Dissertations / Theses on the topic 'Health maintenance oragization patients'

The purpose of this study was to determine whether there were differences in mortality, dialysis method survival, hospital admissions and days of hospitalization, between diabetic patients with end-stage renal disease (ESRD) treated by continuous ambulatory dialysis (CAPD) and those treated by haemodialysis (HD).
All diabetic patients (n = 241) treated for newly diagnosed ESRD in four university teaching hospitals, in Montreal, between 1980 and 1993, were studied (n = 112 began with CAPD, n = 129 with HD).
The data regarding these patients were analyzed using actuarial methods and Cox's proportional hazards model, controlling for severity of pre-treatment co-morbid conditions. Intent-to-treat (ITT) and treatment history (TxHx) censoring criteria of analysis were also used.
At baseline, the CAPD patients were younger and had more co-morbid conditions, particularly cardiovascular diseases, than the HD patients did.
The findings regarding mortality and first dialysis method change were similar in both the ITT and TxHx analyses. The mortality rate ratios varied with time since beginning of treatment. The adjusted mortality rate ratios (ARR) for CAPD patients relative to HD patients during year 1, 2, 3, and thereafter were 1.1, 1.6, 2.9, and 4.5 respectively. The rate of dialysis method change was also greater in the CAPD patients compared with HD patients (ARR = 4.4, P $<$ 0.001).
Both the rate of hospital admissions and average days of hospitalization for the CAPD patients were about twice those for the HD patients (0.21 vs 0.11 admissions, and 4.6 days vs 2.4 days, per month of first dialysis therapy).
The findings regarding mortality suggest that in the short term, the initial choice of dialysis method and any subsequent switch between CAPD and HD for a patient can be made without serious concern about the influence of the dialysis modality on patient survival. However, in the longer term, the influence of the choice of the initial dialysis on patient survival is substantial.

The purpose of this study was to revise and expand the Hope Maintenance Scale. An exploratory design was used to content analyze qualitative data collected from 226 heart transplant patients in the primary study, "Predictors of Quality of Life in Heart Transplantation". Results supported five of the six original dimensions of hope contained in the Hope Maintenance Scale. The five dimensions substantiated were: Downward Comparison, Fostering Optimism, Belief in a Powerful Other, Avoiding Painful Situations or Material, and Viewing the Situation as Temporary. Subcategories for the dimension of Optimism were generated and termed: Forced Optimism, Guarded Optimism, Euphoria, and Gratefulness. The subcategory of Exceptional Experience was developed for the category of Downward Comparison. Normalizing was proposed as an antecedent of hope. Of subjects who expressed normalizing activities, 60% also used other hope maintenance strategies. Of subjects who reported Threats to Normalizing, 42% used no other hope maintenance strategies.

Includes abstract.
Includes bibliographical references.
Part A: is the research protocol which outlines the background and the process of this research. This study is a population-based observational study nested within the Groote Schuur Hospital (GSH) cohort of a global study, REMEDY which is a prospective, multicentre, hopital-based registry for rheumatic heart disease (RHD). This study made use of geographical information systems (GIS) as a tool to investigate the effect of distance on the maintenance of INR therapeutic ranges in RHD patients. Part B: elaborates on the background and highlights the importance of this research by exploring the existing theoretical and empirical literature relevant to the topic. It describes the importance of the maintenance of the INR therapeutic range and how geographical factors can influence patient adherence to medication, and how it can act as a barrier to access health care. It provides examples of how GIS has been used to investigate the effect of distance on adherence in other studies. This literature review aimed to establish whether the maintenance of therapeutic ranges in RHD patients on anticoagulant therapy is correlated with the distance travelled from patient's residence to the clinic where INR monitoring takes place. Part C: presents the entire project in a format suitable for journal submission. The background of this research project is summarised and the results are presented and discussed.

