Dissertations / Theses on the topic 'Minorities – Medical care – Great Britain'
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1
Grubb, Penelope Ann. "The impact of information technology upon primary health care in Great Britain." Thesis, University of Hull, 1991. http://hydra.hull.ac.uk/resources/hull:4567.
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This is a study of the impact of information technology on health care in Great Britain. Its major aim is to identify means by which information technology may improve the quality of health care in specific areas within the health services.The study concentrated upon general practice and was split into three stages. The first was a survey of general practice computing, conducted to give an overview of the use of computers in general practice. Following this, was a more detailed study of general practice miniclinics. The final stage was an in-depth investigation into the use of computers in the care and treatment of diabetes.
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Beniuk, Kathleen. "Integrating evidence-based medicine and service design : a study of emergency department crowding." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610514.
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Carter, Holly R. "The Effects of Age, Sex, and Class Stratification and the Use of Health Care Services among Older Adults in the United Kingdom." Thesis, University of North Texas, 1999. https://digital.library.unt.edu/ark:/67531/metadc2256/.
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As the population ages, providing health services for the growing number of older people will become an increasingly difficult problem. In countries where the health services are provided by the government, these problems are involved with complicated issues of finance and ethics. This is the case of the National Health Service, the government institution providing health care for the citizens of the United Kingdom. Knowing what social factors influence health care usage can be a link to match usage and funding. Literature has shown that health care utilization can be predicted by social factors, as well as the medical model, and from this orientation social variables were drawn from the 1994 General Household Survey. Social factors were analyzed to determine relationships that exist between certain types of health care use and these factors. Age, sex, and class, the three main factors shown in literature to affect usage, were then analyzed to determine if services are allocated on the basis of these factors or the basis of need from illness and disability. Results of the study show that of the predisposing variables, age, sex, and class, are associated with most types of health care use. From the enabling variables, both source of income and visits from friends and relatives are associated with most types of health care. Of the illness determinants, disability, limiting illness, restricted activity days and eyesight difficulty were all related to health care use. When intervening control variables were introduced, the intervening control variables of difficulty with activities of daily living and difficulty with instrumental activities of daily living had an explanatory effect on the use of home help, district nursing, consultations with a general practitioner at home, consultations with a general practitioner at a surgery or health clinic, and inpatient stays. These services were offered more according to need than the factors of age, sex, and class.
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McCormack, Brendan. "An exploration of the theoretical framework underpinning the autonomy of older people in hospital and its relationship to professional nursing practice." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.670229.
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Ritch, Alistair Edward Sutherland. "Medical care in the workhouses in Birmingham and Wolverhampton, 1834-1914." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/5910/.
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This study of the medical role of the urban workhouses of Birmingham and Wolverhampton after the New Poor Law addresses the following questions: what were the standards of medical and nursing practice and what treatments were used to alleviate inmates’ suffering? It considers the nature of illnesses encountered covering acute non-infective illnesses, infectious disease and chronic disability, and highlights the important role the workhouse played in providing institutional care, especially in the isolation of epidemic diseases. Birmingham workhouse had a well-developed medical service prior to the New Poor Law and this continued until the mid-nineteenth century. By comparison, Wolverhampton workhouse did not meet satisfactory levels of medical and nurse staffing until near the end of the century. The study provides a new perspective on medical care in workhouse infirmaries by showing how standards varied over time within the same institution and how medicalisation of the workhouse began in the early years after the New Poor Law. Medical care in workhouses has been viewed as important only in the context of the development of the National Health Service but this study demonstrates that it provided significant, and at times high quality, medical treatment for the poor.
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White, Christopher P. "NHS resource allocation 1997 to 2003 with particular reference to the impact on rural areas." Thesis, St Andrews, 2009. http://hdl.handle.net/10023/825.
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Humphris, Rachel Grace. "New migrants' home encounters : an ethnography of 'Romanian Roma' and the local state in Luton." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:3af69cfa-2cd7-4972-afb2-14d92238d25a.
