1. Outstanding 4 pointsVery Good .docx

1.
Outstanding 4 points
Very Good 3 points
Good 2 Points
Unacceptable 1 point
Integration of Knowledge
12.5%
The paper demonstrates that the author fully understands and
has applied concepts learned in the course.
Concepts are integrated into the writer’s own insights.
The writer provides concluding remarks that show analysis and
synthesis of ideas
The paper demonstrates that the author, for the most part,
understands and has applied concepts learned in the course.
Some of the conclusions, however, are not supported in the
body of the paper
The paper demonstrates that the author, to a certain extent,
understands and has applied concepts learned in the course
The paper does not demonstrate that the author has fully
understood and applied concepts learned in the course.
Topic Focus
12.5%
The topic is focused narrowly enough for the scope of this
assignment.
A thesis statement provides direction for the paper, either by
statement of a position or hypothesis
The topic is focused but lacks direction.
The paper is about a specific topic but the writer has not
established a position.
The topic is too broad for the scope of this assignment.
The topic is not clearly defined
Depth of Discussion
12.5 %

In-depth discussion and elaboration in all sections of the paper.
In-depth discussion and elaboration in most sections of the
paper.
The writer has omitted pertinent content.
Quotations from others outweigh the writer’s own ideas
excessively.
Cursory discussion in all the sections of the paper or brief
discussion in only a few sections
Cohesiveness
12.5%
Ties together information from all sources.
Paper flows from one issue to the next without the need for
headings.
Author’s writing demonstrates an understanding of the
relationship among material obtained from all sources
For the most part, ties together information from all sources.
Paper flows with only some disjointedness.
Author’s writing demonstrates an understanding of the
relationship among material obtained from all sources.
Sometimes ties together information from all sources.
Paper does not flow.
Disjointedness is apparent.
Author’s writing does not demonstrate an understanding of the
relationship among material obtained from all sources.
Does not tie together information.
Paper does not flow and appears to be created from disparate
issues.
Headings are necessary to link concepts.
Writing does not demonstrate understanding any relationship
Spelling and Grammar 12.5%
Minimal spelling and/or grammar mistakes
Some spelling and or grammar mistakes.
Noticeable spelling and grammar mistakes.
Unacceptable number of spelling and/or grammar mistakes
Sources
12.5%

More than 5 current sources, of which at least 3 are peer review
journal articles or scholarly books.
Sources include both general background sources and
specialized sources.
Special-interest sources and popular literature and
acknowledged as such if they are cited.
All web sites utilized are authoritative.
5 current sources, of which at least 2 are peer-review journal
articles or scholarly books.
All web sites utilized are authoritative.
Fewer than 5 current sources or fewer than 2 of 5 are peer-
reviewed journal articles or scholarly books. All web sites
utilized are credible.
Fewer than 5 current sources or fewer than 2 of 5 are peer-
reviewed journal articles or scholarly books. Not all web sites
utilized are credible, and/or sources are not current.
Citations
12.5%
Cites all data obtained from other sources.
APA citation style is used in both text and bibliography
Cites most data obtained from other sources.
APA citation style is used in both text and bibliography.
Cites some data obtained from other sources.
Citation style is either inconsistent or incorrect.
Does not cite sources.
Breast & Body – some background information I have compiled
Your goals as a student in this class are to….
1) To identify and articulate the shared values that unite Mrs.
Bell, Mrs. Graham, Breast & Body Health Inc., and Breast &
Body Health Boutique.
2) To identify and articulate a vision statement that unites and
clearly states what Mrs. Bell and Mrs. Graham want Breast &
Body Health Inc., and Breast & Body Health Boutique to
become.

3) To identify and articulate a unifying mission statement for
Breast & Body Health Inc., and Breast & Body Health Boutique
that declares their reason for being; what their business is.
4) To formulate a strategic plan that exploits current
opportunities while creating new and different opportunities for
the future. Integrating the management, marketing,
accounting/finance, operations, and information systems of
Breast & Body Health Inc., and Breast & Body Health Boutique
to achieve the vision.
Background….
Two organizations with one vision; to help men, women, and
children with cancer (primarily breast cancer). These two
organizations have multiple published mission/vision/purpose
statements. There is a lack of clarity and focus. There is a
need to focus this organization and to develop a clearly
articulated a 3 to 5 year strategic plan.
Organization 1: Breast and Body Health Inc. - Breast and Body
Health Inc. is a 501c3 not-for-profit organization.
Organization 2: Breast and Body Health Boutique - Breast and
Body Health Boutique is a for profit organization.
These two organizations exist symbiotically to help men,
women, and children with cancer. Their primary focus is breast
cancer. From screening, to diagnosis, treatment, and post
treatment, the goal is to help women obtain the products and
services they need to be healthy and to feel confident in their
own skin. Breast & Body Health Incorporated, the not-for-
profit 501c3, raises funds to help cover the costs associated
with cancer products and services, primarily traditional and
custom-made prosthetic breasts, bras, wigs, and other breast
cancer related supplies. The second organization, Breast &
Body Health Boutique, is a for profit organization that sells the
products previously mentioned as well as a full line of women’s
intimate apparel, hand-made lotions and soaps, and clothing.
The revenue generated from Breast and Body Health Boutique is
directed into Breast and Body Health Incorporated which
donates the funds to cover the cancer related costs for

patients/customers who lack health insurance or have
inadequate health insurance to obtain the products and services
they need. From the perspective of a patient or customer, these
two organizations are on in the same.
The World Health Organization defines health as “a state of
complete physical, mental, and social well-being and not merely
the absence of disease or infirmity” (World Health
Organization, 2014, p. 1). As a 4-time cancer survivor, the
founder and co-owner these two organizations, Mrs. Bonnie
Bell, is keenly aware of the essential roles that knowledge,
confidence, and community, play in the journey from the
discovery of a lump, to breast cancer survivor, and from cancer
survivor, to thriver; the complementary roles that physical,
mental, and social well-being play in the pursuit of health.
From the perspective of a patient/customer, these two
organizations are one in the same. They reside in two primary
locations, northern Virginia and central Alabama, as well as two
satellite locations, northern Virginia and eastern West Virginia.
Their specific addresses are as follows:
Primary Locations:
1) Breast & Body Health Boutique - 2217 Papermill Road,
Winchester, VA 22601
2) Breast & Body Health Boutique - 102 Court Street,
Wetumpka, AL 36092
3) Breast & Body Health, Inc headquarters – 62 Niblick Court,
Martinsburg, WV 25405
Satellite Locations:
1) Mary Washington Regional Cancer Center, 1300 Hospital
Drive #101, Fredericksburg, VA 22401
2) Gateway Home Care, 1353 Edwin Miller Boulevard,
Martinsburg, WV 25404
Populations Served:
The primary population served by these organizations are
women and their families afflicted by breast cancer within a
100-mile radius of each location. More specifically, the target
population are women afflicted by breast cancer who lack health

