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1
Van, Heerden Andries Johannes. "Medical practitioners and medical specialists : profile and key factors for South Africa." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/5536.
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Thesis (MBA (Business Management))--Stellenbosch University, 2008.ENGLISH ABSTRACT: Recent years have been witness to the co-existence of incredible advances in human well-being and healthcare development on the one hand and extreme deprivation and a significant drop in numerous health indicators on the other. Central among this paradox lies the key to accessible, comprehensive and dedicated healthcare - the health workforce and the numerous factors impacting on health professionals and health professional data. Key to health care human resource planning is a comprehensive understanding of the environment and demands that health professionals are faced with. This must be supported by knowledge of the profile of health professionals in a specific country and should lead to detailed health resource planning, based on benchmarks and analytical interpretation of the factors that both determine and influence the number of health professionals. This research report provides an abbreviated background to the local and international health sectors, profiles the current number and distribution of medical practitioners and selected medical specialists in the country and internationally, identifies the key factors for consideration in projecting the number of medical practitioners and medical specialists required for South Africa and proposes a framework for taking the process forward. The research showed that, while there are positive aspects to the South African health professional environment, the country faces dire regional disparities and does not compare favourably to many of its international peers in terms of health professional resources. The key aspects that influence health human resources were identified and it became clear that sustainable and comprehensive health resource planning is not a mere matter of ratios, but is indeed dependent on a number of critical success factors. It is critical that health human resource planning in South Africa requires urgent and comprehensive attention. Failure to address this urgently will result in a health care system continuing to struggle to meet the health care needs of the population. A structured approach is possible, but requires dedication and careful planning.
AFRIKAANSE OPSOMMING: Die laaste paar jare is gekenmerk deur die kontras van indrukwekkende vooruitgang in lewenskwaliteit en gesondheidsorg aan die een kant en ekstreme tekortkominge en die verswakking van gesondheidstatistieke aan die ander. Sentraal tot hierdie paradoks is die sleutel tot toeganklike, omvattende en toegewyde gesondheidsorg - die gesondheidswerkers en die vele faktore wat gesondheidswerkers en - data beinvloed. Die kern van gesondheidsorg menslike hulpbronne beplanning is 'n omvattende begrip van die omgewing en vereistes waaraan gesondheidswerkers blootgestel word. Dit moet ondersteun word deur in diepte kennis van die gesondheidswerker profiel binne in 'n spesifieke land en behoort te lei tot gedetaileerde gesondheidsorg menslike hulpbronne beplanning, na aanleiding van toepaslike verwysingsraamwerke en 'n analitiese interpretasie van die faktore wat die aantal gesondheidswerkers beide bepaal en noodwendig beinvloed. Hierdie navorsingsverslag verskaf 'n sinoptiese agtergrondskets van die nasionale en internasionale gesondheidsektore, gevolg deur die profiel (getalle en verspreiding) van die algemene praktisyns en geselekteerde mediese spesialiste, beide in Suid Afrika en internasionaal. Dit identifiseer die belangrikste faktore vir oorweging in die projeksie van die aantal algmene praktisyns en mediese spesialiste benodig en sluit af met 'n voorgestelde raamwerk vir voortgesette omvattende beplanning. Die navorsing het getoon dat, alhoewel die Suid Afrikaanse gesondheidswerker omgewing deur positiewe aspekte gekenmerk word, die land steeds onderworpe is aan daadwerklike streeks ongelykhede en boonop nie besonder positief vertoon teenoor ander soortgelyke lande nie. Die kern kwessies wat gesondheidswerkers beinvloed is geidentifiseer en dit is duidelik dat onderhoudende en omvattende gesondheidsorg beplanning nie bloot die toepassing van ratios is nie, maar dat dit onderhewig is aan 'n groot verskeidenheid kritiese sukses faktore. Dit is van kritiese belang dat gesondheid menslike hulpbronne beplanning in SA daadwerklike aandag geniet. Die nalaat van hierdie verantwoordelikheid, sal lei tot 'n gesondheidsisteem wat nie in staat is om aan die behoeftes van die land te voldoen nie. 'n Gestruktureerde benadering is moontlik, maar verdien toewyding en beplanning.
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Forrest, Mia. "Swedish Obesity Specialists : Obesity and its Treatment at a Specialist Clinic in Stockholm." Thesis, Stockholm University, Department of Social Anthropology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-31035.
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Swedish Obesity Specialists examines how obesity is conceptualized as a medical condition by the staff working at an obesity clinic in Stockholm Sweden. Through eight weeks of participant observations and eight semi-structured interviews this thesis answers the question of how specialist working in the field of obesity construct obesity as a medical site. The thesis aims at understanding how obesity is becoming an issue for medicine, further how obesity’s entry into medicine creates new understandings of the body and medical treatments. Through the theoretical concepts of global assemblages and bio-power I argue that obesity as a disease is defined through seemingly objective criteria aimed at defining a population of sufferers, simultaneously for obesity to be viewed as disease scientifically valid treatments on an individual level must be put into place. By viewing obesity’s entry into medicine as a process of shared consensus, this thesis examines the relationship between global levels of knowledge production and their application and negotiation at one clinic treating obesity. Here expert knowledge and governance are integrated to create both treatment and an idea of what obesity as a medical condition is. In this thesis I argue that the application of expert knowledge and global criteria leads to unexpected views on what can be conceived as medical treatment. Further the thesis discusses how the body of the patient becomes reinterpreted once obesity becomes a medical condition.
Key words: Obesity, medical expertise, global assemblages, governance, lifestyle alteration
3
Carter, Jennifer. "Child life specialists' perspectives in supporting adolescents struggling with medical non-compliance." Thesis, Mills College, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1557343.
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The current study sought to examine child life specialists' perspectives on supporting adolescents struggling with medical non-compliance. The intent of the study was to identify various factors involved in adolescent medical non-compliance and to examine the role of the child life specialist in supporting this population. Eighty-five certified child life specialists were surveyed regarding their work with adolescents and the strategies used to support adolescents struggling with medical non-compliance. The issues surrounding medical non-compliance were examined as well as child life specialist education and how capable child life specialists felt in their ability to support this population. Results support previous literature suggesting a negative impact of typical adolescent development on medical compliance. In addition, results revealed the multidisciplinary team approach and family dynamics as being barriers to supporting adolescents' struggle with medical non-compliance. These findings support the need for additional education to better equip child life specialists in their work with this population.
Keywords: child life specialists, adolescents, medical non-compliance, medical non-adherence
4
Marshall, Martin Neil. "A study of the professional relationneral practitioners and specialists." Thesis, Imperial College London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264930.
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Todd, Catherine Angela. "A clinically valid simulator with tactile sensing to train specialists to perform cochlear implantation." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20070208.171637/index.html.
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Szkil, Andrea Michelle. ""Here everything is possible" : forensic specialists' work with human remains in post-war Bosnia and Herzegovina." Thesis, University of Sussex, 2013. http://sro.sussex.ac.uk/id/eprint/45169/.
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This thesis explores the work carried out by forensic specialists employed by the International Commission on Missing Persons (ICMP). Headquartered in Sarajevo, Bosnia and Herzegovina (BiH), ICMP assists the work of local governments around the world in addressing the issue of missing persons following armed conflict, atrocities, and natural disasters. This thesis focuses on ICMP's efforts to aid the Bosnian government in locating, exhuming, and identifying the remains of the individuals who went missing during the country's recent war (1992-1995). Utilising data obtained via interviews with and observations of ICMP staff members, it primarily represents a study of the management of professional identity in emotionally charged situations, examining the experiences of the forensic specialists who work in the organisation's three mortuary facilities throughout BiH. It explores forensic specialists' work with human remains, their interactions with victims' family members, and their attendance at events in which victims are commemorated and/or buried. Discussion of forensic specialists' experiences with the deceased brings into consideration their varying responses to the remains, emphasising the prevalence and perceived importance of emotional detachment. Situations in which emotional detachment from the remains may prove challenging are considered, as are the varying techniques forensic specialists utilise in managing emotional responses to their work. Examination of forensic specialists' interactions with the living suggests their general dislike of these encounters, although the positive aspects of these interactions are also examined. Exploration of forensic specialists' opinions of attending burials and/or commemorations brings into further consideration the balance between emotional attachment and detachment. While respondents noted the importance of maintaining an emotional connection to their work, they nevertheless emphasised the importance of avoiding such responses while in the mortuary. Commemorations and/or burials become ‘safe spaces' for forensic specialists to express and experience emotional responses to their work that are not overtly professional.
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Yi, Yuxiang, and 易宇翔. "Factors affecting adherence to new specialist outpatient appointments among elderly patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B2662798X.
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Ali, Irena Malgorzata, and n/a. "The impact of information provided by medical libraries on clinical decision making : A study of two hospitals." University of Canberra. Information, Language & Culture Studies, 1996. http://erl.canberra.edu.au./public/adt-AUC20060530.115422.
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A quantitative survey was conducted in two Canberra hospitals that aimed
at ascertaining the impact of information provided by medical libraries on
clinical decision making. Specifically, this research study investigated
clinical, cognitive and quality value of information provided by the medical
librarians to the management of patients and doctors' ability to handle
clinical cases differently as a result of such information. Furthermore, the
relative value of information received from the library was assessed by
comparing it to the value of information received from other sources in
dealing with clinical problems.
The research involved medical specialists and registrars affiliated with these
hospitals. Doctors were asked to select any clinical situation which they
frequently or currently encounter and for which further information would
be useful to them. Once their information requests were identified, they
were then asked to present such requests to the hospital library. In order to
avoid any special treatment, participants were urged not to identify
themselves to the library staff as partaking in the study. It was important
that participants did not search for the information themselves. The doctors
were asked to evaluate the material provided by the library in relation to
clinical care and, thereafter, complete a short questionnaire. This research
took place between October 1994 and March 1995. The questionnaires were
sent to 288 doctors. This represented the total population of specialists and
registrars affiliated with both hospitals at the time of the study. Analysis of
the results is based on a 34% useable response rate.