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This ethnographic study explores how 'Romanian Roma' migrants in the UK, without previous relationships to their place of arrival, negotiate their identity to make place in a diverse urban area. The thesis argues that state forms are (re)produced through embedded social relations. The restructuring of the UK welfare state, coupled with processes of labelling, means that the notion of public and private space is changing. Migrants' encounters with state actors in the home are increasingly important. I lived with three families between January 2013 and March 2014, during a period of shifting labour market regulations and the end of European Union transitional controls in January 2014. Through mapping families' relationships and connections, I identify encounters in the home with state actors regarding children as a defining feature of place-making. The thesis introduces the term 'home encounter' to trace the interplay of discourses and performances between state actors and those they identified as 'Romanian Roma'. Due to the restructuring of UK welfare, various roles assume different 'faces of the state'. These include education officers, health visitors, sub-contracted NGO workers, charismatic pastors and volunteers. The home encounter is presented as a public 'state act' (Bourdieu 2012) where negotiations of values take place in private space determining access to membership and welfare resources. In addition, blurring boundaries between welfare regulations and immigration control mean that these actors' seemingly small decisions have far-reaching consequences. The analysis raises questions of how to understand practices of government in diverse urban areas; the affect of labelling, place and performance on material power inequalities; and processes of discrimination and othering.
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Murphy, Richard. "Health professionals and ethnic Pakistanis in Britain : risk, thalassaemia and audit culture." Thesis, University of St Andrews, 2005. http://hdl.handle.net/10023/2802.
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The central theme or 'red-thread' that I consider in this thesis is the concept of risk as it is perceived by and affects the two sides of the medical encounter -in this instance ethnic Pakistanis and Health Professionals- in Britain. Each side very often perceives risk quite distinctively, relating to the balance between the spiritual and temporal realms. This is particularly germane in matters to do with possible congenital defects within the prenatal realm for the ethnic Pakistani, and predominantly Muslim, side of this encounter. Thus one of the factors considered in this thesis is how senses of Islam impact upon the two sides. By ethnic Pakistanis Islam is seen as central to all life decisions, whilst Health Professionals view Islam with some considerable trepidation, little understanding it or its centrality to the former's decision-making processes. This is particularly significant with regard to attitudes to health and health care. In the initial stages of the project I had thought first cousin marriage (FCM), seen by ethnic Pakistanis as desirable and by Health Professionals as putting ethnic Pakistanis at-risk to be central to the argument, but concluded that concerns around FCM were a 'red herring', merely a trope for the tensions between the two sides -at once both British and at-risk from audit culture. Although no longer central, FCM remains a viable touchstone in consideration of the two sides' perceptions of genetic risk. In this thesis the medical encounter between ethnic Pakistanis and Health Professionals is performed within the realm of the so called New Genetics. Here the respective understandings of the New Genetics are informed by the enculturation processes that shape the two sides' world view. Furthermore, I will agree with Lord Robert Winston's and others' concern that any attempt to eradicate an adaptive genetic mutation, in this instance, thalassaemia, from the gene pool is not only undesirable in the short term, but also that such eradications may have an adverse, and far reaching, effect on whole population groups in the future. The main thrust of my argument is that audit culture not only compounds risk for both sides, but also perpetuates institutional racism within the National Health Service (NHS), by promulgating what I have called the language myth. That is to say that much institutional racism is the unwanted by-product of the NHS's attempts to become more patient centred and its continuing efforts to develop systems of best practice. This professionalisation process within the NHS can be seen to impact most strongly in relation to communication -particularly the claimed language barrier between the two sides. This 'barrier' has worrying policy implications for any meaningful communication between the two sides, notably relating to obtaining informed consent from ethnic Pakistani patients -with a resultant increase in risk for the two sides and clear economic consequences for the NHS.
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康詠儀 and Wing-yee Veronica Hong. "A comparative study of healthcare financing systems in US, UK and HK." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41709858.
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Bland, Rosemary. "Senior citizens, good practice and quality of life in residential care homes." Thesis, University of Stirling, 2006. http://hdl.handle.net/1893/70.
