Dissertations / Theses on the topic 'Expanding knowledge in the health sciences'

This exploratory study utilized Donabedian's Quality model to develop a framework to study patients who must migrate for health care. One year of the Arizona Department of Health Services Discharge Database was used to analyze patient characteristics that influenced discharge travel and the impact of distance on risk adjusted patient outcomes. Geographic Interface software was used to identify rural patients, defined as those with zip codes farther than thirty miles from hospitals. Zip Code analysis was used to create distance variables between 31 and over 300 miles. The key findings for patients who traveled greater distances included larger hospitals, emergency admission type, private insurance, critical care services, and Neuro/Ortho/Trauma diagnosis group. Patients which traveled shorter distances included smaller hospitals, referral or transfer admit source, AHCCCS insurance (or Medicaid) and Women's Health diagnosis group. Outcomes were risk adjusted using age and distance was significant for both number of procedures and length of stay. Patients who traveled farther received fewer procedures and had a greater length of stay. A preliminary cost analysis of the length of stay outliers identified approximately four million dollars in potentially non-reimbursable charges.

The intrauterine device (IUD) is a safe, effective, convenient, reliable, inexpensive, and cost-effective form of reversible contraception. It rivals female sterilization, injectables, and implants with respect to effectiveness in pregnancy prevention. Once inserted, IUDs are nearly maintenance free; some IUDs can even be used for over a decade. In many settings however, the utilization of this form of contraception is poor and a number of barriers to usage exist. These barriers often relate to lack of knowledge and misperceptions among both potential users and healthcare providers. The IUD is a reliable option that may be an ideal form of contraception for many women in South Africa. In order to make this method available on a wider scale, it is necessary to provide correct information to women and health care professionals and to increase the availability and use of this highly effective method. We conducted a cross-sectional descriptive study designed to assess the current knowledge, attitudes, and practices of potential users and health care providers with respect to the IUD. We recruited 205 women between 15 to 49 years of age who were attending family planning and ST! care services at four primary level public clinics (two in the more urban Western Cape Province and two in the rural Eastern Cape Province in South Africa). In addition, we interviewed 32 providers from 12 clinics (six clinics per province). Ethical approval for this research was obtained from both the University of Cape Town and Walter Sisulu University (formerly the University of the Transkei). Permission was also given by the local and provincial health services. Among clients, knowledge of the IUD was poor. About 26% of women had heard of the IUD. After the method was explained to them, 89.7% of women believed that there were advantages to using the IUD and 72.7% of women said that they would consider using the JUD in the future. Also, women thought the IUD was an easier contraceptive method to use than oral contraceptive pills, injectables, male and female condoms, and female sterilization. Logistic regression modelling showed that, after adjusting for level of education, being from the Western Cape, older age, and having heard of emergency contraception all independently predicted awareness of the IUD method. For the most part, providers knew how the IUD worked to prevent pregnancy; however, providers were lacking in more detailed knowledge about the method and had misinformation about the IUD. Almost all (93 .6%) of providers recognized their need for more information and training about the IUD. Providers reported that barriers to IUD usage in South Africa were lack of knowledge of the method on the part of providers (84.4%), a lack of trained providers to insert or remove the IUD (62.5%), limited availability of the device at health facilities (56.3%), and a lack of knowledge on the part of potential users (46.9%). Despite these barriers, 81 % of providers believed women would be interested in the IUD if they knew about it and 73.3% believed the IUD should be promoted in South Africa. Our results suggest that the IUD would be a welcome addition to the contraceptive method mix in South Africa and that both clients and providers would be interested in this method. It is clear that awareness campaigns among women seeking contraception would be necessary for building support and publicizing the IUD. It will also be necessary to train and educate providers, focusing on up to date information, dispelling myths, and proper insertion and removal techniques. South Africa could re-introduce the IUD into the contraceptive method mix and increase women's choice by adding this valuable, viable, and sustainable option to the contraceptive method mix. The findings of this study, which was requested by the provincial health services, will be used to inform policy and as a starting point for assessing the feasibility and acceptability of a greater role for the IUD in the contraceptive method mix in South Africa.

Thesis (Ph.D.)--Indiana University, Dept. of History, 2008.
Title from home page (viewed on May 11, 2009). Source: Dissertation Abstracts International, Volume: 69-08, Section: A, page: 3277. Adviser: John H. Hanson.

This paper will examine the notion of altruism in blood donation as discussed in Richard M. Titmuss's, The Gift Relationship: from human blood to social policy. We consider Titmuss's views and assumptions about altruism and conclude that Titmuss's account of altruism is not incompatible with a religious motivation such as 'regard for the other' found in the concept of covenant. We propose that the covenant relationship between persons and/or institutions obliges those within the relationship to affirm responsibility for one another that in turn deepens altruistically based relationships as promoted in non-paid, voluntary blood systems.

This research explores the connection and interaction between literature describing addiction theory and clinical art therapy practice. Literature spanning a wide variety of theoretical understandings of addiction and recovery was reviewed, as well as literature published on the use of art therapy with the substance abuse population. Using the review of the substance abuse literature as a base, key theoretical concepts were identified and formatted into a table that came to serve as a data coding system. Applying case study methodology, this coding system was then utilized as an analysis tool for the art therapy process and artwork of four clients in residential substance abuse treatment. Analysis of the data resulted in the emergence of five prominent themes amongst those listed in the coding system: 1) Intolerance of negative emotion 2) Problematic family dynamics 3) Traumatic experiences 4) Schemas and restructured cognitions and 5) Cultural issues. These findings were then examined in the context of the art therapy literature on substance abuse. The meanings derived from these findings make a case for greater integration between substance abuse literature and art therapy literature, illustrating the utility of clear and organized incorporation of theoretical ideas about addiction into art therapy with substance abuse clients.