insurance or have inadequate health insurance. That being said,
these organizations serve all individuals in within the
geographic regions served.
On top of helping those with cancer, these organizations engage
in various community outreach and educational events that work
to spread awareness of cancer, the importance of cancer
screening, and how to access available resources.
Again, these organizations have never clearly defined their
primary population beyond “men, women, and children with
cancer”. This will be a major aspect of clarifying and focusing
this organization through the development of a 3 to 5 year
strategic plan.
These two organizations are co-owned by a mother and daughter
team; Bonnie Bell (mother) and Natacha Graham (daughter).
With limited resources these organizations are being operated to
achieve the mission of helping those with cancer. The impact
these two organizations have had since their inception is
amazing. With no formal business training, the owners have
grown these organizations from an idea and a few thousand
dollars into two full retail locations with approximately 6 full
time equivalent employees; they have touched hundreds of
lives. With growth comes opportunities and new challenges.
There are legitimate regulatory and business reasons for
maintaining two distinct entities (for-profit and not-for-profit),
but this also adds to the confusion. There is not a clearly
defined vision that unities these organizations. There is not a
clear mission providing direction. There are no stated goals
that the organizations are operating toward. There is no
strategy. Mrs. Bell and Mrs. Graham work endlessly to raise
funds to help men, women, and children with cancer. They
direct all profits from Breast and Body Health Boutique into
Breast and Body Health Incorporated which donates funds to
cover the cancer related costs of uninsured and underinsured
patients/customers. They have developed a successful model in
a unique niche, but they are working at their capacity.

Strategy Analysis and choice
Chapter Six
Part 1 of 2
Dr. J. Seth Chatfield
1
A Comprehensive Strategic-Management Model

2
The Strategy-Formulation Analytical Framework

3
Matching Key External and Internal Factors to Formulate
Alternative Strategies
6-4

4
The Strengths-Weaknesses-Opportunities-Threats (SWOT)
Matrix helps managers develop four types of strategies:
SO (strengths-opportunities) Strategies
WO (weaknesses-opportunities) Strategies
ST (strengths-threats) Strategies
WT (weaknesses-threats) Strategies
SWOT/TOWS Matrix

This should say “SO Strategies”
SO – Strategies
Add four new in-store promotions monthly (S4, O3)
Add two new repair and service persons (S6, O5)

7
List the firm’s key external opportunities
List the firm’s key external threats
List the firm’s key internal strengths
List the firm’s key internal weaknesses
Match internal strengths with external opportunities
Match internal weaknesses with external opportunities, and
record the resultant WO Strategies
Match internal strengths with external threats, and record the
resultant ST Strategies
Match internal weaknesses with external threats, and record the
resultant WT Strategies
Steps in producing the SWOT/TOWS Matrix
8

This should say “SO Strategies”
The Strategic Position & Action Evaluation (SPACE) Matrix
Two internal dimensions (financial position [FP] and
competitive position [CP])
Two external dimensions (stability position [SP] and industry
position [IP])
Most important determinants of an organization’s overall
strategic position
10

Example Strategy Profiles

12
BCG Matrix
graphically portrays differences among divisions in terms of
relative market share position and industry growth rate
allows a multidivisional organization to manage its portfolio of
businesses by examining the relative market share position and
the industry growth rate of each division relative to all other
divisions in the organization
The Boston Consulting Group (BCG) Matrix

13
The BCG Matrix
14
6-15
The Internal-External (IE) Matrix

Grand Strategy Matrix
based on two evaluative dimensions: competitive position and
market (industry) growth
The Grand Strategy Matrix
16
The Strategy-Formulation Analytical Framework

17
Quantitative Strategic Planning Matrix (QSPM)
objectively indicates which alternative strategies are best

uses input from Stage 1 analyses and matching results from
Stage 2 analyses to decide objectively among alternative
strategies
The Quantitative Strategic Planning Matrix (QSPM)

18
The Quantitative Strategic Planning Matrix (QSPM)

20
1. Make a list of the firm’s key external
opportunities/threats and internal strengths/
weaknesses in the left column of the QSPM.
2. Assign weights to each key external and internal
factor.
3. Examine the Stage 2 (matching) matrices, and
identify alternative strategies that the organization
should consider implementing.
Steps in a QSPM

4. Determine the Attractiveness Scores (AS).
5. Compute the Total Attractiveness Scores.
6. Compute the Sum Total Attractiveness Score.
Steps in a QSPM (cont.)

23
Sets of strategies can be examined sequentially or
simultaneously
Requires strategists to integrate pertinent external and internal
factors into the decision process
Can be adapted for use by small and large for-profit and
nonprofit organizations
Positive Features of the QSPM

24
Always requires intuitive judgments and educated assumptions
Only as good as the prerequisite information and matching
analyses upon which it is based
Limitations of the QSPM

25
“Not only has the “right” corporate culture become the essence
and foundation of corporate excellence, but success or failure of
needed corporate reforms hinges on management’s sagacity and
ability to change the firm’s driving culture in time and in tune
with required changes in strategies.”