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This thesis is an examination of the definition and implementation of ‘good practice’ in residential care for senior citizens. The central contention is that ‘good practice’ is a term that has been variously defined. Different groups define it in different ways, and their definitions have changed over time. This reflexive qualitative study explores ‘good practice’ in local authority, voluntary and private residential care homes in Scotland from the perspective of policy, practice and the experience of senior citizens who live in them. The study is based on analysis of policy documents, historical studies, and reanalysed interview and survey data from two earlier studies conducted by the author and colleagues. The thesis shows that the notion of ‘good practice’ that emerges in policy and practice documents is a confused and often conflicting set of ideas. Historically, the earliest were driven by concerns over cost. In more modern times, statements about ‘good practice’ have had a more benevolent intent but are frequently flawed by paternalistic and ageist assumptions. It is shown that staff in residential homes typically adopt a different set of attitudes: their preoccupation is with safety and the avoidance of risk. Although benevolent in intention, these interpretations of ‘good practice’ are also at variance with what residents themselves actually want. Two particular models or styles of care are examined in detail. One of these is the use of ‘keyworkers’, often implemented in ways that fail to realise its potential. The other is the ‘hotel’ model of care. The potential of this model as an alternative to the statutory model is explored. The thesis concludes that it is a model that can realise the goal of enabling residents to exercise independence, choice and privacy while meeting their needs in residential care.
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Dapar, Maxwell Patrick. "An investigation of the structures and processes of pharmacist prescribing in Great Britain : a mixed methods approach." Thesis, Robert Gordon University, 2012. http://hdl.handle.net/10059/714.
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The aim of this research was to investigate the structures and processes of pharmacist prescribing in Great Britain, focusing on primary care settings. A ‘sequential-mixed methods’ was employed in the conduct of the research. The first phase was a cross-sectional postal questionnaire of all pharmacist prescribers (n= 1654 in January 2009), to quantify the extent and nature of prescribing and key factors associated with prescribing practice. Response rate was 42.3% (n=695). The pharmacy practice setting was significantly associated with prescribing (those in hospital or general medical practice were more likely to have prescribed (p< 0.05), than respondents in community practice). Factor analysis of attitudinal statements on prescribing implementation revealed factors, grouped as: ‘administrative structures and processes’, ‘perceptions of pharmacists’ prescribing role’ and ‘facilities for prescribing’. Scores for ‘facilities for prescribing’ varied depending on practice setting. Respondents in community practice recorded lower median scores compared with those in general medical practices. However, there were no statistically significant differences in median scores between respondents based in GP and hospital settings. In-depth qualitative work undertaken in the second phase further explored facilitators of, and challenges to prescribing practice (e.g. the lack of defined prescribing roles) identified in phase one. Semi-structured interviews were conducted with a purposive sample of 34 prescribers. Prescribers were selected from diverse settings, including secondary care from England and Scotland, to highlight key factors contributing to prescribing success which could potentially inform extrapolations of successful practice from one setting to the other. The ‘framework’ approach to qualitative data analysis was rigorously applied, revealing that the professional isolation and issues around access to clinical data and administrative support in the community setting may have negatively impacted on prescribing implementation. Notably, a perceived lack of clarity and definition of the pharmacist prescribing role was a key theme in hindering prescribing practice of pharmacists irrespective of setting. Participants described ‘ideal’ roles which they perceived as potentially providing clarity, definition and direction to facilitate implementation. The original data generated through this research highlights that prescribing implementation is less than desired, especially in community pharmacies. Pharmacist prescribing appears to have progressed little since supplementary prescribing developments in 2004, even with the much heralded arrival of independent prescribing in 2006. Interestingly, phase 2 participants suggested a ‘hybrid supplementary/independent’ prescribing model, as more likely to succeed. In this model, pharmacist prescribers favour a cooperative practice arrangement in which doctors diagnose and pharmacists prescribe. The implication of these findings and specific recommendations for policy makers, other key stakeholders and practitioners are discussed in detail within the thesis.
