Master of Sciences, Case Western Reserve University, 2022, Applied Anatomy

This study evaluates whether academic performance differs when physician assistant (PA) students learn gross anatomy using a mixed-reality (MR) program versus cadaveric dissection. First-year PA student volunteers at Case Western Reserve University enrolled in an anatomy course were divided into two cohorts. During a given unit, each cohort spent laboratory sessions learning through either dissection or MR. At the end of each unit, participants were given a laboratory practical exam on each modality. Differences in exam scores were compared between modalities within the same cohort and between cohorts on the same modality. While students who performed cadaveric dissection within a given unit had less difference between lab exam scores, positive Pearson's correlation coefficients (r>0.80) and Spearman's rho (rs=0.78) indicate that individual students perform equivalently across both exams. Additionally, no difference was found between cohorts on lecture exams (p>0.05), suggesting that MR holds value in a PA gross anatomy curriculum.

Committee: Susanne Wish-Baratz (Committee Chair); Andrew Crofton (Committee Member); Scott Simpson (Committee Member) Subjects: Anatomy and Physiology; Education; Educational Software; Educational Technology; Health Education; Health Sciences; Higher Education; Medicine; Science Education

Ph.D., Antioch University, 2024, Leadership and Change

The persistent tension and power struggle between healthcare executives and physicians is a prevalent issue in healthcare organizations, often leading to a culture of organizational mistrust. This dynamic stems from perceived conflicting goals: executives are frequently seen as primarily focused on financial outcomes, while physicians are viewed as resistant to change. This study explored how physician fulfillment is experienced at work, with the ultimate goal of identifying potential interventions to bridge the gap between these groups. There is vast research and literature available regarding burnout in healthcare; this research focused on understanding what physicians find fulfilling in their work and identifying actionable factors healthcare system leaders can address to enhance their fulfillment. Key factors identified from the literature include meaningful patient contact, quality of professional relationships, and organizational decision-making input. At the same time, challenges such as administrative burden and loss of autonomy were noted as detriments to fulfillment. After conducting and transcribing semi-structured phenomenological interviews with physicians, the data were coded for meaning, resulting in 169 codes. The prevalence of these broad themes varied concerning each research question, reflecting the complex and multifaceted nature of physician fulfillment. By identifying patterns and connections in the physicians' experiences, this study highlighted the importance of addressing both systemic and individual factors to enhance professional fulfillment. Key findings of the study include the importance of humanizing healthcare goals and several directions for iv healthcare organizations: addressing moral injury, improving patient outcomes, obtaining and utilizing physician input consistently, fostering a supportive culture, and creating time and space for peer support. Targeted interventions to enhance physi (open full item for complete abstract)

Committee: Mitch Kusy PhD (Committee Chair); Beth Mabry PhD (Committee Member); Alan Rosenstein MD (Committee Member) Subjects: Ethics; Health Care; Health Care Management; Health Sciences; Management; Medicine; Public Health

Psy. D., Antioch University, 2017, Antioch New England: Clinical Psychology

This qualitative study utilized interpretive phenomenological analysis (IPA) to explore the patient-physician relational experience from the perspective of patients of lower socioeconomic status (SES). Research shows that physicians engage in collaborative care less frequently with patients of lower SES than with their more advantaged counterparts and that lower SES patients participate less during office visits. Information on the patient-physician relational mechanisms that inhibit collaborative care from the perspective of low SES patients is a key gap in this literature. Five adult patients from the lower socioeconomic strata, who were established patients of a primary care physician were recruited from a primary care practice in a rural area and interviewed. Data analysis identified six superordinate themes that best capture how patients experience the relational dynamics of the patient-physician relationship. The results show that physician-patient power asymmetry can be experienced by patients of lower SES as reminiscent of further examples of previous experiences of stigma and oppression. Future visits or aspects of a treatment plan may be avoided following an unpleasant medical encounter or a weakened patient-physician alliance. The emotional reactions of patients contribute to their loss of voice, and some disclosures are viewed as too risky to share with treating physicians. These interviews also showed that personable physicians increase patient comfort and physicians who proactively seek out and address patient dissatisfaction mend ruptures and strengthen the patient-physician relationship. The study describes the mechanisms by which patients of lower SES are susceptible to experiences of stigma and psychological oppression during medical encounters. It offers implications for practice and possible pathways for future research to minimize experiences that are barriers for patients and to maximize the great potential of the patient-physician relationship (open full item for complete abstract)

