integrative review involved reading, analyzing and selecting articles, and summarizing on a matrix. Findings on occurrences of medication errors in the home included impaired client mental status, confusion related to medication names, limited understanding of medication purpose in the care plan and its side effects, level of health literacy, and client-provider miscommunication in discharge planning. Consistent and conflicting findings are discussed along with gaps in the literature. Limitations and implications for nursing practice, policy, research, and education are also noted.
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Date Issued: 2017
Identifier: CFH0000223, ucf:44678
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0000223

Title: A Root Cause Analysis of the Barriers to Transparency among Physicians: A Systemic Perspective.
Creator: Perez, Bianca, Liberman, Aaron, Oetjen, Dawn, Wan, Thomas, Abel, Eileen, University of Central Florida
Abstract / Description: Transparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis....
Show moreTransparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis. Three predictor variables are used to represent the various dimensions of the context just described. Perfectionism represents the intrapersonal domain, socio-organizational climate represents the interpersonal and institutional domains, and medico-legal environment represents the societal domain. Chin and Benne's normative re-educative strategy provides theoretical support for the notion that successful organizational change hinges upon addressing the structural and cultural barriers displayed by individuals and groups.The Physician Transparency Questionnaire was completed by 270 physicians who were drawn from a multi-site healthcare organization in Central Florida. Structural equation modeling was used to determine whether perfectionism, socio-organizational climate, and medico-legal environment significantly predict two transparency outcomes, namely, error reporting transparency and provider-patient transparency. Perfectionism and socio-organizational climate were found to be statistically significant predictors. Collectively, these variables accounted for nearly half of the variance in each transparency outcome. Within socio-organizational climate, policies had the greatest influence on transparency, followed by immunity and professional norms. Multiple group analysis showed that the covariance model developed in this study generalizes across gender, medical specialty, and occupation. In addition, group means comparisons tests revealed a number of interesting trends in error reporting and disclosure practices that provide insights about the behavioral and cognitive psychology behind transparent communication: 1) Physicians are more inclined to engage in provider-patient transparency compared to error reporting transparency, 2) physicians are more inclined to report serious errors compared to less serious errors, and 3) physicians are more inclined to express sympathy for bad outcomes than they are to apologize for a preventable error or be honest about the details surrounding bad outcomes. These results suggest that change efforts would need to be directed at medical education curricula and health provider organizations to ensure that current and future generations of physicians replace the pursuit for perfectionism with the pursuit for excellence. Also, a number of institutional changes are recommended, such as clearly communicating transparency policies and guidelines, promoting professional norms that encourage learning from mistakes rather than an aversion to error, and reassuring physicians that reporting and disclosure activities will not compromise their reputation. From the perspective of patient safety advocates and risk managers, the results are heartening because they emphasize a key principle in quality improvement - i.e., small changes can yield big results. From an ethical standpoint, this research suggests that healthcare organizations can inhibit (or facilitate) the emergence of professional virtues. Thus, although organizations cannot make a physician become virtuous, it is within their power to create conditions that encourage the physician to practice certain virtues. With respect to leadership styles, this research finds that bottom-up, grassroots change efforts can elicit professional virtues, and that culture change in healthcare lies beyond the scope of the medico-legal system.
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Date Issued: 2011
Identifier: CFE0004153, ucf:49083
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004153

Title: Understanding the Capabilities and Limitations of Advanced Interactive M(&)S: A Cricothyroidotomy Simulation Case Study.
Creator: Campbell-Wynn, Lillian, Proctor, Michael, Kincaid, John, Crumpton-Young, Lesia, Liu, Alan, Burgess, Deborah, University of Central Florida
Abstract / Description: Simulation for surgical education and training is increasingly perceived as a valuable contribution to traditional teaching methods providing a structured learning experience. Surgical simulations allow surgeons to practice tactics, techniques and procedures numerous times without the cost, limitations and ethical problems of using cadaver-based models. The goal of this research is to advance the use of modeling and simulation in support of emergency medical training. This research explores...
Show moreSimulation for surgical education and training is increasingly perceived as a valuable contribution to traditional teaching methods providing a structured learning experience. Surgical simulations allow surgeons to practice tactics, techniques and procedures numerous times without the cost, limitations and ethical problems of using cadaver-based models. The goal of this research is to advance the use of modeling and simulation in support of emergency medical training. This research explores questions identified through a case study of two different modeling and simulation techniques (-) virtual reality and mannequins - in the support of combat emergency medical education and training. To reduce the scope to a manageable dissertation, the research focuses on CricSim as representative form of virtual reality simulation and HapMed as a form of mannequin simulation both with haptic-enabled capabilities. To further narrow the scope, the research focuses on training of a medical technique common to both simulation systems, which for this research was the cricothyroidotomy airway management technique. The U.S. Army expressed interest in training of combat medics in the cricothyroidotomy airway management technique and offered to support experimentation with both facilities and trained combat medics as the sample population. An experiment supporting this research took place at Fort Indiantown Gap, a National Guard Training Center located in Annville, Lebanon County, Pennsylvania and is the home of the Medical Battalion Training Site. An advanced airway management course is augmented with combat medics receiving training and evaluation on performing the cricothyroidotomy procedure using CricSim and HapMed with system experts provided by each respective developer. The NASA Task Load survey is used to collect participants' assessment of workload in terms of Mental Demand, Physical Demand, Temporal Demand, Level of Effort, Performance and Level of Frustration based on four primary tasks of the cricothyroidotomy. Additionally, the Technology Acceptance Model survey is used to provide insight into participant's assessment of usability. Professional trainers also provide their assessment of the virtual simulators suitability in support of the combat medics in performing their tasks based on their standards. The results of the participants' assessment of each virtual simulator take the form of a comparison study. To improve the advancement of medical simulation in the training of cricothyroidotomy procedure, a summary of findings, generalized conclusions, lessons learned and recommendations for future research are illuminated. The dissertation team is comprised of medical experts within the U.S. Air Force Education and Training Command, U.S. Army Research and Medical Command, and the Uniformed Services University of the Health Sciences as well as simulation subject matter experts from the University of Central Florida.
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Date Issued: 2013
Identifier: CFE0005142, ucf:50705
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005142