Quantification of ecosystem services (ES) – the benefits that people obtain from ecosystems – can be valuable for managing multifunctional landscapes and promoting practical conservation measures. However, despite extensive academic attention, actual implementation of ES assessment for management has been limited. Consistent measurement methods and accurate modeling tools are crucial to support successful ES-informed management strategies and ensure the confidence of managers and policy makers in the ES framework. In this thesis, I present two major impediments to ES operationalization, and propose measures to mitigate them. First, a case study reviewing the methods used to measure pollination ecosystem services highlights the extreme variability in approaches to quantifying a single ES. Across 121 studies, 62 unique combinations of indicators were used, suggesting that no accepted conventions or standards are directing indicator selection. This lack of consistency impairs our ability to compare results across studies, and may lead to ineffective ES-based management. In addition to issues associated with ES indicators, quantification using ES models can also be problematic. The models most often used to estimate ES use landuse/landcover (LULC) datasets as their primary inputs, and rely on information about the LULC composition, characterizing the type and amount of each LULC class, without regard for the spatial distribution of the LULC classes. Projections based primarily on composition, however, have been shown to poorly represent service provision. Estimates derived from composition neglect the critical role of landscape configuration (spatial arrangement of LULC types) in the flow and quality of benefits, assuming that two equally sized units of a given LULC type produce the same magnitude of each service, regardless of characteristics such as shape or connectivity with other similar patches. To investigate the relative importance of these spatial attributes in the relationship between LULC and ES provision, I calculated landscape metrics characterizing both landscape configuration and composition, along with provision of 10 ES for 136 municipalities in Southern Quebec. I used structural equation models to combine statistical relationships with hypothesized causal pathways and identify mechanisms and interactions responsible for observed relationships. The proportion of all model-explained variation that was attributable to configuration exceeded that of composition for seven of ten ES. The higher relative influence of configuration suggests that models incorporating LULC information beyond composition can provide more reliable projections to contribute to management and policy decisions. Since landscape configuration can be manipulated independent of changes in composition, ES models that incorporate configuration can be used both to more accurately quantify ES provision and to identify scenarios that minimize environmental impacts of LULC change, simply by altering the spatial pattern of planned changes in land use. The ES framework has potential to support more efficient and effective environmental management. However, in order to move forward within this rapidly growing field and make ES practical for use in management, it is critical to adopt strategies to properly measure and model ES, such as those proposed in this thesis.
La quantification des services écologiques (SE), définie comme les avantages que les gens tirent des écosystèmes, peut être utile pour la gestion des paysages multifonctionnels ainsi que pour promouvoir des mesures pratiques de conservation des écosystèmes. Toutefois, en dépit de l'attention des universitaires, une mise en œuvre efficace de l'évaluation des SE, dans le cadre de la gestion sur le terrain, a été limitée. Des méthodes de mesure cohérentes et des outils de modélisation précis sont essentiels pour favoriser l'implémentation des stratégies de gestions informées par les SE et pour s'assurer de la confiance des gestionnaires et des politiciens dans l'utilité du concept des SE. Dans cette thèse, je présente deux obstacles majeurs à l'opérationnalisation des SE et je propose des mesures pour atténuer ces obstacles. Tout d'abord, je présente une étude de cas sur les méthodes utilisées pour mesurer le service écosystémique de pollinisation dans la littérature. Cette étude souligne l'extrême variabilité dans les approches de quantification d'un seul SE. À travers les 121 études, 62 combinaisons uniques d'indicateurs ont été utilisées, ce qui suggère qu'il n'y a pas de conventions acceptées ou de normes pour diriger la sélection des indicateurs. Ce manque de cohérence nuit à notre capacité de comparer les résultats entre les études, et peut conduire à une gestion inefficace basée sur les SE. Deuxièmement, la quantification utilisant des modèles de SE peut également être problématique. Les modèles les plus souvent utilisés pour estimer les SE proviennent des bases de données sur l'utilisation actuelle des terres/le couvert terrestre (UT/CT) comme entrée de données primaires, et s'appuient sur des informations sur la composition UT/UC, caractérisant le type et la quantité de chaque classe UT/UC, sans égard à la répartition spatiale des classes de UT/UC. Cependant, il a déjà été démontré que les projections fondées principalement sur la composition représentent mal la provision de SE. Les estimations basées sur la composition du paysage néglige le rôle critique de la configuration du paysage (l'arrangement spatial des classes de UT/UC) dans le flux et la qualité des prestations de SE, car les estimations supposent que deux unités de même taille, d'un type d'UT/UC donné, produisent le même ordre de grandeur de chaque service. Afin d'évaluer l'importance relative de ces deux attributs spatiaux sur la relation entre la UT/UC et la provision de SE, j'ai calculé des métriques paysagères qui caractérisent à la fois la composition et la configuration du paysage, de même que la fourniture de 10 SE pour 136 municipalités du sud de la province du Québec. J'ai utilisé des modèles d'équations pour d'identifier les mécanismes et les interactions responsables des relations observées. La proportion de la variation expliquée par les modèles est plus attribuable à la configuration qu'à la composition dans sept des dix modèles de SE. L'influence relativement plus élevée de la configuration suggère que les modèles incorporant des informations au-delà de la composition de l'UT/UC peuvent fournir des prévisions plus fiables pour contribuer aux décisions de gestion. Parce que la configuration du paysage peut être manipulée indépendamment des changements dans la composition, les modèles de SE qui intègrent la configuration peuvent être utilisés à la fois pour quantifier avec précision la provision de SE et pour identifier des scénarios qui minimisent les impacts environnementaux du changement d'UT/UC simplement en modifiant la répartition spatiale des changements prévus à travers le paysage. Le concept des SE a le potentiel de contribuer à une gestion environnementale plus efficace. Afin d'aller de l'avant dans ce domaine en pleine expansion et faire des SE un concept pratique dans la gestion, il est essentiel d'adopter des stratégies qui mesurent et créent des modèles de SE adéquats, telles que celles proposées dans cette thèse.

Psychiatric illnesses can sometimes lead to behavioral outbursts that need to be addressed quickly to deescalate potentially explosive situations. Nurses are in a unique position to respond to such outbursts by calling for a rapid response team. Nurses who are part of the rapid response team should be well-informed of their roles and responsibilities in managing aggressive and violent behavior. The purpose of this project was to explore RN's and LPN's knowledge and perceptions of a rapid response team in a psychiatric facility. The Iowa model of evidence-based practice provided the framework to integrate theory into practice to improve care. A quantitative descriptive design was implemented with a convenience sample of nurses using a 4-part questionnaire. Of the 64 surveys distributed on 5 wards, 59 were completed for a response rate of 92%. Descriptive statistics were used to analyze nurse responses to demographic data and background data. A Chi-square statistic was calculated to investigate the relationship between RN and LPN responses to the Likert Agreement Scale; no significant difference in responses was found. Open-ended questions allowed nurses to comment on their role and position during a code. The comments were sorted into categories of reoccurring themes. Results suggested that nurses need to understand signs of behavioral escalation and strategies to deescalate a potentially volatile patient. Nurses commented that knowledge during a code, reasons for calling a code, and good communication skills are essential in code situations. Findings from this project can benefit nurses who work psychiatric emergencies by underscoring the need to development of psychiatric rapid response teams and to update current standards of inpatient care.

This study investigated the effect of postpartum home teaching on primiparous women's knowledge of infant care. Twenty-one low-risk primigravidae women were randomly placed in a control or experimental group. Subjects in the experimental group viewed a videotaped program on infant care a second time, at home on the third day postpartum. Tests were administered prior to hospital discharge, on the third day postpartum, and at 28-32 days postpartum. A short interview was conducted to obtain opinions regarding videotaped educational materials. The subjects (n = 21) retained most of the information presented after the first viewing and expressed satisfaction with the educational format. The results were not statistically significant, though mean test scores increased over the three test intervals.

Much of Sub-Saharan Africa lags behind the world in reproductive health. The nine villages surrounding Gorongosa are remote rural villages with very limited access to health care, and contraceptive options. A survey regarding the health of women and children in the community was created and every woman between the ages of 15, and 59 was surveyed, a total of 2438 in all. There were many sections but this thesis focuses on the results of the contraception and family planning segment. In this population only 4% of women are using any form of family planning, 8.2% state they would like to, but only 3% state a desire to become pregnant at the point of the survey. Only 17.2% can name a method of contraception, and 27% believe that temporary contraception can lead to permanent infertility. Significant associations were found between knowledge and positive beliefs about contraception and use, or a desire to use contraception, indicating there is a role for educational programs to help inform women of their options and give them the opportunity for reproductive self-determination.

Background: Oral health is a part of general health and it is therefore important that nurses are able to detect abnormalities in the mouth to refer to dental care. Aim: The aim of this study was to examine oral health knowledge regarding oral diseases and oral hygiene among nursing students at two universities - InHolland University and University of Victoria [UVic]. Method: This study has a quantitative cross-sectional design based on a questionnaire. Chi-square tests were made to discover differences between the two universities. Results: The study consists of a total of 105 questionnaires. The participants had good knowledge of oral hygiene. Concerning knowledge about dental caries, gingivitis, and periodontitis, limited knowledge and several statistical significant differences between the universities were found. The extent of the oral health education was between 1-10 hours in the respective universities. Several nurses considered that they did not feel ready or were unsure if they have enough knowledge about oral health for their future work. Conclusion: The study has shown that the nursing students at both InHolland University and UVic have basic knowledge regarding oral hygiene but moderate knowledge in oral diseases regarding development and prevention of dental caries, gingivitis and periodontitis.
Bakgrund: Oral hälsa är en del av allmän hälsa och därför är det viktigt att sjuksköterskor kan upptäcka eventuella avvikelser i munnen för att remittera vidare till tandvård. Syfte: Syftet med studien var att undersöka kunskap om oral hälsa gällande orala sjukdomar och munhygien bland sjuksköterskestudenter vid InHolland University och University of Victoria [UVic]. Metod: En kvantitativ tvärsnittsstudie med enkät som datainsamlingsmetod genomfördes bland tredje års sjuksköterskestudenter vid InHolland University och UVic. Chi-2 tester utfördes för att jämföra variabler mellan universiteten. Resultat: Studien består av totalt 105 enkäter. Resultatet avseende munhygien visade på goda kunskaper inom ämnet. Resultatet avseende kunskaper om karies, gingivit samt parodontit visade på en begränsad kunskap och skillnader återfanns mellan universiteten. Omfattningen av utbildning inom oral hälsa på programmen låg mellan 1-10 timmar på båda universiteten. Flera sjuksköterskestudenter ansåg att de inte kände sig redo eller var osäkra på om de var redo att tillämpa sina kunskaper inom oral hälsa, genom att upptäcka och jobba preventivt, i framtida arbetet. Slutsats: Studien visar att sjuksköterskestudenter har grundläggande kunskaper avseende munhygienen men måttlig kunskap inom orala sjukdomar avseende uppkomst och prevention av karies, gingivit och parodontit.

