Dissertations / Theses on the topic 'District Base Hospital'

China has the largest population and the fastest growing economy in the world. The general public's demand for health is rising promptly with the improvement of the living standard. However, the limited and unbalanced medical resource have caused the prominent problem of the society, even in the capital city of Beijing, the new hospital constructions with rational allocation is iminent and significant. Along with the technology development and Internet popularization, GIS approaches and related products has been widely used in the people's daily life. The main focus of this paper is to select a site for building a new hospital in Haidian District of Beijing using GIS-based Multi-Criteria Analysis (MCA). With Analytical Hieraichy Process(AHP) and Rank Order Method (ROM) for the weight setting on factor criteria, necessity tests and sensitivity tests are applied to check which criteria are really necessary and how the results are sensitive to their weight change. The optimal site located in Wenquan Town (E: 116.182, N:40.039) is screened from several candidate sites usin Google Earth maps, which makes the ultimate result more convincing and practical. It can be concluded that GIS-based MCA with necessity and sensitivity tests proposes a novel and useful reference to other site selection decision makers, and also provides constructive tools for the public asministration to set up efficent databases for decision makers to carry out spatial analyses. To make it more maneuverable and practical, a further research on th improvement of this method will have a promising future.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, 2014.
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O Brasil e o mundo enfrentam um cenário epidemiológico, demográfico e econômico dinâmico que sugere grandes desafios para os sistemas de saúde, especialmente os públicos e universais. O crescimento e a agudização das doenças crônicas não-transmissíveis e a perda prematura de pessoas jovens por acidentes e violências são problemas que exigem a configuração de um modelo de atenção centrado. Neste sentido, o Ministério da Saúde junto aos estados e municípios vem trabalhando desde 2010 na implantação de redes de atenção à saúde, no intuito de superar a gestão e a atenção fragmentadas. O presente estudo teve como objetivo geral analisar a inserção do Hospital de Base na Rede de Atenção às Urgências e Emergências no Distrito Federal, e como objetivos específicos caracterizar o HBDF no SUS, caracterizar o serviço de pronto-socorro, Centro de Trauma, deste hospital no SUS, bem como descrever a aplicação dos critérios de qualificação desse serviço enquanto porta de entrada hospitalar de urgência e emergência prioritária. A coleta de dados se deu através de informações secundárias dos sistemas oficiais do Ministério da Saúde e do hospital em questão e da aplicação de questionário com gestores e trabalhadores do serviço de prontosocorro e do Centro de Trauma, porta de entrada dos usuários graves. Os dados coletados foram analisados devidamente considerando a triangulação utilizando-se a técnica de análise temática. Conclui-se que há desconhecimento dos profissionais de saúde participantes do estudo quanto à inserção do hospital na Rede de Atenção às Urgências e Emergência do Distrito Federal; a alta demanda de usuários e definição de fluxos assistenciais e pactos na rede incipiente; a aplicação parcial dos critérios estabelecidos pelo Ministério da Saúde; o pouco investimento na educação permanente em saúde dos trabalhadores; boas práticas em relação à regulação de urgências e emergências pelo SAMU; e, o anseio dos gestores pela efetivação do trabalho em rede. Assim, o processo de inserção do hospital estudado na rede de atenção às urgências e emergências no Distrito Federal acontece de forma lenta e gradual, porém esta ação está presente nos anseios dos gestores e trabalhadores do serviço de prontosocorro e do Centro de Trauma do hospital, por isso deve ser geradora de mobilização para a mudança e para a efetivação da rede de atenção à saúde. __________________________________________________________________________ ABSTRACT
The Brazil and the world face a dynamic epidemiological, demographic and economic scenario suggests major challenges for health systems, especially public and universal. Growth and worsening of chronic non-communicable diseases and premature loss of young people from accidents and violence are problems that require the setting of a model of focused attention. In this regard, the Ministry of Health with states and municipalities has been working since 2010 on the establishment of networks of health care in order to overcome the management and fragmented attention. The present study had as main objective to analyze the insertion of the Base Hospital Network Emergency Care and Emergencies in the Federal District, and characterize the specific objectives HBDF in SUS, characterizing the service emergency room, trauma center, this hospital the SUS, as well as describe the application of eligibility criteria that service while hospital entrance door of urgency and priority emergency. Data collection occurred through secondary information systems officers from the Ministry of Health and the hospital concerned and a questionnaire with managers and workers of the emergency services and trauma center, a gateway for serious users. The collected data were analyzed with due regard to triangulation using the technique of thematic analysis. We conclude that there is a lack of health professionals participating in the study as the insertion of the hospital in the Network Emergency Care and Emergency Federal District; the high demand of users and defining care flows and covenants in incipient network; partial application of the criteria established by the Ministry of Health; little investment in continuing education in health workers; good practice in relation to the regulation of the SAMU emergency care; and the desire of managers for effective networking. Thus, the insertion process studied in the care network to emergency care in Federal District hospital happens slowly and gradually, but this action is present in the anxieties of managers and workers of the emergency services and trauma center's hospital, so it should be generating mobilization for change and for the effectiveness of the health care network.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, Pós-graduação em Medicina Tropical, 2017.
Texto parcialmente liberado pelo autor. Conteúdo liberado: resumos, referências e apêndices.
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A sífilis é uma doença infecto-contagiosa de transmissão sexual e vertical. Nos últimos anos, sua incidência vem aumentando em gestantes, recém nascidos, homens que fazem sexo com homens e em portadores do HIV. A sífilis pode ser classificada em estágios segundo o tempo de infecção e as manifestações clínicas. O acometimento ocular e do sistema nervoso central pode ocorrer em qualquer fase da doença. O diagnóstico da sífilis é realizado atráves da associação de dados clínicos, epidemiológicos e laboratoriais. Os pacientes devem ser atendidos na atenção básica, à exceção daqueles com manifestações graves. Este estudo propôs estudar o perfil clínico e epidemiológico dos pacientes atendidos no Hospital de Base do Distrito Federal. Objetivo: Descrever o perfil clínico e epidemiológico dos pacientes com sífilis atendidos no Hospital de Base do Distrito Federal no período de1º de janeiro de 2012 a 31 de dezembro de 2015. Métodos: Realizou-se um estudo descritivo baseado na análise dos dados clínicos, epidemiológicos e laboratoriais contidos nos prontuários. Resultados: Foram avaliados 191 pacientes atendidos nos ambulatórios, enfermarias e na emergência. A maioria (79,58%) era proveniente do Distrito Federal. A idade média foi 48 anos, com predomínio do sexo masculino (66,49%). A sífilis latente tardia representou 110 (57, 59%) casos; sífilis primária 8 (4,2%); sífilis secundária 4 (2,1%) e a sífilis latente recente 3 (1,57%) casos. A infecção pelo HIV estava associada em 54 (28,27%) pacientes. A sífilis ocular foi diagnosticada em 16 (8,37) casos e a neurossífilis em 12 (6,28%). Dos 153 (80,1%) pacientes com indicação de tratamento, somente 72 (47,05%) foram tratados. Discussão: A grande maioria dos pacientes foi diagnosticada como portadora de sífilis latente tardia, principalmente devido baixa qualidade dos dados relativos a sinais e sintomas da doença disponíveis nos prontuários. Pelo mesmo fato, em 81 (42,40%) pacientes não apresentavam nenhum registro de tratamento nos prontuários e prescrições médicas. Entre os pacientes sem dados relativos ao tratamento, dois tinham neurossífilis e cinco sífilis ocular. Conclusão:.As limitadas informações relativas a sinais, sintomas e ao tratamento da sífilis foram determinantes para o elevado número de pacientes com diagnóstico de sífilis latente tardia. A excassez de dados comprometeu de forma importante a avaliação do perfíl clínico dos pacientes da instituição e evidenciou fragilidades no atendimento dos pacientes com sífilis.
Syphilis is an infectious disease sexual and vertical transmission. In recent years, its incidence has been increasing in pregnant women, newborns, men who have sex with men and people with HIV. Syphilis can be classified in stages according to the time of infection and clinical manifestations. Ocular and central nervous system involvement may occur at any stage of the disease. The diagnosis of syphilis is made through the association of clinical, epidemiological and laboratory data. Patients should be cared for in basic care, except for those with severe manifestations. This study proposed to study the clinical and epidemiological profile of the patients attended at the Base Hospital of the Federal District. Objective: To describe the clinical and epidemiological profile of patients with syphilis attended at the Base Hospital of the Federal District from january 1, 2012 to december 31, 2015. Methods: A descriptive study was conducted based on the analysis of the clinical, epidemiological and laboratory data contained in the medical records. Results: A total of 191 patients attended at outpatient clinics, hospitalization room and in the emergency room were evaluated. The majority (79.58%) came from the Federal District. The mean age was 48 years, with a predominance of males (66.49%). Late latent syphilis represented 110 (57, 59%) cases; primary syphilis 8 (4.2%); secondary syphilis 4 (2.1%) and recent latent syphilis 3 (1.57%) cases. HIV infection was associated in 54 (28.27%) patients. Ocular syphilis was diagnosed in 16 (8.37) cases and neurosyphilis in 12 (6.28%). Of the 153 (80.1%) patients with indication of treatment, only 72 (47.05%) were treated. Discussion: The vast majority of patients were diagnosed as having latent late syphilis, mainly due to poor quality of data regarding signs and symptoms of the disease available in the medical records. By the same fact, in 81 (42.40%) patients did not present any records of treatment in medical records and prescriptions. Among the patients with no treatment data, two had neurosyphilis and five ocular syphilis. Conclusion: Limited information on signs, symptoms and treatment of syphilis were determinant for the high number of patients diagnosed with latent late syphilis. The lack of data significantly compromised the evaluation of the patients' clinical profile and showed weaknesses in the care of patients with syphilis.