Committee: F. Alexander Blount EdD (Committee Chair); James Fauth PhD (Committee Member); Cynthia Whitaker PsyD (Committee Member) Subjects: Clinical Psychology

Doctor of Education (Ed.D.), Bowling Green State University, 2006, Leadership Studies

This study addresses post-implementation usage behavior of Computerized Physician Order Entry (CPOE) system among physicians in an organization by applying the Technology Acceptance Model (TAM). Implementation of CPOE is considered a major organizational activity by chief information officers (Kini & Savage, 2004), and physician acceptance of CPOE ultimately decides the success of CPOE implementation (Davis, 1989). Hence, this study assumes much importance. A CPOE-TAM instrument was developed for this study and assessed with principal component analysis. Six hypotheses were developed and tested using hierarchical multiple regressions. Study results suggest that the ‘total causal effects' of perceived usefulness of CPOE (PU) and perceived ease of use of CPOE (PEOU) on behavioral intention to use CPOE (BI) and CPOE adoption are striking, and PU is more important than PEOU in their relative influence on BI and CPOE adoption. Implications of the findings suggest that training sessions need to emphasize ‘usefulness' of CPOE and any increase in ease of use features of CPOE would directly influence usefulness of CPOE, which in turn influence BI and CPOE adoption. Studying the adoption of CPOE within an organizational context among physicians by applying TAM contributes richly to research literature in these major domains. This CPOE-TAM study was well-validated, and a parsimonious CPOE-TAM instrument is now available to information system and human-computer interaction researchers and practitioners. This CPOE-TAM instrument could be split further into two instruments: one for prediction of future acceptance of CPOE, and the other for explanation of CPOE adoption.

Committee: Patrick Pauken (Advisor) Subjects:

Ed.D., Antioch University, 2023, Education

Many forms of oppression create barriers for health care, further health disparities, and impact the wellness of physicians. As health disparities, caused by the social determinants of health, complicate the practice of medicine, physicians' risk of burnout increases. The practice of Physician Cultural Responsibility provides a means to overcome health disparities and support physicians while embracing the intersectionality of the populations they serve. Incorporation of Physician Cultural Responsibility into physician professional identity is essential for the practice to be life-long. As there is no standardized curriculum to address teaching the practice of Physician Cultural Responsibility, this study aims to evaluate a proposed curriculum for the adoption of Physician Cultural Responsibility into students' physician professional identity, student experience, and knowledge transfer. Through the transformative research paradigm and transformative learning theory, a mixed-methods study of deidentified qualitative and quantitative data was performed using MaxQDA and SPSS (α = 0.05) analytical software. Results suggest successful adoption of Physician Cultural Responsibility in physician identity development, successful knowledge transfer, as well as improvements in collaboration, belonging, and support in student experiences with within in first year medical students. This curriculum offers best practices for a methodology to address the inequities of practice in cultural competency education requirements within medical education. This includes inclusive and culturally responsive pedagogy aimed at supporting the students' development of skills that improve the patient-physician connection with all patients, limit the impact of personal biases on medical practice, and dismantle the social categorization of medicine. The practice of Physician Cultural Responsibility and it's adoption in physician professional identity yields an opportunity to cre (open full item for complete abstract)

Committee: Lesley Jackson Ph.D. (Committee Chair); Tony Kashani Ph.D. (Committee Member); Warren Jones M.D., F.A.A.F.P. (Committee Member) Subjects: Curricula; Curriculum Development; Education; Health Care; Higher Education; Medical Ethics; Medicine; Minority and Ethnic Groups; Multicultural Education; Public Health Education