Title: An Empirical Evaluation of an Instrument to Determine the Relationship Between Second-Year Medical Students' Perceptions of NERVE VP Design Effectiveness and Students' Ability to Learn and Transfer Skills from NERVE.
Creator: Reyes, Ramsamooj, Hirumi, Atsusi, Sivo, Stephen, Campbell, Laurie, Cendan, Juan, University of Central Florida
Abstract / Description: Meta-analyses and systematic reviews of literature comparing the use of virtual patients (VPs) to traditional educational methods support the efficacy of VPs (Cook, Erwin, (&) Triola, 2010; Cook (&) Triola, 2009; McGaghie, Issenberg, Cohen, Barsuk, (&) Wayne, 2011). However, VP design research has produced a variety of design features (Bateman, Allen, Samani, Kidd, (&) Davies, 2013; Botezatu, Hult, (&) Fors, 2010a; Huwendiek (&) De Leng, 2010), frameworks (Huwendiek et al., 2009b) and...
Show moreMeta-analyses and systematic reviews of literature comparing the use of virtual patients (VPs) to traditional educational methods support the efficacy of VPs (Cook, Erwin, (&) Triola, 2010; Cook (&) Triola, 2009; McGaghie, Issenberg, Cohen, Barsuk, (&) Wayne, 2011). However, VP design research has produced a variety of design features (Bateman, Allen, Samani, Kidd, (&) Davies, 2013; Botezatu, Hult, (&) Fors, 2010a; Huwendiek (&) De Leng, 2010), frameworks (Huwendiek et al., 2009b) and principles (Huwendiek et al., 2009a) that are similar in nature, but appear to lack consensus. Consequently, researchers are not sure which VP design principles to apply and few validated guidelines are available. To address this situation, Huwendiek et al. (2014) validated an instrument to evaluate the design of VP simulations that focuses on fostering clinical reasoning. This dissertation examines the predictive validity of one instrument proposed by Huwendiek et al. (2014) that examines VP design features. Empirical research provides evidence for the reliability and validity of the VP design effectiveness measure. However, the relationship between the design features evaluated by the instrument to criterion-referenced measures of student learning and performance remains to be examined. This study examines the predictive validity of Huwendiek et al.'s (2014) VP design effectiveness measurement instrument by determining if the design factors evaluated by the instrument are correlated to medical students' performance in: (a) quizzes and VP cases embedded in Neurological Examination Rehearsal Virtual Environment (NERVE), and (b) NERVE-assisted virtual patient/standardized patient (VP/SP) differential diagnosis and SP checklists. It was hypothesized that students' perceptions of effectiveness of NERVE VP design are significantly correlated to the achievement of higher student learning and transfer outcomes in NERVE.The confirmatory factor analyses revealed the effectiveness of NERVE VP design was significantly correlated to student learning and transfer. Significant correlations were found between key design features evaluated by the instrument and students' performance on quizzes and VP cases embedded in NERVE. In addition, significant correlations were found between the NERVE VP design factors evaluated by Huwendiek et al.'s (2014) instrument and students' performance in SP checklists. Findings provided empirical evidence supporting the reliability and predictive validity of Huwendiek et al.'s (2014) instrument.Future research should examine additional sources of validity for Huwendiek et al.'s (2014) VP design effectiveness instrument using larger samples and from other socio-cultural backgrounds and continue to examine the predictive validity of Huwendiek et al.'s (2014) instrument at Level 2 (Learning) and Level 3 (Application) of Kirkpatrick's (1975) four-level model of training evaluation.
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Date Issued: 2016
Identifier: CFE0006166, ucf:51150
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006166