O maior consumo de concentrados de hemácias está relacionado a pacientes que enfrentam procedimentos cirúrgicos. A solicitação de reserva de concentrados de hemácias para cirurgia em quantidades muito além do necessário sobrecarrega a Agência Transfusional, configura desperdício de recursos humanos, danos ao erário e prejuízo ao paciente, haja vista que muitos hemocomponentes são reservados para cirurgias, mas poucos são utilizados. A dificuldade no transporte e armazenamento dos hemocomponentes em condições adequadas fora da Agência Transfusional é fato que agrava essa situação e aumenta o desperdício, pois muitos hemocomponentes são solicitados, não são utilizados e retornam ao Serviço de Hemoterapia sem condições de serem reintegrados ao estoque. Tendo em vista que o Hospital de Base do Distrito Federal é a unidade hospitalar com o maior quantitativo em solicitação de reservas de concentrados de hemácias, e por ser recomendável que cada Serviço de Hemoterapia desenvolva seu protocolo específico e personalizado, o objetivo desse estudo é criar um manual de reserva de concentrados de hemácias para procedimentos invasivos, com o quantitativo de hemocomponentes a serem reservados para cada tipo de cirurgia, visando promover o uso racional do sangue no referido hospital. Para isso foi realizado um levantamento dos dados de cirurgias realizadas no Hospital de Base do Distrito Federal nos meses de fevereiro a julho de 2015. Em cada cirurgia foi analisado se houve solicitação e utilização de reserva de hemocomponentes. Com os dados obtidos foi calculado o índice de pacientes transfundidos para cada tipo de cirurgia, sendo confeccionado o manual, que consiste em um quadro com a conduta hemoterápica a ser adotada em cada tipo de cirurgia, se nenhuma, ou realização de tipagem e pesquisa de anticorpos irregulares, ou realização de prova de compatibilidade e reserva de concentrado de hemácias. Foi calculada a quantia aproximada de recursos com insumos que seria economizada caso fosse adotada a conduta sugerida no ano estudado. Para que o manual seja efetivamente aplicado tanto no momento de realizar a solicitação da reserva quanto no momento de preparar a reserva, deve haver uma sistemática de implantação do manual no ambiente hospitalar, com orientações quanto ao correto preenchimento do tipo de cirurgia no mapa cirúrgico e na requisição de reserva ao Banco de sangue. É importante a reavaliação periódica e comparação das solicitações de reservas de concentrados de hemácias para cirurgias eletivas com o cenário do ano anterior. O sucesso na implementação deste manual depende da compreensão e colaboração de uma equipe multidisciplinar de cirurgiões, anestesistas e colaboradores da Agência Transfusional.
Optimizing blood ordering and transfusion has been largely discussed because of patient\'s safety and money constraints. The highest use of red blood cells in a hospital is related to surgical procedures. The preoperative blood order in quantities much higher than necessary, overloads the Blood bank, which configures wasted human resources, wasted public resources and can cause injury to the patient. In most hospitals many blood components are reserved for surgeries, but few are used. The difficulty in transporting and storing the blood components in suitable conditions outside the Blood bank aggravates this situation and increases the costs. Many blood components are requested but not used and return to the blood transfusion service without conditions to be reintegrated into the stock. Considering that Hospital de Base of the Federal District Brazil is the one with the highest quantity of preoperative crossmatching orders in our state, the purpose of this study was to create a maximum blood ordering schedule (MBOS) for elective surgeries. MBOS has been established since 1977 and should be based on recommendation that each hospital may develop for its specific needs. This MBOS should recommend the maximum packed red blood cell quantity to be reserved for each type of surgery, aiming to promote the rational use of blood in the hospitals. For that, a survey of the data of surgeries performed at the Hospital de Base was carried out from February to July 2015. For each surgery, we analyzed if there was a request and use of a packed red blood cell. With the data obtained, the index of patients transfused for each type of surgery was calculated, and the manual was elaborated, consisting of a chart with hemotherapy decision to be adopted in each type of surgery. The manual included 3 types of recommendations for blood bank staff: none, type and screen only, or crossmatch units of packed red blood cells. The approximate amount of resources that would be saved if the suggested strategy were adopted in 2015 were also calculated. The idea is to have a systematic implementation of the manual in the hospital considering the moment of ordering blood products and the moment of adopting the strategy proposed at the blood bank. Some improvements are needed such as guidelines with suggestions including the complete and accurate filling of the surgical map (exact type of surgery) and implementation of a better blood ordering system with more information about patients and surgeries. This kind of manual most be reviewed periodically since surgical procedures can change over time with new techniques been included in the therapeutic strategies. The success in implementing this manual depends on the consent and collaboration of a multidisciplinary team including surgeons, anesthesiologists, and blood bank staff.

Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, 2011.
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A leucemia mielóide crônica é doença mieloproliferativa crônica, caracterizada pela presença do cromossomo Filadélfia, que é o resultado da translocação balanceada entre os cromossomos 9 e 22. A conseqüência molecular desta translocação é a formação de um gene híbrido BCR-ABL, que codifica uma proteína quimérica com atividade tirosina quinase, diretamente implicada na patogênese da doença. O mesilato de imatinibe (Glivec®) é um inibidor seletivo dessa enzima. O presente estudo realizou uma análise descritiva, observacional e retrospectiva de pacientes atendidos no ambulatório de Hematologia do Hospital de Base de Brasília, no período compreendido entre maio de 2002 a abril de 2009 e teve como objetivo, avaliar a eficácia do tratamento com mesilato de imatinibe como opção de primeira linha, em portadores de leucemia mielóide crônica em fase crônica, através das respostas hematológica e citogenética, assim como pela avaliação de desfechos de longo prazo, como a sobrevida global e sobrevida livre de progressão para fases mais adiantadas da doença. Cento e cinco pacientes foram elegíveis, sendo que 98 (93,3%) deles, em fase crônica precoce, isto é, menos de um ano entre diagnóstico e início do tratamento. Cinquenta e cinco (70,5%) de 78 pacientes foram classificados como de risco intermediário ou alto risco, de acordo com o escore prognóstico de Sokal. A taxa de resposta hematológica foi de 96,4% ao longo do estudo. Aos doze meses, as respostas citogenéticas maior e completa foram de 71,7% e 65,9%, respectivamente, enquanto aos 48 meses, de 83,7% e de 80,5%, respectivamente. A resposta molecular maior apresentou taxa crescente de resposta acumulada, chegando a 59,5% aos 48 meses. A sobrevida global foi de 92,1% aos 48 meses, com 89,3% dos pacientes apresentando sobrevida livre de progressão para fases mais avançadas da doença, no mesmo período. A resposta citogenética maior aos 12 meses correlacionou-se, significativamente, com a sobrevida global (p = 0,010) e com a sobrevida livre de progressão (p = 0,032). Não houve diferenças significativas nas taxas de resposta citogenética completa aos 12 meses (p = 0,592), na sobrevida global (p = 0,489) e na sobrevida livre de progressão (p = 0,306), de acordo com o escore prognóstico de Sokal. A dose utilizada foi de 400mg ao dia, em média. A medicação foi bem tolerada, com apenas 2 (1,9%) dos pacientes mostrando toxicidade hematológica graus 3 – 4. A mediana de seguimento foi de 23 meses (variação de 3 a 97 meses). Ao término da avaliação 73 (69,5%) dos pacientes ainda faziam uso do mesilato de imatinibe e 32 (30,5%) tinham descontinuado a medicação, sendo que 18 (17.1%), por resposta insatisfatória. O tratamento de pacientes portadores de Leucemia Mielóide Crônica em fase crônica, com mesilato de imatinibe, proporcionou taxas de respostas inferiores às dos principais estudos clínicos, mas relacionou-se com sobrevida livre de progressão e sobrevida global em significativa proporção de pacientes. Seguimento por tempo mais prolongado será necessário para melhor avaliação dos desfechos de sobrevida, dado o relativo curto período de observação. ______________________________________________________________________________ ABSTRACT
Chronic myeloid leukemia is a myeloproliferative disorder characterized by Philadelphia chromossome, which is the result of a balanced translocation between chromosomes 9 and 22. The molecular consequence of this translocation is a hybrid BCR-ABL gene, which encodes a chimeric protein with tyrosine kinase activity, directly implicated in the pathogenesis of the disease. Imatinib mesylate (Glivec®) is a selective inhibitor of such protein. This was a descriptive, observational and retrospective analysis of patients in Hospital de Base, Brasília-Brazil, followed from May 2002 to April 2009. The aim was to assess the efficacy of imatinib mesylate as front-line therapy in chronic-phase chronic myeloid leukemia patients, with hematologic and cytogenetic response, as well the long-term outcomes, such overall survival and progression-free survival to later stages of the disease. One hundred and five patients were eligible and 98 (93.3%) were in late chronic-phase, that is, less than one year, from the start of therapy. Fifty-five (70.5%) out of 78 patients were in intermediate or high risk group of Sokal score. The hematologic response rate was 96.4% at any time during the observation period. The cumulative rates of major and complete cytogenetic responses at 12 months were 71.7% and 65.9%, respectively, while at 48 months, they were 83.7% and 80.5%, respectively. Molecular response rate improved slowly and steadily over time, reaching 59.5% at 48 months. The 4-year overall survival and progression free survival rates were 92.1% and 89.3%, respectively. Cytogenetic response by 12 months significantly correlated with overall survival (p = 0.010) and progression-free survival (p = 0,032). There were no significant differences in the rates of complete cytogenetic response at 12 months (p = 0.592), in overall survival (p = 0.489) and in progression free survival (p = 0.306), according to Sokal risk score. The dose of imatinib was 400 mg daily on average and the drug was well tolerated, with only 2 (1.9%) patients showing hematological toxicity grades 3-4. The median follow-up was 23 months (range 3 – 97). At the end of the evaluation 73 (69.5%) of patients were still using imatinib mesylate and 32 (30.5%) had discontinued the medication, eighteen (17.1%) for unsatisfactory response. Treatment with imatinib mesilate as frontline therapy in chronic-phase chronic myeloid leukemia patients, induced lower response rates than published data, but was related to satisfactory rates of survival and event-free survival. Best analysis of long-term outcomes requires extended follow-up, given the short observation period.

