Ineffective transitional care programs for ensuring the continuation of care from acute settings to the home settings post discharge can result in rehospitalization of elderly patients with chronic diseases. Usually, transitional care should be time-sensitive, patient-centered services intended to ensure continuity of care and an efficient transition between health care settings or home. A patient centered transitional care program was implemented at an outpatient primary care facility to reduce readmission rates. Institutional Review Board approval was obtained.

Twenty adult patients with chronic diseases discharged from an acute setting were identified. A follow up phone call and/or a home visit within 24-72 hours post discharge was employed. The Care Transitions Measure (CTM®) and Medication Discrepancy Tool (MDT®) were utilized to identify quality of care of transition and medication discrepancies. A chart audit collected data on the age of participant, diagnosis for initial hospitalization, CTM score, home visit, and ED visits or re-hospitalizations after 30 days of discharge. The outcome indicated that transitional care within primary care utilizing evidence-based practices is beneficial in reducing readmission rates. A logistic regression showed model significance, p = .002, suggesting that the CTM score was effective for both telephone support (TS) and home visit (HV).

A correlation analysis showed that as age of participants increased, the CTM score decreased, indicating that older adults required more support. A significance p <.001, of a proportional test indicated that readmission rates after the intervention was lower. It is evident that providing a timely and effective transitional care intervention in a primary care setting can reduce hospital readmissions, improve symptom management and quality of life of adult patients with chronic diseases.

Aphasia is an impairment that affects many different aspects of language and makes it more difficult for a person to communicate with those around them. Treatment for aphasia is often administered by a speech-language pathologist in a clinical setting, but researchers have recently begun exploring the potential of virtual reality (VR) interventions. VR provides an immersive environment and can allow multiple users to interact with digitized content. This exploratory paper proposes the design of a VR rehabilitation game –called Pact– for adults with aphasia that aims to improve the word-finding and picture-naming abilities of users to improve communication skills. Additionally, a study is proposed that will assess how well Pact improves the word-finding and picture-naming abilities of users when it is used in conjunction with speech therapy. If the results of the study show an increase in word-finding and picture-naming scores compared to the control group (patients receiving traditional speech therapy alone), the results would indicate that Pact can achieve its goal of promoting improvement in these domains. There is a further need to examine VR interventions for aphasia, particularly with larger sample sizes that explore the gains associated with or design issues associated with multi-user VR programs.

Globally, breast cancer is the most common cancer in women. The disease and treatment cause many unfavorable symptoms such as fatigue, pain, and psychological stress. Research suggests that stress may negatively impact survival and recurrence outcomes of breast cancer patients. Cognitive-behavioral stress management (CBSM) programs have been found to improve these outcomes. In this thesis, I propose using virtual reality as a tool for CBSM to improve symptoms and outcomes for non-metastatic breast cancer patients.

Globally, breast cancer is the most common cancer in women. The disease and treatment cause many unfavorable symptoms such as fatigue, pain, and psychological stress. Research suggests that stress may negatively impact survival and recurrence outcomes of breast cancer patients. Cognitive-behavioral stress management (CBSM) programs have been found to improve these outcomes. In this thesis, I propose using virtual reality as a tool for CBSM to improve symptoms and outcomes for non-metastatic breast cancer patients.

Survivors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) often experience chronic symptoms that include fatigue, shortness of breath, and brain fog. The collection of ongoing post-COVID-19 symptoms have been classified as Post-Acute Sequela of SARS-CoV-2 (PASC). Older adult patients are especially susceptible to experiencing PASC related complications and have a high risk for long-term cognitive impairment symptoms. Definitions for categorizing PASC- associated cognitive impairment and neuropsychological assessments used to evaluate cognitive impairment are inconsistent between studies examining older adults. This systematic review aims to identify which neuropsychological tests best identify cognitive impairments associated with PASC and suggest a guide to standardize the measurement of PASC-related cognitive impairments. Through a literature search using PubMed, we included within this review 14 studies that fulfilled our inclusion and exclusion criteria evaluating middle-aged and older adult populations affected by PASC-associated cognitive impairments. The majority of the studies used tests designed to screen for general cognitive function to test for the prevalence of cognitive impairment, with the most common one being Montreal Cognitive Assessment (MoCA), followed by MMSE and TICS. MoCA reported the highest prevalence of the general cognitive screeners which suggests higher sensitivity and specificity. Telephone Interview for Cognitive Status (TICS) demonstrated similar scores as MoCA despite administration being remote while MMSE identified the lowest prevalence. Four studies also used domain-specific cognitive evaluations and reported instances of cognitive impairment in individuals who had previously tested healthy. Furthermore, the results gathered in this review were stratified based on disease symptom severity. This review identifies MoCA to be better suited for evaluating general cognitive impairment in older adults. TICS has the added utility in being able to access a wider range of older adults through remote screening. Disease severity must be clearly defined to allow better comparisons between studies and allow for standardization. Early identification of PASC-associated cognitive impairment in middle-aged and older adults can be performed using general cognitive function evaluations and administering a baseline cognitive evaluation one month after infection is suggested.