Rural West Virginia has a very high percentage of older adults. The age-related disease of Alzheimer’s threatens the health of older Appalachians, yet research on Alzheimer’s disease (AD) in this population is scarce. In order to improve screening rates for cognitive impairment, Appalachians need to understand their vulnerability. The first step would be to assess their knowledge about AD but a suitable AD knowledge test has not been developed. The purpose of this study was to test the reliability and validity of a new measure of knowledge about AD that is culturally congruent, and to examine factors that may predict AD knowledge in this rural population. A correlational descriptive study was conducted with 240 participants from four samples of older adults in south central rural Appalachian West Virginia using surveys and face-to-face interviews. Results from tests for stability, reliability including Rasch modeling, discrimination and point biserial indices, and concurrent, divergent, and construct validity were favorable. Findings were that although more diversity in test item difficulty is needed, the test discriminated well between persons with higher and lower levels of education [F(2, 226) = 170.51, p = .001]. Using multiple regression, the predictors of AD knowledge included caregiver status, miles from a healthcare provider, gender, and education; (R²=.05, F(4,187) = 2.65, p =. 04). Only years of education accounted for a significant proportion of unique variance in predicting the total BKAD score (t = 2.14, p =. 03). Implications include the need for further tool refinement, testing for health literacy, coordination with recent statewide efforts to educate the public regarding AD, and community based participatory research in designing culturally effective education programs that will ultimately increase screening and detection of Alzheimer’s disease in rural populations.

The social environment is hypothesized to broadly influence health by facilitating the distribution of health-promoting resources (e.g., health knowledge; Berkman, Glass, Brissette, & Seeman, 2000). One important health-related resource, knowledge of acute myocardial infarction (MI) symptoms, is theoretically expected to be stratified by social relationships. Like the social environment, socioeconomic status is also associated with multiple health outcomes and is involved in the stratification of health resources (SES; Marmot et al., 1991; Pappas, Queen, Hadden, & Fisher, 1993; Berkman et al., 2000; Oakes & Rossi, 2003), and in turn markers of SES (i.e., income and education) are related to MI symptom knowledge (Dubard, Garrett, & Gizlice, 2006; Lutfiyya, Lipsky, Bales, Cha, & McGrath, 2008). The present study examined the relationship between MI symptom knowledge and functional and structural measures of the social environment in a large U.S. representative sample (N = 33,326). In addition, this study examined the relative contribution of social environment measures in the relationship between SES (income and education) and MI symptom knowledge. A functional measure was defined using a single item assessing perceived emotional support with answers ranging from never to always. Structural measures were obtained by summing responses to 7 items assessing number of frequent social contacts within past two weeks. MI symptom knowledge was defined by the summation of correct answers to 6 questions assessing knowledge of MI symptom categories and the appropriate emergency response. Continuous MI symptom knowledge scores ranged from 0 to 6 with higher values indicating higher knowledge. In the primary multivariate analysis, both dummy-coded social environment measures were associated higher MI symptom knowledge scores after controlling for sociodemographic, health status and SES covariates. Having emotional support usually and always was associated with a .27 and .22 (SE = .05, p < .001; SE = .05, p < .001) increase in MI symptom knowledge scores compared to those reporting never/rarely having emotional support respectively. Also, having 7 social contacts within the past two weeks was associated with a .47 (SE = .08, p < .001) increase in MI symptom knowledge scores compared to having 0/1 social contacts. Emotional support and social contacts explained 5% to 24% (SE = .01, p < .001; SE = .02 p < .001) and 9% to 19% (SE = .02, p < .001; SE = .03, p < .001) of the relationship between MI symptom knowledge and the two SES measures (education and income) respectively. By demonstrating a social environment stratification of a health resource, these findings demonstrate the broad health influence of social ties in a large nationally representative sample (Berkman et al., 2000; House, 2001).

Background: Incident rates of dengue fever are rapidly increasing worldwide. Contributing factors including climate change, urbanization, globalization, and vector mutation, are creating significant public health challenges. Dengue fever has no vaccination, and no cure; therefore prevention through vector control is the primary method of public protection. Research indicates that community involvement is critical in achieving vector control, and that children, disproportionally burdened by this disease, are an effective and appropriate population to target with interventions. Innovative, sustainable, cost effective strategies are needed. Objective: It was theorized that an educational animation regarding dengue fever, created using CDC guidelines, would be effective at improving knowledge, attitude, and practices in primary school children in Florida. An animation entitled "Dengue Fever Comes To Town" was developed to assess this concept. Methods: A pretest/posttest study was conducted. Knowledge changes were statistically evaluated using a Two-tailed Paired Sample t-test. Attitude changes were evaluated using a Wilcoxon Matched Pair Signed Rank. Practice changes were evaluated using a chi-square test. Results: The animation was effective at improving knowledge, attitude, and practices in third through fifth grade levels, for both males and females. Recommendations: Given the vulnerability of the population, and the increasing risk of dengue fever, establishment of preventive education is recommended, including adding the educational animation to school curricula in Florida.

The purpose of this descriptive study was to describe Taiwanese nurses' knowledge about and attitudes toward persons with AIDS (PWAs). One hundred and two subjects were recruited from three large medical centers in Taiwan during December, 1992 and January, 1993. A backtranslated Chinese version AIDS Vulnerability Survey (AVS) was used to measure Taiwanese nurses' knowledge of AIDS and attitudes toward persons with AIDS. Findings of this study indicated that Taiwanese nurses lack knowledge of AIDS, have negative attitudes toward PWAs, and perceived themselves highly vulnerable to AIDS. A positive relationship was found between attitudes toward PWAs and length of work experience (r = -.28, p ≤ .05). Significant differences were found between marital status and attitudes toward PWAs (t = -2.58, p ≤ .05), indicating that married nurses had more positive attitudes toward PWAs than single nurses.

The purpose of this study was to investigate knowledge regarding the gluten-free diet among non-celiacs following the diet. Specifically, this study examined how knowledge differed among gluten-free diet followers by reason(s) for following a gluten-free diet, source(s) from which information on the gluten-free diet is obtained, level of education attained, age, and sex.

A convenience sample of 129 usable knowledge assessment surveys completed by non-celiac gluten-free diet followers was utilized in this study. Participants were recruited via Facebook groups or pages, or by announcement flyers that were posted on community information boards at health food stores. It was found that participants, ages 40-49, had a greater knowledge of the gluten-free diet than those ages 20-29. Subjects who were 50 or over also had greater knowledge than those of ages 20-29 years. Results indicated that greater knowledge of the gluten-free diet is associated with older age.

Using a multiple baseline design, this study examined the effect of preferred items in increasing medication knowledge among individuals diagnosed with a mental illness. Participants were asked questions regarding their Haldol medication. After baseline, participants received the answers and a pharmacy-generated medication profile. During the Repeated Trials intervention, participants were given only verbal feedback. Those who had not reached criterion after 4 weeks entered the Preferred Trials intervention. In this phase, participants received a high, medium, or low preferred item contingent on the number of correct answers. All participants increased their number of correct answers. Although the effects of a contingent preferred item were mixed, this study showed that information regarding medications can be learned with minimal staff intervention.

The purpose of this descriptive correlational research was to identify the relationship between nursing expertise, defined as embodied nursing knowledge, nurse’s educational background and experience, and client outcomes. Hierarchical multiple regression and Pearson product moment correlation were used to determine the strength of the relationships between embodied nursing knowledge and home health outcome improvement measures in a convenience sample of 107 home health registered nurses. Embodied nursing knowledge was measured by Minick’s Manifestations of Early Recognition instrument. Scores on the Outcome and Assessment Information Set, version C (OASIS-C), measured client outcome improvement. There were no significant differences between participants’ knowledge of their clients, knowledge of the system and institution, knowledge of their own and colleagues’ skills, level of nursing education and experience, or total years of home health nursing experience and mean total clientcentered improvement. Age had a significant, negative relationship to the mean percent score on the OASIS for improved client-centered outcomes. The outcome improvement measures from the nine home health agencies were at or above the state and national averages, which created a restricted data range for the findings. The restricted data range of the outcome improvement measures may have lessened the validity of the findings in this study and advocates that future studies may need to employ the use of purposeful selection of the sample population in home health. The concepts of knowledge of clients and their families, knowledge of the home health system, and knowledge of registered nurses own skills may not be the same construct in home health as in acute care nursing practice. Further research should explore those concepts that may be used specifically in home health. Understanding the characteristics of home health has the potential to assist home health agencies understand how to support their registered nurses to provide quality care thereby achieving improved clinical outcomes by developing rich structured information base practice.

