Thèses sur le sujet « Health administrations »

Malaria has long been a major public health concern, with historic roots dating back thousands of years. This febrile disease is caused by a parasite that is transmitted among vertebrates by mosquitoes. Over the past century, global eradication programs have focused on minimizing populations of the insect vectors, and administering treatments to people infected, especially young children and pregnant women, as they are the most vulnerable to suffering severe complications. Overall, these programs have decreased the geographic distribution and global disease burden; however, malaria remains a major problem in regions where these efforts have been unsuccessful. In 2015, there were an estimated 214 million cases throughout the world, resulting in approximately 438,000 deaths; however, over 3 billion people are living at risk of becoming infected with malaria. Widespread use of the few available effective insecticides and anti-malarial drugs has conferred resistance in both parasitic and mosquito species, decreasing the effectiveness of current interventions. As anti-malarial resistance and insecticide resistance spread, the need for novel malaria interventions becomes more urgent.

One novel approach to combatting malaria was pilot-tested by researchers in the Department of Microbiology, Immunology and Pathology at Colorado State University. The Repeated Ivermectin Mass Drug Administration to control Malaria, or the RIMDAMAL study, evaluated the safety and effectiveness of repeated village-wide administrations of an anti-parasitic drug to prevent malaria in children ≤ 5 years old. The RIMDAMAL study was a randomized trial carried out in Burkina Faso, a small tropical country in West Africa. Ivermectin (IVM) is a common anti-parasitic used around the world to prevent and treat parasitic diseases. Recent evidence has demonstrated that IVM is toxic to malaria-transmitting mosquitoes, and can inhibit the propagation of some life stages of malaria parasites. Initial analyses of the RIMDAMAL data found significantly fewer childhood malaria cases in intervention villages that received repeated IVM administrations, compared to control villages.

This study is a geospatial analysis of the RIMDAMAL data to provide further insight as to how this intervention could be implemented. There were two study aims for this research: 1) identify significant clustering of high and low childhood malaria incidence within each study village; and 2) identify significant clustering of high and low childhood malaria incidence throughout the entire study region. In total, eight villages were enrolled in the study, four of which served as controls, while the other four received the intervention. Residents of each village live in concessions, or compounds of extended family. Geospatial coordinates were collected for each concession within a study village, along with data on the participants within each concession. Using this data, incidence density of malaria among children 5 years old or younger was calculated at the concession level. Concessions were mapped, and spatial clustering of incidence density values was evaluated using the Getis-Ord Gi* (G-I-star) spatial autocorrelation statistic. To evaluate within village clustering, each of the eight study villages were analyzed individually, and between village clustering was evaluated by analyzing the entire study region.

Within each village, several “hot spots,” or statistically significant clusters of high malaria incidence density values were recognized during analyses with max clustering, at the 95% confidence level. Statistically significant clusters of low incidence density were identified in one study village during the analysis with max clustering. The proportion of concessions identified as significant clusters varied by village, ranging from 12% to 91.3%. There seems to be no trend in clustering patterns seen within each village; some villages had randomly distributed hot or cold spots, while others appeared more clustered.

The spatial clustering patterns in the whole study region are more telling. Max clustering occurs in a bimodal pattern with two peaks; at 2,100 meters and 10,000 meters. The clustering patterns that occur indicate regions of similar malaria incidence. The proximity and locations of these villages may imply the RIMDAMAL protocol has regional impacts. Additional research is needed to evaluate how to most effectively implement this intervention to protect against malaria.

Staff turnover is high in the hospital industry, influencing health care administration leaders to implement successful strategies to decrease staff turnover. The purpose of this case study was to explore successful strategies to reduce hospital employee turnover. Five health care leaders from Raleigh, North Carolina hospitals were in the sample drawn from the population of medical professionals with successful employee retention in their hospital settings. The conceptual framework for this study was the Herzberg dual-factor theory with the supporting theory, Maslow’s hierarchy of needs theory, and the opposing theory, Vroom’s expectancy theory. Semistructured interviews occurred with 5 leaders. The review of hospital human resource documents, website pages, and training program information combined with interview data for methodological triangulation using the Yin 5-step process, leading to 5 themes. Participants emphasized selective recruitment and hiring with a focus on hiring employees for a good organizational fit. Participants discussed different ways of engaging, supporting, and motivating hospital employees. Strategies included valuing employees, effective communication, recognition, and respect. Participants identified a fair, flexible, collaborative, and safe organizational culture as ideal for the retention of hospital employees who fit with the hospital environment. Reducing employee turnover may improve customer relations and quality of care in hospitals, leading to lower health care costs, representing positive social change for hospital employees and the patients served.