Title: Impact of Interruption Frequency on Nurses' Performance, Satisfaction, and Cognition During Patient-Controlled Analgesia Use in the Simulated Setting.
Creator: Campoe, Kristi, Talbert, Steven, Sole, Mary Lou, Andrews, Diane, Jentsch, Florian, University of Central Florida
Abstract / Description: Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of...
Show moreProblem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of interruption frequency on nurses' PCA interaction has not been fully measured or described.Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses' (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses' perceptions of the impact of interruption frequency.Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar's test, and Friedman's test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs' perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar's test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses' perception of interruption frequency: the nature of interruptions and nurses' reaction to the interrupted work environment.Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs' described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs' perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs' performance accuracy and cognitive workload.
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Date Issued: 2015
Identifier: CFE0005770, ucf:50099
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005770

Title: The Communicative Value of EMR Education: Medical Students' Perceptions of Introductions to EMRs.
Creator: Burry, Justiss, Scott, Blake, Wheeler, Stephanie, Brenckle, Martha, University of Central Florida
Abstract / Description: Research in medical education includes a number of studies that describe the complexities (Tierney et al., 2013; Gagon et al., 2009; Pippitt, Stevenson, (&) Samuelson, 2013), benefits (Milano et al., 2014; Hammoud et al., 2012; Silverman et al., 2014), and limitations (Peled, Sagher, Morrow, (&) Dobbie, 2009; Wald, George, Reis, (&) Taylor, 2014; Pelletier, 2016) of helping medical students understand and achieve fluency with electronic medical records (EMRs). In addition, studies in the...
Show moreResearch in medical education includes a number of studies that describe the complexities (Tierney et al., 2013; Gagon et al., 2009; Pippitt, Stevenson, (&) Samuelson, 2013), benefits (Milano et al., 2014; Hammoud et al., 2012; Silverman et al., 2014), and limitations (Peled, Sagher, Morrow, (&) Dobbie, 2009; Wald, George, Reis, (&) Taylor, 2014; Pelletier, 2016) of helping medical students understand and achieve fluency with electronic medical records (EMRs). In addition, studies in the rhetoric of health and medicine (RHM) have been calling to attention the effectiveness of rhetorical studies within medical contexts (Scott, Segal, (&) Keranen, 2013; Segal, 2005; Rausch, 2016; Fountain, 2014; Melocon and Frost, 2015; Graham and Herndl, 2014). However, there is not a unified idea of the best way to teach EMR fluency, nor is there any research that studies and analyzes the perceptions of students in their undergraduate medical education, including their pre-clerkship years. This thesis investigates students' perceptions of their medical education at the University of Central Florida's College of Medicine (UCF COM), specifically how 76 students who participated in surveys and focus group interviews perceive and engage with their education and ideas of EMR application and fluency. It also compares their perceptions with the goals of the module directors who designed the curriculum. In its analysis, this thesis employs classical and contemporary scholarship about stasis theory (Crowley and Hawhee, 2012; Fahnestock and Secor, 1988) to identify points of congruence and dissonance between students and module directors, as well as across cohorts of students in their first, second, and third years. Through data analysis, I found key points of congruence and dissonance between the perceptions and experiences of students and goals of module directors. I also identified key factors affecting both groups, such as the time constraints of the curriculum and the fact that hospitals use different EMR systems. The results of this study demonstrate the complexities of medical education and EMR education for both students and module directors. By understanding how rhetoric can be more beneficial to other fields, such as medical education, this study can help those creating curricula better reach outcomes that both students and licensing boards will appreciate. That said, more research needs to be conducted to understand how regulated medical education creates these points of contention between future physician curriculum designers.
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Date Issued: 2017
Identifier: CFE0006723, ucf:51887
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006723

Title: PROTOCOL BASED SCREENING TOOLS TO IDENTIFY SEPSIS PATIENTS TRANSPORTED BY EMERGENCY MEDICAL SERVICES.
Creator: Moser, Isaiah, Talbert, Steven, University of Central Florida
Abstract / Description: Sepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in...
Show moreSepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in predicting sepsis and secondary what the initiation of a sepsis alert has on the patients' outcome. Results found included that sepsis screening tools when in place decrease time to identification, decrease time to antibiotics, increase amount of fluid administration, and overall reduce hospital stay and mortality rate. With these findings educational training for EMS providers and the introduction of generalized protocols are of the upmost importance. Further research is needed to be done to create a consistent tool to be used by all EMS agencies that has a validated predictive value of sepsis.
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Date Issued: 2017
Identifier: CFH2000155, ucf:46061
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000155

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