Includes abstract.
Includes bibliographical references.
The primary aim of this research was to compare the impact of a six-week facility-based therapeutic group (FBTG) programme with that of usual care on weight loss and reduction in BMI in obese patients with one or more risk factors for the development of NCDs or existing NCDs, attending a district hospital in the Cape Metropole.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, Pós-graduação em Medicina Tropical, 2017.
Texto parcialmente liberado pelo autor. Conteúdo restrito: Conclusão e apêndice.
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Introdução: os óbitos por dengue têm sido bastante estudados, porém não se conhece suficientemente bem todos os fatores associados a esses óbitos.Objetivo: identificar os fatores associados à mortalidade por dengue no Distrito Federal no período de 2007 a 2015. Métodos: estudo epidemiológico descritivo e analítico tipo caso-controle, de base hospitalar, de 71 óbitos por dengue ocorridos no Distrito Federal, Brasil, entre janeiro de 2007 e dezembro de 2015. O grupo de casos (pacientes que tiveram dengue com pelo menos um sinal de alarme, internados na rede pública ou privada do DF e evoluíram para óbito), foi comparado com o grupo controle (pacientes que tiveram dengue com pelo menos um sinal de alarme, internados na rede pública ou privada do DF e que sobreviveram). Casos e controles foram confirmados por critério laboratorial. As informações foram coletadas a partir de prontuários médicos, sendo analisadas, entre outras, algumas variáveis relacionadas à qualidade da assistência médica. Utilizou-se a regressão logística para a identificação dos fatores associados aos óbitos. A regressão logística multivariada foi realizada utilizando-se a análise de variância (ANOVA) do modelo completo, empregando-se, posteriormente, o teste qui-quadrado. Resultados: as seguintes variáveis foram selecionadas: “idade maior que 45 anos”, “presença de diabetes”, de “hipertensão arterial sistêmica”, de valores de “uréia maiores que 50 mg/dl”, de “leucócitos menores ou iguais a 4.000/mm3”, “tempo entre o início dos sintomas e o primeiro atendimento maior ou igual a 3 dias” e “percorreu três ou mais serviços de saúde”. Conclusões: as variáveis selecionadas foram consideradas fatores importantes para a ocorrência dos óbitos por dengue no Distrito Federal. Sugere-se a adoção de medidas nos serviços de saúde que garantam um atendimento mais adequado a esses pacientes.
Introduction: while there have been many studies about deaths by dengue, it is not well known all the risk factors associated with such deaths.Objective: to identify the risk factors associated with dengue mortality in the Brazilian Federal District during the period 2007 to 2015.Methods: a case-control, hospital-based, descriptive and analytical epidemiological study of 71 deaths from dengue in the Federal District, Brazil, occurred from January 2007 to December 2015.The case group (patients who had at least one warning sign, from the public or private hospital networks of Federal District, who died) was compared to the control group (patients who had at least one warning sign, from the public or private hospital networks of Federal District, who did not die). Cases and controls were confirmed by laboratorial criteria. The information was gathered by means of medical records, which were also analysed for quality of the medical service offered to the inpatients. Logistic regression was performed to identify the factors associated to the deaths. Multivariate logistic regression was performed using the analysis of variance (ANOVA) of the complete model, the chi-square test being used aftwerwards. Results: the following variables were selected: "age greater than 45 years", "presence of diabetes", "systemic arterial hypertension", "urea values greater than 50 mg / dl", "leukocytes less than or equal to 4,000 / mm3 "," time between onset of symptoms and first care greater than or equal to 3 days "and" went through three or more health services”. Conclusions: the selected variables were considered important factors for the occurrence of dengue deaths in the Federal District, Brazil. It is suggested to adopt measures in the health services that guarantee a more adequate care for these patients.

Thesis (Dr.P.H.)--Boston University
BACKGROUND: The potential of hospital performance measurement (HPM) to contribute to improved quality of care and patient outcomes is underrepresented in the health system strengthening literature and no standardized HPM instrument exists for hospitals in developing countries. The problem centered Participatory Action Research (PAR) approach is particularly suited to addressing complex organizational problems in low resource settings and is gaining acceptance as an applied research method in healthcare settings. METHODS: This quasi-experimental study using the PAR approach was carried out in 4 hospitals in Cameroon. Quantitative (415 surveys) and qualitative (129 interviews and 77 observations) methods examined how participating in the design of a HPM instrument influences health personnel's knowledge, attitude, interest, and intention to continue use of performance measurement for quality improvement. Changes in scores for the above outcomes from before and after implementation of the performance indicators were compared to scores from a non-participating control hospital at the same time points. RESULTS: Personnel designed and pilot tested performance measurement indicators in all hospital services. Hospitals that actively participated in instrument design showed a statistically significant increase in HPM knowledge and attitude, and were more likely to report intention to continue using HPM as compared to the non-participating hospital. Hospital personnel participating in the design process were more aware of the workload barriers to implementing HPM but nonetheless were more motivated to continue the HPM effort. In addition, the PAR approach fostered ownership, increased skills, raised awareness of performance gaps, and led to a contextually appropriate tool. CONCLUSIONS: The results of this study demonstrate the feasibility of designing and implementing an HPM instrument in a low-resource health care system and highlight the positive benefits of the PAR approach. Further research is needed to determine the effect of regular HPM on quality of care and its sustainability over time in resource constrained settings.

