Medicine

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Prostate Cancer Screening of Heterosexual Caribbean American and African American Men and their Partners

The incidence and prevalence of prostate cancer are very alarming among men in general, among African American men more narrowly, and among Caribbean American men more specifically. While the disease has variable impact on men of different racial and ethnic backgrounds the impact of the disease on diagnosed Caribbean American men and their families is of particular importance. Prostate cancer screening decisions and behaviors can be very helpful in prevention, early intervention, treatment and recovery from prostate cancer. This research uses a symbolic interactionist framework within a family systems approach towards evaluating and understanding the experience of prostate cancer screening decision making among heterosexual Caribbean American men and their partners. A family systems approach is a comprehensive approach that considers important concepts relevant to the experience of illness and decision making surrounding health maintenance decisions. Symbolic interactions theory (SIT) focuses on the associations between symbols or shared meanings and verbal and non-verbal interactions actions and communications. It is a framework for understanding how human beings engage in relationships with each other and illustrates how they experience a variety of decision making processes. People are seen as employing their reasoning and symbolizing capacities and flexibly interpreting circumstances while simultaneously adapting to the same circumstances based on how they interpret the situations they confront. A qualitative research using Focus Groups of with 26 men and 24 women who identified as heterosexual Caribbean American and African American men and their partners was done. Their prostate cancer screening decision making experiences were evaluated in order to aid in the development of hypotheses and generate understanding about preventive and intervention strategies for serving the African American and Caribbean American community

What If It Be All True

If all these things be true, then I must be in earnest. Every thing connected with God and Christ, with sin and pardon, with life and death, with wrath and favor, with time and eternity, is so unspeakably momentous that I must be up and minding these things without delay. If I am not in earnest I am a fool, for what shall it profit me to gain the whole world and to lose my soul?https://place.asburyseminary.edu/ecommonsatsdigitalresources/1236/thumbnail.jp

Falls prevention among older adults at a Nursing home in a northern suburban of Perth in Western Australia

The objective was to identify factors leading to falls and determine the role of nurses and carers play in falls prevention. A retrospective audit of the performance of nurses and carers regarding falls prevention among older adults was used. Residents who had a fall during July 2015 (n=25) were identified using purposeful sampling. Data for this study were collected from the files of these residents. Data analysis was done by using the Fisher exact test which was appropriate for the collected data. Residents aged 85-89 years had the most falls (32%); however, one resident who fell five times in the studied month was aged 90 years. Residents aged 70-74 years had the lowest number of falls (8%). Twenty-two (88%) of the residents who fell were incontinent, 20 (80%) were confused, 19 (76%) were using walking aids and four (16%) were blind. Only five (20%) residents who reported falls in the studied month were independent. Most falls occurred among residents of advanced age, and among those who had incontinence, were confused and failed to use walking aids. Residential home staff should increase vigilance during specific times and monitors closely residents with a high risk of falls

Characteristics and outcomes of patients with an unscheduled return visit within 72 hours to the Paediatric Emergency Centre at a Private Tertiary Referral Hospital in Kenya

Introduction: Patients’ unscheduled return visits (URVs) to the paediatric emergency Centre (PEC) contribute to overcrowding and affect health service delivery and overall quality of care. This study assessed the characteristics and outcomes of paediatric patients with URVs (within 72 hours) to the PEC at a private tertiary hospital in Kenya. Methods: We conducted a retrospective chart review of all URVs within 72 hours among paediatric patients aged ≤15 years between 1 July and 31 December 2018 at the tertiary hospital in Nairobi, Kenya. Results: During the study period, 1.6% (n=172) of patients who visited the PEC returned within 72 hours, with 4.7% revisiting the PEC more than once. Patients’ median age was 36 months (interquartile range: 42 months); over half were male (51.7%), 55.8% were ambulatory and 84.3% were insured. In addition, 21% (n=36) had chronic diseases and 7% (n=12) had drug allergies. Respiratory (59.5%) and gastrointestinal (21.5%) tract infections were the most common diagnoses. Compared with the first visit, more patients with URVs were classified as urgent (1.7% vs. 5.2%) and were non-ambulatory (44.2% vs. 49.5%, p=\u3c0.001); 18% of these patients were admitted. Of these 58% were male, 83.9% were aged 0–5 years, 12.9% were classified as urgent, 64.5% had respiratory tract infections and 16.1% had gastrointestinal tract infections. Being admitted was associated with patient acuity (p=0.004), laboratory tests (p=\u3c0.001) and ambulatory status (p=0.041). Conclusion: The URV rate is low in our setting. Patients who returned to the PEC within 72 hours tended to be male, under 5 years old and insured. Many were non-urgent cases with diagnoses of respiratory and gastrointestinal tract infections. The findings suggest that some URVs were necessary and may have contributed to better care and improved outcomes while others highlight a need for effective patient education and comprehensive initial assessment