ABSTRACT Name: Gail Elizabeth Parsons Date: August, 2011 Title of thesis: Exploring The Experiences of Osteoarthritic Patients Awaiting Hip And Knee Arthroplasty: Informing and evaluating the effectiveness of a health maintenance intervention. Aim of the study To explore the lived experiences of patients with severe osteoarthritis of the hip and knee joint whilst awaiting primary joint replacement surgery. To utilise findings from interviews and evidence-based literature to develop a health maintenance clinic (HMC) intervention, followed by its evaluation. Methodology A mixed method design was adopted: an exploratory approach incorporating descriptive phenomenology consisting of unstructured interviews with participants awaiting their hip or knee replacement surgery, followed by a randomised control trial (RCT) to compare the existing preoperative assessment service with a health maintenance clinic intervention. Setting and sample A purposeful sample of 6 people with osteoarthritis awaiting joint replacement were interviewed. In addition, a sample of 250 people (mean age 73 years) were recruited via an orthopaedic out-patient department for the RCT following referral to the waiting list for hip or knee replacement surgery. Outcome measures The Western Ontario and McMaster Osteoarthritis Index (WOMAC) tool was used at the time of referral to waiting list and again during the preoperative assessment appointment. The Hospital Patient Satisfaction Index (HP SI) was administered at the preoperative assessment appointment. Number of surgery postponements was also recorded. Results Six themes emerged from the interview data: living and coping with pain; not being able to walk and move around; coping with every day activities; how others see me; help, advice and support whilst awaiting surgery; effect upon family, friends and helpers. The RCT revealed; no significant difference between the total WOMAC scores between the two groups. Participants attending the HMC (experimental group) were significantly more satisfied with their care. There was no relationship between satisfaction and WOMAC scores. There was a significant difference in the number of postponements of surgery between groups, with a greater proportion of participants proceeding to surgery in the experimental group. Conclusion The interview data generated new knowledge of the experiences, concerns and symptoms of individuals waiting for primary hip and knee replacement surgery. Health maintenance provision 'tailored' to the individual was revolutionary at the time of the study. Patient satisfaction was significantly high and the number of postponements of surgery was significantly less for those attending the clinic.

Psychosocial differences between weight loss maintainers and weight loss non-maintainers were compared at least one year after reaching a medically approved weight goal through a medically supervised weight loss program. Research questions addressed differences between groups on the dimensions of somatization, obsessive/compulsive issues, interpersonal sensitivity, depression, anxiety, hostility, ability to resolve past emotional issues, social interpersonal relationships, and tolerance of ambiguity. The all-female sample consisted of maintainers of weight loss (N=30), non-maintainers (N=33), psychotherapy maintainers (N=14), and psychotherapy non-maintainers (N=ll). Research instruments administered were the Symptom Checklist-90-Revised, Fundamental Interpersonal Relations Orientation-Behavior, Personal Orientation Inventory, and Budner Scale for Tolerance/Intolerance of Ambiguity. To determine differences between groups, a t test was performed on data relating to the maintaining and non-maintaining groups. An analysis of variance was performed on data related to the maintaining, non-maintaining, psychotherapy maintaining, and psychotherapy non-maintaining groups. An intercorrelation matrix was completed for all variables. Non-maintainers of weight loss had significantly more difficulty with somatic problems as indicated in the results of both the t test and the analysis of variance (p < .009, p < .02, respectively). Non-maintainers expressed more complaints which focused on cardio-vascular, gastrointestinal, respiratory, and somatic equivalents of anxiety (headaches, pain, discomfort of the gross musculature). An analysis of variance showed non-maintainers (p < .05) to be significantly less effective in resolving past emotional issues than maintainers, psychotherapy maintainers, and psychotherapy non-maintainers. Non-maintainers were more burdened by guilt, regrets, and resentments from the past. Results of the analysis of variance indicated that psychotherapy maintainers (p < .03) were more socially adjusted than maintainers, non-maintainers, and psychotherapy non-maintainers. Inclusion and control subscales characterized psychotherapy maintainers to be more socially adaptable and flexible. They assumed responsibility without support of others and were less burdened with fears of helplessness and incompetence.