碩士
國立臺灣大學
會計學研究所
92
The trend of the development of Taiwan healthcare industry is following the change of managed care system. Since the National Health Insurance (NHI) has dominantly controlled the redistribution of the healthcare resource, the reimbursement for hospitals is getting more inadequate than before. The referring system of NHI is failure so that the traditional pyramid form of healthcare network has been dissociated. The medical centers at the top level are getting bigger and bigger. They are not only doing the R&D and intensive care but also the primary care that is originally belonging to the district hospitals’ duty. According to the new global budget policy of NHI, the yearly growth rate of the health care system is limited within 4%. It is such a business crisis that the district hospitals at the middle level of the system have to deal with. Several steps have been done by hospitals for the changing of the external environment. Internally, the hospitals pay more attention to cost control, administrative management and flexibility, continue quality improvement, competitive advantage, medical informatics, and the segment of non-insurance payment services. Externally, they are looking for horizontal and/or vertical integrations, strategic alliances and portfolio investments. Take it for granted; the resource of the private district hospitals is in short supply. The strategic revolution of hospital management is going on and on. Systems or networks are being formed continually in Taiwan. We would like to know if any strategic choice for governance mode of Taiwan-based private district hospitals could create a sustainable ability of trans-regional extension of the healthcare enterprise, even entering the healthcare market of Mainland China. Three private district hospitals in Taoyuan County have been chosen purposely as materials in this case study. Deep interviews have been arranged to the top manager in each hospital. Through the interviews, the strategic choices, drivers and governance modes have been detected. The results of the observation are explained and analyzed with the review literatures. All of those hospitals have different strategic choices and governance modes. The hospital, which has a strategic alliance with a medical center, totally reserves its unified ownership and independent organization. The driver for change is induced by shortages of skills. The character of this kind of strategic alliance is in short term and conservative contracting. The other hospital emphasizes value added. Using the concept of centralization, it wants to integrate the resource within its system. The driver for change is induced by quality improvement. It is classified as a system with unified ownership. The last hospital follows the financial leadership. The driver for change is induced by cost containment. Its healthcare network of strategic alliance has been spreading around the whole country rapidly. Each unit preserves the ownership of its hospital. In the other words, the ownership of this kind of network is not unified but hybrid. They share the competitive advantage from cost down as well as the efficiency of professional or non-professional processing. Recently, This hospital is the first successful mover of Taiwan based hospitals extending its network to Mainland China. A suitable governance mode is probably one of the key factors of Taiwan-based private district hospitals not only the growing ability of system/network business locally but also the transnational healthcare business in Mainland China.

碩士
國立臺灣大學
醫療機構管理研究所
94
Objective The objectives of this study are to understand: (1) the characteristics of the district hospitals; (2) the management problems that district hospitals are facing currently; (3) the feasibility of developing hospital-based nursing home (4) the SWOT analysis of hospital-based nursing home (5) the key factors that have helped district hospitals transformed into nursing homes. Method This study has adopted in-depth interview of qualitative research in 2005 on three individuals who were CEO of district hospitals to discuss the management problems that the district hospitals are facing currently and whether the establishment of nursing home can be the solution. Subsequently, interview with two former health officers are supplemented to address the dilemma faced by district hospitals and broader viewpoints on the establishment of nursing home. Significant findings & conclusion The major dilemma faced by district hospitals: the difficulties of recruitment, the decreasing source of income from inpatients, the inadequacy of competitive advantages, the tightening of health insurance subsidy and the rigidity of evaluation standard. The strategies of district hospitals: the strategic alliance, the joint venture, the hospital-based nursing home, the joint outpatient service and collective purchase. The SWOT analysis for hospital- based nursing home: (1) Strengths (S) – the better hardware equipments, the outstanding emergent nursing quality, the flexible human resource allocation, the abundant medical resources and the professional nursing staff; (2) Weaknesses (W) – more medical disputes, worse atmosphere in hospitals, high turnover rate of nursing staff and higher charges; (3) Opportunities (O) – the increasing needs for sub-acute care, the rising medical treatment of chronic illness for elderly, the ageing needs and the social needs; (4) Threats (T) – keen competition in prices and demand for improving quality. Suggestions Policy and management: (1) The government should establish sub-acute care system and assist small-scaled hospitals to develop hospital-based nursing home, converting them into sub-acute care institutions, as well as consolidating their concepts of long-term care and reduce the minimum number of bed for acute illness from 20 to 10. (2) The Bureau of National Health Insurance should subsidize sub-acute care. (3) The district hospitals should improve their management quality to ward sub-acute residents from large-scaled hospitals to independent nursing home. Future study: (1) Conduct more interviews in district hospitals, large scale hospitals and independent nursing homes in the Northern cities or other cities in Taiwan to get a better understanding of whether there are cultural differences between the Northern cities and Southern cities, as well as participation and interaction among all levels of health care organizations; (2) investigate the number of potential sub-acute patients and using the results as references for assisting district hospitals to develop sub-acute care institution.

碩士
長庚大學
醫務管理學研究所
95
While facing financial difficulty due to policies set by the National Health Insurance program and intense market competition, and also confronting different reimbursement standards and increasingly stringent hospital accreditation, small scale hospital institutions are experiencing amplifying cost burdens, leading to the need of developing an effective system for evaluating cost management to prolong operation. Presently, the accounting structure the case hospital is using only calculate the amortization of each departmental levels instead of grasping detailed cost information of specific operational procedures within different departments, which might possibly lead to cross-subsidizing between them. This research employs the basis of activity based costing to confer the cost structure of a hemodialysis in a district hospital, and also compare the expenses and cost difference between conventional hemodialysis and high flux hemodialysis. The statistics obtained from the hemodialysis centre of year 2004 showed that the total number of dialysis done were 7,961 cases, of which, 61.5% of the cases were done by conventional hemodialysis and 38.5% were done by high flux hemodialysis. 1) Re-amortization of hemodialysis activity cost using activity based costing resulted in extra 538NTD compared to the original amortization method used by the accounting department. 2) Results also showed that even though the unit-price of the equipment used by high flux hemodialysis is higher than conventional hemodialysis, the equipment for high flux hemodialysis can be used repeatedly; therefore, the cost of high flux hemodialysis was lowered by 148NTD relative to the cost of conventional hemodialysis. The research proposes that: 1) the application of activity-based costing can provide a more reasonable and precise data of medical service costs. 2) Understanding the profit and loss of each medical procedure, which allows management to look for the best combination of products to improve the operational performance. 3) Carefully grasping the status of every department, medical entries, resource consumption, and analyze each detailed operational procedures to improve the allocation of resources. 4) The training and establishment of basic cost management concept is important for every medical personnel.