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2023, Health Programs

Currently, rural hospitals account for thirty percent of all hospitals in the United States (U.S). However more of these facilities have experienced closure in the last decade than any time in U.S. history. Typical reasons for this occurrence are financial distress stemming from shrinking patient volume, physician departure, and reimbursement reductions. Currently the state of Tennessee has experienced several rural hospital closures to date. Finding opportunities to grow in-patient census while expanding substantial revenue generation is paramount to slow the closure trend. Covid-19 has caused a recent rise and demand for telehealth services in the healthcare industry. Is now a time for rural hospitals to improve telehealth resources to capture greater patient volume and potential improvement in revenue reducing financial burdens? A descriptive causal design utilizing secondary data from four rural hospitals in east Tennessee will determine if telehealth has increased in-patient volume over a four-year period of time. Diagnosis related groups (DRG) will be tested with Pearson's Chi-square with year over year group comparisons for improvement before, during, and since the pandemic. As telehealth use has grown during Covid- 19, have rural hospitals leveraged benefits to care for specialty diseases (i.e., neurology, nephrology, pulmonology) that before may have not been an option? Can comparing hospitals to understand if less or greater telehealth is performed in each studied facility influence in-patient volume? Using Medicare payment codes consideration for this research maybe used in other geographic regions to perform similar analysis in the future.

Committee: Cynthia Smoak (Committee Chair); Jennifer Sheinberg (Committee Member); John Suozzi (Committee Member) Subjects: Health Care; Health Care Management

Doctor of Nursing Practice , Case Western Reserve University, 2020, School of Nursing

Abstract Urgent cares are a newer concept in health-care delivery that has experienced growing popularity. The care is generally provided as a fast-paced, walk-in service. Urgent care can be driven by market forces to increase revenue, but patient-care delivery needs to be founded on evidence-based practice. Patient experience is a driving force in health care and is a large determinant of clinic success. Yet, patients' expectations to perceived needs are not always based on evidence-based practice. Aligning patient experience with evidence-based care is essential to quality health-care delivery. This project evaluated provider-patient communication skills and use of a communication tool among providers in an urgent care, and assessed the relationship to patient experience scores. All of the health-care providers who participated found the AIDET® communication tool helpful. There was a significant change in knowledge, skill, and attitude in the elements of the AIDET communication tool. There was no change in patient experience scores. There was low participation due to the COVID-19 pandemic, which changed work flow at the urgent care.

Committee: Carol Savrin DNP (Committee Chair) Subjects: Nursing

Doctor of Philosophy, Case Western Reserve University, 2018, Management

Overall healthcare spending in the U.S. is in the trillions and more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared to other OECD countries. The majority of spending is directed toward small patient populations with chronic diseases. Within the context of access to insurance coverage and a certain level of health literacy, experts believe increased patient–physician shared decision making (SDM) should result in better care and lower cost. However, the study of the physician's role in facilitating SDM is limited. By understanding what factors predict when physicians will implement SDM during the treatment of specific chronic diseases, we can begin to understand the dynamics that most influence behaviors and offer recommendations to improve certain aspects of healthcare in the United States. A sequence of three studies was completed by interviewing or surveying 369 physicians who treat hemophilia and primary immune deficiency (PID). The study used dual process theory to explain the relationship between patient-centered care and SDM within a wider framework of power balance, patient/physician traits, and organizational context. These studies were supplemented by an analysis of 1) survey of 33,162 individuals across theU.S.; 2) 25 million hospitalization records from New York State comparing two (2) five-year periods; and 3) data from 200 million individual-level, de-identified enrollment data and health insurance claims across a continuum of care (both inpatient and outpatient). The first study qualitatively explored decision making between hemophilia physicians in the U.S. and U.K. and found U.S. physicians to be more patient-centric and less rule-based. The second study quantitatively tested the relationship between slow/rational vs. fast/intuitive decision making by U.S. physicians treating PID and SDM as mediated by patient-centric care; results showed a statistically significant relationship between slow/rational deci (open full item for complete abstract)