Maintenance of appropriate posture is essential for the prevention of various musculoskeletal disorders. Postural stress is a common issue in elementary school children. The literature review indicated that schoolteachers have inadequate and improper postural knowledge. Based on such concepts, elementary schoolteachers in this present study implemented a postural awareness education program designed by the American Posture Institute. The present study indicated that postural awareness amongst schoolteachers was significantly low before the start of the program and was significantly increased after implementing the program (p < 0.01). Moreover, the program results seemed to match the expectations of the posture awareness program. However, the analysis also indicated that teachers failed to achieve requisite postural knowledge on all postural concepts (p < 0.01). Hence, the study necessitated the need for improving the postural awareness program (which was designed and developed by API). The study participants failed to develop a holistic knowledge on postural concepts and could not correlate different postural concepts with one another (p > 0.05). The study necessitated the need for sensitizing schoolteachers on different aspects of physiology and anatomy before implementing a postural education program.

The Female Athlete Triad is a syndrome defined by disordered eating, amenorrhea, and osteoporosis seen in female athletes. This directed project presented the assessment of knowledge and the importance of education among female athletes regarding the Female Athlete Triad. The researcher worked with the athletic department and the female athletes at California State University, Long Beach. A quantitative study, quasi-experimental, one-group design was completed. A one-group pretest- posttest was used on 45 female athletes to evaluate their knowledge base before and after the educational intervention.

Results indicated a significant increase in the athletes' scores for knowledge of the Female Athlete Triad between the pretest and posttest ( p < .01). The increase in scores signified that a 1-hour education session improved the knowledge base for the female athletes of the Female Athlete Triad. A major recommendation would be to include coaches, trainers, and parents in the educational process.

The purpose of this project was to assess nursing students' knowledge of breastfeeding guidelines and benefits. A nonexperimental, descriptive design was used with a convenience sample of 40 students enrolled in a nursing program at a southern California university. Participants took a modified Breastfeeding Knowledge Questionnaire. The questionnaire consisted of 17 knowledge items covering the benefits and guidelines of breastfeeding. Descriptive and inferential statistics were used to analyze student knowledge and to test for differences in knowledge levels.

Of a possible 17 points, the mean knowledge score was 14.08 ± 1.56. There was a significant difference between male and female students' knowledge scores (p = .023). More than one third of the students scored below 80%. Improving breastfeeding education in nursing curricula is necessary to prepare future nurses with essential knowledge about breastfeeding.

The child welfare system in the state of Tennessee has faced many challenges, including accessing best practice mental health treatment, particularly for youth experiencing traumatic stress. In response, five state-funded groups, who were created to provide support and consultation to the Department of Children’s Services, initiated a project to train agencies serving the child welfare system in the use of evidence-based treatment. The result of this multi-disciplinary collaboration, which included individuals from the National Child Traumatic Stress Network, was a state-wide dissemination and implementation program on the use of Trauma-Focused Cognitive Behavioral Therapy. The presenter(s) will briefly outline the development of the project; discuss gaining support in both urban and rural underserved communities; and share important lessons learned.

Decades of research attest to the psychological benefits of exercise, documenting improved psychological functioning for specific disorders as well as biological systems. Notable trends include reduction of psychological symptoms (e.g., anxiety, depression), increases in self-esteem, facilitation of neurogenesis, enhancement of cognitive functioning, and improvements in stress response. The majority of these studies call for increased utilization of exercise interventions within clinical practice. However, decades of exercise research and the two existing studies on practice habits suggest that exercise continues to be widely underutilized. The data suggest that clinicians believe exercise is beneficial; they report high confidence and rates of utilization in exercise interventions; however, they also report low levels of education in exercise psychology. It was hypothesized that one possible cause for this persistent research-practice gap may be mental health professionals' (MHPs) misperceptions of their own competence, namely the Dunning-Kruger phenomenon. Methods: An original, electronic survey was disseminated to MHPs via email, social media posting, and snowball sampling. Eighty-three clinicians completed the survey, which collected data on beliefs and practice habits; perceptions of confidence and competence; and research knowledge. Results: Findings supported previous observations, documenting high levels of confidence amongst MHPs despite low levels of exercise education. Knowledge of research was poor; data suggest that the Dunning-Kruger phenomenon is a factor in the ongoing research-practice gap within exercise psychology. Conclusions: This is the first study to measure fact-based competence of MHPs and offer an explanation for the longstanding underutilization of exercise. Findings suggest that clinicians may be at risk for overestimating their own abilities in areas that are less familiar. Further research is needed regarding MHPs’ exercise-related competence in order to elucidate the complex nature of factors examined here.

Thesis (Ph. D.)--Massachusetts Institute of Technology, Whitaker College of Health Sciences, Technology, and Management, Dept. of Brain and Cognitive Sciences, 1986.
MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCE
Bibliography: leaves 143-154.
by Christopher Granger Atkeson.
Ph.D.

This exploratory study is a first attempt to translate the Indian cultural context from a socio-cultural, and legal perspective by identifying the values attributed to Indian textile craftsmanship by Indian textile and fashion stakeholders, and how their perspective is influenced by the global recognition and perception of Indian textile crafts and connotation of “Made in India”. At the same time the study investigates the meaning of “sustainability” in the Indian cultural context, in relation to textile craftsmanship, and how this relates to the Western concept of “sustainability”. Through field research in conjunction with a series of in-depth unstructured interviews, this study reveals that Cultural Sustainability is the dominating narrative in the Indian cultural context due to the prevalence of culturally embedded sustainability practices and the role of textile craftsmanship in sustaining livelihood, being a unique exercise of positioning Indian textile craftsmanship within a framework of cultural heritage as a valuable source of knowledge for sustainable practices in the fashion and textile industry. Unique about this study are the India-centric approach combined with the ethnicity of the subjects interviewed - who are, without exception, Indian nationals, whose work, voice and reputation are shaping India's contemporary textile craft -sustainability narrative (being referred to as the “Indian textiles and fashion elite”) and the framing of traditional craftsmanship from a legal perspective, introducing the notion of legal protection of traditional textile knowledge and traditional cultural expressions.

Lowered motivation can influence the involvement of adults with brain injury in the rehabilitation process, ultimately affecting the extent of their progress. This within-subject, pretest/posttest design examined the effects of an education program focusing on concepts of neuroplasticity on 34 adults with brain injury. Quantitative data was taken from pre-presentation and post-presentation surveys and was analyzed for significant change. Results indicated that the presentation was successful in increasing (a) the knowledge of neuroplasticity as evidenced by significant change in two out of three items, and (b) level of motivation as evidenced by significant change in six out of nine items. Effects of age, education level, and time post-injury were discussed. Study conclusions validate the use of education to increase motivation in people with brain injury, and provides new information about the use of neuroplasticity in education.

Changes associated with Alzheimer's Disease (AD) in the association cortices of temporal, occipital, and parietal lobes of the brain, result in significantly impaired performance of AD subjects on tests of semantic memory. The most prevalent theory regarding the deterioration of semantic memory is that it is a bottom-up process. That is, the knowledge of attributes becomes lost or inaccessible prior to the knowledge of categories. Previous research of this theory has resulted in conflicting results. The purpose of this study was to test further the theory, while taking into account task difficulty. Thirty probable AD and 28 normal elderly subjects were administered tasks of attribute and categorical knowledge. Results revealed significant differences in performance as a result of task difficulty. These results call into question the methodology previously used to assess the bottom-up theory, as well as the ability to use attribute and categorical knowledge separately.