碩士
中國醫藥學院
環境醫學研究所
91
The purpose of this study is to research on the role play of contemporary community-based hospitals. By means of practical operation on community-based hospitals, the health of the people in the community can be promoted. For data collection, it adopts further qualitative research in-depth interview(Objects being interviewed are based on health administrative officers, practical administrative workers in the hospital, scholars in academic field, professionals, and the public people.) The content and purpose of this research include (1) Acknowledgement of interviewees to the meaning of community-based hospitals (2) Realization of role playing of the interviewed object in the community-based hospitals (3) Studying on services provided by community-based hospitals and possible resources assistance. The result of this study, as to acknowledgement aspect to the interviewees on community-based hospitals, we discover that there are classified into six viewpoints, including “Viewpoint on service items”, “Viewpoint of feedback to active concerns” “Viewpoint on relationship establishment”, “Viewpoint on function and features of community”, “Viewpoint of compensation on medical resources shortage area”, and “Viewpoint of marketing under emphasis”. The supporter of “Viewpoint on service items” was the most high one (approx. 40%). However, the reason of hospital have to step into community progressively, according to the viewpoints of the interviewees, it was classified into five categories: including “Based on demand for prevention on disorder”, “Relation to the existence of the hospital”, “To meet the demand of the public”, “”Based on duty feedback”, and “To close tight the relation and interact between each other”. Among them, “Based on demand for prevention on disorder” was supported by most of the supporters. The expectation of interviewees toward the role of community-based hospitals can be classified into 6 categories: including “Education consulting type”, “Health administration type”, “Policy operating type”, “Authority power operation change type”, “Resource integration type”, and “Communication interact type”. Among them, the role on “Education consulting type” was the most expectation. Moreover, the expectation of interviewees on service items of community-based hospitals can be classified into six categories: including “Services provided by 3-Step 5-Grade Prevention” “Services designed according to different objects”, “Establishment of public health data system”, “Holding the activities in the community”, “Stressing on communication and interaction”, “Providing medical preferential welfare”. The most expectation for interviewees on service items was “Services provided by 3-Step 5-Grade Prevention”. The expectation of the interviewees on service operating methods of community-based hospitals was classified into seven categories, including “Combination other groups to service simultaneously”, “Holding local demand to supply the services”, “United with appropriate occasion and sites”, “Making use of circulation media”, “United with festivals”, “Establishment a special organization for management”, and “Attracting the people to participate in with gifts”. Nevertheless, most of the interviewees expected that “Combination other groups to service simultaneously” was implemented to gather other organizations, or resources of other groups to supply the service with more powerful assistance. Furthermore, the organizations or groups resources for interviewees to seek for can be classified into 5 categories: including “Civil organization assistance”, “Governmental organization assistance”, and “Important key man and objects assistance”. Most of the interviewees consider that “Civil organization assistance” was the way to seek for. Finally, in accordance with the findings of this research, the researcher suggested that the Health Administration Dept. and hospital should set-up a special unit to in charge of, that special single window must be operated solely for the community-based hospitals. Moreover, Health Administration Dept. shall program well the good policies and encouragement methods for implementation of community hospitals to let medical resources not be wasted. While, the academic field shall take its role to educate people for solution and let people realize the content of hospital community as well as attend in progressively for better personal and community health. Key words: Community-based hospitals, Role play.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018.
Background: The World Spine Care (WSC) is a non-governmental organization that provides evidence-based spinal care to underserved communities around the world. The WSC opened a clinic in the Mahalapye District Hospital (MDH) in 2011 (Haldeman et al., 2015:2304). The WSC aims for long term presence in Botswana. They will require ‘buy in’ from the local community including the health care professionals of the region. Little is known about how WSC has been received by other health care professionals in the settings where they are present. Hence, this study aimed to determine the knowledge, attitudes and perceptions of health care professionals working at the MDH about the WSC. Method: A qualitative exploratory descriptive study was conducted using semi-structured interviews. Twenty health care professionals were interviewed at the Mahalapye District Hospital to ascertain their levels of knowledge, attitudes and perceptions. The interviews were semi- structured and conducted in English and later transcribed verbatim. The transcripts were then analyzed using the thematic analysis described by Graneheim and Lundman (2003:105). Thereafter codes, categories and themes were formed. Results: A variety of health care professionals from different departments were interviewed. Three overarching themes emerged from the data: knowledge of WSC and the management of spinal related disorders at the MDH, the perceived role of WSC, challenges to integration and possible solutions. The HCPs had varying levels of knowledge of the WSC depending on the amount of interaction they had with WSC. Some HCPs who had greater inter-professional interaction with WSC displayed more positive attitudes towards WSC. Many of the HCPs had a positive perception of the WSC though they were not confident in their knowledge of the WSC scope of practice which has limited referral by HCPs WSC. This is mainly due to an unclear referral pathway within the hospital and limited knowledge of WSC’s scope of practice. Increased awareness and an improved system of referral was a strong recommendation made. Many mentioned an unclear referral pathway for their patients. Those who had interacted with WSC generally had pleasant personal interactions with the WSC. Several of the HCPs had themselves been patients of the WSC. Most HCPs felt that WSC was beneficial to patients and made suggestions for WSC to expand to other centres across Botswana. Conclusion: Overall there was a positive perception of WSC however more effort to increase knowledge of what WSC offers and how it can be integrated into the hospital is necessary. Future studies should assess the perceptions of patients as well as knowledge and attitudes of HCPs towards WSC at other sites.
M