Committee: Kalle Lyytinen Ph.D (Committee Chair); Adrian Wolfberg Ph.D (Committee Member); Yunmei Wang Ph.D (Committee Member); J. B. Silvers Ph.D (Committee Member) Subjects: Health Care

MA, University of Cincinnati, 2010, Arts and Sciences : Communication

This study explored the uncertainty experienced by parents of children with hemangiomas and vascular malformations (HVMs)—commonly known as birthmarks. Because HVMs do not belong to one specific discipline, they might be considered an “orphan” illness. The complexities of this condition impact parents' experiences with complex uncertainty. Thirteen months of participant-observation combined with a survey approach were utilized to assess the uncertainty of parents and their communication with physicians at an HVM clinic. Two Communication theories – Babrow's (1992) Problematic Integration Theory and Brashers et al.'s (2000) Communicative Management of Uncertainty Theory – and Mishel's (1988) Uncertainty in Illness Theory, were used as theoretical frameworks to interpret results. The findings of this study highlight the interwoven uncertainties posed by “orphan” illnesses and how they influence parents' communication and their ability to assign meaning to the illness experience. These complexities also suggest that existing measurement scales may not well operationalize the multilayered and complicated nature of uncertainty experienced by parents. Finally, the study suggests that existing theories on of illness uncertainty might be expanded to include unique uncertainties of “orphan” illnesses and distinctive characteristics surrounding parental uncertainty.

Committee: Stephen Haas PhD (Committee Chair); Teresa Chandler Sabourin PhD (Committee Member); Heather Zoller PhD (Committee Member) Subjects: Mass Media

PHD, Kent State University, 2011, College of Arts and Sciences / Department of Sociology and Criminology

The therapeutic efficacy of the patient-physician interaction plays a central role in medicine. Many factors impact the patient-physician interaction, and ultimately affect health outcomes. Health follows a social gradient. Being poor matters to health and health care access in the U.S. with socioeconomic status being a strong, consistent predictor of morbidity and mortality. Health disparities include differences in health status; access to, utilization, and quality of care; and health care delivery. Unequal treatment of patients on the basis of their personal or group characteristics warrants attention, unequal treatment not justified by the patient's underlying health condition or treatment preference. This dissertation examined the relationship between patient socioeconomic status and patient satisfaction, and determined if patient-physician communication mediated this relationship. Three hypotheses were tested though secondary analyses of data from the Direct Observation of Primary Care study, a landmark multi-method study representing the most comprehensive glimpse into the content and context of family medicine outpatient visits to date. The data supported hypothesis 1. Patients' insurance status related significantly to physician-patient communication. Patients insured by Medicaid had visits that were significantly more physician-centered. In addition, male patients, patients with better physical health, and patients whose visits were more complex had visits that were more patient-centered. Conversely, as patients' mental health improved, the visits became more physician-centered. Results were mixed for hypothesis 2. Satisfaction with the care-delivery site was unrelated to communication but was significantly related to patient age and overall health with older and healthier patients rating the site significantly higher. Communication related significantly to satisfaction with the physician and overall satisfaction. Satisfaction with the physician and o (open full item for complete abstract)

Committee: Timothy Gallagher PhD (Committee Chair); Brian F. Pendleton PhD (Committee Co-Chair); Donna Martsolf RN, PhD, CNS (Committee Member); Christian Ritter PhD (Committee Member); Mark Savickas PhD, PCC (Committee Member); Clare Stacey PhD (Committee Member) Subjects: Sociology

Doctor of Philosophy, Case Western Reserve University, 2011, Organizational Behavior

