Outcome assessment (Medical care)

Liposuction is a common invasive procedure. Liposuction is performed for cosmetic and non-cosmetic reasons. Its use in regenerative medicine has been increasing. Its invasive nature renders it to have complications which can cause limitations in patients' recovery and patient lives. This thesis’s aim is to create an analytical framework to assess the liposuction procedure and its outcomes. The fundamental requirement to create this framework is to have a complete understanding of the procedure which includes preparation and planning of the procedure, correctly performing the procedure and ensuring patient safety on day 0, week 2, week 4, and week 12 of the procedure. 54 patient’s liposuction outcomes were followed till week 12. Data collection is the first part of the framework, which involves understanding the complex surgical outcomes. Algorithms that have been previously studied to assess morbidities and mortalities have been used in this framework to assess if they can assess liposuction outcomes. In this framework algorithms like decision tree, XG boost, random forest, support vector classifier, k nearest neighbor, k means, k fold validation have been used. XG boost performed best to assess liposuction outcomes without validation. However, after cross validation other algorithms which are random forest, support vector machine and KNN classifier outperformed XG boost. This framework allows to assess liposuction outcomes based on the performance of the algorithms. In future, researchers can use this framework to assess liposuction as well as other surgical outcome.

Recent federal legislation has incentivized hospitals to focus on quality of patient
care. A primary metric of care quality is patient readmissions. Many methods exist to
statistically identify patients most likely to require hospital readmission. Correct
identification of high-risk patients allows hospitals to intelligently utilize limited resources
in mitigating hospital readmissions. However, these methods have seen little practical
adoption in the clinical setting. This research attempts to identify the many open research
questions that have impeded widespread adoption of predictive hospital readmission
systems.
Current systems often rely on structured data extracted from health records systems.
This data can be expensive and time consuming to extract. Unstructured clinical notes are
agnostic to the underlying records system and would decouple the predictive analytics
system from the underlying records system. However, additional concerns in clinical
natural language processing must be addressed before such a system can be implemented. Current systems often perform poorly using standard statistical measures.
Misclassification cost of patient readmissions has yet to be addressed and there currently
exists a gap between current readmission system evaluation metrics and those most
appropriate in the clinical setting. Additionally, data availability for localized model
creation has yet to be addressed by the research community. Large research hospitals may
have sufficient data to build models, but many others do not. Simply combining data from
many hospitals often results in a model which performs worse than using data from a single
hospital.
Current systems often produce a binary readmission classification. However,
patients are often readmitted for differing reasons than index admission. There exists little
research into predicting primary cause of readmission. Furthermore, co-occurring evidence
discovery of clinical terms with primary diagnosis has seen only simplistic methods
applied.
This research addresses these concerns to increase adoption of predictive hospital
readmission systems.

In spite the heavy investments in therapeutic research breast cancer still impacts the
lives of women globally. The projected incidence of new cases in USA for 2008 is 67,770,
with estimated 40,480 deaths. In this study, we investigated the therapeutic efficacy of
Cytoreg®-genistein combination treatment on MCF-7 human breast cancer cells. MCF-7
cells were treated with genistein and Cytoreg® single and combination treatments for 24-
48hr; and the chemosensitivity assessed using bioassays: Trypan Blue and MTT for cell
viability; Ethidium bromide/Rhodamine 123 to assess apoptosis induction; F AM PolyCaspase
binding assay for mechanism of action. The overall data indicated dose- and timedependent
cell death in the MCF-cells and that apoptosis was the major means of treatmentinduced
growth inhibition. There was evidence of Cytoreg®-induced autophagy in the cells.
The overall findings indicated that genistein-Cytoreg® combination was more efficacious
than either genistein or Cytoreg® alone. Cytoreg® enhanced the phytosensitivity of MCF-7
cells to genistein isoflavone.

Human Immunodeficiency Virus (HIV) results in a decline in the body's ability to
fight infection as the illness progresses. Events contributing to disease progression
include the emergence of viral mutations and loss of T -helper cells. This results in a
decline in overall physical well-being. One explanation for this occurrence is lack of
adherence with recommended treatment plans that can result in viral mutations and
replication. The health care team establishes a plan to prevent or delay this decline in
health. Can clinicians expect absolute commitment to plans of care without their knowing
their effects on patients' life? This study was conducted to answer the research question,
"What is the culture of living with HIV as it shapes adherence to plans of care for
patients in south Florida?" in order to understand HIV positive patients' responses to
managing complex medical regimens. In an effort to understand the life-world and
experiences of patients who are HIV positive, an ethnographic study was conducted to explore how patients manage the daily demands of living with IDV. In addition,
environment of care was observed to determine if it influenced adherence to medications
and plans of care. Through the use of ethnography, interviews of IDV positive patients
were conducted, several of whom had significant adherence issues and one person who
might be considered an ideal patient. Several different settings were included in the
research to determine what impact environment had on patients' adherence to
medications and plans of care. Fear, trust, self-worth, literacy, financial and disease
specific themes emerged and lead to the development of a model for adherence to plans
of care for IDV positive patients. This model may enhance clinician/patient collaboration
to achieve maximized health and delay progression of mv disease.