Medical specialists were by far the higher number of respondents (70%) as
compared with registrars (30%). Eighty-one per cent of the doctors said that
the information provided by the library refreshed their memory and 82% said
that it would contribute to better quality of medical care. Eighty-six per cent
indicated that some of this information was new to them and 99% said that
the information provided was up to date. Ninety-four per cent said that the
information provided by the library was of clinical value to them.
As the result of the information provided by the library 75% of respondents
would either definitely or probably handle some aspects of the clinical
situation differently than they would have done it otherwise. The level of
importance of the change for the optimal care of patients was assessed with
54% regarding it as important, 42% as moderately important.
Specifically, as the result of the information provided, the doctors were
able to change the following:
diagnosis 10%,
choice of lab tests 20%,
choice of other diagnostic investigations 24%,
choice of drugs 27%,
choice of other management 58%,
reduce length of hospitalisation 10%,
post-operative care of patients 25%,
advice given to patients 47%. On the basis of the received information the doctors were able to avoid
the following:
hospitalisation of patients 11%,
risk of hospital acquired infection 8%,
surgical intervention 19%,
tests or other investigation 23%,
additional out-patient visits 12%.
Discussions with colleagues were reported to be most valued sources of
information for the purpose of clinical decisions (59%), followed by diagnostic
imaging (49%), librarian (45%), lab tests (42%) and patients' medical records
(30%). The librarian's role as contributing to the process of clinical decisions was
rated highly with 88% ranking it as either important or moderately important.
The results of significance p test statistic performed at 0.05 significance level
suggested that, for this study, there was a significant relationship between the
frequency of library use and doctors' ability to change the choice of laboratory
tests, diagnostic investigations, and the choice of prescribed drugs.
The results of this research study demonstrate that medical librarians can
positively contribute to clinical management of patients by providing timely and
accurate information. Further research is recommended in order to determine
the impact of the whole range of library services on health care outcomes.
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Olejownik, Jennifer M. "Complementary and alternative medical providers and the experience of integration a case study /." Columbus, Ohio : Ohio State University, 2007. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1187096162.
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Kottler, Stephanie J. "Prevalence of Staphylococcus aureus and MRSA carriage in three populations." Diss., Columbia, Mo. : University of Missouri-Columbia, 2008. http://hdl.handle.net/10355/6066.
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Thesis (M.S.)--University of Missouri-Columbia, 2008.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. "December 2008" Includes bibliographical references.
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Vanzella, Elídio. "Aportes estruturais e profissionais para atenção a saúde do idoso: um olhar sobre a realidade do município de joão Pessoa/PB." Universidade Federal da Paraíba, 2012. http://tede.biblioteca.ufpb.br:8080/handle/tede/6528.
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Previous issue date: 2012-02-23Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The aging of the population is occurring at an unprecedented level, so it became the subject of discussions in various sectors of society. The process of aging of the population of João Pessoa, the state capital of Paraiba, challenges the government and its public health policies, to attend the needs for improvement of hospital services, because in the near future there will be more elderly than that hospital structures to meet the standards established by Ordinance No. 249/SAS/MS, 2002 that addresses the standards for registration of Reference Centers for the Elderly Health Care. Among the physicians, the option by specialties with a focus on elderly, such as geriatrics is not accompanying the growth curve of the elderly population. To analyze the situation in the city of Joao Pessoa, it was held an exploratory-descriptive and inferential study, developed from quantitative and qualitative approaches to deepening of the phenomenon in focus. Data related to hospitals, were collected through a questionnaire with closed questions in the healthcare institutions that agreed to participate of this research and the Regional Council of Medicine of Paraiba (CRM / PB) provided information on the specialties and number of medical professionals in office. The data related to hospitals were analyzed and then it was checked the similarities and differences of these institutions compared to that proposed Ordinance No. 249/SAS/MS of 2002 in order to classify them as Reference Centers for the Elderly Health Care. In relation to the data of the doctors, they were analyzed statistically using the methodologies of Time Series and Regression Analysis. The results showed that the city of João Pessoa, in 2011, did not have hospitals that met the Ordinance of the Ministry of Health regarding the standards for registration of Centers of Reference on Health Care of the Elderly. In relation to medical professionals, it was observed that, the number exceeds the ratio recommended by the World Health Organization. However, the number of physicians in the most demand specialties by the elderly has an unfavorable trend in the relation doctor elderly, and the specialty of geriatrics present the major deficiency without a perspective of a better situation in the short time.
O envelhecimento da população brasileira está ocorrendo em um nível sem precedentes, por isso tornou-se tema de discussões em diversos setores da sociedade. O processo de envelhecimento da população de João Pessoa, capital do Estado da Paraíba, desafia o governo e suas políticas públicas de saúde, a atender às necessidades de aperfeiçoamento dos serviços hospitalares, pois em um futuro próximo haverá mais idosos do que estruturas hospitalares que atendam aos padrões estabelecidos na Portaria nº249/SAS/MS, de 2002, que trata das normas para cadastramento de Centros de Referência em Atenção à Saúde do Idoso. Entre os médicos a opção pelas especialidades com foco no idoso, como a Geriatria, não está acompanhado a curva de crescimento da população idosa. Para analisar a situação na cidade de João Pessoa, realizou-se um estudo do tipo exploratório-descritivo e inferencial, desenvolvido a partir de abordagens quanti-qualitativas para aprofundamento do fenômeno em foco. As informações, referentes aos hospitais, foram coletadas por meio de um questionário com perguntas fechadas junto às instituições hospitalares que concordaram em participar da pesquisa e o Conselho Regional de Medicina da Paraíba (CRM/PB) forneceu as informações relativas às especialidades e número de profissionais médicos em exercício. Os dados referentes aos hospitais foram analisados, e então, verificadas as aproximações e distanciamentos destas instituições em comparação ao que propõe a Portaria nº249/SAS/MS, de 2002 de modo a classificá-los como Centros de Referência em Atenção à Saúde do Idoso. Quanto aos dados dos médicos, estes foram analisados estatisticamente por meio das metodologias de Séries Temporais e Análise de Regressão. Os resultados demonstraram que a cidade de João Pessoa, no ano de 2011, não possuía hospitais que atendessem a Portaria do Ministério da Saúde quanto às normas para cadastramento de Centros de Referência em Atenção à Saúde do Idoso. Em relação aos profissionais médicos, observou-se que na cidade, o número excede a relação recomendada pela Organização Mundial da Saúde. No entanto, o número de médicos nas especialidades mais procuradas pelos idosos apresenta uma tendência desfavorável de relação médico para idoso, sendo a especialidade de Geriatria a grande deficiência atual e sem perspectivas de uma situação melhor a curto prazo.
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GAUTHERIE, PASCAL. "Aspects actuels de l'enseignement des specialites medicales en allemagne." Université Louis Pasteur (Strasbourg) (1971-2008), 1992. http://www.theses.fr/1992STR1M176.
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Betina, Ludmila, and Heléne Persson. "SJUKSKÖTERSKORS BEDÖMNING AV SPECIALIST-SJUKSKÖTERSKORS KOMPETENS INOM PSYKIATRISK VÅRD." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26171.
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Bakgrund: Bristen på specialistsjuksköterskor inom psykiatri är stor, men ändå efterfrågas inte kompetensen av arbetsgivaren. Förslag att minska antalet specialistutbildningar har lagts fram varav psykiatri är en av dem. Syfte: Syftet med studien var att undersöka hur sjuksköterskor bedömer specialist-sjuksköterskors kompetens inom psykiatrisk vård. Metod: En kvantitativ webbaserad studie genomfördes med totalt 110 sjuksköterskor med erfarenhet från psykiatrisk vård. Resultat: Den specialistutbildade sjuksköterskan bedöms ha en högre kompetens än grundutbildade sjuksköterskor av samtliga, men med lika uppgifter och ansvar. Självskattning hos specialister är högre. Erfarenhet är av stor betydelse för kompetensen. Slutsats: Kompetensen hos specialist-sjuksköterskor bedömdes vara högre än hos grundutbildade sjuksköterskor, men arbetet och ansvaret är detsamma. Det finns behov av att arbetsgivare tydligare tillvaratar kompetensen hos specialistutbildade sjuksköterskor. Synliggörandet av den specifika kompetensen kan då på sikt resultera i fler specialister inom psykiatrin.Background: The shortage of specialist nurses in psychiatry is great, but the skills are still not required by the employers. Proposals to reduce the number of specialist courses have been made, of which psychiatry is one of them. Objective: The aim of the study was to investigate how nurses assess specialist nurses´ competence in psychiatric care. Method: A quantitative web based study was conducted with a total of 110 nurses with experience from psychiatric care. Results: The specialist registered nurse is judged to have a higher competence than registered nurses, but with equal tasks and responsibilities. Self-esteem among specialists are higher. Experience is of great importance for the competence. Conclusion: The competence of specialist registered nurses was assessed to be higher than that of registered nurses, but work and responsibilities are the same. There is a general need for employers to more clearly utilize the competence of specialist nurses. The visibility of the specific competence can then in the long run result in more psychiatry specialist nurses.
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Østraa, Inger Elisabeth. "Evaluering av det lovbaserte legefordelingssystemet i Norge i perioden 1999 til 2013." Thesis, Nordic School of Public Health NHV, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3635.