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Sutton, David A. "The public-private interface of domiciliary medical care for the poor in Scotland, c. 1875-1911." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/1234/.
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This thesis explores domiciliary medical care for the poor in Scotland. Domiciliary care is understood as medical care provided in the home by qualified medical practitioners, or medical students. The poor are understood as those simply unable to ‘pay the doctor’ for the services they received. Focus is upon service provision, and therefore this thesis is a study of the different medical agencies engaged in the visitation of patients, and of the diverse ways medical practitioners as agents of different medical services facilitated or administered treatment. The period under focus is from 1875 to the National Health Insurance Act, 1911. Particular focus falls on urban Scotland, and Glasgow and Edinburgh. The interface between public and private provision is understood as the distinction between services provided for paupers, the legal poor, and services provided for the remainder, also unable to pay, and described as occupying ‘the boundary line between self-support and parish help’. Three types of service provider are identified: the poor law, medical charity, and medical missions. The thesis is divided into four main parts, buttressed by an introduction and conclusion. Chapter One sets the parameters to study of domiciliary medical care for the poor by identifying a literature of home visitation, and by identifying pressing issues concerning treatment in the homes of the poor of Glasgow and Edinburgh, like physical structure and family. Chapter Two is comprised of eight sections and looks at public provision in the form of the poor law medical services. Of particular interest are the local management, and the medical officers who provided the service. In turn focus is put upon the role of medical relief under the Poor Law (Scotland) Act, 1911; the structure of outdoor medical services in Glasgow and Edinburgh; the role of the local medical sub-committee of the parish board; and the parochial medical officers and their work. A prosopographical approach is taken to profile the parochial medical officers. Chapter Three, comprising five sections and conclusion, looks at private provision by medical charity. At issue is the range of charity dispensaries that provided outdoor services to the poor. A prospectus identifying the range of services is provided; outdoor medical services in Edinburgh and Glasgow are detailed; the interconnection between charity dispensary, domiciliary medical care, and medical educational requirements – particularly in Edinburgh – is investigated; and new developments occurring at the start of the twentieth century in health services requiring home visits are outlined. Chapter Four is comprised of nine main sections plus conclusion and looks at private provision by home medical missions. An overview of the literature of medical missions is provided, before focus falls, in turn, on medical missions in Edinburgh; medical missions in Glasgow; the medical work of medical missions; opportunities provided for women; how medical missions work was justified against criticisms; differences between providers; the response to provision from the Catholic immigrant community, and the work of the St Vincent de Paul Society.
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McEldowney, Rene P. "A century of democratic deliberation over American and British national health care : extending the Kingdon model /." Diss., This resource online, 1994. http://scholar.lib.vt.edu/theses/available/etd-06062008-164612/.
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Sehrawat, Samiksha. "Medical care for a new capital : hospitals and government policy in colonial Delhi and Haryana, c.1900-1920." Thesis, University of Oxford, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.670191.
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Liu, Lixun. "Exploring ethnic inequalities in cardiovascular disease using Hospital Episode Statistics." Thesis, St Andrews, 2009. http://hdl.handle.net/10023/819.
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Shamberg, Neil S. "Shell shock in the origins of British psychiatry." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1045637.
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This study has presented a comprehensive overview of the origins of modern British and American military psychiatry, chiefly in response to World War I shell shock. The study examined the state of British psychiatry during the nineteenth century, as the new railroads, mines, and factories produced accident victims with post-traumatic stress disorders. As World War I began, psychoanalysis was in its infancy, and most British psychiatrists faced with a victim of shell shock fell back on an eclectic mix of treatments, including electro-shock therapy, hot baths, massages, moral persuasion, lectures, exhortation, etc. While a few British and American psychiatrists practiced either psychotherapy or disciplinary methods exclusively, the majority of practitioners used a variety of methods, depending on the doctor's point of view and the circumstances of the case at, hand. Psychotherapeutic developments in the inter-war period are also explored and discussed.Department of History
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O'Connor, Patricia. "Looking for harm in healthcare : can Patient Safety Leadership Walk Rounds help to detect and prevent harm in NHS hospitals? : a case study of NHS Tayside." Thesis, University of St Andrews, 2012. http://hdl.handle.net/10023/2804.