碩士
中國醫藥大學
醫務管理學研究所碩士班
97
Research Purpose: Since December 2005, the Methadone Maintenance Treatment (MMT) project has been implemented by the government. Now the accumulative number of people receiving therapy was more than 17,000, and the person-time of taking medication was 5,331,066 (person/day). But so far few researchers have examined the physical and mental status of drug addicts under treatment. Therefore, in this study, we will examine the physical and mental status of drug addicts under treatment especially focusing on the significant differences caused by their individual characteristics, situations of using other substances, and the factors involving them in the MMT project. Research Method: This study used a self-administered, structured questionnaire to collect people, with their agreement, who participated in MMT project, and receiving treatment over two months in central Taiwan. There were 410 valid questionnaires (valid return rate is 77.36%). First, we use Pearson product-moment correlation, independent-sample t test, and one-way ANOVA to inquire into the influence relationship of each variable. Second, we use multiple regression analysis and stepwise multiple regression analysis to find the important factors affecting the physical and mental status of drug addicts under treatment. Research Results: The subjects tend to be male, the marriage status was unmarried, the education level was high school or above, the financial status was general, employed and in a habit of smoking. Their average age is 36.63 years old, the average duration of using heroin is 8.13 years, and the average period of participating in MMT project is 7.44 months. Advanced analysis found that age, educational level, self-conscious financial status, working conditions, the average number of years of heroin use and the doses of Methadone caused significantly differences for Physical Component Scale (PCS) on drug addiction treatment patients. And, self-conscious financial status and working conditions caused significantly differences for Mental Component Scale (MCS) on drug addiction treatment patients. Conclusion and Suggestion: Overall, drug addiction treatment patients with lower ages or full-time jobs or better financial status will get better treatment results in their physical and mental health. In order to conduct case management and understand the outcome of the treatment, we recommend that it should create a national database in the future and assess their physical and mental health status regularly.