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Formål:Hensikten med studien er å undersøke hvilken effekt det lovbaserte legefordelingssystemet, som var aktivt i Norge fra 1.1.1999 til 30.6.2013, har hatt, og hvordan ordningen har påvirket utviklingen i legestillinger i primærhelsetjenesten og spesialisthelsetjenesten i Norge. Studien kan gi myndighetene et bedre kunnskapsgrunnlag om statlig regulering av legestillinger. Metode: Forskningsspørsmålene er i hovedsak belyst gjennom kvantitative deskriptive analyser av registerdata og tilgjengelig statistikk. Saksdokumenter og vedtak om tildeling av legestillinger er gjennomgått, og det er gjennomført en kvalitativ analyse av bakgrunnsdokumentene ved innføringen av ordningen. Den teoretiske rammen for studien er folkehelsearbeid, organisasjonsteori og resultatkjeden som et styringsverktøy ved gjennomføring av evalueringer. Resultat: Studienviser at nye legestillinger i primærhelsetjenesten har vært prioritert i hele perioden. Dette kan ha bidratt til å redusere sosiale ulikheter i helse. Antall ubesatte legestillinger er i perioden 1.1.1999 til 30.6.2013 redusert til under 1% av alle legestillinger, både i primærhelsetjenesten og spesialisthelsetjenesten. I samme periode økte antall utdanningsstillinger for leger i spesialisering med 36%. I alt 54% av alle nye legestillinger i spesialisthelsetjenesten er gitt innen nasjonale satsningsområder og prioriterte spesialiteter. Av de nordiske landene har Norge hatt høyest økningen i legedekning pr 1000 innbyggere i allmennlegetjenesten. Konklusjon: Studien viser at den statligereguleringenav nye legestillinger har hatt en effekt, og at et målrettet reguleringssystem kan være et godt administrativt virkemiddel for nasjonal legefordeling og geografisk fordeling av leger. God forankring og bred deltaking er suksesskriterier.Purpose: This study aimedto investigate the effect of the legally based system for allocating new positions for physiciansunder a policy that wasin effectin Norway between 1 January 1999 and 30 June 2013.The study also aimed to increase understanding of a government-regulated physician distribution system. Method: The primary methodology involved using quantitative descriptive analysis to review registry data and available statistics. Case documents and decisions related to theallocation of physician positions, and case and policy documents related to the original justification for the government-regulated physician distribution systemw ere also reviewed. The theoretical thesis and framework for this study is public health, organization theory, and the "result chain" as a management tool for executing evaluations and deliberations. Result: Theresults of the study show that vacant positions for physicians, both primary and specialists, decreased to less than 1% during the study period. During this same time period, 54% of all new hospital positions were assigned a priority specialty. Positions for specialist education increased 36%. Among the Nordic countries, Norway had the highest increase in coverage by primary care physiciansper 1,000 capita during the past 15 years. Conclusion:The government-regulated physician distribution systemin Norway has been effective. Robustness, consensus building, and broad participation are key conditions and ingredients in the recipe for success.
ISBN 978-91-982282-2-9
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Xu, Meng. "Specialised transcription factories." Thesis, University of Oxford, 2008. http://ora.ox.ac.uk/objects/uuid:a41d3243-c233-491a-916b-4e329cace434.
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The intimate relationship between the higher-order chromatin organisation and the regulation of gene expression is increasingly attracting attention in the scientific community. Thanks to high-resolution microscopy, genome-wide molecular biology tools (3C, ChIP-on-chip), and bioinformatics, detailed structures of chromatin loops, territories, and nuclear domains are gradually emerging. However, to fully reveal a comprehensive map of nuclear organisation, some fundamental questions remain to be answered in order to fit all the pieces of the jigsaw together. The underlying mechanisms, precisely organising the interaction of the different parts of chromatin need to be understood. Previous work in our lab hypothesised and verified the “transcription factory” model for the organisation of mammalian genomes. It is widely assumed that active polymerases track along their templates as they make RNA. However, after allowing engaged polymerases to extend their transcripts in tagged precursors (e.g., Br-U or Br-UTP), and immunolabelling the now-tagged nascent RNA, active transcription units are found to be clustered in nuclei, in small and numerous sites we call “transcription factories”. Previous work suggested the transcription machinery acts both as an enzyme as well as a molecular tie that maintains chromatin loops, and the different classes of polymerases are concentrated in their own dedicated factories. This thesis aims to further characterise transcription factories. Different genes are transcribed by different classes of RNA polymerase (i.e., I, II, or III), and the resulting transcripts are processed differently (e.g., some are capped, others spliced). Do factories specialise in transcribing particular subsets of genes? This thesis developed a method using replicating minichromosomes as probes to examine whether transcription occurs in factories, and whether factories specialise in transcribing particular sets of genes. Plasmids encoding the SV40 origin of replication are transfected into COS-7 cells, where they are assembled into minichromosomes. Using RNA fluorescence in situ hybridisation (FISH), sites where minichromosomes are transcribed are visualised as discrete foci, which specialise in transcribing different groups of genes. Polymerases I, II, and III units have their own dedicated factories, and different polymerase II promoters and the presence of an intron determine the nuclear location of transcription. Using chromosome conformation capture (3C), minichromosomes with similar promoters are found in close proximity. They are also found close to similar endogenous promoters and so are likely to share factories with them. In the second part of this thesis, I used RNA FISH to confirm results obtained by tiling microarrays. Addition of tumour necrosis factor alpha (TNF alpha) to human umbilical vein endothelial cells induces an inflammatory response and the transcription of a selected sub-set of genes. My collaborators used tiling arrays to demonstrate a wave of transcription that swept along selected long genes on stimulation. RNA FISH confirmed these results, and that long introns are co-transcriptionally spliced. Results are consistent with one polymerase being engaged on an allele at any time, and with a major checkpoint that regulates polymerase escape from the first few thousand nucleotides into the long gene.
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Eldridge, Houser Jennifer L. "Health educators’ perceived preparedness to provide the centers for Medicare and Medicaid services’s Annual Wellness Visit." Diss., University of Iowa, 2019. https://ir.uiowa.edu/etd/6941.
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The Annual Wellness Visit (AWV) is a benefit available to Medicare beneficiaries. This benefit has the potential to address many areas of prevention in one focused visit to the primary care clinic, yet it is currently being provided to only 19% of Medicare beneficiaries. This research attempted to examine the extent to which certified health education specialists (CHES) have provided and perceive themselves to be prepared to provide the preventive health services (PHS) within the AWV, along with seven additional preventive counseling services (PCS).
A web-based survey assessed the perceived preparedness of health educators, specifically CHES (N=998), to deliver these PHS. The results of these surveys include the development of a single factor internally consistent scale to measure perceived preparedness for the PHS within the AWV. They reveal health educators were least prepared to assist with end-of-life-planning and conduct a basic hearing test. No association was found for education level and perceived preparedness; however, prior experience did account for a significant amount of the variance in perceived preparedness to provide AWV services. Lastly, when compared to historical data regarding physician’s perceived preparedness to provide PCS, health educators were more prepared to counsel on diet and exercise and less prepared to counsel on six other PCS. These results may aid in the understanding of whether CHES perceive they are prepared to provide (PHS) and demonstrate the experience CHES have with each of these PHS.
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Lane, Cathie Anne Clinical School St George Hospital Faculty of Medicine UNSW. "Optimising Australian postgraduate medical education and training in nephrology." Awarded by:University of New South Wales. Clinical School - St George Hospital, 2009. http://handle.unsw.edu.au/1959.4/44662.
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The optimal manner in which to train nephrologists has not been studied. The objectives of this research were to determine:- 1. The educational and historical basis underpinning the Australian nephrology training program. 2. The drivers surrounding a career choice in nephrology. 3. What constitutes an ???ideal??? nephrologist and how nephrologists spend their work time, thereby identifying skills and attributes to be fostered in training. 4. Impediments to training, including examination of the available workforce. Five sub studies were undertaken, utilising a combined quantitative and qualitative approach (mixed methods): 1) A national Basic Physician Trainee (BPT) questionnaire, 2) a national nephrology workforce study, and in-depth interviews of: 3) nephrology patients, 4) nephrology trainees and 5) practicing nephrologists. New findings arising from this research reveal: doctors choose nephrology as a career if exposed to the specialty in a positive manner with good role models, however, there are a range of modifiable factors that make nephrology unattractive to many BPTs; workload is high, impacting negatively on training and trainee recruitment; Nephrologists spend most time in the management of dialysis and transplant patients but have a range of other roles in day to day practice, essential information to develop a competency based training program; availability of nephrologists for training is suboptimal and will likely worsen; Patients and doctors apply and weight parameters differently when defining an ???ideal nephrologist???. Both groups believed that specialist knowledge remains an essential requirement but patients focused more on good communication skills. This research provides evidence that the training program should incorporate training in advanced communication and basic research skills and promotion of an holistic approach to patient care. There is no formal alignment of training with assessment. Trainees and nephrologists believe that feedback is critical to learning, yet the assessment process is not underpinned by sound educational principles. This can be rectified using the findings of this research in conjunction with curriculum development and performance assessment. This research should provide an approach to the examination of training that is applicable to many internal medicine specialties. Importantly, nephrology training can now be improved with sound educational principles, underpinned by the findings of this research.
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Wong, Ming-yan Sharon, and 黃明欣. "Management of access to Hong Kong public specialist out-patient services." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48426180.
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Introduction
Accessibility to care is a key measure for quality health care. Waiting list resulted due to disequilibrium between demand and supply. Waiting time is a common issue in public health care services. Long waits and delays dissatisfy patients, affect clinical outcome and increase health care costs. Access management is therefore important to enhance patient safety, increase satisfaction and reduce service inefficiency. In Hong Kong, waiting lists for public specialist out-patient services have been increasing over the past years. Promotion of appropriate referrals and appropriate utilization between primary and secondary care was identified as one of the current strategies for service demand management. Referral guidelines were introduced to define the clinical conditions to be referred. Appropriate work up and trial of treatment was recommended before referral to specialist care. They were translated into standard referral letter templates and built into the existing electronic medical record system as an execution platform to facilitate workflow and enhance compliance. This electronic referral system was piloted since January 2010 in Department of Accident of Emergency and General Out-patient Clinic at one local public hospital in Hong Kong.
Methods
The objective of the study was to evaluate the effectiveness of current strategy in access management to public specialist out-patient services. All new case referrals to Medical and Surgical Specialist Out-patient Clinics (SOPC) of the pilot hospital from January 2010 to December 2010 were examined. While, the new case booking data from January 2009 to December 2009 in respective units of the same hospital was used as control group for comparison. Potential changes in number and distribution of new case bookings at medical and surgical SOPC as well as their corresponding waiting time were looked into. Comparison of referral pattern before and after the implementation of new referral system was performed.