Uncontrolled diabetes leads to blindness, amputation, kidney failure, and death. Despite such severe complications, treatment adherence rate for diabetes is low. This dissertation explores a mediational model of treatment adherence in type 2 diabetics. Mediation analysis goes beyond assessing whether a predictor causes change in an outcome; it examines how that change occurs. Specifically, this research hypothesizes that a patient's positive/negative emotional states, represented by the Lorenz attractors of Positive and Negative Emotional Attractors (PNEA), mediate the relationship between psychosocial correlates of doctor-patient relationship and treatment adherence. The study was conducted in Karachi, Pakistan. Survey respondents were 375 type 2 diabetic patients and their companions who attended follow-up clinics; and 25 physicians who examined them. Mediation analysis was performed using hierarchical linear modeling techniques to account for nested data. Bootstrapping procedure tested the significance of mediated effects. Findings confirmed the hypotheses that empathy, trust, information exchange, rapport, physicians' PNEA and diabetes knowledge were associated with treatment adherence. Patients' PNEA was found to completely mediate the relationships of empathy, trust, rapport and diabetes knowledge with treatment adherence. The relationships of information exchange and physician's PNEA with that of treatment adherence were partially mediated. No association was found between treatment adherence and social support, co-morbid depression or shared decision-making. The results also demonstrated that higher levels of a patient's Positive Emotional Attractor (PEA) were related to higher levels of treatment adherence. Overall, these findings lend support to the proposition that a patient's emotional state plays a pivotal role in treatment adherence outcome.

Committee: Richard Boyatzis PhD (Committee Chair); Christopher Burant PhD (Committee Member); James Stoller PhD (Committee Member); Corinne Coen PhD (Committee Member) Subjects: Health Care; Health Education; Organizational Behavior; Psychology; Social Psychology

Psy. D., Antioch University, 2012, Antioch New England: Clinical Psychology

The job satisfaction of rural primary care physicians is of import given the crucial role these physicians play in rural health care systems and their consistent decline in numbers nationwide. The professional isolation of practicing in rural areas, particularly in accessing specialty care, creates greater burdens for rural physicians than their more urban counterparts, which likely contributes to their low level of job satisfaction. The shortage of mental health providers in rural areas in particular is thought to create a burden for rural primary care physicians, who generally neither have the time, training, nor expertise to adequately deal with complex mental health difficulties. Thus, integrated primary care—the provision of mental health services in the clinical flow of primary care medicine through the employment of behavioral health consultants—might reasonably improve rural physician satisfaction. Due perhaps to the novelty of this practice in rural primary care clinics, little research has examined this idea. This study uses a qualitative methodology—interpretive phenomenological analysis—to explore how rural physicians in integrated primary care settings experienced this innovative practice. Connections of this practice to physician job satisfaction are discussed, as are the implications toward facilitating this service in rural primary care practices. Limitations of this study are considered and directions for future research suggested. This research concludes with a personal reflection on my experience as a trainee in a rural integrated primary care clinic.

Committee: James Fauth PhD (Committee Chair); Thomas Stearns PhD (Committee Member); Amanda Houle PsyD (Committee Member) Subjects: Clinical Psychology

Doctor of Education , University of Dayton, 2024, Educational Administration

Cardiovascular disease continues to be the number one killer of women in America, yet barriers to lifesaving healthcare increase (Centers for Disease Control and Prevention, 2022). Incidence of sexism in medicine proves to be a leading cause of these barriers including underrepresentation of female patients in crucial research studies, lack of understanding and education of female specific cardiac symptoms, and the underutilization of advanced diagnostic imaging tests for female patients who could produce suboptimal results in lesser diagnostic testing causing misdiagnosis. Feminist critical theories were used to challenge the gender gap within the medical field and research along with the communities of practice theory, showing how embedded sexism to the medical field creates an unconscious social learning upholding norms. Practical action research was used to conduct this study due to the direct connection between testing and diagnosis of patients, having the potential to make an impact on patient care on a larger scale. Research was conducted utilizing HIPAA compliant cardiology patient data obtained to observe the ordering patterns of physicians within cardiology practices. An anonymous Physicians' Knowledge of PET Eligibility and Symptoms for Female Patients scale survey was used to collect data from practicing cardiologists to view opinions, attitudes, and education around female specific cardiac symptoms. This data was analyzed using Chi-square tests to understand the relationship between various factors such as qualifying ICD-10 (diagnosis) codes, sex of the patient, and qualification for a cardiac PET scan. The results show that there was no significant relationship between sex and if the patient qualified for a cardiac PET scan, showing that physicians have a lack of understanding of the incredible benefits of cardiac PET for female patients, who are exceptional candidates for PET due to attenuation artifacts. Results also show a positive statistical rela (open full item for complete abstract)