碩士
國立臺灣大學
健康政策與管理研究所
101
Background: Result from life quality survey can assess degree of painfulness in various diseases and health-related life quality among population; a number of different life quality questionnaires are developed both in Taiwan and aboard. In general, single scale is used to measure life quality assessment and multi scales are rarely used in this situation. Objective: This research is to investigate hemodialysis patients'' health-related life quality, in order to understand the current situation in their life and explore the fundamental properties of hemodialysis patients, disease characteristics and blood biochemical values in differences of various health-related life quality scales, to further compare differences between scales. Method: Cross-Sectional Study is used in this research, using four types of scales EQ-5D, SF-12, KDCS, WHOQOL-BREF (TW) to collect dates on hemodialysis patients from four regional hospitals in central and northern Taiwan. Statistical methods utilize ANOVA analysis, Simple Linear Regression and Generalized Estimating Equations to evaluate the basic properties of hemodialysis patients, disease characteristics and biochemical data on health-related life quality differences, to further study difference in four scales. Results: A total of 398 hemodialysis patients participated in this study, the average age was 61.16 ± 13.77 years. There were 184 males (46.2%) and most were married (70.4%). The results showed that patients with higher educational level, duration of 1-3 years dialysis, more active social activities, better living capabilities , and normal serum albumin had a positive correlation in four types of health-related life quality scales. Four health-related quality of life scales show: (1) EQ-5D in female sex, age over 50 years old, unmarried, divorced and widowed, with sequelae, abnormal serum albumin, and with severe diseases had a significant negative correlation; education above junior high school, 1-3 years duration of dialysis, with social activities, KPS all had a significant positive correlation; (2) SF-12 in physiological health dimension, women, ages over 50 years old, unmarried, divorced and widowed, with sequelae, abnormal serum albumin, and with severe diseases had a significant negative correlation; education above junior high school, 1-3 years duration of dialysis, with social activities and daily physical condition had a significant positive correlation; in dimensions of mental health, aged over 50 years, unmarried, divorced and widowed, abnormal serum albumin, and with severe diseases had significant negative correlation; education about junior high school, 1-3 years duration of dialysis, and with social activists had a significant positive correlation; (3) KDCS in physical health dimension, female gender, age over 50 years old, unmarried, divorced and widowed, abnormal serum albumin and with severe diseases had a significant negative correlation; in dimensions of mental health, education about junior high school and 1-3 years duration of dialysis had a significant positive correlation; (4) WHOQOL-BREF (TW) in physiological health dimension, age over 50 years, unmarried, divorced and widowed, with sequelae, abnormal serum albumin, and with severe diseases had a significant negative correlation; education about junior high school and 1-3 years duration of dialysis had a significant positive correlation; in dimensions of mental health, unmarried, divorced and widowed, with sequelae, abnormal serum albumin, and with severe diseases had a significant negative correlation; education about junior high school, 1-3 years duration of dialysis and with social activists had a significant positive correlation.; in dimensions of social relations, women, education above junior high school, 1-3 years duration of dialysis, with social activities and normal daily physical condition had a significant positive correlation; in environmental dimensions, unmarried, divorced and widowed had a significant negative correlation ; education about junior high school had a significant positive correlation. Results from generalized estimating equation: social activities in physiological, mental, and social relation dimensions of EQ-5D、SF-12、and WHOQOL-BREF (TW) all had significant positive correlations; daily physical conditions in physiological dimension of EQ-5D、SF-12 and in physiological and social relation dimensions of WHOQOL-BREF (TW) all had significant positive correlations. Conclusion: Women, higher age, education level of elementary school, divorced, widowed and unmarried, dialysis for 1 year or less, with sequelae and complications, low participation in social activities, poor daily physical condition, low scores in disease severity, and abnormal serum albumin, health-related quality of life is poor. EQ-5D, SF-12 and WHOQOL-BREF (TW) in physiological health dimension are consistent; SF-12 and WHOQOL-BREF (TW) in mental health dimension are consistent.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2009.
Chiropractic in Israel has become a more integrated part of many aspects of health care policies, in that it is practised in multidisciplinary medical teams, is now included in HMOs and hospitals services, and has contributed to research and military programmes. However, the chiropractic profession still has its problems. Without laws or legitimate recognition to protect chiropractors, the playing fields could never be levelled for all chiropractors in Israel. Patient use and demand for complementary and alternative practitioners, including chiropractors, is gradually increasing. However, there has been no research to investigate the perceptions of chiropractors, medical doctors and chiropractic patients (i.e. key stakeholders) regarding the integration of the chiropractic profession in the Israeli health care system. The purpose of this study was to explore and describe the perceptions of a selected group of stakeholders about the integration of the chiropractic profession in the Israeli health care system. Such an exploration might help the profession to secure its position and claim a higher status in society. This is desirable to educate the public and the authorities on the many positive advantages of chiropractic, include access to chiropractic services for people who traditionally have not been able to use these services because of economic barriers or internal government and authorities limiting laws, as well to enhance its public image such as honesty, integrity and objectivity in the health care, and to avoid any criticism of organized medicine. It therefore stands to reason that the factors that might contribute to this type of development should be considered as soon as possible in those countries where chiropractors practise. This type of investigation is important not only in the Israeli setting, but indeed in every country where the profession is aiming toward increased recognition and awareness of the contribution of chiropractic to health care. Chiropractic now has the opportunity to expand its influence and take a more active role in health care issues. Therefore, although geographically removed, South Africa stands to gain interesting and useful information from an investigation of this nature. The investigation was carried out within a post positivist approach close to that of critical realism, using an interpretive methodology. The sampling was purposive as individuals were targeted for their knowledge in three main topics, these being the scope of chiropractic practice, inter-professional relations between Doctors of Chiropractic (DCs) and Medical Doctors (MDs), and developmental issues. The participants included five chiropractors, three medical doctors and three chiropractic patients, who all resided in the metropolitan area of Tel Aviv. were presented in tabular form in order to facilitate analysis and interpretation. Although there were some discrepancies regarding the knowledge and background of the participants about the topics discussed, all the participants met the inclusion criteria. The results show that chiropractic stands at the crossroads of mainstream and alternative medicine. Therefore it is important to establish a leading statement on identity, which must be clear, concise and immediately relevant to both the public and the profession. Although inter-professional relations between MDs and DCs in Israel are improving, further research should be conducted to provide suggestions on how chiropractors can overcome barriers and improve communication with MDs and other health care professionals in the Israeli health care system. In general, the participants agreed that governmental legislation, recognition and support are important endorsements with respect to the societal relevance and development of the profession. Therefore issues such as public awareness of chiropractic education and scope of practice, research and evidence-based practice must be emphasized accordingly in order to facilitate the development of chiropractic practice in Israel.