Background: The rapid diffusion of Novel Psychoactive Substances (NPS) constitutes an important challenge in terms of public health and a novelty in clinical settings, where these compounds may lead to erratic symptoms, unascertained effects and multi-intoxication scenarios, especially in emergency situations. The number of NPS available on the illicit drug market is astonishing: official reports suggest the appearance of a new drug every week. NPS may be enlisted in many different families such as synthetic phenethylamines, tryptamines, cathinones, piperazines, ketamine-like compounds, cannabimimetics and other plant-derived, medical products and derivatives. Therefore, healthcare services and professionals are often called to face this unknown 'galaxy' where NPS users seem to perceive traditional services 'unfitting' for their needs, requiring an attention which is quite different from known classic drug abusers. In this context, the Recreational Drugs European Network (ReDNet), a research project funded the European Commission and led by the University of Hertfordshire, aimed to explore the NPS galaxy and develop information tools for vulnerable individuals and professionals working with them. This initiative reported specific Technical Folders on new drugs and disseminated the collected information through innovative communication technologies (e.g. multimedia tools, social networking and mobile phone services) internationally. Aim and objectives: The aim of this work is to evaluate and contribute to expand the knowledge of health professionals on NPS. The key objectives are: 1) to assess the level of knowledge on NPS amongst a sample of Italian healthcare professionals; 2) to evaluate the effectiveness of dissemination tools developed by ReDNet, including an SMS-Email/mobile service (SMAIL); 3) to understand the clinical impact of NPS by providing four Technical Folders and collecting two clinical cases on NPS. Methodology: According to the objectives, the methodological approach has been articulated in the following three phases. Phase 1: investigating knowledge and preferred channels of information via an online survey among health professionals in Italy. This first Italian study on NPS awareness had been online from February to July 2011, recruiting participants from Departments of Addiction, Psychiatry and other services. Phase 2: evaluating the ReDNet initiative. An evaluation questionnaire was designed and disseminated online to assess the various resources provided by ReDNet project; it had been online from April to July 2013, targeting professionals registered to ReDNet services. This phase also investigated the SMAIL service, a mobile application that was the latest technological tool developed by ReDNet team. Phase 3: promoting evidence based work in clinical practice through the preparation of four Technical Folders and two case reports. Technical Folders followed the methodology optimised during the ReDNet experience, organising NPS data under specific headings, measured for the need of health professionals. Case reports were collected in a Dual Diagnosis Unit in Italy ('Casa di Cura Parco dei Tigli'); assessed patients revealed for the first time the use of NPS; clinical interviews were conducted to collect a full anamnesis while for the first time psychopathological characteristics were measured in NPS abusers, using a psychometric instrument (MMPI-2). Results: In Phase 1 Italian services, in particular interviewees (n=243) from Departments of Psychiatry and Addiction, showed a strong interest for the subject but a poor understanding of NPS: 26.7% of respondents did not know if their patients ever used NPS; at the same time they considered this phenomenon as very relevant to their profession (e.g. psychomotor agitation [75.7%], errors in the assessment [75.7%], management of the clients [72%]); in addition less of a quarter of them had reliable information on new substances. Interviewees also reported the need for easily accessible channels of information to expand their expertise in the field (including emails [70%] and dedicated websites [51.9%]). The ReDNet initiative (Phase 2) reached professionals (n=270) from European countries and various other regions; they appreciated the website above all (48.5%), which provided access to other information (in form of academic papers, news, technical folders, etc.). The integration of technological-based and classic educational resources was used to self-educate professionals (52.6%) and supply information for research (33.7%) with up-to-date and 3 reliable information; in the same Phase the SMAIL service was analysed in its first 557 searches: in the pilot period 122 professionals used SMS inquiries (95%), asking information on NPS while highlighting the increasing number of NPS available on the market. Technical folders (Phase 3) described two new phenethylamines (Bromo-dragonfly and 25I-NBOMe), a novel ethno drug (Kratom) and a new synthetic cathinone (alpha-PVP) whose severe effects were also described in one of the clinical cases. The first case report (Alice) involved a clubber who used mephedrone and other NPS with a severe worsening of her psychiatric disturbances; the second one (Marvin) described a patient who was referred by a psychiatric service and revealed himself as a 'psychonaut' with an intense abuse of alpha-PVP. Conclusions: The exploration of the NPS galaxy is a new challenge for healthcare professionals. In this study, Italian services seemed to be unprepared to face the emergency and requested rapid access to reliable information; the ReDNet project provided both technology-based and traditional resources to expand knowledge on NPS, making professionals more aware of emerging issues and helping especially clinicians working in the field (e.g. via SMAIL service and Technical Folders). Overall, it can be observed that effective information services on NPS targeted at professionals initiatives should include an online interface integrating up-to-date information, describing NPS through specific Technical Folders and disseminating scientific literature; the use of technological tools, including mobile applications, is an important strategy to support health professionals in their activity. Finally, more 'visual' guidelines, possibly in the form of a 'map' of these heterogeneous compounds, could be a useful framework to describe NPS to physicians and other professionals who are often unprepared and unconfident to face such an expanding galaxy.

Background: Pain is part of the human experience. The management of pain is a problem of significant magnitude in the United States. Nurses are on the forefront of this issue with the capacity to assess and respond to patients needs. Nurses' knowledge and attitudes towards pain can predict the nurses' ability to adequately meet patient's pain reduction needs.

Objective: The aim of this DNP project was to replicate a 1996 study comparing outcomes of the attitudes and knowledge regarding pain survey of a convenience sample of medical-surgical nurses in 2013 with nurses from 1996 to determine if attitudes towards pain have changed.

Method: Cross-sectional, descriptive, comparative design. The Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP) and a demographic survey were utilized to assess the nurses' knowledge level and attitudes toward pain and pain management.

Sample: A convenience sample of nurses (n=58) from nine in-patient, medical-surgical units at a large multi-facility health care system volunteered to participate.

Results: No significant differences were found between the attitudes on pain from the 1996 and 2013 respondents. The mean score on the NKASRP was 67%. No significant correlations were identified between any demographic variable and nurses' scores.

Conclusion: Despite increased educational preparation since 1996, the mean score on the NKASRP remained well below what is considered average knowledge. Nursing academics and hospital orientations need to evaluate nurses' attitudes and knowledge and provide the education that can help nurses provide adequate pain management to patients.

Human Papillomavirus (HPV), the most common sexually transmitted infection in the United States, was firmly linked to a new subset of oropharyngeal squamous cell carcinomas (OSCC's) in late 2007. With growing rates of West Virginians affected by HPV-related oral cancers it becomes pertinent to verify that public healthcare professionals of all disciplines are aware of this causal relationship and educating their patients. The purpose of this study was to determine the knowledge level, attitudes and behaviors of a convenience sample of West Virginia's public healthcare professionals regarding the oral implications of HPV before and after and educational presentation. A pre- and post- intervention survey methodology was utilized with an additional survey mailed to the sample population four months later. Chi-square tests for independence and binary logistic regression were utilized to determine any significant differences of answer choice on all three surveys. Statistical analysis revealed a significant increase in knowledge concerning oral cancer related to HPV on two of the three survey questions (X2= 6.4, p=0.03, X2=6.3, p=0.02). After the educational lecture participants indicated they were more likely to engage and educate the public about oral cancer caused by HPV (X2= 4.2, p =0.08), encourage their at-risk patients to seek oral cancer screenings (X2=2.1, p=0.18) and claim to have taken every opportunity to speak with patients about oral cancer caused by HPV (X2=14.5, p=0.0001). Knowledge of and patient education efforts by West Virginia public healthcare providers concerning the oral implications of HPV has increased as a result of the lecture. The knowledge gain indicated knowledge deficiencies on the topic which indicates the topics' future application for interprofessional education (IPE). It is recommended that this topic be applied to IPE in other states or within other settings such as the correctional environment or Native American reservations.