Committee: Meredith Wronowski (Committee Chair) Subjects: Gender; Gender Studies; Health; Health Care; Health Care Management; Health Education; Health Sciences; Medical Ethics; Medical Imaging; Medicine; Public Health; Public Health Education

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

The United States pediatric population is unique in that the epidemiological trends differ from those seen in the adult population. When discussing the pediatric emergency department (ED), this is typically a setting with high patient flow which requires swift diagnoses and treatment. Ideally, all patients should have equal opportunity to receive their highest possible level of quality healthcare, regardless of social determinants of health (SDOH) such as patient race/ethnic background, preferred spoken language, socioeconomic status, and insurance status. This is essentially the concept of health equity. The goal is to provide responsible and ethical healthcare to patients. If healthcare delivery is disproportionate, this may result in the overcrowding of EDs, delays in patient care, economic burden on the healthcare system, and increased morbidity and mortality. Some scholars have claimed that both individual and systemic biases have resulted in inequitable healthcare delivery. The following research study investigated health equity in the United States pediatric ED via the following question: What government and organizational policy changes can be made to enhance ED pediatric patient equity by utilizing first-hand information from ED physicians? The selected methodology for this research was qualitative and utilized in-depth semi-structured interviews of 15 pediatric ED physicians via Franklin University's Zoom platform. ATLAS.ti software was used to assist in identifying key themes and sub-themes from the code transcriptions.

Committee: David Meckstroth (Committee Chair); Karen Lankisch (Committee Member); John Suozzi (Committee Member) Subjects: Epidemiology; Ethics; Gender Studies; Health; Health Care; Health Care Management; Language; Literacy; Medical Ethics; Medical Imaging; Medicine; Mental Health; Native American Studies; Public Health; Public Health Education

MS, University of Cincinnati, 2023, Medicine: Genetic Counseling

Health care provider (HCP) continuing education with regard to genomic testing remains an area of concern. Numerous studies have shown the benefits of continuing education for HCPs, including through online modules, in improving confidence for utilizing clinical genomic testing. It remains unclear if these approaches have changed how HCPs perceive their own knowledge. We utilized a modified version of a validated genetic counseling self-efficacy scale to assess what changes in self-efficacy can be observed when comparing HCP response before and after completion of a series of case-based, online, genomic education modules (GEMs). Focusing in on 12 genetic counseling competencies, participants were surveyed before and after completion of online education modules on genomic testing. We also considered whether completion of the GEMs could affect other variables such as changes in practice behavior including referrals to clinical genetics providers and genomic tests ordered. We hypothesized that HCP self-efficacy in the 12 target areas would improve after completion of the modules. Sixteen HCPs, across various specialties, completed the modules and both pre and post-test surveys. Using a paired t-test, we found significant improvements in mean self-efficacy in 8 of the 12 categories for which participants were surveyed (p ? 0.004) after their completion of the online modules. We saw a trend towards increase in both absolute genomic test ordering and referrals to HCPs in genetics though below the established significance threshold. The results of this study suggest improvement in HCP self-efficacy after completion of educational modules and provide an approach to measure HCP self-efficacy for other genomic educational modules. Additional studies involving a larger sample size are needed.