Results
Changes in referral pattern in terms of distribution of triage categories have been observed. Number of semi-urgent cases was significantly increased in 2010 compared with 2009 in both Medical and Surgical SOPC (p=0.006 and p=0.048). Shortening of overall median waiting time was also seen in both Medical and Surgical SOPC of the pilot hospital in 2010. Consistent reduction with statistically significance was noted in all triage categories of both specialist clinics, except urgent cases in Surgical SOPC. Larger effect was seen in non-urgent cases, with 9 weeks and 4 weeks shortening of waiting time in Medical and Surgical SOPC respectively. For overall distribution of waiting time, persistent multimodal patterns were observed in both Medical and Surgical SOPC during the study period. Major peaks were identified within 2 and 8 weeks time of appointment, while scattered clustered bookings were seen along the timeline with waiting time up to years.
Discussion
The observed result was reinforcing the direction on current strategy, despite direct causal relationship could not be established at the moment. Changes in referral pattern could possibly be explained by the behavioral change of clinicians upon referral and triage of patients due to the introduction of the new referral system. Potential Hawthorne effect during the pilot period should therefore be considered. In view of the complexity and interconnectedness of various service components in the health care system, further studies should be of value to identify the change agent in the system and look into the efficiency gain as well as outcome improvement. Long term and regular monitoring mechanism of waiting time with specific set of performance indicators has to be in place for continuous quality improvement. Taking the public health approach by applying operational studies and simulation models should therefore be the way for further improvement of operational efficiency and service planning in the whole public health system.
Conclusion
Appropriateness of referrals and utilization between primary and specialist services was introduced for access management of public specialist out-patient services in Hong Kong. Changes in referral pattern with shortening of waiting time were observed. In order to manage the accessibility issue effectively, a balanced approach on demand, queue and capacity management was suggested to be adopted at the organizational level. Collaboration across sectors particularly with the direction to strengthen primary care would also be needed globally at the system level for a healthy, equitable and sustainable system.published_or_final_version
Public Health
Master
Master of Public Health
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Lannie, Antonia Lydia. "Experiences of the older person with cancer : a qualitative study of medical and specialist ward settings." Thesis, University of Dundee, 2014. https://discovery.dundee.ac.uk/en/studentTheses/544b9190-2798-4ff8-8e90-7898de5cd4d5.
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This thesis combines two research strands: cancer patients’ experiences and care of the older person. Previous cancer research has identified that health care professionals may treat older people with cancer differently, perceiving them as having less power; offering fewer treatment options; and less access to specialist cancer care. This qualitative study seeks to illuminate and compare the experiences of patients and health care professionals in two contrasting hospital wards (specialist and medical). This study considers how cancer patients manage their psychological and social needs. It also explores the challenges for health care professionals. Purposive sampling captures diversity of patient and health care professionals’ perceptions. Semi-structured interviews were conducted with patients and focus groups and semi-structured interviews with professionals. Analysis highlighted commonalities and also different emphasis accorded to issues such as societal perceptions, expectations of care, life stage, relationships, identity, and emotions. The hospital serves as a ‘halfway house’ for patients, allowing them to work through challenges in a ‘protected’ environment. However, health care professionals had difficulties addressing the future and managing some therapeutic opportunities. These are discussed using the thematic codes of ‘professional etiquette’, and types of emotional engagement with patients. Although older people with cancer are often perceived as a homogenous group they may have varying psychosocial needs. Moreover, patients’ understanding is frequently more sophisticated than professionals acknowledge. Finally the thesis will discuss the implications of this research for professional education, assessment and provision of care for the older person with cancer.
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Au, Yeung Kin-nam Simon. "Managerial perspective cost analysis of non-attendance in specialist outpatient clinics (SOPD) and reasons behind /." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B3197143X.
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Arksey, Hilary. "Interactions and influences between lay and expert groups in the construction of medical knowledge : the case of RSI." Thesis, Lancaster University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.306876.
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MacKay, Michael Hubbard. "The rise of a medical speciality : the medicalisation of elite equine care c.1680-c.1800." Thesis, University of York, 2009. http://etheses.whiterose.ac.uk/14229/.
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There are currently very few historians of veterinary medicine and outside of their scholarship there is almost nothing that has been written about veterinary history in the past thirty years. This is despite the fact that medical historians have created a large body of scholarship since the 1980s, including studies of political movements, social and cultural histories, histories of ideas of the medical profession, histories of specific diseases and histories of science. The lack of veterinary history is also striking because there has been a plethora of research corning from the field of human/animal relations. Furthermore, the history of animal care before formal veterinary education (1790s) is even more neglected and the scholarship that does exist is over forty years old and generally anachronistic-save the work of Louise Curth. This is all despite the outstanding changes that were occurring during the eighteenth century in Britain. Part of the reason that the current interpretations of eighteenth-century animal care are so anachronistic is due to the focus of historians upon the emergence of the London Veterinary College (1792) as an enlightened step toward progression. This is far from correct because a new medical specialty emerged in animal care over a century before the College. This thesis shows that those involved in the gentlemanly practice of farriery created a new specialised field of farriery that was much more medical. Like midwifery, oculism and dentistry, equine medicine became a new medical specialism. This is demonstrated by analysing elite farriery literature published between 1550 and 1800, by reconstructing the identity of eighteenth century farriery practitioners (especially those that claimed to be gentlemen), by uncovering the practice of these elite practitioners in horse hospitals and anatomy lectures. These findings suggest a new narrative of the history of animal care, showing that veterinary medicine was a product of the larger changes in equine medicine occurring well before the 1790s.
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Au, Yeung Kin-nam Simon, and 歐陽健男. "Managerial perspective: cost analysis of non-attendance in specialist outpatient clinics (SOPD) and reasonsbehind." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B3197143X.
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Goldberg, Sarah. "Confused older patients' experiences of care on a specialist medical and mental health unit compared with standard care wards." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/13107/.
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There are concerns about cognitively impaired older patients’ experiences of general hospital care. Nottingham University Hospital developed a medical and mental health unit (MMHU) as a demonstration model of best practice dementia care. This thesis describes a controlled clinical trial comparing patients’ experiences of care on the MMHU to standard care wards. Patient experience was measured using the structured non-participant observational tool Dementia Care Mapping. Observations lasted 6 hours during which a score was recorded every five minutes for the patient’s mood and engagement and activity, together with incidents of enhancing and detracting staff behaviours. Noise (alarms, background noise and co-patients calling out) was recorded. 90 (46 MMHU, 44 Standard care) patients were observed between March and December 2011. At admission, most characteristics of patients on MMHU and standard care were similar. However, patients observed on MMHU had more behaviour disturbance, more often were care home residents and were less disabled than those observed on standard care. Patients on MMHU experienced a median 11% (95% Confidence Interval (CI) 2%, 20%) improvement in the proportion of time in positive mood and engagement (79% versus 68%); a median 3 (95%CI 1, 5) more enhancers (4 versus 1); a median 13% (95%CI -17%, -7%) less time noise could be heard (79% versus 92%) but a median 15% (95%CI 1, 23%) increase in proportion of time co-patients called out (21% versus 6%). Patients on MMHU had a better experience of care than those on standard care wards in terms of their mood and engagement, number of enhancers and improved noise levels, but experienced more co-patients calling out. This is the first study measuring an intervention to improve cognitively impaired older patients’ experiences in the general hospital and the first study to use the Dementia Care Mapping tool to evaluate an intervention in this setting.
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BRICOTEAU, DIDIER, and STEPHANE HODEN. "Une nouvelle specialite medicale : la sante publique, pour quoi faire ? debouches pour les internes de sante publique en france en 1990, prospective." Lille 2, 1990. http://www.theses.fr/1990LIL2M295.
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Wagner, Becca R. "The Integration of Child Life in the Medical Diagnosis Camp Setting." Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1470313013.
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Yeung, Sze-ying. "A case control study of the referral pattern and patient non-attendance in medical and surgical specialist outpatient clinics in Hong Kong." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/b39724293.
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MacVane, Fiona Ellen. "Midwifery knowledge and the medical student experience : an exploration of the concept of midwifery knowledge and its use in medical students' construction of knowledge during a specialist obstetric rotation." Thesis, University of Bradford, 2010. http://hdl.handle.net/10454/4904.
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The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.
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MacVane, Fiona E. "Midwifery knowledge and the medical student experience. An exploration of the concept of midwifery knowledge and its use in medical students' construction of knowledge during a specialist obstetric rotation." Thesis, University of Bradford, 2010. http://hdl.handle.net/10454/4904.
Full textAbstract:
The literature concerning what medical students learn from midwives during specialist
obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery
attachments for medical students, it is almost non-existent.
Working with midwives is arguably the only opportunity medical students have to
experience holistic or social models of maternity care, focusing on normality rather than
on the medical concept of risk.
This study sought to discover how medical students constructed their knowledge about
childbirth during a six week specialist rotation in obstetrics in a Northern English
teaching hospital (NETH), with particular emphasis on whether participants assimilated
any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase
of the research, focused on MK, utilizing an international sample of experienced
midwives. Resulting themes were used to develop the data collection tool for the second
phase of the research.
The research employed a qualitative case study method with students from a single year
cohort comprising the case. Data were collected using a tool consisting of three problem
based learning (PBL) scenarios. These were presented to the students in consecutive
interviews at the beginning, the middle and the end of their obstetric rotation.
Following analysis, five main themes were identified which illuminated the medical
students' construction of knowledge about maternity care. These were explored and
discussed. The thesis concludes with recommendations for increasing opportunities for
IPE in the medical and midwifery curricula.
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Vaflor, Amy Louise. "Advanced Practice Registered Nurses and Medical Executive Committee Membership: A Quality Improvement Proposal." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1616670175777308.
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Yeung, Sze-ying, and 楊思瑩. "A case control study of the referral pattern and patient non-attendance in medical and surgical specialist outpatient clinics inHong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B39724293.
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Ndlebe, Lusanda. "Occupational exposure to tuberculosis: knowledge and practices of employees at specialised tuberculosis hospitals." Thesis, Nelson Mandela University, 2017. http://hdl.handle.net/10948/14245.