JEL Classification System: M19; I19.
A scientific and reasonable performance salary system is the most effective way for public hospitals to achieve management goals. The “full-cost bonus accounting” mode of clinical departments, namely, the bonus distribution mode of first subtracting costs from revenue and then taking a percentage as bonus for the staff is currently the mainstream model for accounting and distributing hospital bonus. Such a model encourages clinical departments to create revenue. But as the modern hospital management is becoming more intensive and sophisticated, such a mode can no longer suit the hospitals’ needs for staff motivation, service risk and management cost, especially the practice of linking doctors’ performance incentives with individual economic benefits, which becomes a hospital performance management error, and does not conform with the requirements of the Ministry of Health for performance salary distribution. As the drivers of hospital development, doctors represent the core competencies of hospital management. Therefore, under the principles of the new health care reform performance salary allocation, how to make good use of “doctors’ performance salary” incentive to improve the operational efficiency of the hospital has been a problem facing the hospital management. Founded in 1958, the Fourth People’s Hospital of Nanhai District is a district/county-level Level-2 general hospital. The current performance salary distribution system has been in place for nearly 10 years. The majority of hospital workers complain a lot about the current program and doctors are not enthusiastic about their work. There often appears in the clinics the phenomenon of undue prescription and excessive examination. The satisfaction rate of the general public is not high, therefore doctors are very much looking forward to the reform of the performance system in hospital. This research uses the Fourth People’s Hospital of Nanhai District as a case for study. Through the collection of the reviews, literature of the media and academia about health care reform at district level hospitals and doctors’ performance salary in recent years, this research uses relevant management theory to investigate and analyze the internal management and current situation of allocation in the Fourth People’s Hospital of Nanhai District. In addition, relevant factors involved in hospital management and performance are also sorted, selected, and analyzed. Standards and application measures of doctor’s performance allocation ratio are put forward, so as to provide useful reference for doctor’s performance allocation in the county-level hospitals under the background of the new health care reform. In this way, measures can be figured out to improve the management of performance in hospitals.
A existência de um sistema de pagamento de salários baseado na performance que seja razoável e científico é fundamental para que a gestão possa atingir os seus objetivos. Presentemente, o modelo “full-cost bónus accounting” que consiste na distribuição de uma percentagem da margem ao staff após deduzidos os custos aos proveitos é o mais usado. Um modelo baseado nesta lógica encoraja o staff a criar proveitos. Contudo, com a sofisticação da gestão hospitalar este modelo não possibilita a motivação do pessoal nem garante a gestão dos custos e do risco de serviço e satisfação dos requerimentos impostos pelo Ministério da Saúde para a distribuição de compensações salariais. Os médicos representam as competências chave na gestão hospitalar já que estes são fundamentais para o desenvolvimento do hospital. Consequentemente, de acordo com os princípios de reforma das compensações salariais, a forma de recompensar os médicos pelo seu desempenho é um tópico crucial para a gestão hospitalar. Fundado em 1958, o hospital Fourth People de Nanhai District é um hospital geral do tipo ‘district/county-level Level-2’. As atuais práticas de compensação salarial têm estado em vigor há cerca de 10 anos. A maioria dos trabalhadores do hospital estão insatisfeitos relativamente a este sistema e os médicos não estão entusiasmados com o trabalho que desenvolvem. Frequentemente existe prescrição excessiva de medicamentos e de exames médicos. O grau de satisfação dos utentes do hospital não é elevada, pelo que é muito importante que se reforme a forma como a avaliação de desempenho é presentemente realizada. Esta investigação recorre ao hospital Fourth People de Nanhai District como caso de estudo. Recorrendo a uma revisão da literatura e da imprensa recentes, relacionada com a reforma do sector da saúde e da distribuição de compensações salariais, esta investigação usa teoria relevante de gestão para estudar e analisar a gestão interna e o atual sistema de performance existente no hospital Fourth People de Nanhai District. Adicionalmente, os fatores envolvidos na gestão hospitalar e na performance são identificados e analisados. Medidas e standards de distribuição de compensações são propostos como forma de possibilitar alternativas uteis no processo de avaliação de desempenho dos médicos no âmbito das reformas recentes do setor da saúde. Desta forma, procedeu-se ao desenvolvimento de diversas medidas que possam melhorar a gestão da performance nos hospitais.

碩士
國防醫學院
護理研究所
87
Abstract Objective: The purpose of this study was to establish a unit-based shared governance model for certain district hospitals. The study employed a nonequivalent control group pretest/post-test design. Fifty-three subjects — controlled by age, tenure, and educational level — were chosen from a “quote sampling” of IPNG pretest scores from six units at Tainan’s District Teaching Hospital Nursing Department. Method: The study employed By Martin’s systematic evaluation. Phase I. to collect manager’s and staff’s perceptions of the existing condition by open question. Phase II. to measure organizational efficiency using the INS or Index of Nursing Satisfaction (noting that the Cronbach’s  value was 0.91). Phase III. to measure organizational activity using the IPNG or Index of Nurse Professional Governance (noting the Cronbach’s  value was 0.98, and the test-retest  value was 0.74). Phase IV. to interview and collect the research team’s opinion regarding the probability of maintaining this model in the future. The model implementation time was approximately four months, and from the beginning, managers and staff were empowered by the shared governance concepts and through the implementation and evaluation of the model. Conclusion: The unit-based model was established. The major findings of the study were as follows: 1. nurse’s professional governance and work satisfaction rose; 2. an enhanced partnership between managers and nurses was established; 3. nurses could express their self-perceptions through their own autonomy and authority; 4. managers found much potential in their staffs, competence and work effectiveness went up. It was suggested that the roles of managers and nurses be refined so that there is greatest trust between them and that managers delegate more power to the nurses. A new committee should be established so that nurses can more effectively communicate with their managers about professional right to practice. It would try to use different cross-professional formats, sampling sizes, , and nursing-sensitive patient outcomes as indicators for the next study to survey governance feeling, or correlation of the different indicators. The research suggested that professional caregivers audit their own responsibility and accountability. Limitations were found in that there was not enough time to evaluate long-term effectiveness of the model, and that the self-report questionnaire is not effective in evaluating the actual difference between the manager’s leadership effectiveness and actual care. Key Words: unit-based shared governance model, satisfaction

碩士
嘉南藥理科技大學
醫務管理系
100
Objectives: Colorectal cancer (CRC) is the third main cause of cancer death in Taiwan. The Taiwanese Bureau of Health Promotion is committed to promoting public awareness of the need for prevention and early detection for colorectal cancer. The aim of this study was to assess the knowledge of risk or protection factors and preventive practices regarding CRC of adults in Taiwan. Methods: This institutional review board-approved cross-sectional study was conducted with 265 subjects (aged 50-69) subjects participating in a community-based fecal occult blood testing (FOBT) screening program at a teaching hospital in southern Taiwan between 29 April 2011 and 20 April 2012. A self-administered questionnaire on demographic characteristics and family history of CRC; knowledge regarding risk and protection factors on a scale of 0 to 100 (0 indicates strongly disagree and 100 indicates strongly disagree); dietary and lifestyle practices on a two-point of yes/no scale was employed. The results of FOBT were filled out by the FOBT case manager. Results: Two hundred fifty subjects (94.3%) responded. Of all the subjects, the mean score of knowledge regarding CRC risk and protection factors had 69.2±11.4 and 67.3±11.7 respectively. Compared with subjects receiving positive FOBT results (n=52), subjects receiving negative FOBT results (n=198) had higher knowledge score about CRC risk and protection factors (risk factors:70.1±11.3 vs. 65.7±10.9, p<0.05; protection factors: 68.8±11.9 vs. 61.3±8.9, p<0.001) and were more likely to perform the beneficial CRC preventive practices (10.5±1.7 vs. 8.3±2.1, P<0.001). In the multiple linear regression, only age was an independent determinants of the knowledge regarding CRC risk and protection factors, the subjects aged above 60 had lower knowledge score (β=-0.17, p<0.05) about risk and protection factors than those aged from 50 to 59; moreover, the knowledge regarding CRC risk and protection factors was significant for predicting beneficial CRC preventive practices in the present subjects (p<0.001). In a logistic regression model including age, sex, education and family history of CRC variables showed that the knowledge regarding CRC risk and protection factors was associated with lower positive FOBT results (OR=0.97; 95% CI, 0.95-0.98), whereas only the performance of beneficial CRC preventive practices was associated with lower positive FOBT results (OR=0.60; 95% CI, 0.50-0.72) when it was incorporated in the model. Conclusions: The results of FOBT screening population survey reveal moderate awareness of CRC risk and protection factors and emphasize the importance of beneficial CRC preventive practices. There are age-related differences in knowledge regarding CRC risk and protection factors, which is higher among younger people aged from 50 to 59.