Cultural Aspects of Strategy Choice

26
Board of directors
a group of individuals who are elected by the ownership of a
corporation to have oversight and guidance over management
and who look out for shareholders’ interests
Duties of the Board of Directors
Control & Oversight over Management
Adherence to Legal Prescriptions
Consideration of Stakeholder Interests
Advancement of Stockholders’ Rights
Governance Issues

27
Board of Director Duties and Responsibilities

28
Principles of Good Governance
29
Strategies require regular reappraisal
Every org. needs to establish and communicate clear objectives
and strategies
Use the tools described in this chapter (SWOT, SPACE, BCG,
IE, QSPM) but also incorporate:
Behavioral
Cultural

Political
Conclusion
Aspects of strategy generation and selection

30
Strategic
ManageMent15thedition
Fred r. david | ForeSt r. david
a competitive advantage approach
conceptS
and caSeS
SWOT - Internal Strengths
B&B is in touch with their communities and gives back
whenever possible. This has allowed their business to travel far
and wide by word of mouth.
B&B make women feel beautiful, sexy, pampered by their

personal service and unique products.
B&B caters to all people, not just women or women with breast
cancer.
They are a one stop shop for breast cancer products and
services.
Most employees are certified professional bra and
mastectomy/prosthetic fitters
Customer education and training (informing customers what
they are doing and why they are doing it/They share their
expertise) – this has created significant customer loyalty
B&B provides women with a positive and supportive
atmosphere that can be unmatched by more commercialized
competitors.
They help those in need no matter their financial situation.
They work with all insurances including Medicaid and Medicare
B&B works well with physicians and has a strong physician
network.
SWOT – Internal Weaknesses
Lack of resources (physical/financial/human)
Their competitive advantage can be replicated (personalized
fittings)
Financial Clarity - Resources are very limited and there is a
major lack of financial data.
Lack of brand awareness. As far as the general population of
women there is not a great awareness that B&B is a superior
option for bra fitting compared to retail stores.
No coherent marketing strategy
Hard to attract employees who will be committed and stay with
B&B for meager pay (Child care can be more expensive than
compensation)
A lack of focus in connecting the two businesses and not being
able to have a unifying vision/mission or goals/objectives.
The owner tries to do everything and can get overwhelmed.

Overly altruistic – helping others to the point of organizational
failure.
Very limited online presence and no online sales
SWOT – External Opportunities
Huge growth potential.
Competitors are not personable and make the women feel like
less of a person. B&B offers a place where they can feel
comfortable going.
They are different from a regular Durable Medical Equipment
facility because not only do they offer breasts prosthesis, but
they give women a choice. Most DME places will give you a
small option and say choose instead of seeing what fits.
There is a growing need for their products and services not only
for women with breast cancer but for teenagers and for the male
population (including transgender/transvestite).
The obesity epidemic is creating an expanding market of women
with large breast sizes that would greatly benefit from personal
fittings.
Very little direct competition within the breast cancer product
and service niche
Potential of new legislation that includes custom breast
prosthesis under Medicare.
Introduction of an online shopping platform.
Strategic alliances/partnerships - Also being able to partner
with other likeminded companies could help gain exposure and
help grow the revenue of the company.
Social media as a low-cost marketing platform.
SWOT – External Threats
Online competition.
An inconsistent flow of financial support. The for-profit is not

currently profitable and the not-for-profit must survive on
donations, there could be either a surplus or deficit in funds at
any given time.
B&B is more expensive than traditional retails. Walmart is
cheaper and so is Lane Bryant. Even Victoria secrets can be a
little less pricey and have more inventory.
Policy changes – Medicare/Medicaid/commercial health
insurance.
Small geographical service area.
Competitors are able to deliver what the customer assumes is
their fit without having to come into the store.
New competition entering their market.
Potential for health providers to aggressively enter the market –
seeing a greater provider emphasis on psychosocial health
requirements of cancer treatment/recovery.
Potential of family (mother/daughter) conflict or disagreement
causing organizational problems.
Heavy reliance of health insurance reimbursement.
“Breast & Body” Strategic Plan | Identification of SWOT
Factors & SWOT/TOWS Matrix
You are assigned to identify current SWOT factors that will
form the foundation of your
strategic plan for Breast & Body. Specifically, you must
identify a minimum of:
• 10 internal Strengths of Breast & Body
• 10 internal Weaknesses of Breast & Body
• 10 external Opportunities for Breast & Body

• 10 external Threats for Breast & Body
These SWOT factors should be as actionable as possible,
meaning they are suggestive
of potential strategies to pursue and they are meaningful in
terms of having strategic
implications. Quantify your factors to the extent possible and
select factors that will be
helpful in deciding what actions to recommend to the firm,
rather than selecting
nebulous factors too vague for an actionable response. We have
very limited internal
financial data for Breast & Body. Please operate under the
assumptions that all
internal resources are very limited.
Using the SWOT factors you have identified, develop a SWOT
matrix.
A SWOT matrix seeks to develop strategies based on the factors
you have
identified. Your goal is to match the key external and internal
SWOT factors you have
identified to formulate alternative strategies. Specifically, you
need to develop two (2)
strategies for each of the four (4) categories of strategies: SO
strategies, WO
strategies, ST strategies, and WT strategies (a total of eight (8)
strategies). Again, we
have very limited internal financial data for Breast & Body.
Please operate under the
assumptions that all internal resources are very limited. Your
strategies will need to
reflect this fact (i.e. opening additional retail locations is not
currently a strategy that is
feasible).

SO (strengths-opportunities) Strategies use a firm’s internal
strengths to take
advantage of external opportunities.
WO (weaknesses-opportunities) Strategies aim at improving
internal weaknesses by
taking advantage of external opportunities.
ST (strengths-threats) Strategies use a firm’s strengths to avoid
or reduce the impact
of external threats.
WT (weaknesses-threats) Strategies are defensive tactics
directed at reducing
internal weakness and avoiding external threats.
*** Please refer to chapter 6 PowerPoint ((( attached ))) for
detailed
information regarding the development of a SWOT matrix.
Also, use
google for more understanding.
*** NO PLAGIARISM
Running head: INFECTION PREVENTION
1
INFECTION PREVENTION
15

Phase # 2 Infection
Prevention
Literature Review
Healthcare acquired infections constitute a major public
health issue and it is affecting millions of people on a yearly
basis. The approximation from the recent studies is showing
more than 5 percent of the hospitalized patients are exposed to
nosocomial infections. Many studies further show that the
surgical site infections are the common infections associated
with nosocomial infections and it is contributing to about 30
percent of all healthcare acquired infections cases.
Study by Ayed et al (2015) shows that healthcare
providers are continuously exposed to pathogens which are
sometimes severe and lethal. Nurses specifically are more
exposed to different infections during the course of providing
healthcare services to the patients. This study indicates that it is
therefore crucial for nurses to possess sound knowledge as well
as strict adherence to the infection control practices. Updating
the acquaintance and the practices of nurses through
involvement in ongoing in-service educational programs and
putting more focus on the role of the current evidence-based
practices of infection prevention in the continuous training is
important. Provision of the training to the newly recruited
nurses regarding the infection control frequently as well as
replicating the study through observation checklist is necessary
in assessing the level of practice (Imad, Ayed, Faeda, & Lubna,
2015).
Study by Desta et al (2018) reveals that working
experience is a stronger predictor of the knowledge in relation
to the prevention of the infection. In this study, the goal was to
the relationship between the acquaintance, practice and