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Knowledge and safer practices regarding occupational exposure are crucial to all employees working in healthcare facilities, especially Tuberculosis (TB) hospitals. This study aimed to explore and describe the knowledge and practices of employees working in three specialised TB hospitals regarding occupational exposure to TB. The results of the study will be used to make recommendations to the Eastern Cape Department of Health (ECDOH) and hospital managers that could assist in reducing the prevalence of occupational TB. This quantitative, descriptive and contextual study was conducted in three specialised TB hospitals in the Nelson Mandela Bay Health District (NMBHD). Convenience sampling was used to select the research participants. The knowledge and practices of 181 employees towards occupational exposure to TB and infection control was measured through a self-administered questionnaire. The questionnaire covered areas such as the knowledge of TB and infection control, the infection control policy, infrastructure as well as patient transportation. The whole population was targeted and out of a potential 253 employees, 181 were on duty during the stage of data collection and agreed to willingly participate in the study. The data was analysed descriptively using MS excel and MS word. This study revealed that 69% (n=124/181) of employees in the three specialised TB hospitals in the NMBHD have adequate knowledge of infection control. However, only 10% (n=18/181) of employees reported appropriate infection control practices, while almost half of the participants 42% (n=76) apparently practice infection control poorly. The majority (78%, n=141) of the employees in the three specialised TB hospitals in the NMBHD reported knowing about the availability of an infection control policy in their respective hospitals, however only 42 % (n=76) have reportedly read the policy. In conclusion, knowledge and practices regarding occupational exposure in specialised TB hospitals in the NMBHD is not optimal. It is however, important to note that the majority of employees have knowledge about the TB disease itself and its symptoms. Recommendations were made in order to improve infection control knowledge and practices. These include the development of a plan for purchasing of equipment to address infection control, development of a curriculum specific for non-nursing personnel and the establishment of a plan to ensure the availability of patient consultation rooms and dining halls. A further recommendation deemed important by the researcher was isolation glass as a compulsory specification when purchasing patient transportation vehicles, in order to provide protection for the drivers transporting patients to and from the hospital.
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Majerienė, Nijolė. "Šeimų, auginanačių regėjimo negalės vaikus, santykių su sveikatos priežiūros specialistais patirtis." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2005. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2005~D_20050610_092629-22751.
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Summary
The paper analyses the problems that occur in the relationship between families, which raise blind children, and medical (or other) specialists and indicates the possible directions of improving and deepening these relations. The purpose of the paper: to analyse the experience of the relationship between the families, which raise the children with visual disabilities, and medical specialists. The subject of the paper: what is the experience of the relationship between the families, raising blind children, and medical specialists in the process of helping the child. The paper tried to purify the experience of each family, to sense the meanings, which parents endow their empathies with, to ascertain what suspenses and hopes they foster.
The qualitative analysis was taken for analysing the experience of the families and the specialists and the instrument for compilation the data was a qualitative interview. 7 women, raising the children with visual disabilities, participated in the research. The problems are researched in three aspects: firstly, the factors are identified, which help or disturb the families, raising the blind children, to overcome the psychological and spiritual discomfort, which is connected with the birth of the disabled child and his/her development, and which can have the influence to the health of the family members; secondly, the efforts are made to reveal the real requirements of these families, which are related to the services of medical and... [to full text]
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Almathkuri, Jalal Haris. "Investigating the motivation behind language alternation in the multilingual medical workplace : a study of language practices at King Abdul Aziz Specialist Hospital, Saudi Arabia." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/417871/.
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This study investigates the use of Language Alternation (LA) between Arabic and English by the employees of King Abdul Aziz Specialist Hospital (KASH) from a socio-cultural perspective in order to explore the motivation behind LA practices in this multilingual medical workplace. There were 75 participants including doctors, nurses, and administrative employees. Most of the participants are Saudis, however some of them are nationals of other Arab countries and others are nonArab, in both cases having different linguistic and cultural backgrounds. Data for this qualitative study were collected through observations, recording of naturally occurring interactions, and individual semi-structured interviews. The duration of the recorded material is nearly 35 hours. Using a combination of Interactional Sociolinguistics (Gumperz 1982), Politeness Theory (Brown & Levinson, 1987 and Scollon, et al., 2012), and Accommodation Theory (Giles & Powesland, 1975; Giles, 1973; Giles et al., 1987 and Giles, et al., 1991) as a theoretical framework, the findings from the data were grouped in themes and analysed in order to find out the reasons for and functions of LA. The results of the analysis indicate that the use of LA among the employees of KASH was generated by two major types of factors: institutional factors, due to which participants appeared to switch from one language to another because of conditions and/or constraints arising from the institutional setting, and cultural factors, which appeared to result in participants alternating between Arabic and English due to certain cultural beliefs and norms delineating cultural differences and overcoming cultural issues arising from the use of a foreign language. The major findings of this study include that LA is used to resolve communication difficulties, to facilitate effective communication using particular technical concepts and expressions, to negotiate power, hierarchy and personal relationships, to avoid using certain Arabic terms that are regarded as sensitive by some listeners, and to preserve the meaning of certain terms and expressions by using them in one particular language rather than the other, especially those regarded as formulaic chunks with specific cultural significance. The study concludes with research implications, implications for medical authorities and educators, and recommendations for future research.
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Wong, Wing-yee Victoria. "Patterns of doctor-shopping behaviour in non-attenders of specialist out-patient clinics in Hong Kong is it related to patients' health perception? /." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971350.
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Larsson, Jan. "Anaesthetists and Professional Excellence : Specialist and Trainee Anaesthetists’ Understanding of their Work as a Basis for Professional Development, a Qualitative Study." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4518.
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Rosenfeld, Mark. "Whiplash-associated disorders from a physical therapy and health-economic perspective : a study of an active physical therapy involvement and intervention for the treatment of acute whiplash-associated disorders and an analysis of its costs and consequenses /." Göteborg : Institute of Neuroscience and Physiology, Division of Physical Therapy, Sahlgrenska Academy at Göteborg University, 2006. http://hdl.handle.net/2077/711.
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Bellissimo, Silvia. "La lingua dei medici: analisi contrastiva tra l'italiano e il tedesco di collocazioni nella comunicazione tra specialisti." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2018. http://amslaurea.unibo.it/15238/.
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Il presente lavoro si pone come obiettivo quello di esaminare collocazioni statisticamente rilevanti che emergono dalla comunicazione tra specialisti del settore medico e di verificarne la solidità nella comunicazione divulgativa. L’indagine è stata svolta in italiano e in tedesco per consentire di notare analogie e differenze nel comportamento delle collocazioni nelle due lingue. La prima parte della ricerca, che consiste nell’estrazione delle collocazioni, è stata svolta a partire da sei parole (keywords) su corpus di specialità bilingue costruito manualmente. Il corpus in questione ha dimensioni piuttosto grandi ed è costituito da due subcorpora di circa 500 mila parole. La seconda parte della ricerca, che consiste nel verificare la solidità delle collocazioni estratte nella comunicazione divulgativa, è stata svolta confrontando i valori statistici MI delle collocazioni estratte dal corpus di specialità con quelli delle stesse collocazioni in un corpus generale. Questo passaggio ha consentito di mettere in risalto le collocazioni che sono più solide nella comunicazione specialistica o, in alcuni casi, esclusive del discorso scientifico.
Il lavoro consiste di 4 capitoli. Il primo capitolo introduce gli scopi e la rilevanza della ricerca. Il secondo capitolo illustra i materiali e il metodo utilizzati per lo svolgimento delle ricerche. Il terzo capitolo illustra i risultati che abbiamo ottenuto, accompagnati da un’analisi dei collocati e dall’interpretazione dei valori MI estratti dal corpus di specialità e di riferimento. Alla fine del capitolo 3 sono inoltre presenti alcune osservazioni riguardanti la traduzione di alcune collocazioni italiane che non dispongono di una collocazione corrispettiva in tedesco, ma vengono piuttosto espresse tramite Komposita. Il quarto capitolo presenta le conclusioni tratte dai risultati e i suggerimenti per ricerche future.
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Hillström, Moa. "När barn far illa : - BHV-sköterskors uppfattningar av stöd." Thesis, Högskolan i Skövde, Institutionen för hälsa och lärande, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-16866.
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Bakgrund: Antalet barn som far illa ökar samtidigt befaras det finnas ett mörkertal av barn som far illa men som aldrig upptäcks eller uppmärksammas. Detta tros bero på att inte tillräckligt många upprättar orosanmälningar till Socialtjänsten. Att upprätta en orosanmälan kräver stöd och en yrkesgrupp som särskilt berörs av detta är de sköterskor som arbetar inom BHV. Syfte: Att belysa BHV-sköterskors uppfattningar av stöd i arbetet med barn som far illa. Metod: Sju BHV-sköterskor intervjuades. Datamaterial analyserades med fenomenografisk ansats. Resultat: Tre beskrivningskategorier och nio underkategorier utformades. Resultatet visar att stöd är ett begrepp med flera innebörder. Det belyser också betydelsen av stöd samt vilka konsekvenser uteblivet stöd kan få. Organisatoriska faktorer påverkar BHV-sköterskans stöd och kan utgöra ett hinder i BHV-sköterskans arbete och uppfattning av stöd. Konklusion: Stöd kan vara avgörande för BHV-sköterskans arbete och omvårdnadsansvar. Uteblivet stöd skulle kunna få förödande konsekvenser. Utvecklad samverkan genom ett multiprofessionellt team ger stöd åt BHV-sköterskan och förbättrar samtidigt vårdkedjan för de barn som far illa. Organisatoriska faktorer påverkar BHV- sköterskan vilket bör tas i beaktning vid utformning och utveckling av vården.Background: The number of maltreated children are increasing and a great number of cases are estimated to never be detected or noted. This is believed to be caused by not enough reports to the Social Services which requires courage and support. A professional group that is affected by this are child health care nurses. Aim: To enlighten child health care nurses’ perceptions of support in working with maltreated children. Method: Seven child health care nurses were interviewed. The data were analysed through a phenomenographic approach.Results: Three description-categories and nine subcategories were formed. The results enlighten that support is a concept of several meanings, the meaning of support and what consequences lack of support can lead to. The results also show that organizational factors impact the support of the child health care nurse. Conclusion: Support can be a deciding factor in the child health care nurse’s work and responsibilities. Lack of support could have devastating consequences. A developed multi-professional team offers support to the child health care nurse and simultaneously improves the chain of care for the maltreated children. Organizational factors affect the child health care nurse, which should be taken into consideration in designing and developing health care.
