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- Creators: Arizona State University
- Creators: Baker, Laurie
The coastal Ilo Chiribaya polity is associated with the Andean Late Intermediate Period in the lower Osmore drainage of southern Peru. Previous analyses indicate that Chiribaya sites in this area formed a señorío, an Andean chiefdom with separate occupational groups of fishers and farmers. The most complex excavated Chiribaya site in this region is Chiribaya Alta. At this time, excavations have sampled nine of the cemeteries present at the site. Two of these cemeteries, four and seven, have the most elaborate burials at the site and are each associated with different occupational communities.
This dissertation examines community, gender, and age identities at Chiribaya Alta through the use of three case studies. The first case study argues that the iconographic designs on coca bags interred with the dead signified occupational community identities. Coca bags buried in cemetery four have designs relating to mountains and farming, whereas those from cemetery seven have symbols associated with water. These designs correspond to the occupational community groups associated with each of these cemeteries. The second case study uses grave good presence and absence to examine the nature of gender roles and identity at Chiribaya Alta. Multiple correspondence analysis indicates that normative gender roles are reflected in grave good assemblages, but that gender identity was flexible at the individual level. The final case study presents newly generated age-at-death estimations using transition analysis combined with mortuary analyses to explore the manner in which gender and age intersect for older individuals at Chiribaya Alta. This final paper argues that there is an elderly identity present amongst individuals at Chiribaya Alta and that gender and age intersect to impact the lives of older men and women differently.
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.
Background:
Thirty to fifty percent of cancer patients undergoing chemotherapy will experience
chemotherapy induced nausea and or vomiting (CINV) despite the use of antiemetic prophylaxis Uncontrollable CINV can lead to complications that add extra stress to patients, increase in healthcare costs, and utilization of resources. CINV can lead to chemotherapy dose reductions, treatment delays, chemotherapy changes, or discontinuation of treatment. Guidelines exist to better prevent and treat CINV. Evidence supports the use of guidelines to prevent CINV, however patients still suffer from CINV often due to a lack of guideline adherence.
Objectives:
The purpose of this project was to increase CINV guideline adherence by increasing knowledge of antiemetic guidelines utilizing an educational intervention for providers and nurses at an outpatient oncology office.
Methods:
A brief educational intervention on CINV and recommended NCCN guidelines was
conducted with providers and nurse (n=6) at an oncology practice in Southwestern United States. An evaluation to assess change in knowledge was performed using a pre and post test format. Statistical analysis was performed using descriptive statistics, McNemar tests and Wicoxan Signed Rank Test.
Findings:
There was a significant effect on knowledge of NCCN antiemetic guidelines (Z=-1.89, p=0.059, mean 2.5) post intervention. There also was a significant impact on likelihood to use guidelines in practice (Z=-1.89, p=0.059, mean 2.5). Increasing awareness and likelihood to CHEMOTHERAPY INDUCED NAUSEA AND VOMITING 3 follow recommended guidelines may improve CINV symptoms in patients undergoing chemotherapy and improve the treatment outcomes for these patients.