In recent years, the financial barrier to access for prescription contraceptives has been lifted due to the Affordable Care Act. However, there is still a barrier to access because those who want it still need to get a prescription from a provider. This business plan proposes the establishment of Azura Digital Health, a scheduling tool that obstetricians and gynecologists can use to schedule their appointments, while also offering patients convenience for birth control prescriptions and assistance with finding the women’s health provider that is right for them. Allowing patients to choose their provider can increase quality for their health, since they can choose the doctor they feel is best for them. Additionally, the convenience of getting their birth control prescription helps patients get a simple prescription for what they need in a timely manner. The scheduling tool allows providers to market themselves and broaden their patient base, as Azura Digital Health would do that work for them. Azura Digital Health hopes to improve women’s healthcare quality, breaking the barrier to prescriber access.

Medication errors are a major concern for patient safety, and cost the health care system billions of dollars each year. There is evidence that Barcode Medication Administration Technology decreases medication errors. However, little is known about the factors that affect Barcode Medication Administration Technology Acceptance by Nurses. The purpose of this research was to investigate the relationships between caring, role conflict and role ambiguity, organizational commitment and barcode medication administration technology acceptance by nurses.

A quantitative non-experimental correlational design was utilized for this study, in addition to two qualitative questions. Eighty-six nurses completed four questionnaires measuring the study variables. Two of the four hypotheses were supported. There was a negative correlation between role conflict and role ambiguity and technology acceptance, indicating that nurses in this study who experienced less role conflict and role ambiguity were more likely to accept BCMA technology. There was also a positive correlation between organizational commitment and technology acceptance, indicating that nurses in this study that were highly committed to their organization were more accepting of BCMA technology. The qualitative findings indicated that nurses experienced some frustration when aspects of the technology malfunctioned, making the medication administration process time consuming. However, nurses verbalized that BCMA technology made their role of medication administration safer and more efficient.

This study's findings can assist administrators, nurse educators and informatics directors in providing adequate training, support, resources and environment for promoting BCMA technology acceptance by nurses. This will help to promote patient safety and technology acceptance and may result in less turnover due to nurse role conflict and role ambiguity.

The dynamic mental health landscape has placed undue strain on hospitals, providers, and the community at large, resulting in gross inequities in access to care for underserved populations. This business plan proposes the establishment of a Los Angeles area non-profit community mental health clinic, embedded with a mission to accept adult patients suffering from co-occurring mental health and chronic medical conditions, regardless of insurance status and ability to pay. Under the Patient Centered Medical Home model, the aim of the Clinic will be to treat patients holistically by incorporating an interdisciplinary team of clinicians to ensure optimal health outcomes. While this plan acknowledges the challenges in serving indigent populations, the Clinic will contract with Medi-Cal and commit to continuous fundraising efforts to remain financially sustainable in order to improve the health of vulnerable Angelenos.

PRN psychotropic medication administration is a common practice used by psychiatric RNs in acute inpatient mental health settings to manage anxiety and agitation in patients, and as a result, there are high incidences of PRN psychotropic medication administration (Mugoya & Kampfe, 2010). There is limited documentation indicating that therapeutic non-pharmacological interventions are utilized prior to PRN psychotropic medication administration (Curtis et al., 2007). The purpose of this scholarly project was to determine what non-pharmacological interventions are used by mental health RNs prior to or in lieu of administering PRN psychotropic medication to manage anxiety and agitation in adult psychiatric hospitalized patients. Another aim of this project was to determine what factors influence mental health RNs' decisions to administer PRN psychotropic medications. A descriptive study was conducted. Two survey-type self-reporting tools were used. Twenty RNs completed Nursing Surveys. Thirteen RNs completed both Nursing Surveys and Nursing Intervention Tracking Forms. Findings from this study revealed that non-pharmacological interventions successfully resolved problems over 1/3 of the time and may prevent the use of PRN psychotropic medications. In cases where PRN psychotropic medication was not administered, distraction was the non-pharmacological intervention most often used. The most common factor influencing RNs' decisions to administer PRN psychotropic medications was a high level of anxiety persistent after non-pharmacological interventions were used. This study reinforces the importance of RNs using non-pharmacological interventions to manage patients exhibiting signs or symptoms of anxiety or agitation.