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Åkesson, Ida, and Malin Wilding. "Läkares erfarenheter av Regionalt läkarstöd till ambulanssjukvården : En kvalitativ intervjustudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-62440.
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Bakgrund: Regionalt Läkarstöd (RLS) har utformats för att säkra prehospital involvering från läkare. Dagens ambulanssjukvård ställer höga krav på att bedöma och triagera patienter till rätt vårdnivå. Till sin hjälp i sitt dagliga arbete med detta behöver sjuksköterskan en läkare som är väl insatt i verksamheten. Syfte: Att beskriva läkares erfarenhet av att fungera som rådgivare till sjuksköterskor inom ambulanssjukvården Metod: Kvalitativ intervjustudie med tio läkare som tjänstgör som RLS. Analysen genomfördes med en kvalitativ innehållsanalys. Resultat: Resultatet beskrivs med de fyra kategorierna Teamsammanhållning, Frustration, Bristande ansvarskänsla och Lyhördhet, som speglade läkarnas erfarenheter av att vara telefonstöd till sjuksköterskor. Ett latent huvudbudskap identifierades som Skör tillit. Att som en del i teamet finnas som stöd och rådgivare till sjuksköterskor i ambulanssjukvården upplevdes som positivt och funktionen ses som relevant och viktig. Det krävs en god teamsamverkan mellan professionerna för en patientsäker vård och för att uppnå det utkristalliserades tillit som en nyckelfaktor. Konklusion: En telefonbaserad bakjourslinje dit sjuksköterskor kan vända sig för råd och stöd är en relevant funktion för läkarna, där de känner sig som en del i det prehospitala teamet. I arbetet med bättre teamsamverkan inkluderande god kommunikation för säker vård, är gemensamma möten och övningar en viktig del för att ge professionerna en chans att mötas som personer och främja ökad förståelse för varandras kunskap och utforma gemensamma mål.Background: Regional Medical support has been designed to ensure an involvement of doctors in the prehospital field. The current system for ambulance care raise high demands to ensure a correct patient assessment and triage to the right level of care, and for their assistance in this daily work, the nurse needs a doctor who is very knowledgeable in the organization. Purpose: To describe doctors’ experience of functioning as advisors for nurses working in the ambulance. Method: A qualitative research design was conducted including interviews with nine doctors serving as Regional Medical support. The content analysis was conducted according to a qualitative content analysis method. Result: The analysis resulted in the four categories team spirit, frustration, lack of sense of responsibility and responsiveness, which mirrored the doctors’ experiences of acting as a phone support for specialist nurses on the ambulance. An underlying main message was identified as delicate trust. To be part of the team and act as a support and advisor for nurses working on the ambulance was perceived as positive, relevant and important. Good teamwork between the professions is required to guarantee patient safe care, and to obtain that, trust came through as a key factor. Conclusion: For the nurses to have an on call doctor that they can reach on the phone for support and advice was seen as a relevant system for the doctors, where they feel as a part of the prehospital team. In the continuous work for better teamwork, including good communication for safe care, it's important with common gatherings and training sessions to give the professions a chance to meet in person and gain a better understanding for each other’s roles, and enunciate common goals.
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Nilsson, Jenny, and Veronica Hansson. "Överlämning från barn- och ungdomspsykiatrin till vuxenpsykiatrin." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26181.
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Psykisk ohälsa ökar bland unga vuxna och därtill behovet av att olika aktörer samverkar. Barn- och ungdomspsykiatrin arbetar med barn- och ungdomar som har psykisk ohälsa. Ungdomar som är i behov av fortsatt psykiatrisk vård överlämnas till vuxenpsykiatrin efter 18års ålder. Överlämningen från barn- och ungdomspsykiatrin tenderar att bli särskilt svår för ungdomar med neuropsykiatriska funktionsnedsättningar. Syfte: Syftet var att undersöka sjuksköterskors uppfattningar om överlämning från barn- och ungdomspsykiatrin till vuxenpsykiatrin. Metod: En kvalitativ intervjustudie med semistrukturerade intervjuer genomfördes. Totalt intervjuades åtta sjuksköterskor yrkesverksamma inom barn-och ungdomspsykiatrin eller vuxenpsykiatrin. Intervjuerna analyserades med konventionell innehållsanalys och manifest ansats. Resultat: Tre kategorier som svarade på syftet identifierades, nämligen oklara direktiv, vuxen på en dag och en god process. Slutsats: Bristande överlämning var en återkommande uppfattning bland sjuksköterskorna men också en oro över att ungdomarna inte var redo för överlämningen vid 18års ålder. Ökat samarbete från barn- och ungdomspsykiatrin till vuxenpsykiatrin var önskvärt av samtliga sjuksköterskor för att säkerställa patientsäkerheten.Mental illness is increasing among young adults and the need for different actors working together. Child and adolescent psychiatry work with children and adolescents who have mental illness. Young people who need continued psychiatric care are transmitted to adult psychiatry after 18 years of age. The transition from child and adolescent psychiatry to adult psychiatry tends to be particularly difficult for adolescents with neuropsychiatric disabilities. Aim: The aim was to examine nurse’s perceptions of the transition from child- and adolescent psychiatry to general adult psychiatry. Method: A qualitative interview study with semi-structured interviews was conducted. In total, eight nurses working in child and adolescent psychiatry or adult psychiatry were interviewed. The interviews were inductively analysed with conventional content analysis and a manifest approach. Result: Three categories that responded to the aim were identified; unclear directives, adult in one day and a good process. Conclusion: Deficient transition was a recurring opinion among nurses, but also a concern that young people were not ready for transition at the age of 18. Increased collaboration from child- and adolescent psychiatry to adult psychiatry was desired by all nurses in order to ensure patient safety
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黃穎兒 and Wing-yee Victoria Wong. "Patterns of doctor-shopping behaviour in non-attenders of specialist out-patient clinics in Hong Kong: is itrelated to patients' health perception?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971350.
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Valls-Lacroix, Marie-Noëlle. "Les professions sanitaires et sociales : leur evolution et leur impact dans l'histoire sociale du xxeme siecle." Paris 7, 1987. http://www.theses.fr/1987PA070039.
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Acteurs a part entiere de l'action medico-sociale, les travailleurs (para) medicaux et ou sociaux restent constamment confrontes a la realite socioeconomique de notre societe, qui par un jeu de sollicitations ideologiques inherentes au contexte historique, oriente la specificite technique de leur fonction. La plupart de ces professions nous frappent de prime abord par leur jeunesse, l'engouement quasi-vocationnel qu'elles ont suscite, enfin leur forte feminisation. Indices singuliers, traducteurs de quelques determinisme socio-culturel quant a la canalisation des carrieres medico-sociales dans les rouages de reseaux institutionnels bien precis. Nous considerons au prealable certaines particularites communes, a savoir, d'une part un niveau insigne de technicite garanti par 3 ou 4 annees d'etudes apres le baccalaureat, et d'autre part une finalite medico-sociale, de surcroit accompagnee d'objectifs tout aussi curatifs que preventifs, definissant de la sorte les schemas elementaires d'une action specialisee au demeurant globale. En deduction logique nous retenons : parmi les professions sociales : assistances sociales - animateurs socio-culturels - educateurs specialises - conseilleres en economie sociale et familiale. Parmi les professions (para) medicales et ou sanitaires : infirmiers - puericultrices - sages-femmes. Notre analyse met en evidence un ecart persistant entre la haute qualification de ces metiers indispensables au bon fonctionnement du dispositif medico-social et une gratification institutionnelle relativement limitee, que nous tentons d'expliciter par la question suivante : quelle reconnaissance peut offrir la "puissance publique" et administrative a des activites inscrites jadis dans le domaine particulier des savoir-faire improvises benevoles et feminins, dans une societe ou la representation collective a longtemps vehicule l'image de la femme en simple executante du pouvoir decisionnel, a fortiori masculin ?
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Petersson, Lisa, and Sara Samuelsson. "Att vara specialistsjuksköterska inom medicinsk vård : En digital studie." Thesis, Malmö universitet, Fakulteten för hälsa och samhälle (HS), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-41669.
