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- Creators: School of Social and Behavioral Sciences
- Creators: Thrall, Charlotte
We have seen the joy pets bring into people’s lives, and the sadness that follows the loss of them. Many pet owners view their pets as more than just animals: they are family. They offer a level of love and support similar to friends and family, despite not being human. Some pets are also trained as service animals to assist humans who struggle with diagnosed physical, mental, and other disabilities. However, emotional support animals appear to lie somewhere between pets and service animals, as there are rules and policies still developing around them. With more and more college students requesting to bring ESAs on campus, the question of their effectiveness has been raised. The aim of this honors thesis study is to examine the effectiveness of ESAs in alleviating mental health symptoms in college students. More specifically, I wanted to evaluate students who currently live on campus (or have lived on campus in the past). The first aim will be to determine whether non-pet owners versus ESA owners (and pet owners in general) show a difference in their stress levels. The second aim is to examine if owning a pet or ESA predicts stress levels differently between genders. The final aim of the study is to determine if degree of attachment to pets predicts differences in stress in the owners.
Veterans are approximately 30% more likely than non-veterans to suffer from severe hearing impairment. Tinnitus, or ringing in the ears, which is increasingly common among military service men and women, has been linked to significant cognitive and psychological impairment and can be worsened by the same sounds that trigger post-traumatic stress disorder (PTSD). In fact, tinnitus and PTSD often present as comorbidities, and recent studies suggest these two disorders may share a common neurological pathway. Additional studies are required to better understand the connection between hearing loss and impaired cognitive function such as that observed in with PTSD. Here, we use the fruit fly, Drosophila melanogaster, to explore the relationship between hearing loss and cognitive function. Negative geotaxis climbing assays and courtship behavior analysis were used to examine neurobehavioral changes induced by prolonged, intense auditory stimulation. Preliminary results suggest that exposure to loud noise for an extended period of time significantly affected Drosophila behavior, with males being more sensitive than females. Based on our results, there appears to be a potential connection between noise exposure and behavior, further suggesting that Drosophila could be an effective model to study the link between hearing loss and PTSD.
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).
The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.
A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.
Psychological stress plays a vital role in skin disease. The worsening and reoccurrence of signs and symptoms of a wide array of skin diseases have been linked by various studies to stress. Together, stress and skin disease synergistically inhibit occupational, social, and emotional functioning resulting in diminished quality of life (Dixon, Witcraft, & Perry, 2019). Heightened levels of stress may contribute to an assortment of immediate and future adverse outcomes. These outcomes include triggering a skin outbreak, impairing function, behavioral avoidance, intense negative emotions such as shame and embarrassment, and emotional distress such as depression and anxiety (Dixon et al., 2019).
The purpose of this paper is to discuss the relationship of stress, anxiety, and depression to the specific chronic skin diseases of acne vulgaris, psoriasis, vitiligo, rosacea, and atopic dermatitis. It will also discuss how a psychotherapeutic intervention called mindfulness-based stress reduction (MBSR) may decrease anxiety and depression in individuals affected by chronic skin diseases. This paper will also highlight the impact of MBSR on treatment adherence to dermatological prescription medications. A pilot program conducted in a dermatology clinic evaluates the effectiveness of an online mindfulness-based stress reduction intervention to decrease patient anxiety and depression.
Results indicate clinical significance in that participants noted reduced anxiety and depression symptoms and scores, enjoyed MBSR and would continue MBSR. The potential benefits of this pilot program may include decreased patient anxiety and depression, increased patient satisfaction, increased treatment adherence, improved patient satisfaction of intervention, and improved patient outcomes.