connected aspects of infection prevention among healthcare
employees. Education level is a key determinant to the level of
experience when it comes to the control or the prevention of
infections. According to this study, it is clear that healthcare
providers with advanced experience as well as advanced age are
significantly linked with the knowledge. This is basically based
on the fact that as healthcare providers are getting older, they
are more likely to have advance knowledge due to their
experiences as well as having worked with their seniors (Desta,
Ayenew, Sitotaw, Tegegne, Dires, & Getie, 2018).
Teshager et al (2015) also studies the knowledge,
practices, and the related aspects towards the reduction or
prevention of the surgical site infections among nurses who
were employed in Amhara Regional State Referral healthcare
facilities, in the Northwest Ethiopia. This study looked at some
of the factors linked with the knowledge of the nurses regarding
the prevention of the surgical site infections. Based on the
bivariate analysis of this study, the age, year of service, sex of
the participants, and training on the infection prevention
techniques were found to be the key factors associated with the
knowledge on the prevention of infections. On the other hand,
the year of service, sex, and the training on the infection
prevention were found to be greatly linked to the multivariate
assessment (Teshager, Engeda, & Worku, 2015).
Based on the outcome of the analysis, males’ nurses are
three time more likely to be knowledgeable on the prevention of
the surgical site infections as compared to the female
counterparts. Nurses who have served for more than five years
were twice more likely to be knowledgeable on the issue of
infection prevention as compared to the healthcare employees
who have worked for less than five years. Nurses who have been
involved in the training program related to the prevention of the
infection techniques were twice more likely to be
knowledgeable regarding the prevention of the surgical site
infections as compared to nurses who have never attended such
trainings.

Human are playing an important role in healthcare
acquired infections and therefore adequate nurse staffing is
important. Batran et al (2018) in their study on whether the
standard precautions for healthcare acquired infection among
nurses working in the public sector is satisfactory indicates that
compliance to the standard precautions by the healthcare
providers is related to their knowledge, the standards precaution
training, and the experiences they are having. Standards
precautions are used as guideline while offering healthcare
services to the patients in spite of the supposed infection status.
According to this study, the standard precautions are targeted at
reducing the transmission of the healthcare acquired infections
as well as protecting the nurses and other healthcare providers
from the sharp injuries (Batran, Ayed, Salameh, Ayoub, &
Fasfous, 2018).
Jahangir et al (2017) aimed at assessing the knowledge
and the practices of the nurses in relation to the spreading of the
healthcare acquired infections within the government healthcare
facilities in Lahore. Based on this study, it was evident that
nurses are having knowledge regarding the spread of
nosocomial infections. They are also well informed regarding
the safety precautions and the use of alcohol-based formulation.
Nevertheless, their practices towards reduction of the spread of
the hospital associated infections are at unsatisfactory level.
This study also reveals that nurses are more exposed to
acquiring and transmitting hospital associated infections as they
provide nursing care to the patients. It is therefore
recommended that nurses must have adequate knowledge as well
as the practice towards controlling and preventing the spread of
nosocomial infections (Jahangir, Ali, & Riaz, 2017).
Using standardized precautions to help in the
prevention of patient from acquiring nosocomial infections is an
important part of the nursing care. Study by Moyo (2013),
reveals that many nurses are more concerned about their lives as
compared to the patients since they are handling different
patients from ward to ward. Alternatively, Ventilator patients

are more exposed to the healthcare acquired infections whereby
the contaminated equipment can be a source of those infections.
Nurses who are delivering healthcare services to these patients
are also at higher risk of acquiring illness from such equipment
(Moyo, 2013). Methodology and the design of the study
This study is an institutional based and it will therefore
be done from May 25, 2019 to June 25, 2019. Healthcare
providers having qualification of doctors, health officers,
nurses, midwives, x-ray technicians, pharmacists, and the
laboratory technicians will be selected for this study. Healthcare
providers who are ill plus those who are on leave were never
included in the study.
Self-assessed questionnaire will be utilized to help in
the collection of data through distribution at the healthcare
workers. The self-administered questionnaire was modified
CDC infection prevention and control assessment tool for the
acute care healthcare facilities. The questionnaire was
organized using English language and the pre-test was
performed in the study area on 5 percent of healthcare workers
and this was excluded from the actual study to help in
evaluation of the content as well as the approach of the
questionnaire and some necessary adjustment which were
necessary to be made.
The analysis of the data will be based on summary of
the proportions, frequencies, the average, the score on
knowledge is dichotomized as 1 for being knowledgeable and 2
for not being knowledgeable. The practice score is
dichotomized as 1 for good practice and 2 for poor practice.
Sampling Methods
A total of 250 participants will be selected as the
population participants. The participants are the healthcare
employees who are involved in the direct care of the patients for
a period of four weeks in every ward. The systematic random
sampling will be used to help in the identification of the study
participants through using the list of healthcare employees
posted in every ward in the facility as a sampling frame. The

first selection of the participant will be based on random
selection. The selection of the sample for the study is based on
using healthcare providers who are doctors, nurses, midwives,
laboratory technologists, pharmacists, and healthcare officers.
Necessary tools
One of the tools to be used in this study is the self-
administered questionnaire to help in the collection of the data.
This tool will be adapted from the modified Center for Disease
Control and Prevention and the control assessment tool used for
the acute care patients. Any logarithm or flow map developed
Healthcare Facility
References
Batran, A., Ayed, A., Salameh, B., Ayoub, M., & Fasfous, A.
(2018). Are standard precautions for hospital-acquired infection
among nurses in the public sector satisfactory? AMHS , 6 (2),
223-227.
Desta, M., Ayenew, T., Sitotaw, N., Tegegne, N., Dires, M., &
Getie, M. (2018). Knowledge, practice and associated factors of
infection prevention among healthcare workers in Debre Markos
referral hospital, Northwest Ethiopia. BMC Health Serv Res, 18,
465.
Haque, M., Sartelli, M., McKimm, J., & Bakar, A. M. (2018).
Healthcare-associated infections – an overview. Infection Drug
Resist, 11, 2321-2333.
Imad, F., Ayed, A., Faeda, E., & Lubna, H. (2015). Knowledge
and Practice of Nursing Staff towards Infection Control
Measures in the Palestinian Hospitals. ERIC, 6 (4), 79-90.
Jahangir, M., Ali, M., & Riaz, M. S. (2017). Knowledge and
Practices of Nurses Regarding Spread of Nosocomial Infection
In government Hospitals, Lahore. J Liaquat Uni Med Health Sci,
16 (3), 149-153.
Moyo, G. (2013). Factors influencing compliance with infection
prevention standard precautions among nurses working at
Mbagathi district hospital, Nairobi, Kenya. Doctoral