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Bakgrund: Specialistsjuksköterskor har en central roll i upprätthållandet av en god och patientsäker vård. I nuläget tillvaratas inte specialistsjuksköterskans kompetens, vilket har minskat yrkets attraktivitet. Det finns ingen kompetensbeskrivning framtagen för specialistsjuksköterskor med inriktning medicinsk vård, vilket bidrar till svårigheten att definiera yrkesrollen. Syfte: Syftet med studien var att undersöka hur specialistsjuksköterskor med inriktning medicinsk vård beskriver sin yrkesroll och kompetens. Metod: En digital studie med specialistsjuksköterskor inom medicinsk vård i södra delen av Sverige. En kvalitativ innehållsanalys med induktiv metod genomfördes. Resultat: Analysen resulterade i två generiska kategorier: Att växa in i rollen som specialistsjuksköterska och Att höja kvaliteten i vården genom kunskap. Specialistsjuksköterskorna beskrev sig ha en fördjupad kompetens efter utbildningen, vilket ledde till en mer avancerad praktik och en större trygghet i rollen. Med en djupare förståelse för vården som helhet följde också en större frustration, exempelvis kring organisatoriska hinder för en god omvårdnad. Specialistsjuksköterskorna roll innebar bland annat att ta ansvar för att bedriva en god och säker vård, att genomföra förbättringsarbeten, sprida evidensbaserad kunskap och vara ett stöd till kollegor. Slutsats: Resultatet indikerar att förändringar i organisationen behövs. Specialistsjuksköterskor behöver mer tid och resurser för att kunna utöva omvårdnad på avancerad nivå och för att deras unika kompetens skall komma patienten till ännu större gagn. Studien har gett en indikation om vad yrkesrollen och kompetensen som specialistsjuksköterska inom medicinsk vård innebär men ytterligare förtydligande av yrkesrollen krävs.Background: Specialist nurses have a central role in maintaining good and patient-safe care. At present, the specialist nurse's competence is not properly utilized, which has reduced the profession's attractiveness. There is no description of competence produced for specialist nurses of medical care, which contributes to the difficulty of defining the professional role. Aim: The aim of the study was to investigate how specialist nurses of medical care describe their professional role and competence Method: A digital study with specialist nurses of medical care in the southern part of Sweden. A qualitative content analysis with an inductive method was carried out. Results: The analysis resulted in two generic categories: Growing into the role of specialist nurse and Improving the quality of care through knowledge. The specialist nurses described themselves as having in-depth competence after their education, which led to a more advanced practice and greater security in the professional role. With a deeper understanding of care as a whole came a greater frustration, among other things about organizational barriers to good care. The role of specialist nurse in medical care involved taking responsibility for conducting good and safe care, carrying out improvement work, disseminating evidence-based knowledge and being a support to colleagues. Conclusion: The results indicate that changes are needed at the organizational level. Specialist nurses need more time and resources to be able to practice nursing at an advanced level and for their unique skills to benefit the patient more. The study has given an indication of what the professional role and competence as a specialist nurse in medical care entails, but further clarification of the professional role is required.
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Stenlund, Andreas, and Stefan Birko. "Förekomst och förebyggande av hot och våld mot ambulanspersonalen i norra Sverige." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74912.
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Hot och våld mot ambulanspersonal har visat sig vara ett växande problem och påverkar möjligheten att ge god omvårdnad till patienten. Förekomsten av hot och våld prehospitalt har inte studerats i Sverige i samma utsträckning som i andra länder. Syftet med denna studie var att belysa förekomsten av hot och våld mot ambulanspersonalen i norra Sverige och hur detta kan förebyggas. Detta undersöktes med en webbaserad kvantitativ tvärsnittsstudie av enkätdesign med möjlighet till fritextsvar. Denna studie visade att majoriteten (80,4%) av ambulanspersonalen hade blivit utsatt för verbala hot någon gång under de senaste tre åren. 26,8 % av ambulanspersonalen skattade att de hade blivit utsatta för fysiskt våld under samma period. En statistiskt signifikant skillnad mellan män och kvinnor när det gäller deras skattning av att ha blivit utsatta för fysiskt våld kunde påvisas. En majoritet av ambulanspersonalen svarade att de aldrig hade utsatts för sexuellt ofredande de senaste tre åren. Kvinnor skattade i högre grad än männen att de blivit sexuellt ofredade och skillnaden var signifikant. Utifrån frågan om vilken typ av problematik som är vanligast, gällande personer som utövat fysiskt våld, framkom att personer som intagit både alkohol och droger/narkotika skattades som överrepresenterade. Denna studie genererar kunskap om vikten av att ha stöd från arbetsgivare och ett gott samarbete med andra myndigheter, exempelvis polis. Att göra riskbedömningar och att använda sig av lågaffektivt bemötande där det finns risk för hot och våld kan förebygga detta. Det är av fortsatt vikt att följa och studera utvecklingen av hot och våld mot ambulanspersonal och arbeta med hur detta kan förebyggas.
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Buetto, Luciana Scatralhe. "Os significados de ser enfermeiro especialista em oncologia." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-07102009-153327/.
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Trata-se de um estudo qualitativo, com a utilização da perspectiva sociológica do conhecimento e da educação, que teve como objetivo interpretar os significados de ser Enfermeiro Especialista em Oncologia, entre os egressos do Curso de Especialização em Enfermagem em Oncologia, da Escola de Enfermagem de Ribeirão Preto, da Universidade de São Paulo. Foram entrevistados 20 profissionais atuantes na área de enfermagem oncológica, egressos da primeira, segunda e terceira turmas da especialização. A cole ta de dados ocorreu no período de março/2008 a janeiro/2009, no ambiente de trabalho de cada participante. Utilizamos o referencial metodológico do estudo de caso instrumental, do método do relato oral pontual, e da técnica de entrevista semi-estruturada. Para apreender os significados analisamos os dados por meio da análise de conteúdo indutivo. Primeiramente, os dados foram organizados e codificados em núcleos de sentidos; a seguir, construímos os três núcleos temáticos: a trajetória do enfermeiro em busca da especialização em oncologia, a prática do especialista em oncologia: o universo novo e ser enfermeiro especialista em oncologia: a construção da nova identidade, pelos quais obtivemos a compreensão do fenômeno. No primeiro núcleo temático, abordamos o contexto de trabalho que determinou a busca pelo curso de especialização pelo enfermeiro, onde os aspectos significativos foram a primeira inserção no mercado de trabalho, as perspectivas profissionais, as dificuldades de inserção em áreas especializadas apenas com o conhecimento da graduação, a exigência da qualificação profissional pelo mercado de trabalho, a troca de experiências com outros profissionais e suas expectativas futuras quanto à sua prática especializada. No segundo tema, ao interpretarmos a nova práxis do enfermeiro especialista, depreendemos que a sua formação especializada subsidia a prática profissional. Esta apresenta diversas interfaces, resultantes das características individuais, profissionais e institucionais, acrescidas das condições sócio-históricas de todos os envolvidos e suas interrelações, que constroem as diferentes formas de compreensão do cotidiano e do conhecimento da enfermagem oncológica. Ao construirmos o terceiro núcleo acerca da nova identidade do enfermeiro especialista em oncologia, evidenciamos a importância da interação da identidade do trabalho, do cotidiano com as relações de ser/fazer e a sua compreensão sobre o processo de cuidado do paciente oncológico. Os significados de ser enfermeiro especialista em oncologia são uma composição entre o conhecimento técnico-científico adquirido na graduação, o conhecimento especializado e sua experiência clínica; é uma reafirmação da sua escolha pela especialidade. Consideramos que a elaboração dos significados para estes enfermeiros não são um processo acabado, pois se reconstrói e re-significa diariamente, ampliando a sua compreensão de ser especialista, no contexto de cuidado ao câncer.This qualitative study aimed to interpret the meanings of being an Oncology Specialist Nurse, through the sociological perspective of knowledge and education, among former students of the Nursing Oncology Specialization Course, of the University of São Paulo at Ribeirão Preto College of Nursing. Twenty nurses who were part of the three first classes of the specialization course and work in oncology nursing were interviewed. Data collection was done between March 2008 and January 2009, at participants work. The instrumental case study, the accurate oral report method and the semi-structured interview technique were used as methodological framework. Inductive content analysis was used to identify the meanings. Firstly, data were organized and codified in meaning cores; afterwards three thematic groups were formed: nurses trajectory in the search for oncology specialization, oncology specialists practice: the new world and being an oncology specialist nurse: the construction of the new identity, through which the phenomena were understood. The first thematic group addressed the context of work that induced the search by nurses for the specialization course, in which the significant aspects highlighted were: the entry in the labor market, professional perspectives, difficulties faced to entry specialized areas only with skills acquired in undergraduate studies, demand for professional skills by the labor market, experience exchange with other workers and their future expectations regarding the specialized practice. The interpretation of specialist nurses new praxis, in the second theme, showed specialized training support the professional practice. This practice presents several facets, resulting from individual, professional and institutional characteristics. The socio-historical conditions of the people involved and their interrelationship also influence, building different ways to understand daily life and oncology nursing knowledge. The third group, about oncology specialist nurses new identity, evidenced the importance of the interaction of works identity and daily life with the relation of being/doing and its understanding about oncological patients care process. The meanings of being an oncology specialist nurse involve technicalscientific knowledge acquired during undergraduate studies, specialized knowledge and clinical experience; and is a reaffirmation of the choice for the specialty. The development of the meanings to these nurses is not a finished process, since everyday they rebuild and re-mean them, broadening their understanding of being a specialist, in the context of cancer care.
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Sukkar, Malak, and sukkarm@stvmph org au. "Executives' Decision Making in Australian Private Hospitals: Margin or Mission?" RMIT University. Graduate School of Business, 2008. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20081031.162754.
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This thesis examines decision making at executive level in Australian private hospitals as a social phenomenon, since individuals draw meaning from their own biographical and social environmental experiences. The researcher interpreted the constructed realities of the factors influencing executives' decisions within the context of private hospitals - a field that is rarely examined through the lens of social research. Using an Interpretivist research paradigm, the researcher conducted semi- structured and in-depth interviews with sixteen executive members who are experts in their field and represent both sectors of the private hospital industry: private for-profit and private not-for-profit. The data generated was transformed into technical accounts using an abductive research strategy and adopting Schütz's notion of first-order and second-order constructs. Using Giddens' Structuration Theory, that stressed the fundamental role of the human agent, the structure and their mutual dependence, the researcher moved beyond the interpretation of individuals' meanings, to incorporate the structure as an entity that can be formed and reformed. The researcher interpreted social actors' constructed meanings of these social phenomena in their work environment to form the elements of a two-dimensional decision making model at organisational level, incorporating the present with the future and the internal with the external factors. On an individual level, three different approaches to decision making were identified, based on whether executives perceived the decision making phenomenon as intuition, as a reasoned process or as an expected outcome. While being from a limited research sample, the findings of this study suggest that the paradox of mission / economic decisions restrained executives in the not-for-profit sector from strengthening their hospitals' financial performance, putting at risk, therefore, their ability to achieve social dividends as a way to proclaim their mission. On the other hand, in the for-profit sector, shareholders' dividends appeared to be a strong catalyst for attaining profit maximisation when making decisions. In both settings, the findings suggest that the role of stakeholder theory is questionable, particularly when executives remained hesitant to involve medical specialists, whom they considered to be major stakeholders and profit generators for private hospitals. This attitude appeared to be constant, despite the changes identified in executives' individual approaches to decision making. However, early signs of shifts towards adopting more commercially and socially accountable decisions were apparent in not-for-p rofit and for-profit sectors respectively. The thesis sets out recommendations to assist executives in managing the different factors that interplay to form executives' decisions. The importance of having a mission in business longevity and the integration, as opposed to alignment, of strategic goals with business operations when making executive decisions in private hospitals was highlighted. The implications for both sectors are described and recommendations for further research are suggested.