Patients who are hospitalized and are without voice would like to participate in
their care. This requires clear communication. Speak for Myself™ (SFM) was developed
for use at the bedside so that communication may be facilitated between patient and nurse when the patient is voiceless. The objective of this study was to evaluate Speak for Myself™ at the bedside and to measure the outcomes. This was a mixed methods, one group pre-test-post-test, quasi-experimental study. Twenty adult patients in three
hospitals in South Florida agreed to use Speak for Myself™ during their acute care
hospital stay (M = 8.86 hours). This group of participants (n = 20) ranged from 45 to 91
years old (males = 14; females = 6). Of the participants, 15 (75%) self-identified as
European American, 2 (10%) self-identified as Hispanic, 2 (10%) self-identified as
African American, and 1 (5%) self-identified as Asian. Ten of the participants (50%)
were in respiratory failure. Two (10%) were receiving oxygenation measures related to
unspecified complications of their illnesses. Of the remaining eight participants (40%),
one each was receiving oxygenation measures due to atrial fibrillation, arteriosclerotic
heart disease, cardiogenic shock, endocarditis, neck abscess, renal failure, status post
seizure activity, and tongue metastasis.

The highly complex role of the Chief Nursing Officer (CNO) requires the refinement of a multitude of competencies and leadership skills in this unprecedented time of healthcare reform. As the senior most patient advocate in our medical centers the CNO is responsible for translating research into practice, policy development and implementation creating value based patient-centric strategies to transform health care.
The ability to sustain and thrive in this role is essential in repositioning nursing as a
knowledgeable discipline actively contributing to the redesign of healthcare. This exploratory descriptive phenomenological study was designed to explore and
describe the elements that contribute to the sustainment of CNOs in their practice of
nurse executive leadership. Ray’s (1989) Theory of Bureaucratic Caring, Authentic
Leadership Theory (Wong & Cummings, 2009), and Resiliency Theory (Earvolino-
Ramirez (2007) provided the theoretical lens through which this study was grounded. Semi-structured telephonic interviews were conducted with twenty CNOs all with
two consecutive years experience in their current role. Six themes emerged after thorough content analysis which describes the lived experience of sustainment. Each theme was supported by several subthemes. Themes emerged as: Loving the Profession, Having a Broader Impact Reflecting on One’s Own Work, Learning to Manage Conflict, Maintaining Work/Life Balance Working with Supportive Leaders.

Over the last fifty years quality of care has been a consistent problem in nursing home facilities. The federal government implemented a bureaucratic system as an attempt to improve this standard. This thesis traces the emergence of this system in nursing homes and illustrates its failure to solve the problem. George Ritzer's four-point McDonaldization model of bureaucracy is applied to argue that the bureaucratic system for governing nursing homes has a negative effect on the quality of care. Although this hypothesis has proven to be accurate, additional factors were consistently cited as having detrimental effects on resident care. These include issues such as insufficient pay and lack of training/education for CNAs. Moreover, human greed and societal views of the elderly appear to be the true root of the problem.

The study investigated the effects of music to reduce anxiety and decrease intubation times in coronary artery bypass graft and valve replacement surgical patients in an acute care hospital. Anxiety can contribute to everything from heightened emotional stress, increased pain, blood pressure changes as well as lethal cardiac dysrhythmia and reduction in peripheral and renal perfusion. Research has shown, music as a therapeutic modality, relieves anxiety and pain in patients before and after surgery. What patients hear during surgery can be a rich source of anxiety. Wearing earphones during surgery will eliminate this source of anxiety. Music is reported to distract patients in an alien environment and provide a comforting and familiar effect in discomforting conditions. Soothing music can produce a hypometabolic response characteristic of relaxation in which autonomic, immune, endocrine, and neuropeptide systems can be altered. Similarly, music produces desired psychological responses and reduction in anxiety and fear.

atisfaction with diabetes care, perceived feelings of empowerment to participate in self-care management, and glycemic control in a sample of older African American men and women with diabetes. A descriptive correlational quantitative design was used. The participants in this study were 73 men and women of African descent who were at least 50 years, English speaking, and diagnosed with diabetes for at least one year. The participants were asked to complete three survey instruments: the Patient Satisfaction Questionnaire-18 (PSQ-18), which measured how satisfied the participants were with their medical care; the Diabetes Empowerment Scale-Short Form (DES-SF), which measured attitudes towards diabetes and self-management of diabetes; and a demographic form, which collected data on the demographics of each participant. The most recent hemoglobin A1c (HbA1c) of each participant was obtained from the medical records. The correlations between HbA1c, DES, and the PSQ-18 subscales were exam ined. The study data indicated all correlations were statistically significant and negative with one exception. There was no correlation between HbA1c and time spent, a satisfaction subscale. Approximately half the participants were high school graduates, married, and reported being born in the Caribbean. Most had primary care physicians, but less than half reported attending a diabetes education program. The average BMI was 33.0. The findings of this study indicated older African adults who reported higher satisfaction with the care provided by their health care provider reported feeling more empowered to participate in diabetes self-care and reported lower HbA1c levels, suggesting better glycemic control (R2 = .39; P=<.001).

The implantable cardioverter defibrillator (ICD) is an electronic medical device that was invented by Dr. Michael Mirowski and his team in 1980. The purpose of the ICD, which is implanted in a person's chest, is to sense and shock the heart when detecting a lethal cardiac arrhythmia into a rhythm that can sustain life. While the ICD saves lives, it also has the potential to deliver painful shocks when it is activated. The ICD was initially inserted in people who had survived a sudden cardiac arrest; the device is now being implanted in older adults with heart failure and no known history of cardiac arrhythmias. When talking with patients and personal family members who had an ICD, it was unclear what influenced their decision to have an ICD implanted. Understanding the experience of decision-making for older adults who had an ICD has added to nursing knowledge, practice, and education when working with people who had an ICD inserted. To understand the lived experience, the researcher conducted a phenomenological research study, guided by the theoretical lens of Paterson and Zderad's (1976/1988) humanistic nursing and analyzed the data as outlined by Giorgi (2009). The results of the study indicated the participants' lived experience of decision-making for older adults who had an implantable cardioverter defibrillator inserted was influenced by the following : trust in their physician's decision; accepting the device was necessary; the decision was easy to make; and hope and desire to live longer.