dissertation, University of Nairobi.
Stone, P. (2017). Economic burden of healthcare-associated
infections: an American perspective. Expert Rev Pharmacoecon
Outcomes Res, 9 (5), 417-422.
Teshager, A. F., Engeda, H. E., & Worku, W. Z. (2015).
Knowledge, Practice, and Associated Factors towards
Prevention of Surgical Site Infection among Nurses Working in
Amhara Regional State Referral Hospitals, Northwest Ethiopia.
Surgery Research and Practice.
1
15
Phase # 3 Implementation
Infection Prevention
Implementation
Task
Duration
Assessment of the current practices

1 week
Identification of the factors leading to high cases of healthcare-
acquired infection
5 weeks
Pre-Training
Two weeks
Training
5 weeks
Process of assessing the situation and communication with the
key stakeholders
Ongoing process
The implementation plan process of this research
project is aimed at addressing issues related to the knowledge,
practices, and other factors such as the socio-demographic
factors, and the healthcare facility factors which are considered
to be playing important roles towards the prevention of
healthcare-acquired infections. The implementation process for
the change implementation plan in reducing the healthcare-
acquired infections requires adequate resources which will be
necessary towards training the healthcare providers to have the
required knowledge needed to improve their skills in relation to
the prevention of the healthcare-acquired infections. Resources
will also be important in ensuring that the required tools or
equipment are purchased to help in ensuring that their effective
control or preventive measures in place.
Some of the important tools or equipment which will
be necessary to be purchased includes the gloves, hydrogen
peroxide, alcohol disinfectant, sterilizer machine, and the
alcohol hand disinfectant. Other resources or tools required
include pens and notebooks which will be important when
training the staffs on the safety measures in relation to the
process of preventing healthcare-acquired infections. The
implementation program towards the reduction of the
healthcare-acquired infection will be based on stages. Stage 1:
Assessment of the current practices (One Week)

The first stage will be involving the process of
assessing the current practices in place which are being used
towards a reduction of the infection rates. This stage will also
involve the assessment of the knowledge of the healthcare
providers especially nurses regarding the techniques and the
effective methods being used to help in the reduction of
infections in the facility. The assessment will also involve
looking at some of the steps which have been put in place to
help in combating the incidences of the prevention rates within
the facility. One-week duration will be enough towards ensuring
that there is a complete assessment of the areas which requires
improvement.Stage 2: Identification of the factors leading to
high cases of healthcare-acquired infection (5 days)
The second stage will involve the identification of
some of the factors which are contributing to the spread of the
infection rate within the facility to help in the designing of the
effective training approaches which meets the gaps within the
facility in relation to the prevention of healthcare-acquired
infections. This stage will be taking around 5 days for
completion. Stage 3: Pre-Training (Two Weeks)
The third stage of the implementation process the pre-
training which will take about two weeks. This stage will
involve the assessment of the tools and then scheduled for the
training sessions (in-person training). Stage 4: Training (5
weeks)
The fourth stage will involve the training process
whereby there will be a performance of the in-person training
sessions towards quality healthcare improvement. Training
webinars will be checked in this stage. There will also be a
collection of the baseline information; making completion of
the implementation preparedness checklist. This stage will take
around five weeks.Stage 5: an ongoing process of assessing the
situation
The next stage will be a continuous bi-weekly
gathering to make a continuous assessment of the situation.
There will be an updating of the action plans as well as the

implementation of the checklist. The last stage will be involving
a contours process whereby activities such as continuous weekly
meeting will be important to help in determining the challenges
being faced as well as the areas which are successful. In this
stage, there will be the determination of the successful intervals
for the healthcare providers. Frequent collection and analysis of
the data regarding the practices towards preventing healthcare-
acquired infections will be analyzed.
There will be a review of relevant supplementary
learning network webinars. There will also be a pilot like
interventions through the selection of specific departments or
wards which are usually having a continuous flow of patients to
help in giving a clear picture regarding the effectiveness of the
program. There will be continuous training of the current and
new as well as the assessment of the healthcare providers with
regard to how they are being affected by socio-demographic
factors i.e. age, marital status, religion, ethnicity, level of
education, and the work experiences and health facility factors.
There will be assigned of the responsibilities to the
staffs to help in improving the implementation process aimed at
reducing healthcare-acquired infections. Each healthcare
provider will be assigned the responsibility with a focus on the
identification of the factors which might be further increasing
the rate of healthcare-acquired infections other than those which
have been identified to be the major contributors.
There will be continuous communication and giving
reports in relation to the prevention processes. The prevention
practices of healthcare-acquired infection are only developed
through having a continuous operational procedure which is
involving reporting the emerging issues and areas that requires
improvement; therefore, through the existence of continuous
communication process, it will be possible to deal with the issue
of healthcare-acquired infections as a team. Regular assessment
of the progress and creating a plan to keep the process of
implementation of the targeted practices to other departments
within the facility will be of great value.