碩士
國立台北護理學院
護理研究所
96
Abstract Hypertension is one of the most prevailing chronic diseases in the world. The prevalence in Taiwan is getting higher each year. In addition to control with medication, life style adjustment is also suggested to be included in the treatment plan. The current health education protocol in OPD provided only segmental reminders than individualized instruction on daily practice. To fulfill the needs, this study intended to implement and evaluate the effects a nurse developed disease management protocol on hypertension self-care knowledge, daily health care behaviors, blood pressure and self-efficacy of health related behaviors among hypertension patients. A quasi-experimental design were applied, total 58 OPD hypertension patients were recruited and assign into experimental (n=28) and control group(n=30). The intervention were an 8week group activities with two hours per week, compared to regular OPD care for the control group. The research instruments included questionnaires for hypertension knowledge, self efficacy, blood pressure data, and weekly exercise logs. Data was collected at one week before and after the intervention for both group. In order to evaluate the residual effect of the experimental group, extra measurement was done in one month after intervention. After the data cleaning, the SPSS 12.0 package software was applied and percentile, means, standard difference, independent t test, Chi square test and paired t-test were employed to analyze the basic attributes of the two groups and to compare the difference of effects of care before and after the both groups. The results indicated the experiment group scored was increased 3.07±2.48 in self-care knowledge, which is significantly higher than the scoring of control group (p =.03), and the tracing one month after intervention, the effect still maintained (p <.01). In daily health care behaviors, the experiment group showed increase of 12.75±10.41 after intervention, and is significantly higher than control group (p =.00).Among the items, diet （p =.00）and exercise （p =.01）showed with significant effects than control group, but in medication compliance （p =.14）and in timely return for consultation （p =.53）were no significant between two groups. In the tracing, it were found that excpet exercise time, the rest of the effects were maintained. (p <.01). The mean value of systolic and diastolic pressures dropped 10.00±14.44mmHg and 5.96±8.28mmHg in experiment group which were significantly different from control group (p =.03). The self-efficacy in diet and exercising behaviors increased 15.11±11.01 points and was significantly higher than control group (p =.00) and the effect traced one month later was still maintained (p <.01). The results supported the nurse developed disease management protocol which based on learning theory and self-efficacy promoting skill had better outcomes than regular OPD care, it may provide a reference for other hospitals in planning Chronic Disease Management program for OPD patients. Key Words: Hypertension Patient, Disease Management, Self-Care knowledge, Daily Health Care Behavior, Blood Pressure, Self –Efficacy of Health Related Behaviors.

Background: There is global concern about the impact of lifestyle related diseases which have been on a steady increase in recent years. Poor nutrition, reduced physical activity and cigarette smoking have been documented as the main lifestyle behaviors that result in an increase in prevalence of the three most common occurring chronic diseases of lifestyle namely: diabetes, hypertension and cardiac diseases. Healthcare workers are frontline personnel and are seen as role models by their family, friends and the community they serve. It is therefore important that positive healthy lifestyle behaviors are practiced and encouraged by healthcare workers themselves. Objectives: To develop an initial descriptive profile of hospital employees with regards to their general knowledge, attitudes and practices about healthy lifestyles and to make appropriate recommendations to the hospital management on how the workplace can support the adoption of healthy lifestyles. Methods: The study was conducted at one health institution using the permanently employed staff as the study population. An exploratory descriptive study design was used in context of the precede-proceed planning framework. Self-administered questionnaires and consent forms were distributed in English and isiZulu. Collection boxes were placed in all wards and departments. Data was captured using the SPSS version 13 statistical package. Results: The response rate was 42%. Respondents were classified into the administrative, general staff and health professional categories. There was a significant difference (p=0.03) between the staff body mass index and their weight perception. Knowledge and attitude had mean indices of greater than 70% and the practice indices were lower for all three categories at less than 45%. A significant difference was found between certain staff categories in the knowledge and attitude indices but no significant difference existed in their practices. Conclusion: All categories of staff possessed adequate knowledge and attitudes but this is not transferred into positive health promoting practices. The possibility of workplace health promoting interventions was well supported by staff especially with regards to healthier meal choices at the staff dining room and an onsite gym facility. The main limitations of the study were the non-standardized data collection tool, and the poor response rate, which make the generalization of the study findings difficult.
Thesis (M.PH.)-University of KwaZulu-Natal, 2008.

Text in English
The purpose of this research was to investigate occupational health and safety challenges and their impact on health care workers (HCWs) in selected public hospitals from the Gauteng Province, South Africa. Method: A quantitative descriptive cross-sectional survey was conducted among HCWs in the study sites. A two-staged sampling that include purposive sampling of study sites and census sampling of 2000 HCWs was used. Self-administered questionnaires were used to obtain data from HCWs. In addition, two different checklists were used to conduct retrospective records reviews to assess occupational health and safety (OHS) policy compliance and occupational injuries and diseases occurrence. The SAS Release 9.3 was used to analyse data. The Fischer Exact test and Chi-square were also used to determine the association of variables and P-value was set at <0.05 to indicate significant association. Results: A total of eight public hospitals and 926 (46.3%) HCWs who were all females nurses participated in this survey. Major occupational health hazards reported by the participants include: needle-stick injuries 275 (54.67%), slips trips and falls 67 (13.32%) and splashes 57 (11.33%). The analysis of open-ended responses indicated increased workloads, long hours of work and shift work as the most reported psychosocial hazards among HCWs. The reviewed records indicated that back injuries 22 (4.37%), tuberculosis (TB) 17 (3.38%) and asthmatic reactions 8 (1.59%) were the commonly reported occupational injuries and diseases among the HCWs. The records review also revealed a lack in the conducting of adequate medical surveillance among participants. The results showed poor compliance with the OHS policy and a negative impact of biological and psychosocial hazards on the HCWs. Conclusion: There was a high risk of exposures to biological hazards whilst providing care to patients, thus warranting the implementation of robust preventive measures. As a result, the guidelines were developed to promote the health and safety of HCWs with a view to promoting policy compliance and preventing the occurrence of occupational injuries and diseases as well as their impact among HCWs.
Health Studies
D.Litt et Phil. (Health Studies)