First-year university biology students' difficulties with graphing skills

Student Number : 0110601M - MSc research report - Faculty of ScienceBased on the perceived need for improved graphing skills of students at first-year university level, two lecturers wanted to produce a web-based computer programme to improve first-year university biology students’ ability to construct and interpret graphs. Prior to designing and developing the package, however, it was important to establish whether there was a need for such a programme, and what might need to be included. The investigation to establish this provided the research described in this research report. A situation analysis was conducted to establish the nature and extent of the problems of graphing skills discussed anecdotally in the staff room of biology departments at a number of institutes. The ultimate intention (beyond this study) was to determine whether the problems were extensive and serious enough to warrant developing supplementary teaching materials to teach graphing skills. All lecturers (n = 5) and teaching assistants (n = 4) involved in using or teaching graphing skills to first-year biology students at one university were identified and interviewed. The purpose of the interviews was to establish the problems they believed are exhibited by their first-year students (with reference to graphing skills), and the nature and extent of current teaching of such skills in their first-year courses. In order to triangulate the information on student’s problems an item analysis was conducted of all questions incorporating graphs in two mid-year examination papers (n = 478 and n = 65), and students were observed during a practical session (n = 43). Results revealed that students experienced fewer problems with interpreting graphs than with graph construction. Of the four categories of graph interpretation problems identified by the teaching staff, the most popular category was students inability to describe quantitatively what the graph is showing (4 teaching staff). This was confirmed in the question paper analysis when 58% of the medics students (n=478) were unable to answer correctly one question involving several interpretation skills. No specific skills for graph interpretation were observed as being a problem in the College of Science question paper (n=65). Observations showed interrelating graphs as the biggest problem (5 students out of 43). Five categories for problems with graph construction were identified by the teaching staff. The most commonly mentioned problem (4 teaching staff) was identifying or plotting variables, whereas class observation revealed scaling axes as the most problematic skill shown by students (15 out of 43). In the exams, 80% of the medics students could not correctly answer one question requiring multiple skills including identifying variables, and 56% could not correctly answer another question that required skills that also involved identifying variables. The College of Science question paper revealed that 85% of the students could not supply the units of measurement for the y axis. A needs analysis was conducted to establish how the lecturers thought graphing skills should be taught and who should teach the skills. This information was needed to provide suggestions (from education “experts”) about what could be included in the computer programme to be developed subsequent to the research study, and how the teaching could best be done. Four members of the teaching staff said it was important to give students a lot of exercises to practice the skills and five members of the teaching staff said it was the responsibility of the university tutors or lab staff to teach graphing skills

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http://www.ester.ee/record=b4089102*es

Improve primary care performance through operations management: An application to emergency care and preventive care