Communication with the key stakeholders of the
healthcare facility is another important step and this has to be
an ongoing process. Stakeholders, in this case, are the
individuals who are directly involved or are affected by the
increasing incidences of the healthcare-acquired infections. The
stakeholders include patients, healthcare providers; groups
providing financial support to the hospital, and the hospital
management among others. There will be continuous
communication and consultation with the stakeholders to help in
rolling out the program as well as expanding the process of
building the sustainability of the program. Stakeholders will be
important in providing feedback regarding the program aimed at
addressing the existing gaps in addressing issues related to the
prevention of healthcare-acquired infections. The stakeholders
will be helping in identifying the areas which require some form
of refinement as well as giving suggestions on the new
approaches of initiatives which should be applied or adopted.
Continuous cooperation, as well as collaboration with
patients, will be important in ensuring that there is a success in
improving the process of addressing issues related to the
prevention of healthcare-acquired infection. Patients are the
highly exposed individuals to healthcare-acquired infection,
therefore, an effective process of educating them on how to
report and stick by the instruction of the healthcare providers
especially those who are placed on an isolated room will be
important in helping to reduce the exposure to healthcare-
acquired infections such as tuberculosis. With regard to working
together with the management of the healthcare facility, the
success of the program will be achieved through support from
the management. The top management is key stakeholders who
are the individuals who are giving go ahead with the process of
making an improvement to the issue of concern. Top
management will be providing the financial support needed to
purchase the materials required towards making the mission of
healthcare-acquired infection prevention activities possible. It
cannot be possible to make an improvement to the concerns

related to the infection if the management is not fully engaged
since the project is doom to fail due to a lack of full support.
Materials, activities and the cost
In order to meet the objective of full implementation of
the program, it is important to have the required resources in
place. These resources are the materials or the equipment which
are supposed to be purchased to help in ensuring that every
activity being undertaken such as the training of the staffs as
well as engaging the key stakeholders i.e. healthcare providers,
management, financial supporters, and the patients are
effectively involved in the process of implementation.
Therefore, the materials and the activity of training and
communicating with the stakeholders are categorized below
based on the amount required to support each activity or
purchase of the materials needed.
Materials/ Activities
Costs
Gloves
$ 300
Manila paper for designing the waste segregation protocol
$ 15
More laboratory coats
$ 100
Hydrogen Peroxide
$ 500
Alcohol Disinfectant
$ 300
Sterilizer Machine
$ 800
Alcohol Hand Disinfectant
$ 100
Pens and Notebooks
$ 150
Construction of the isolation room
$ 5000
Training of healthcare providers

$ 3000
Communication with the stakeholders
$ 800
Miscellaneous
$ 2000
Total
$ 13,065
References
223-227.
465.
Resist, 11, 2321-2333.
16 (3), 149-153.

Outcomes Res, 9 (5), 417-422.
1
10
Assessment of the knowledge, practice, and the associated
factors of Healthcare Acquired Infection Prevention
Assessment of the knowledge, practice, and the associated

factors of Healthcare Acquired Infection Prevention
Healthcare acquired infection/nosocomial
infection/hospital acquired infections are becoming a major
international challenge in many healthcare facilities especially
in the low- or middle-income nations. It is anticipated that
around 10 percent of patients in the healthcare facilities from
developing nations are developing healthcare acquired
infections and this subsequently leads to negative impacts on
healthcare outcomes. It also leads to increase hospital stay,
economic burden, morbidity cases, and increase in the mortality
incidences. Some of the common healthcare acquired infections
include Hepatitis B and C virus, HIV infections, and even
Tuberculosis which are often transmitted by healthcare workers
who are not observing the practice related to the infection
prevention measures.
According to the United States Center for Disease
Control and Prevention, there are about 1.7 million patients who
have been hospitalized as a result of acquiring infection within
the facilities while undergoing treatment for other healthcare
concerns. Many studies reveal that simple infection control
procedures like cleaning of the hands using alcohol-based hand
rub is helping in the prevention of the spread of the disease.
The increase in the infection rate caused by the healthcare
acquired infection is due to the poor practices of infection
prevention and control, lack of knowledge or failure to
implement knowledge related to the process of preventing and
controlling nosocomial illnesses, and other associated factors
(Desta, Ayenew, Sitotaw, Tegegne, Dires, & Getie, 2018).
The Problem
The high burden of nosocomial infections is as a result of
the absent of the standardized infection control prevention
program in place. The main reason why there is absence of
standardized infection prevention procedures is as a result of
inadequate resources, improper sanitary situation and the poor
hygienic practices. Healthcare infections which were absence at
time when a patient is being admitted are acquired by patients

during the process of healthcare services within the hospital.
Healthcare providers are considered to be in the front line with
regard to the process of ensuring that there is self-protection as
well as making sure that patients are free from infections
(Haque, Sartelli, McKimm, & Bakar, 2018).
The process of preventing infection prevention is
involving and it involves the placing of major barriers between
the vulnerable hosts and the pathogens as well as some of the
major components of the safe and improved quality of services
being delivered at the healthcare facility level. Therefore,
healthcare acquired infections related mortality and morbidity
can be prevented through having an effective prevention
program such as proper hand hygiene. The process of
implementing the standard precautions such as safety injections,
isolations precautions, bathing among patients, antibiotic use or
stewardship, vaccinations, environmental cleaning,
disinfections, and the sterilization process through successful
comprehensive departmental based safety program as well as
surveillance are important steps which can be relied on for the
purposes of control and prevention of the infections.
In resource constraint facilities, it is becoming hard to
control infections rates of clients who are acquiring healthcare
infections as well as the exposure of healthcare workers to such
infections. There are some of simple standard precaution
procedures as well as improved knowledge which have been
found to be important when it comes to the reduction of the
infections. Even though there is existence of such evidences in
relation to availability of the level of awareness and practices in
preventing infections and the associated aspects, there are
reduced cases of exploiting such knowledge, practices, and the
associated factors many healthcare facilities. Significance
of the problem
Low-cost intervention processes are available to help in
preventing or controlling the cases of nosocomial infections.
Majority of healthcare knowledge as well as adherence to the
infection prevention is still very minimal. This therefore

implies that improvement of knowledge as well as practice of
healthcare employees with regard to the prevention of infection
is important when it comes to the reduction of the burden
caused by the healthcare acquired infections. The outcomes of
this research work will be important as a contribution for the
policy makers, programmers, and healthcare employees towards
improvement of the clinical services and the means of achieving
sustainable development objectives.
Identification of this problem is also important when it
comes to the reduction of the mortality cases. The study of this
problem is helping in the generation of the meaningful data with
regard to the practices, knowledge, and other associated factors
of healthcare acquired infections. This is important in
processing the measuring the outcome of the patient safety
practices. Through monitoring the process and the outcome
measures as well as the evaluation of the existing relationship is
important in establishing the good process which results in good
health care outcomes.
Through identification of the problem related to the
knowledge, practices and the associated factors in healthcare
acquired infections, it is possible to have an effective process
measure which is giving a reflection of the common practices
which can be applied in healthcare setting. It enables the
facility to make a selection of the outcome measures related to
the occurrence, harshness, and the preventability of the outcome
proceedings. It is estimated that over 1.7 million patients are
suffering from the nosocomial infections in the United States.
The overall direct cost of infections to healthcare facility is
ranging between $ 28 billion to $ 45 billion.
Even though this range appears to be wider, healthcare
acquired infections seem to be expensive. Additionally, some of
these diseases are preventable; nevertheless, few healthcare
facilities are still faced with the problem of controlling the
issue. Therefore, identification of the gap with regard to the
control of healthcare acquired infections is important in
reducing its rate thus helping the nation and healthcare facilities