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Larsen, Anton, and Andrea Marklund. "Kroppsspråk, handpåläggning, hängslen och livrem : ambulanspersonalens upplevelse av att bedöma och vårda patienter vid språkförbistring." Thesis, Sophiahemmet Högskola, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3115.
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Bakgrund: Sverige har genomgått en förändring i demografi där en allt större del av befolkningen inte har svenska som modersmål. Samtidigt går ambulanssjukvården från att vara en transportfunktion där destinationen alltid varit akutsjukhus till att vara patientens första möte i en obruten vårdkedja. I detta nya uppdrag ingår att inhämta information, bedöma, vid behov behandla och slutligen transportera eller hänvisa patienten till rätt vårdnivå. Grunden för detta är en korrekt anamnes, bedömning och triagering.Detta ställer krav på individanpassad och differentierad vård. Språkförbistring på sjukhus har visat sig resultera i ökad handläggningstid, en större mängd undersökningar och fler vårdskador. Prehospitalt har forskning på språkförbistring inriktat sig på larmsamtal. Syfte:Syftet med denna studie var att undersöka ambulanspersonalens upplevelse att bedöma och vårda patienter vid språkförbistring.Metod: Syftet besvarades genom en kvalitativ studie med induktiv kvalitativ innehållsanalys. Deltagarna utgjordes av sex ambulanssjuksköterskor och två ambulanssjukvårdare som alla hadeerfarenhet av att bedöma och vårda patienter vid språkförbistring. Intervjudeltagarna rekryterades genom bekvämlighetsurval från ett mellansvenskt län. Data inhämtades med semistrukturerade enskilda intervjuer och analyserades med hjälp av induktiv innehållsanalys. Resultat: Fyra huvudkategorierframträdde. En mer fysisk bedömning beskrev hur ambulanspersonalen vid språkförbistring i större utsträckning nyttjade yttre, fysiska attribut för att göra en skattning av patientens kontaktorsak och allvarlighetsgrad. Att kommunicera annorlunda rörde hur vårdarna sökte kommunicera med patienten trots språkförbistring. Att handlägga utan information avhandlade information som ambulanspersonalen trots försök upplevde svår att klarlägga samt hur detta påverkade deras handläggning av patienten. Slutligen presenterades kategorin att skapa en relation vid språkförbistring som belyste hur intervjudeltagarna upplevde att deras mellanmänskliga vård påverkades vid språkförbistring. Slutsats:Studiens resultat påvisar att ambulanspersonals upplevelse av bedömning och vård vid språkförbistring karaktäriseradesav osäkerhet och en önskan om att kompensera för informationsluckor. Denna kompensation yttrade sig genom en noggrannare, bredare fysisk undersökning och bedömning samt en handläggning och vård som arbetar efter modellen ”hängslen och livrem”. Detta upplevdes också som begränsande då vårdarna avhöll sig från vissa åtgärder, såsom smärtstillning eller omstyrning till närakut, primärvård eller geriatriskt sjukhus. Då patienten var kritiskt sjuk upplevde inte personalen att omhändertagandet skiljde sig mot ett möte utan språkförbistring. Vid de tillfällen patienten inte var uppenbartakut sjuk upplevde personalen att de inte kunde ge samma möjligheter till en individanpassad vård och handläggning.En del av denna problematik skulle kunna adresseras genom ett utökat och anpassat besluts- och översättningsstöd för ambulanspersonalen.Background: Sweden is going through a demographic change in which a larger part of the population no longer has swedish as its first language. At the same time the ambulance service is transforming from a purely transporting service to an integrated part of the patients overall healthcare. This new mission involves to gather information, to assess, when needed to treat and finally to transport or direct the patient to the most suited level of care. This process is based on a correct patient history, assesment and triage. Previous research has shown that language barriers in hospitals result in an increased risk of delays, costly examinations and injuries. Prehospital research on language barriers have traditionally focused on the emergency phone-call. Aim: The purpose of this study was to explore ambulance staffs experiences and perceptions of assessing and caring for patients where language was a barrier. Method: This was a qualitative study using a qualitative content analysis. Participants included six Swedish ambulance nurses and two ambulance nursing assistants who all had experience in assessing and caring for patients where language had been a barrier.Participants were recruited based on convenience. Data was collected through semi-structured interviews and analysed using inductive content analysis. Results:Four main categories emerged. A more physical evaluation encompassed how the providers increased the importance of outside physical attributes to assess the patients condition and level of urgency. To communicate differently comprised hos staff despite language barriers sought to communicate with the patient. To process without information described information that staff despite attempts were unable to map and how this affected their assessment and decision-making. The final category regarded to create a relationship through the language barrier and how participants perceived that their interpersonal carewas affected by language difficulties. Conclusion: The ambulance staff perceived and experienced the assesment and care where language was a barrieras characterised by a higher degree of uncertainty and a wish to compensate for alack of information. This compensation manifested itself through a more thorough, wider physical examination and an assessment based on the principle of ”belt and suspenders”. This was perceived as a limitation as staff abstained from certain actions, such as administering pain relief or directly admitting the patient to primary care or a geriatric ward. The assessment and care for the critically ill patient did not differentiate from that of the everyday case. The moderately ill patient however was perceived as not to be given thesameoptions to an individually adapted care and handling. Part of this problematique could be adressed through an expanded and adapted language- and decision making-tool for the crews.
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Carro, Adriana Rosa Linhares. "Caracterização do perfil dos candidatos ao Concurso de Residência Médica do Sistema Único de Saúde, no período de 1999 a 2004." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-12022008-130826/.
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O objetivo deste estudo foi caracterizar o perfil dos candidatos ao Concurso de Residência Médica do Sistema Único de Saúde a partir do Concurso 1999, comparando-o com o concurso realizado 5 anos depois, Concurso SUS 2004. Trata-se de um estudo descritivo a partir da utilização de dados secundários contidos num banco organizado pela Fundação Carlos Chagas e disponibilizado para a Secretaria de Estado da Saúde de São Paulo. As variáveis dos candidatos analisadas foram: sexo, idade, opção de escolha, local de graduação, natureza jurídica da faculdade de graduação, bem como seu desempenho no Exame Nacional de Cursos - Provão, presença e situação de habilitação no concurso. O número de candidatos aumentou 18% no período, sendo a maioria dos inscritos do sexo masculino, embora as mulheres tenham aumentado seu percentual de participação. A maior parte dos candidatos encontra-se na faixa entre 22 e 24 anos, seguida por candidatos na faixa entre 25 e 27 anos, tendo havido um envelhecimento do perfil dos candidatos no período. A maioria dos inscritos origina-se da Região Sudeste, sobretudo do Estado de São Paulo, e as Regiões Norte e Centro-Oeste contribuem com o menor percentual de candidatos. De forma geral predominam candidatos graduados em faculdades públicas, principalmente federais e, no caso dos candidatos graduados no Estado de São Paulo, a maior parte graduou-se em faculdades privadas. As especialidades com maior número de candidatos são as das Áreas Básicas, sobretudo a Clínica Médica, seguida pelas especialidades com acesso direto, enquanto as especialidades que exigem cumprimento de pré-requisito anterior contam com o menor número de candidatos, apesar de ser o único grupo que apresentou incremento no percentual de candidatos no período. A maior parte dos inscritos graduou-se em faculdades com conceito C na avaliação do provão, sendo o percentual de candidatos oriundos de escolas com ótima avaliação no provão (conceitos A ou B) é um pouco superior ao de candidatos oriundos de escolas com avaliação ruim (conceitos D ou E). A relação entre o número de candidatos habilitados e o de presentes (índice de habilitação) é maior para a Região Sul, enquanto a Região Norte apresenta o menor índice entre as regiões. Este índice ainda é superior para candidatos oriundos de faculdades públicas assim como para os candidatos oriundos de escolas com melhor avaliação no provão. O índice de ausência sofreu redução de 50% no período, sendo maior para candidatos graduados em escolas públicas, assim como para os originários da Região Sul do país.The objective of the study was to describe the applicants profile to Single Health System Medical Residency Contest in 1999, comparing to applicants profile to the contest placed five years later. This is a descriptive study, based on secondary data organized by Fundação Carlos Chagas and put available to Secretaria de Estado da Saúde de São Paulo. The applicants\' variables analyzed were: gender, age, medical specialty, place of graduation, legal nature of university\'s graduation course, performance at the Courses National Examination, attendance frequency and contest habilitation condition. The number of applicants increased 18% in the period and most of the applicants were men, although women had increased their relative participation. In 1999 and 2004, most of the applicants were between 22 and 24 years, followed by applicants between 25 and 27. However, the relative participation of this last group has increased in 2004, pointing to an ageing of the applicants profile in the period. Most of the applicants were from Brazil Southwest region, especially from São Paulo state; Brazilian North and Center regions contributed with the smallest number of applicants. In general terms, applicants that graduated from public universities (mainly federal universities) predominate and applicants from São Paulo state were, in most cases, graduated from private universities. The specialties that had the highest number of applicants were Basics Areas (mainly Medical Clinic), followed by direct access specialties, while specialties that requires a concluded program had the smallest number of applicants; however, this were the only group which relative number of applicants had increased during the period. Most of the applicants were from universities with grade C in the national examination, and the number of applicants from universities with a good performance (grade A or B) was a little higher than the applicants from universities with a bad performance (grade D ou E). The relationship between the number of applicants habilitated and the number of applicants that were present (index of habilitation) is higher in South Region, while the North Region presents the smallest index; this index is higher when considering applicants from public universities and universities with good performance in the Courses National Examination. The absence index had decreased 50% in the period, being higher in applicants from public universities than from private ones, as in applicants from the South of the country.
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