Committee: Laura Ramsey Ph.D. (Committee Chair); Cynthia Prows R.N. M.S.N. (Committee Member); Carrie Atzinger M.S. C.G.C. (Committee Member) Subjects: Health Sciences

Specialist in Education (Ed.S.), University of Dayton, 2023, School Psychology

The Child Find mandate expects local school districts to identify children with suspected disabilities and provide a multi-factored evaluation in a timely manner. However, it is difficult for school districts to be aware of needs in children ages 0-5 before they start school. Although all states must meet the standards for finding children in need for intervention, the number of children with development delays is far higher than the number of children enrolled in intervention services. One way to meet this need is through physicians partnering with their local district to aid in the identification process. The purpose of this study was to determine the relationship between a physician's years of experience and understanding of the referral process, as well as to better understand barriers between physicians and a school district that could limit the referral process. Through a mixed method constructivist design, using surveys and an in-depth interview, ten physicians located within the district provided insight into their understanding of the referral process, barriers to referrals, and strategies to improve the physician/district collaboration. A Pearson Correlation found no correlation between years of experience and understanding of the referral process. Responses to open-ended questions and the in-depth interview indicated perceived barriers due to limited physician/district communication. Collaboration was desired; however, physicians expected the district take the initiative to arrange informative meetings. The results of this study could be used to improve collaboration and communication for the improvement of the referral process.

Committee: Susan Davies (Committee Chair); Deborah Turner (Committee Member); Scott Hall (Committee Member) Subjects: Education; Educational Psychology; Special Education

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2023, Health Programs

The prevalence of health disparities among minorities is linked to low health literacy, implicit biases, mistrust, and unfavorable outcomes among disadvantaged populations (Nadeem & Kaiser, 2022). This issue stresses the need for improved provider patient interactions which are described as trustworthy relationships that are characterized by active listening, time spent interacting, and shared decision-making to achieve advances in health literacy (Rockwell et al., 2022). There is a gap in the literature on how race, gender and patient satisfaction affect the patient clinician interaction. This study addresses this gap by examining the impact of patient gender and race on patient satisfaction within the physician patient interaction. Medical Expenditure Panel Survey data from 2017 to 2018 was analyzed using t-tests and multiple linear regression analysis. This analysis had a total of 4553 responses, 1938 males (43%) 2615 female (57%) 946 Black non-Hispanic (20.78%) and 3607 White non-Hispanic (79.22%) respondents. Overall, no significant differences exist between a patients' perception of whether a provider explained medical options based on the patients' gender nor ethnicity. The analysis also found that significant differences exist between a patients' perception of whether a provider showed respect based on the patients' gender or ethnicity. Statistically more females than males indicated that their physician showed respect from them. Additionally, more Black non-Hispanics than White non-Hispanics were shown to statistically indicate that their physician showed them respect. To truly understand trends connected with patient and provider perspectives as they relate to patient satisfaction, future research should focus on broader societal implications by obtaining demographic information on the physicians' gender and ethnicity.

Committee: Kathleen Wiggins (Committee Chair); Alynicia Bowen (Committee Member); Jennifer Harris (Committee Member) Subjects: Health Care Management

DNP, Kent State University, 2022, College of Nursing

Biosimilars are pharmaceutical agents approved by the Food and Drug Administration (FDA) as an option to treat multiple medical conditions. In rheumatology, they are used as an option to treat inflammatory diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SpA). The term spondyloarthritis is used to describe a group of disorders, including ankylosing spondylitis (AS), nonradiographic axial spondyloarthritis (nr-axSpA), forms of arthritis associated with psoriasis (PsO), psoriatic arthritis (PsA), and with inflammatory bowel diseases (IBD), among others. The structure and therapeutic effects of biosimilars are similar to previously developed and approved patented biologic pharmaceutical agents. However, they cannot be considered identical, as they are not a product of controlled chemical synthesis but are produced by living cells. The main reason for possible differences is related to patent expiration dates, which typically occur for an active ingredient several years prior to the expiration of patent protection for a manufacturing process. Consequently, competitors may produce the active ingredient, but utilizing a different process, which can often result in variations in impurities and efficacy. With biologic production further complicated by the use of live organisms as production “reactors”, FDA's decision to classify off-patent biologic pharmaceutical agents as “biosimilar” rather than “generic”, as is done for small molecule synthetic pharmaceuticals, underscores the similar rather than identical efficacy of a reference biologic vs. its biosimilar. However, as with small molecule generic pharmaceuticals, biosimilars can be made available at a lower cost making them an economically preferred alternative. Available research data suggests that biosimilars and their reference products have comparable pharmacokinetics, safety, and efficacy. In January of 2019 majority of patients diagnosed with rheumatic diseases managed by the department of rheuma (open full item for complete abstract)

