MS

thesisSeveral methods exist for monitoring software development. Few formal evaluation methods have been applied to measure and improve clinical software application problems once the software has been implemented in the clinical setting. A standardized software problem classification system was developed and implemented at the University of Utah Health Sciences Center. External validity was measured by a survey of 14 University Healthcare Consortium (UHC) hospitals. Internal validation was accomplished by: an indepth analysis of problems details; revision in the problem ticket format; verification from staff within the information systems department; and mapping of old problems to the new classification system. Cohen's Kappa statistics of agreement, used for reliability testing of the new classification systems, revealed good agreement (Kappa = .6162) among HELP Desk agents in consistency of classifying problems calls. A monthly quality improvement report template with the following categories was developed from the new classification system: top 25 problems; unplanned server downtimes; problem summaries; customer satisfaction survey results; top problems details; case analyses; and follow-up of case analysis. Continuous Quality Improvement (CQ) methodology was applied to problem reporting within the Office of Information Resources (OIR) and a web-based ticket entry system was implemented. The new system has resulted in the following benefits: reduction in problem resolution times by one third; improved problem ticket information; shift of 2 FTEs from call center to dispatch due to the increased efficiency of the HELP DESK; and a trend in improvement of customer satisfaction as measured by an online survey. The study provided an internal quality model for the OIR department and the UUHSC. The QM report template provided a method for tracking and trending software problems to use in conducting evaluation and quality improvement studies. The template also provided data for analysis and improvement studies. The template also provided data for analysis and improvement of customer satisfaction. The study has further potential as a model for information system departments at other health care institutions for implementing quality improvement methods. There is potential for improvement in the information technology, social, organizational, and cultural aspects as key issues emerge over time. There can be many consequences to the data collected and many consequences of change can be studied

MS

thesisThe purpose of this study was to determine the feasibility of instituting collaborative practice in the Intensive Care Unit of a community hospital. The conceptual framework for the study was based on Kurt Lewin's theory of Force Field Analysis. Determining the forces involved in a setting, and categorizing them as restraining or supporting forces provide information for effecting change. From a force field analysis, a determination can be made of whether or not a change is actually possible. Restraining and supporting forces were identified by administering questionnaires to nurses, physicians, and administrative personnel who would be involved in or affect by change. Evaluations of the questionnaires as to supporting, restraining or neutral were completed by a panel of six judges. The panel included a Director of Nursing, Director of Continuing Education, Clinical Nurse Specialist, Medical director of an Intensive Care Unit, a physician who was one of the highest admitters to an Intensive Care Unit over a period of one year, and the Director of Institutional Research in the hospital being studied. Results of the study supported the feasibility of implementing collaborative practice in a small community hospital in Ogden, Utah

Bone mineral density in elite adolescent female figure skaters

<p>Abstract</p> <p>Elite adolescent figure skaters must accommodate both the physical demands of competitive training and the accelerated rate of bone growth that is associated with adolescence, in this sport that emphasizes leanness. Although, these athletes apparently have sufficient osteogenic stimuli to mitigate the effects of possible low energy availability on bone health, the extent or magnitude of bone accrual also varies with training effects, which differ among skater disciplines.</p> <p>Purpose</p> <p>We studied differences in total and regional bone mineral density in 36 nationally ranked skaters among 3 skater disciplines: single, pairs, and dancers.</p> <p>Methods</p> <p>Bone mineral density (BMD) of the total body and its regions was measured by dual energy x-ray absorptiometry (DXA). Values for total body, spine, pelvis and leg were entered into a statistical mixed regression model to identify the effect of skater discipline on bone mineralization while controlling for energy, vitamin D, and calcium intake.</p> <p>Results</p> <p>The skaters had a mean body mass index of 19.8 ± 2.1 and % fat mass of 19.2 ± 5.8. After controlling for dietary intakes of energy, calcium, and vitamin D, there was a significant relationship between skater discipline and BMD (p = 0.002), with single skaters having greater BMD in the total body, legs, and pelvis than ice dancers (p < 0.001). Pair skaters had greater pelvic BMD than ice dancers (p = 0.001).</p> <p>Conclusions</p> <p>Single and pair skaters have greater BMD than ice dancers. The osteogenic effect of physical training is most apparent in single skaters, particularly in the bone loading sites of the leg and pelvis.</p