El propósito principal de esta tesis es aplicar el método de gestión de operaciones para mejorar el rendimiento de los responsables de proporcionar atención sanitaria en relación con dos componentes principales de la atención primaria: atención de urgencia y atención primaria. Durante muchos años, en la atención sanitaria se han aplicado los sistemas de gestión de operaciones (OM) y de investigación de operaciones (OR) con la finalidad de mejorar la eficiencia en la prestación de los servicios sanitarios. El núcleo del sistema de atención médica es la atención sanitaria, cuyas funciones principales incluyen el suministro de un punto de entrada, la prestación de atención médica y preventiva fundamental y ayudar a los pacientes a coordinar y a integrar la atención, aspectos que son fundamentales de cara a mejorar no solo el resultado sanitario de los pacientes, sino también el rendimiento en términos de coste de todo el sistema sanitario (Starfield 1998). En un estudio sobre el rendimiento de la atención primaria y del sistema de salud (Schoen et al., 2004), en EE. UU. se registró un índice de utilización del departamento de urgencias (ED) muy superior al de otros tres países, el cual venía acompañado de un menor porcentaje de adultos que dispusieran de un doctor, un lugar o una clínica habitual donde acudir al caer enfermos. Por este motivo, el capítulo 2 de esta disertación aborda la mejora del departamento de salas de urgencia a través del rediseño del proceso. Otro hallazgo fundamental de la encuesta es que Canadá cuenta con el menor índice de chequeos en términos de prueba de Papanicolaou y mamografías. Debido a la importancia de la atención preventiva para salvar vidas y reducir costes, el capítulo 3 de esta disertación analiza cómo mejorar el programa de atención preventiva financiado por el gobierno a través del diseño de la red. El capítulo 2 establece el contexto de un departamento de urgencias (ED) en un hospital terciario con un censo anual de 55 000 pacientes, y analiza la forma en la que el proceso de rediseño de una prueba sanguínea específica tiene un determinado impacto sobre la congestión del ED. De forma más específica, analizamos en cambio en tres magnitudes de rendimiento después de que el análisis de la muestra de sangre del paciente para determinar los niveles de troponina fuera trasladada del laboratorio central del laboratorio al interior del ED. Mediante la teoría de la asignación de colas de prioridad, generamos hipótesis sobre las siguientes medidas de rendimiento: tiempo de espera (definido como la diferencia de tiempo entre el registro de entrada del paciente y la asignación de cama), tiempo de servicio (definido como la diferencia de tiempo entre la asignación de cama y la distribución, el metabolismo y la eliminación de un fármaco) y calidad del servicio (definido como el índice de revisión de los pacientes tras 72 horas). Mediante un modelo de diferencias en diferencias, determinamos que el rediseño del proceso está asociado con unas mejoras estadísticamente significativas en casi todas las mediciones de rendimiento operativo. Concretamente, encontramos que la adopción de POCT está asociada a una reducción del 21,6 % en el tiempo de servicio entre los pacientes objeto de la prueba durante las horas punta, y en una reducción de entre el 5,9 % y el 35,5 % en el tiempo de espera en función de la categoría de prioridad del paciente durante esas mismas horas punta. Además, encontramos que la adopción de un POCT estaba asociada con una mejora de la calidad del servicio, puesto que la probabilidad de recaída pronosticada se redujo en un 0,64 % durante su uso. También descubrimos importantes efectos indirectos a través de todo el sistema en pacientes que no habían sido objeto de un POCT (pacientes que no son objeto de prueba). En otras palabras, la adopción de un POCT está asociada con una reducción del tiempo de espera entre estos pacientes que no son objeto de prueba de un 4,73 % y a una reducción del 11,6 % en el tiempo de espera en función de la categoría de prioridad de los pacientes durante las horas punta. Al examinar el impacto del POCT entre ambas poblaciones de pacientes, tanto los que fueron sometidos a la prueba como los que no, se pudo determinar que esta investigación es única a la hora de identificar los grandes beneficios en el sistema que pueden lograrse a través del rediseño del proceso asociado al ED. El tercer capítulo de esta tesis emplea un modelo de elección de preferencias para analizar las prioridades del cliente en la atención preventiva desde la perspectiva de la configuración del servicio. Aplicamos el modelo en el contexto de un programa de chequeos asociados con el cáncer de mama financiado por el gobierno en Montreal (Canadá), con el fin de identificar las contrapartidas que reciben los participantes del programa a la hora de acceder a un conjunto de instalaciones con diferentes configuraciones de servicio basadas en sus auténticas preferencias. De forma más concreta, analizamos estas preferencias en relación con el tiempo de espera para obtener cita, el tiempo de desplazamiento a la clínica en la que se vaya a practicar el chequeo, la disponibilidad del aparcamiento de la clínica, el horario de apertura de la clínica, el tiempo de espera dentro de la clínica el día del chequeo, la preparación del personal de enfermería, el proceso de chequeo y el tiempo de espera para recibir el resultado. Pudimos comprobar que la preparación del personal de enfermería (es decir, si son capaces de responder preguntas relacionadas con el chequeo o con el cáncer de mama) y el tiempo de espera para obtener una cita eran los factores más determinantes a la hora de elegir una clínica, seguidos de cerca por la disponibilidad de aparcamiento. Mediante el análisis de clases latentes también podemos confirmar que, al contrario de lo apuntado por otras investigaciones, no existe una heterogeneidad clara entre los participantes del programa. Nuestro modelo Arena de simulación muestra que tener en cuenta las preferencias del cliente en el diseño de las configuraciones del servicio mejorará notablemente tanto el nivel de congestión como el índice de participación en las nuevas pruebas. Como conclusión de ambos capítulos, esta tesis trata de generar implicaciones en términos de gestión en lo que respecta a la configuración de la atención sanitaria que puedan ayudar a mejorar la calidad del servicio mediante el uso de un enfoque de metodología empírica. Vemos que pueden acometerse importantes mejoras en los servicios existentes a través del rediseño del proceso de servicio y de la comprensión de las preferencias del cliente, sin necesidad de revisar todo el sistema de atención sanitaria

Hepatitis A Antibody Seroprevalence in a Selected Kenyan Pediatric Population

The incidence of infection by Hepatitis A virus shows regional variation being highest in developing countries. Determination of age specific Hepatitis A virus (HAV) seroprevalence and the associated risk factors would help better plan for national preventive strategies including vaccination. We carried out a cross-sectional study on 300 children from Nairobi city, Kenya during the years 2003-2004. The age range of the children was 2 - 14 years and were from low and high socioeconomic status (SES) families. The indicators of SES included employment status, residence, number of children per patient’s household, parents’ level of education and source of drinking water. SES was encoded and analysed using Statistical Program for Social Sciences (SSPS) version 16.0. Seroprevalence increased significantly with advancing age. Seropositivity of HAV antibodies was significantly higher among children of low SES, 77.6% by the age of 14 years compared to children of high SES, 38.9% by the same age. Crowded household and parental education were significantly associated with high seropositivity and seronegativity respectively. There is significant rate of seronegativity amongst the studied population especially those from richer backgrounds making them more susceptible to severe infection in future with concomitant complications. We propose that revision of national vaccination program should be considered to include Hepatitis A vaccination