Committee: Lynn Gaddis (Committee Chair); Dana Hensen (Committee Member); Lisa Onesko (Committee Member) Subjects: Nursing

Master of Arts, The Ohio State University, 2021, Bioethics

The ethical issues associated with randomized controlled trials (RCTs) and the tensions between clinical care and clinical research are amplified in times of public health crises. To illustrate, this thesis will focus on two types of research cases related to COVID-19 RCTs. Each case, one pertaining to clinical treatments and another pertaining to vaccinations, will be presented and the relative ethical issues that each case raises will be teased out. Intrinsic conflicts are present in the physician-researcher role due to the nature of opposing responsibilities physician-researchers are tasked with; they are responsible for the welfare of patients as well as the integrity of research processes and results. Trust within the relationship between the physician-researcher and patient-subject is paramount to avoid the exploitation of patient-subjects as a vulnerable population. It is important for patient-subjects to trust that physician-researchers are concerned with protecting best interest. The fact that physician-researchers are exposed to an abundance of conflicts of interest when inviting patient-subjects to partake in clinical trials adds multiple layers of ethical complexity. This thesis will also explore the relationship between equipoise and clinical research, delving into the question of when it is ethically permissible for physician-researchers to enroll patient-subjects in RCTs. Rather than regarding Fried's equipoise and clinical equipoise as competing concepts, this thesis will argue for a conceptualization that sees Fried's equipoise and clinical equipoise be applied in a complementary manner, which will support the preservation of the integrity of the physician-researcher role. Furthermore, analysis of the COVID-19 research cases will exemplify how the concept of equipoise has limitations and holds varying degrees of relevance depending on the context.

Committee: Dana Howard PhD (Advisor); Courtney Thiele JD, MA (Committee Member); Karla Zadnik OD, PhD (Committee Member) Subjects: Medical Ethics

Master of Arts, The Ohio State University, 2020, Bioethics

Euthanasia and physician assisted suicide (PAS) have been accepted as a legally approved means of dying and as an appropriate medical procedure in six countries, 8 states and Washington, D.C. (mydeath-mydecision.org). Dutch society has accepted euthanasia under the Termination of Life on Request and Assisted Suicide Act (2002) and included it within a physician's duty. On 21 April 2020, the Act was expanded to allow euthanasia for adults with dementia. The Act now permits individuals with an advance euthanasia directive (AED) to request euthanasia should they experience dementia in the future. Proponents support the expansion based on individual autonomy and view it as providing a compassionate way to end suffering, enabling individuals to maintain control of their death. Opponents see the expansion as proof of a slippery slope or a gradual shift toward greater acceptance. For them, this is ultimately lessening the value of a human life and an expansion of a moral wrong. It is this element which will be explored within this thesis. One of the primary arguments presented is that the Dutch Act encompasses a logical expansion which was inevitable. By allowing euthanasia to be authorized as an acceptable medical practice Dutch society experienced a foundational change in its approach to death which undermined the value of an individual life. Dutch society no longer values all life, but instead places greater importance toward lives of value. The Act has reshaped medical practice and consequently lessened the value of life for individuals living with an illness or incapacity. The approach has not been widely adopted across the globe; the Netherlands remains as an exception. However, other countries are beginning to adopt new laws allowing PAS. The Dutch provide an example of how easily the practice becomes normalized once permitted. Dutch society is moving away from the value of a life, previously based on religious foundations. They instead move toward establishi (open full item for complete abstract)

Committee: Matthew Vest PhD. (Advisor); Courtney Thiele J.D. (Committee Member) Subjects: Ethics; Health; Medical Ethics