Psychiatric illnesses can sometimes lead to behavioral outbursts that need to be addressed quickly to deescalate potentially explosive situations. Nurses are in a unique position to respond to such outbursts by calling for a rapid response team. Nurses who are part of the rapid response team should be well-informed of their roles and responsibilities in managing aggressive and violent behavior. The purpose of this project was to explore RN's and LPN's knowledge and perceptions of a rapid response team in a psychiatric facility. The Iowa model of evidence-based practice provided the framework to integrate theory into practice to improve care. A quantitative descriptive design was implemented with a convenience sample of nurses using a 4-part questionnaire. Of the 64 surveys distributed on 5 wards, 59 were completed for a response rate of 92%. Descriptive statistics were used to analyze nurse responses to demographic data and background data. A Chi-square statistic was calculated to investigate the relationship between RN and LPN responses to the Likert Agreement Scale; no significant difference in responses was found. Open-ended questions allowed nurses to comment on their role and position during a code. The comments were sorted into categories of reoccurring themes. Results suggested that nurses need to understand signs of behavioral escalation and strategies to deescalate a potentially volatile patient. Nurses commented that knowledge during a code, reasons for calling a code, and good communication skills are essential in code situations. Findings from this project can benefit nurses who work psychiatric emergencies by underscoring the need to development of psychiatric rapid response teams and to update current standards of inpatient care.

Mental illness is characterized by alterations in thinking, mood and behavior and is associated with significant distress and impaired functioning. Many mental illnesses and medications used in their treatment, can in some way impair fitness-to-drive.
This thesis comprises two independent but complementary articles. In the first article, the authors review the most recent literature on fitness-to-drive amongst individuals with mental illness, including those using psychotropic medications. In the second article, the authors assess current attitudes, practices, and knowledge of Canadian psychiatrists concerning driving safety amongst individuals with mental illness using a nation wide cross-sectional survey based on a random sample of practicing Canadian psychiatrists.

Obesity or being overweight is a prevalent health concern around the world. Despite the growing problem in developing countries such as Kenya, there is scant literature available on obesity or being overweight among women in rural Kenya. This research study provides information necessary for bridging the gap in understanding the perceptions, beliefs, and knowledge of obesity among women in rural Kenya. This study used the social cognitive theory (SCT) framework to assist in understanding the impact of obesity or being overweight among women living in rural Kenya. Participants were women aged 20 to 45 recruited from a local church in rural Subukia. Using a phenomenological inquiry, in-depth interviews were conducted. Data obtained were analyzed by open coding. Themes that emerged from data analysis showed that less than half of the study participants had an appropriate knowledge of obesity. Participants desired to have big round bodies, as it was perceived as desirable and as being healthy. However, this perception put these women at increased risk of obesity and associated health risks. Implications for positive social change include the use of study findings by policy makers to develop obesity prevention programs. Such programs may promote obesity awareness and obesity prevention strategies. This promotion may include providing education on topics such as healthy nutrition and the importance of physical activity. Policy makers may develop obesity prevention programs aimed at not only educating, but also empowering rural communities to practice healthy lifestyles based on their cultural and social norms. Such empowerment may encourage the adoption of obesity reducing lifestyles and positive behavior change.

A significant gap exists between evidence-based practice (EBP) and actual occupational therapy (OT) practice in the management of a disabling post-stroke impairment - unilateral spatial neglect (USN). With improved patient outcomes linked to the use of best practices, it is crucial to modify OTs' actual practices in stroke care. To date, no research study has used knowledge translation (KT) to increase knowledge of EBP specific to OTs managing post-stroke USN. The first manuscript of this thesis explores how the "Knowledge to Action Process" model developed by Graham and colleagues, can be used as a step by step guide in creating an effective KT intervention for OTs working in acute stroke care. It describes how previous research has already addressed the "Knowledge Creation" domain of the model through the creation of synthesized materials and knowledge tools. It then goes on to describe how the first two steps of the "Action Cycle" domain have also been addressed; the main problem between EBP and actual practice has been identified and the evidence on best practice USN management has been adapted for acute care. The subsequent two steps that have not yet been addressed include assessing barriers to knowledge use and implementing an intervention. The Knowledge to Action Process model stresses that in order for a KT intervention to be effective in changing clinician practices, the facilitators and barriers faced by clinicians treating a specific clientele, in a specific type of setting, need to be identified.A few studies have assessed the barriers and facilitators to using EBP in rehabilitation; however none are specific to occupational therapists treating post-stroke USN. Thus, the objectives of the second manuscript were twofold: Phase 1) to identify the barriers and facilitators that affect EBP use by acute care OTs treating individuals with post-stroke USN; and Phase 2) to create, to pilot test, to evaluate the feasibility and to conduct preliminary analyses of effectiveness of a multi-modal KT intervention geared towards increasing EBP knowledge acquisition and self-efficacy for USN assessment and treatment. A sub-objective was to conduct preliminary analyses of the association between potential explanatory variables and change in knowledge acquisition and EBP self-efficacy.In the first phase, two focus groups (n=9) were held where acute care OTs treating patients with stroke discussed the barriers and facilitators to EBP use faced in practice. Key barriers included lack of time and basic EBP skills, and lack of personal motivation to change current practices and habits. Key identified facilitators included a multidisciplinary stroke team, recent graduation, and having access to learning material and several educational days annually. In the second phase, a multi-modal USN KT intervention was pilot tested on 20 OTs from Quebec and Ontario. Clinicians took part in an 8 week intervention beginning with a 7 hour in-person USN KT training session. This was followed by an 8 week reinforcement period where they continued their learning online. A pre, pre, post assessment of the main outcome - knowledge of best practices in USN management, was measured online via the Knowledge Questionnaire. The secondary outcome EBP self-efficacy, was assessed using the EBP Self-Efficacy Scale immediately prior to and following the in-person training session. All OTs improved in knowledge of EBP USN management and as a group, a statistically significant improvement was achieved. Similarly, significant improvement was found in clinicians' level of EBP self-efficacy. These results demonstrate that a multi-modal KT intervention based on the Knowledge to Action Process model and identified barriers and facilitators is feasible and effective based on preliminary analysis. However, further investigation of this KT intervention through a randomized control trial is necessary to validate the results on effectiveness obtained in this study.
Il existe un grand écart entre les données probantes et la pratique actuelle des ergothérapeutes traitant les patients qui ont subi un accident vasculaire cérébral (AVC) et qui sont atteints de la négligence spatiale unilatérale (NSU). Il est très important de modifier les pratiques actuelles de ces cliniciens vu l'amélioration remarquable des symptômes de NSU reliés à l'utilisation des données probantes. À date, il n'existe aucune étude de recherche utilisant l'application des connaissances (ADC) comme moyen d'augmenter les connaissances des données probantes spécifiquement pour ergothérapeutes traitant la NSU. Le premier manuscrit de cette thèse décrit comment un modèle d'ADC le « Knowledge to Action Process » conçu par Graham et collègues, peut guider le développement d'une ADC efficace ces ergothérapeutes. Il décrit la façon dont les études de recherches précédentes ont déjà adressés le domaine de la création des connaissances. Le manuscrit poursuit en décrivant comment les deux premières étapes du domaine du cycle d'actions ont aussi été adressées. Les deux étapes suivantes qui évaluent les obstacles à l'usage des données probantes et qui mettent en œuvre une intervention d'ADC n'ont pas été adressé à date. Le modèle souligne que l'intervention d'ADC ne pourra être efficace que si les obstacles et facilitateurs vécus par les cliniciens travaillant dans ce domaine sont identifiées. Il existe aucune étude à date qui identifie les obstacles et facilitateurs à l'utilisation des données probantes pour ergothérapeutes travaillant avec les patients avec AVC et la NSU. Les objectifs du deuxième manuscrit sont : Phase 1) d'identifier les obstacles et facilitateurs qui contribuent au manque d'utilisation des données probantes par les ergothérapeutes travaillant en soins aigues avec les patients atteints de la NSU suite à un AVC, et Phase 2) de créer, d'évaluer la plausibilité et d'exécuter des analyses préliminaires d'efficacité d'une intervention d'ADC ayant comme but d'augmenter les connaissances des données probantes et aussi d'auto-efficacité dans l'évaluation et le traitement de l'NSU parmi le même groupe de cliniciens.Dans la première phase, deux groupes de discussions (n=9) avec ergothérapeutes des soins aigues travaillant avec les individus atteints de NSU suite à un AVC ont eu lieu. Les obstacles les plus importants étaient le manque: de temps, d'habileté dans le domaine des données probantes, et de motivation personnelle à changer leur pratique actuelle. Les facilitateurs dominants étaient ayant: une équipe de AVC composée de différentes disciplines, terminée les études récemment et accès aux matériaux d'apprentissages et journées de formation annuellement. Dans la deuxième phase, une intervention d'ADC a été mise à l'essai sur 20 ergothérapeutes provenant des provinces de Québec et de l'Ontario. L'intervention a commencé avec une formation de sept heures suivie par huit semaines de renforcement où les cliniciens ont continué leur apprentissage sur l'internet. Deux évaluations préliminaires et une ultérieure des résultats principaux – les connaissances des données probantes pour la gestion de l'NSU ont été mesurées à travers le « Knowledge Questionnaire » répondu sur l'internet. Le deuxième résultat - d'auto-efficacité pour utiliser les données probantes a été évalué en utilisant le « EBP Self-Efficacy Scale». Les résultats ont démontré que tous les ergothérapeutes ont amélioré leurs connaissances de la gestion de la NSU et en tant que groupe, une amélioration significative a été atteinte. De même, une amélioration significative a été remarquée au niveau d'auto-efficacité pour l'utilisation des données probantes. Ces résultats démontrent qu'une intervention d'ADC basée sur le « Knowledge to Action Process » est réalisable et basée sur l'analyse préliminaire est aussi efficace. Cependant, un essai de contrôle randomisé est requis pour valider les résultats obtenus ici sur l'efficacité de l'intervention d'ADC.