to reduce the expenditures on treatment of the patients with
nosocomial infections. The increased expenditure by the clients
or the government is also associated with longer stay in the
hospital due to the re-infection (Stone, 2017). Purpose of this
study
This study is therefore aimed at investigating the
knowledge as well as the routine practices aimed at preventing
of the hospital associated infection and its associated factors of
preventing infection amongst healthcare providers. The outcome
of this study is important towards development and
implementation of the policies to help in addressing the existing
gaps that is present in addressing issues of hospital associated
infections.Research Questions
This study will be guided by the following questions to help in
meeting the objectives or the purpose of the study. These
questions include:
· What are some of the prevention practices in place to help in
the control of healthcare acquired infections?
· What is the knowledge of the healthcare providers with regard
to the prevention and control of healthcare acquired infections?
· What are the associated factors with the knowledge of
healthcare providers regarding the infection prevention?
Masters Essentials aligned with the topic
One of the most important essential with regard to the
process of preventing nosocomial infections is the quality
improvement and safety. Improvement in the quality of
healthcare services as well as safety of the patients is an
ongoing process within every department of the hospitals. It is
important for the mastered prepared nurse to have the ability of
articulating the techniques, equipment, the performance of
measures, culture of the safety values, and the standards related
to quality, and should be prepared to use quality principles in
the organization. It also requires nurses to be an agent of
change. The issues of hospital associated infections are
becoming a major concern in many healthcare facilities. In
order to overcome the challenges faced in ensuring that there is

minimization of nosocomial infections, joint effort is required
from both healthcare providers particularly nurses who are
continuously interacting directly with the nurses to help in the
reduction of the issue. Joint forces are needed to have a change
in the practice as well as share the knowledge needed to help in
reducing healthcare acquired infections.
Another important essential is the health policy and
advocacy. There is a continuous change in the healthcare sector
and this is influenced by the technological, economic, political,
and the social-cultural aspects. Graduate master’s degree
nursing program is having a requisite knowledge as well as
skills needed towards promotion of health, helping in shaping
the healthcare delivery, and the advancement of the values such
as social justice through processing of policies processes and
advocacy. As advocates, it is the responsibility of healthcare
providers such as nurses to ensure that there is a change in the
way through which the issue nosocomial infections are dealt
with. Nurses and other healthcare providers need to look for
alternative approaches through advocating for the new policies
and incorporate them into healthcare system within the
organization. Nurses have to be responsible towards making an
improvement to the quality of healthcare delivery through
understanding the political determinants of the system as well
as using the knowledge learned in the class work to advocate for
the change in the healthcare provision policies related to the
prevention of hospital associated infections.
Collaboration towards making an improvement to the
patients and population healthcare outcomes is another
important essential. Healthcare providers must work together
towards ensuring that the implementation processes of the new
policies related to the prevention of infection is achieved.
References

223-227.
465.
Resist, 11, 2321-2333.
16 (3), 149-153.
Outcomes Res, 9 (5), 417-422.

Phase 1 Infection Prevention
Feedback
Excellent paper, you provided an in-depth background on the
selected topic (infection prevention). You followed the provided
instructions and highlighted the importance of conducting this
research as well as the necessity to do it. The purpose of the
research was clearly stated, and you provided great research
questions. However, for this class only select one research
question and make sure to narrow your study to a specific
population. Please make the necessary changes for the final
paper.
Phase 2 Design
Feedback
Hello Good description, you provided an excellent description
of different articles related to the topic. Your literature review
is clear and well organized. You followed the instructions of the
assignment and provided a description of the method and
sample selection in a clear and transparent way. APA is
appropriate. Good overall paper, enjoyed the graphics.
Implementation Phase 3
Feedback
Hello Great job highlighting the steps necessary to implement
your project. You accentuated, all the different sections,

including a timeline as recommended by the assignment
instructions. APA is adequate
Phase 4 Results
Hello Good description of the results phase. You provided
specific information regarding the overall result of the project
following the assignment's instructions. However, there were
multiple errors in regard to APA , specifically on the lack of
citation utilized in the text and table formation.
Running head: RESEARCH PAPER
1
RESEARCH PAPER 15
Phase # 4 Results
Infection Prevention
Results Socio-demographics features of the research population
Infection prevention is amongst the challenges
faced in many healthcare institutions in the entire world. This
study assessed the knowledge, practice, and associated factors
aimed at reducing or preventing healthcare-acquired infections
among healthcare workers. In this particular study, a total of
250 healthcare professionals were interviewed and yields a
response rate of 95 percent majorities. There were many
individuals i.e. 150 (60 percent) were in the age bracket of 26 to

3o years old. The majority of the respondents were from
Orthodox Christianity at 72 percent of the population. A higher
percentage of the individuals who participated in this study was
diploma holders at 40 percent (100 participants).
Overall, based on this particular study, it is clear that
the majority of healthcare providers were knowledgeable about
the prevention of healthcare-acquired infections. Many of these
healthcare providers were having sufficient knowledge required
to make a contribution towards helping in reducing healthcare-
acquired infections. This study, therefore, shows that the
outcomes are in line with many other research works which
have shown that healthcare providers are knowledgeable enough
to help in the prevention of infection; nevertheless, the issue of
controlling or preventing such infection is affected by the
attitudes or the socio-demographic factors or lack of adequate
resources to accomplish this mission.
.
Variable
Frequency
Percentage
Age
20 to 25
80
32%
26 to 30
150
60%
Over 31 years
20
8%
Sex
Male
150

60%
Female
100
40%
Marital Status
Single
140
56 %
Married
110
44%
Religion
Muslim
30
12%
Orthodox
180
72%
Protestant
40
16%
Educational Status
Master and Above
80
32 %
Bachelors
70
28 %
Diploma
100

40 %
Work Experience
Over five years
170
68%
5 to 10 years
70
28%
Over 10 years
10
4%
Profession
Physician
30
12%
Nurse
82
32.8%
Midwifery
60
24%
Health officials
18
7.2%
Laboratory Technician
40
16%
Other healthcare providers
20