Thesis: Ph. D. in Medical Engineering, Harvard-MIT Program in Health Sciences and Technology, 2016.
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 115-124).
Clinical predictive models are useful in predicting a patient's risk of developing adverse outcomes and in guiding patient therapy. In this thesis, we explored two different ways to apply domain knowledge to improve clinical predictive models. We first applied knowledge about the heart to engineer better frequency-domain features from electrocardiograms (ECG). The standard frequency domain (in Hz) quantifies events that repeat with respect to time. However, this may be misleading because patients have different heart rates. We hypothesized that quantifying frequency with respective to heartbeats may adjust for these heart rate differences. We applied this beat-frequency to improve two existing ECG predictive models, one based on ECG morphology, and the other based on instantaneous heart rate. We then used machine learning to find predictive frequency bands. When evaluated on thousands of patients after an acute coronary syndrome, our method significantly improved prediction performance (e.g., area under curve, AUC, from 0.70 to 0.75). In addition, the same bands were found to be predictive in different patients for beat-frequency, but not for the standard frequency domain. Next, we developed a method to transfer knowledge from published biomedical articles to improve predictive models when training data are scarce. We used this knowledge to estimate the relevance of features to a given outcome, and used these estimates to improve feature selection. We applied our method to predict the onset of several cardiovascular diseases, using training data that contained only 50 adverse outcomes. Relative to a standard approach (which does not transfer knowledge), our method significantly improved the AUC from 0.66 to 0.70. In addition, our method selected 60% fewer features, improving interpretability of the model by experts, which is a key requirement for models to see real-world use.
by Yun Liu.
Ph. D. in Medical Engineering

It has been proven that there is a connection between the physical environment and health outcomes. Low income and minority communities live in hazardous environments and bear a disproportionate burden of environmental health disparities. Environmental hazards imposed on low income and minority communities require the immediate attention of social workers. Social workers are in a unique position to ensure that the health and well being of oppressed groups is not compromised by environmental factors. This study examined the environmental health awareness of 90 licensed social workers. More specifically, this study assessed the following information from social workers: (1) familiarity with environmental hazards, (2) knowledge of environmental health problems, (3) knowledge of environmental legislation, (4) professional practice of screening clients for past and present exposure to environmental pollutants, (5) professional experiences with receiving environmental concerns from clients, (6) professional practice of advocating for the environmental health of clients, and (7) professional opinions about the need to train and educate social work students and professionals on environmental health. This study asserts that social workers can protect the environmental health of distressed communities across the micro-macro spectrum.

Purpose: The purpose of this study is to assess the impact of preventive dental services (screening, oral health education, and fluoride varnish) given by pediatric medical providers with an assessment of caregivers interviewed at baseline and at 6-months follow-up.Methods: Using a prospective cohort study design, an oral health knowledge and socio-demographic questionnaire was delivered to a cross-section of caregivers of preschool-aged children seen at VCU Children's Pavilion. Baseline data was used to conduct a cross-sectional analysis of caregivers prior to their children receiving preventive dental services (screening, oral health education, and fluoride varnish). Subsequently, six months into the program, caregivers of children receiving preventive dental services were retested on their oral health knowledge. The 23-item questionnaire included knowledge, behavior and opinion items on risk factors for dental diseases, care of child's teeth, and socio-demographic characteristics of the family. Data collection occurred in the clinic waiting rooms and the examination rooms. Results: A sample of 120 caregivers completed the baseline questionnaire. Caregivers at baseline reported 89% of the children have never been to a dentist. Sixty-four percent of caregivers have never been told by a doctor or nurse when their child should go to the dentist. After receiving preventive dental care in a primary care setting, there was a significant increase in the use of fluoridated toothpaste and less trouble brushing the child's teeth. Caregivers reported a significant increase in information given to them by medical residents about how to brush the child's teeth.Conclusion: The delivery of preventive dental services in a primary care setting is effective in improving certain aspects of caregiver oral health knowledge, though persistence is needed to further caregiver education in an effort to improve the oral health of children.

The purpose of this thesis is to evaluate the medical data management expert system at the Pediatric Intensive Care Unit of the Montreal Children's Hospital. The objective of this study is to provide a systematic method to evaluate and, progressively improve the knowledge embedded in the medical expert system.
Following a literature survey on evaluation techniques and architecture of existing expert systems, an overview of the Patient Data Management System hardware and software components is presented. The design of the Expert Monitoring System is elaborated. Following its installation in the intensive Care Unit, the performance of the Expert Monitoring System is evaluated, operating on real vital sign data and corrections were formulated. A progressive evaluation technique, new methodology for evaluating an expert system knowledge-base is proposed for subsequent corrections and evaluations of the Expert Monitoring System.

Healthcare provider practices around older adult sexuality are increasingly the focus of scholarship. Researchers use available scales to study health worker knowledge and behavior in their research. This dissertation argues the need for a new scale, because the available measures are dated and do not account for changes in attitudes and medical advances over three decades. After a review of the increasing role of physicians, social workers, and other health workers providing care for sexual issues throughout history, I describe available scales for measuring knowledge and behaviors about older adult sexuality and review research that employs them. The purpose of the dissertation was to develop a contemporary measure regarding older adult sexuality practices among health workers. I utilized a two-phase plan following Bowen and Guo’s 12-step mixed-method approach for scale development (2012). Phase I included a literature review and qualitative interviews with experts on older adult sexuality regarding the construct. Then I created a universe of items, reviewed them with the experts, and revised items. In Phase II, I tested the items with 155 healthcare providers and conducted analysis for reliability and validity. Based on the analysis, I culled items to create a shortened scale. I proposed a scale consisting of 52 items with three subscales: a 25-item Knowledge subscale, a 13-item Attitude subscale, and a 14-item Behavior subscale. The Knowledge subscale showed poor internal reliability (KR-20 = .625). The Attitudes (α = .825), and Behavior (α = .837) subscales showed good internal reliability. I also evaluated content validity and criterion-related validity for the subscales. Flaws in the methods and analysis make the 52-item proposed scale conceptually unsound. Limitations in generating the pool of items, evaluating the items, and testing reliability and validity did not produce a viable scale. I analyze problems with the methodological approach and propose a redesign that corrects for flaws in the approach employed here. I will use an inductive, social justice model that expands scale development to include interviews with practitioners and older adults. I conclude with a number of research, practice, and policy implications that will result from a redesigned scale.

This research investigated the question of whether automatic or system-generated information classification methods can help humans better manage information. A series of four experiments were conducted; they investigated the usability (i.e., usefulness) of two automatic approaches to information classification, the concept space approach and a Kohonen-based SOM approach in the context of information retrieval. The concept space approach was evaluated in three different domains: Electronic Brainstorming (EBS) sessions, the Internet, and medical literature (the CancerLit collection). The Kohonen-based SOM approach was evaluated in the Internet and medical literature (CancerLit) domains only. In each case, the approach under investigation was compared with existing systems in order to demonstrate performance viability. The basic premise that information management, in particular information retrieval, can be successfully supported by system-based information classification techniques and that humans would find such techniques viable and useful was supported by the experiments. The concept space approach was more successful than the Kohonen-based SOM approach. After modifications to the algorithms based on user feedback from the EBS experiments had been made, users found the concept space approach results to be comparable (in the Internet study) or superior (in the CancerLit study) to existing information classification systems. The key future enhancement will be incorporation of better ways to identify document descriptors through syntactic and semantic front-end processing. The Kohonen-based SOM approach was considered difficult to use in all but one specialized case (the dynamic SOM created as part of the CancerLit prototype). This can probably be attributed to the fact that its associative organization does not match with the standard mental models (hierarchical and alphabetic) for information classification.

This quantitative, retrospective, multivariate, non-experimental study examined the first-time performance of 2,673 academic nurse educators who took the CNE examination between September 28, 2005 and September 30, 2011. Post-positivism and Abbott's system of the professions theory served as the philosophical and theoretical underpinnings of this original research which attempted to determine if a relationship existed between educational preparation or years of full-time faculty employment (independent variables) and first-time pass/fail performance on the CNE examination and in each of content areas (dependent variables). The Chi-square test of independence revealed the lack of a statistically significant relationship between educational preparation and first-time pass/fail performance on the CNE examination. Independent t-tests revealed a statistically significant relationship between Option B study participants and content area three (use assessment and evaluation strategies), ( t[2,671] = -2.20, p = .03); four (participate in curriculum design and evaluation of program outcomes), (t[2,671] = -2.06, p = .04); and six (engage in scholarship, service, and leadership), (t[2,671] = -2.34, p = .02). Binary logistic regression revealed that a one year increase in full-time employment resulted in a 1.05 times greater likelihood of passing the CNE examination (OR = 1.05; 95% CI 1.03, 1.06; p = .00). Last, simple linear regression revealed that years of full-time faculty employment contributed to 3.2% of the variability within content area four, 2.8% within content area six, and 2.1% within content area three. The results of this study provide insight about faculty development and mentoring needs, present evidence to policy makers and nursing education leaders, and offer guidance to curricula developers.

As part of the best evidence, it has been demonstrated that the administration of systemic corticosteroids in the emergency department prevent hospital admissions in children with moderate and severe asthma. Although timing in the administration of systemic corticosteroids is critical to the magnitude of effect, this evidence is not necessarily making its way into practice. Using the Knowledge-to-Action Framework, this thesis aimed to bridge the gap between recommended and actual administration of systemic corticosteroids. In order to meet the demands of the primary objective, this thesis fulfills three sequential objectives: (1) to evaluate the impact of early administration of systemic corticosteroid on admission and document the factors associated with its administration; (2) to explore barriers and potential solutions to delayed corticosteroid administration; and (3) to explore and adapt solutions to the pathway to improve patient outcome. A prospective observational cohort of children aged 2-17 years presenting to the emergency department with asthma was conducted to meet objectives (1) and (3). The main outcome for both objectives was hospital admission. A cross-sectional, self-administered survey as well as two focus groups of physicians, nurses and respiratory therapists who worked in the emergency department was conducted to meet objective (2). Seven hundred thirty-nine (739) children with moderate or severe acute asthma and 79 healthcare professionals working in the emergency department were enrolled as part of this thesis. We documented that the administration of systemic corticosteroids within 75 minutes of triage was associated with decreased rate of hospital admissions and a shorter duration of active treatment compared to administration beyond 75 minutes. Lower triage prioritization and lower baseline Pediatric Respiratory Assessment Measure (PRAM) severity score were associated with delayed corticosteroids administration. Our survey confirmed that healthcare professionals have positive attitudes towards the acute asthma pathway. Knowledge gaps and the struggle to balance the standardization versus individualization of care appeared as key elements to sub-optimal adherence to the pathway. Focus groups of emergency healthcare professionals identified emergency department overcrowding as the main barrier to early corticosteroid administration and endorsed the administration of oral corticosteroids at triage under a medical directive as the best solution to overcome undue delay. However, the solution to administer systemic corticosteroids at triage conflicts with international recommendations that suggest administering systemic corticosteroids to children who have demonstrated a suboptimal response to initial β2-agonist therapy. When comparing these two approaches, we confirmed that delaying administration of corticosteroids after initial bronchodilator does not improve health outcomes and that systemic corticosteroids should preferably be administered as early as possible to children presenting with asthma severity of a PRAM score equal to or greater than 4. This thesis firmly confirms the importance of timing in the administration of systemic corticosteroids in the magnitude of effectiveness. Barriers to timely corticosteroid administration are perceived by healthcare professionals to be organizational and related to the conflict between following the pathway versus individualizing treatment. In exploring strategies to the administration of systemic corticosteroid, increasing delay resulted in increasing admission rates; thereby, negating the value of waiting to administer systemic corticosteroid based on response or severity after initial bronchodilator. Implementation of the interventions should include reassessment of the use of the acute asthma pathway, health outcomes, and the barriers its uptakes, thus repeating the Knowledge-to-Action cycle until optimal adherence has been documented.
Il a été démontré que l'administration de corticostéroïdes systémiques au département d'urgence prévenait l'hospitalisation chez les enfants atteints d'asthme modéré ou sévère. En utilisant le cadre Knowledge-to-Action (KTA), cette thèse vise à combler l'écart existant entre l'administration de corticostéroïdes systémiques recommandée et réelle. Pour rencontrer les exigences de l'objectif principal, cette thèse poursuit trois objectifs consécutifs: 1. évaluer l'impact de l'administration précoce de corticostéroïdes systémiques sur l'hospitalisation et documenter les facteurs associés à leur administration; 2. explorer les barrières et solutions potentielles à l'administration tardive de corticostéroïdes; et 3. adapter les solutions à la trajectoire d'amélioration du pronostic du patient. Une cohorte prospective observationnelle d'enfants âgés de 2 à 17 ans se présentant au département d'urgence pour une exacerbation d'asthme à été menée pour rencontrer les objectifs (1) et (3). Un sondage transversal auto-administré ainsi que des groupes de discussion composés de médecins, d'infirmières et d'inhalothérapeutes travaillant au département d'urgence ont été menés pour rencontrer l'objectif (2). Sept cent trente-neuf (739) enfants atteints d'asthme modéré ou sévère et 79 professionnels de la santé travaillant au département d'urgence ont été recrutés dans le cadre de cette thèse. Nous avons documenté que l'administration de corticostéroïdes systémiques dans les 75 minutes suivant le triage est associée à une diminution du taux d'hospitalisation et à une plus courte durée de traitement actif par rapport à l'administration au-delà de 75 minutes. Une priorité moins élevée au triage et un score de sévérité de base plus bas au Pediatric Respiratory Assessment Measure (PRAM) ont été associés à une administration tardive de corticostéroïdes. Notre sondage a confirmé que les professionnels de la santé ont des attitudes positives envers la trajectoire d'asthme aigu. Le manque de connaissances et la lutte pour atteindre un équilibre entre la standardisation et l'individualisation des soins semblent être des éléments clés pour expliquer l'observance sous-optimale à la trajectoire. Au terme des groupes de discussion auprès de professionnels de la santé du département d'urgence, le surpeuplement de salle d'urgence a été identifié comme étant la barrière principale à l'administration précoce de corticostéroïdes. L'administration de corticostéroïdes oraux au triage sous directive médicale a été identifiée comme étant la meilleure solution pour éviter l'induction d'un délai. Toutefois, la solution d'administrer des corticostéroïdes systémiques au triage entre en conflit avec les recommandations internationales suggérant d'administrer des corticostéroïdes systémiques aux enfants ayant démontré une réponse sous-optimale à un traitement initial de β2-agoniste. En comparant ces deux approches, nous avons confirmé que de retarder l'administration de corticostéroïdes après la bronchodilatation initiale n'améliore pas l'effet sur la santé et que les corticostéroïdes systémiques devraient préférablement être administrés le plus tôt possible aux enfants présentant un score PRAM supérieur à 3. Cette thèse confirme fermement l'importance du délai d'administration des corticostéroïdes systémiques pour la magnitude le l'efficacité. Les barrières au respect du délai d'administration des corticostéroïdes, telles que perçues par les professionnels de la santé, sont organisationnelles et reliées au conflit entre le respect de la trajectoire et l'individualisation du traitement. En explorant les stratégies d'administration de corticostéroïdes systémiques, l'augmentation du délai a entrainé une augmentation des taux d'hospitalisation.