8%
Involved in the training
Yes
90
36%
No
160
64%
There is availability of IP guideline
Yes
100
40%
No
150
60%
Knowledge concerning the infection prevention
In this particular study, a total of 220 (88 percent)
and 210 (84 percent) believed that healthcare-acquired
infections are prevented using disinfection and antiseptic
respectively. A total of 190 respondents (76 percent) believed
that equipment requires the process of decontamination prior to
the sterilization procedure. More than half of the participants
(56 percent) are not well informed regarding the [preparation of
0.5 percent of chlorine solution.
Variables
The level of knowledge
Frequency
Disinfection is helpful in the prevention of the acquired
infections
Ye
220
88 %

No
30
12%
Antiseptic is helping in the prevention of healthcare-acquired
infection
Yes
210
84%
No
40
16%
The is sterilization of the equipment using chemical
Yes
100
40%
No
150
60 %
There is physical sterilization of equipment through the use of
heat and radiation occasionally
Yes
70
28 %
No
180
72%
All pathogens are destroyed through autoclaving
Yes
170
68%
No

80
32%
There is a decontamination of equipment before the sterilization
process
Yes
190
76%
No
60
24%
Protective devices are important when it comes to the reduction
of the infections
Yes
185
74%
No
65
26%
Wearing of gloves is used as a replacement of hand washing
Yes
90
64%
No
160
36%
There is a preparation of o.5 percent chlorine solution
Yes
110
44%
No
140
56%

There is the use of PEP for HIV after being exposed to blood
Yes
230
92%
No
20
8%
The practice of healthcare providers in an effort to prevent
healthcare-acquired infections
In this particular study, the percentages of the
healthcare providers believed it was important to wash hand
before starting to provide healthcare and after completion of
healthcare provision were 140 (56 percent) and 200 (80 percent)
respectively. There was almost equal proportional with regard
to the number of respondents who said there is use of soap to
wash the hands before patient care i.e. 120 (48 percent) and the
individuals who believed that there was no washing of the hands
after provision of healthcare services i.e. 130 (52 percent) based
on the responses given by the study participants, majority of the
respondents believe that there is no use of any type of
protective equipment such as mask, gloves, and gowns among
others. Only 42 participants (16.8) believed that there is the use
of personal protective equipment.
The length of working experience is associated with
the knowledge score based on the outcome of this study.
According to the result of the study, healthcare providers who
have been in the medical field for not less than ten years are
more likely to be knowledgeable about the issues related to the
prevention programs. The increase in the knowledge in relation
to the number of experience is likely to be related to the
increase in the number of years of practice which increases
exposure to different healthcare settings. Such healthcare
providers are exposed repeatedly and are becoming more
experienced through interacting and taking part in working with

senior healthcare providers.
Variable
Response
Figures
Frequency
There is washing of the hands using soap before prior to the
start of healthcare
Yes
140
56%
No
110
44%
There is a habit of washing hand using soap after providing care
to the patient
Yes
200
80 %
No
50
20%
There is washing of the hands without soap prior to or after
patient care
Yes
120
48%
No
130
52 %
There is the use of all categories of personal protective
equipment
Ye
42

16.8
No
208
83.2
Aspects related to the knowledge of the healthcare professionals
regarding the issue of preventing healthcare-acquired infections
Some of the major factors which were associated with
the knowledge in relation to the healthcare-acquired prevention
included age, education attainment, the work experience of the
healthcare providers, sex of the respondents, profession, and
training received in relation to the techniques used in the
prevention of healthcare-acquired infections. Healthcare
providers who are over 31 years were three times more
knowledgeable as compared to individuals or healthcare
providers whose age bracket was 21 to 25 years. Male
healthcare employees were twice likely to be more
knowledgeable as compared to their female counterparts.
This study also reveals that the working experience
strongly influenced the practices towards prevention of
healthcare-acquired infections. Individuals with experience of
more than ten years of work within healthcare sector were four
times likely to possess the knowledge required to help in the
control or prevention of healthcare-acquired infections as
compared to individuals or healthcare provider who had work
experience of fewer than five years in the field of healthcare.
This study also indicates that the level of education
greatly impacted on the knowledge acquired to help in the
prevention of healthcare-acquired infections. In this case,
healthcare providers whose education level was in the Master
level or above Masters level were more knowledgeable as
compared to other levels of education i.e. Bachelors and
Diploma. Healthcare providers with a master level of education
were thrice more likely to be knowledgeable about the issues
related to healthcare-acquired infections. Healthcare workers
with Bachelor level of education were twice more likely to be

more knowledgeable as compared to the healthcare providers
who had a diploma level of education.
The infection training program is also playing an
important role in increasing the level of experience and
knowledge required to help in the reduction of healthcare-
acquired infections. Healthcare providers who have not yet
received training on the techniques required towards prevention
and control of healthcare-acquired infections are less
knowledgeable about the infection prevention as compared to
those who had undergone through the training program related
to the prevention of healthcare-acquired infection. The result
from this study indicating that healthcare providers with higher
education appear to be having more knowledge score as
compared to the low educational level is an indication that these
healthcare providers have acquired more educational
information related to the prevention of healthcare-acquired
infections. Limitation of the study
Healthcare-acquired infections are considered to be a
very broad topic, therefore, it has not been possible to cover all
aspects of the healthcare-acquired infections in this one
research paper. This, therefore, implies that I have been
selective in choosing the major factors in the present argument
with regard to the healthcare-acquired infections which is
causing major concern in the public healthcare sector. Another
limitation of this study is that it was restricted to a specific
healthcare facility.
This, therefore, implies that it does not reveal the real
situation in the entire world, however, it shows that the clear
picture of what is happening in a major healthcare facility in
relation to the lack of knowledge, poor practices, and other
factors such as socio-demographic aspects. These factors are
considered to be playing a major important role in with regard
to the issue of healthcare-acquired infections. Another
limitation in this study is that it was specifically restricted to
the healthcare providers as the key individuals who are playing
a role in the increase in the reduction or increase in the

healthcare-acquired infections. Even though patients are
contributing to the spread of healthcare-acquired infections this
study was mainly focused on the healthcare providers as the
major key players that can be targeted with policies aimed at
controlling healthcare-acquired infection in many healthcare
facilities.
References
223-227.
465.
Resist, 11, 2321-2333.
16 (3), 149-153.
Outcomes Res, 9 (5), 417-422.

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