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Today, in 21st century healthcare at least 10% of hospitalised patients are subjected to some degree of unintended harm as a result of the treatment they receive. Despite the growing patient safety agenda there is little empirical evidence to demonstrate that patient safety is improving. Patient Safety Leadership Walk Rounds (PSLWR) were introduced to the UK, in March 2005, as a component of the Safer Patients Initiative (SPI), the first dedicated, hospital wide programme to reduce harm in hospital care. PSLWR are designed, to create a dedicated ‘conversation’ about patient safety, between frontline staff, middle level managers and senior executives. This thesis, explored the use of PSLWR, as a proactive mechanism to engage staff in patient safety discussion and detect patient harm within a Scottish healthcare system- NHS Tayside. From May 2005 to June 2006, PSLWR were held on a weekly basis within the hospital departments. A purposive sample, (n=38) of PSLWR discussions were analysed to determine: staff engagement in the process, patient safety issues disclosed; recognition of unsafe systems (latent conditions) and actions agreed for improvement. As a follow-up, 42 semi-structured interviews were undertaken to determine staff perceptions of the PSLWR system. A wide range of clinical and non-clinical staff took part (n=218) including medical staff, staff in training, porters and cleaners, nurses, ward assistants and pharmacists. Participants shared new information, not formally recorded within the hospital incident system. From the participants perspectives, PSLWR, were non threatening; were easy to take part in; demonstrated a team commitment, from the Board to the ward for patient safety and action was taken quickly as a result of the ‘conversations’. Although detecting all patient harm remains a challenge, this study demonstrates PSLWR can be a useful tool in the patient safety arsenal for NHS healthcare organisations.
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Sexton, John Bryan. "A matter of life or death social psychological and organizational factors related to patient outcomes in the intensive care unit /." 2002. http://wwwlib.umi.com/cr/utexas/fullcit?p3085063.
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OLESEN, Jeppe Dørup. "Adapting the welfare state : privatisation in health care in Denmark, England and Sweden." Doctoral thesis, 2010. http://hdl.handle.net/1814/14504.
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Defence date: 12 June 2010Examining Board: Jens Blom-Hansen (Aarhus Univ), Pepper Culpepper (EUI), Bo Rothstein (Univ. Gothenborg), Sven Steinmo (EUI) (Supervisor)
First made available online on 8 April 2019
This dissertation deals with the following question: In the past decades some of the countries most dedicated to the universal public welfare state have privatised many of their welfare service provisions. Why is this so? The dissertation takes a close look at privatisation policies in health care in Denmark, Sweden and England in order to figure out how and why the private health care sector has expanded rapidly in recent years. Health care services in Denmark, Sweden and England provide good examples of welfare state service privatisation because these three countries have spent decades building up universal public health care systems that offer free and equal access to all citizens - and these programmes are very popular. In this dissertation I find that the most common explanations for welfare state reform fail to explain these changes: Privatisation policies are not the result of partisan politics, instead they are supported by Social Democratic / Labour parties and in some cases the unions as well. Privatisation is not the result of pressures for fiscal retrenchment; in fact, public health care funding has increased in all three countries over the past decade. Neither is privatisation the straight forward result of new right wing ideas. Certainly, new ideas play a role in this change, but it is difficult to sustain the argument that ideas alone have been the cause of privatisation in these three health care systems. Finally, it has been debated whether privatisation is the result of pressure from EU legislation. This explanation does not hold either for the basic reason of timing. The policies leading to privatisation in Denmark, England and Sweden were all implemented before the European debate over health care services started. Instead, I suggest that privatisation in health care in Denmark, Sweden and England can best be understood as the product of policy makers puzzling over important policy problems (Heclo, 1972). I call this an adaptive process. In this analysis I show that privatisation is the result of several interconnected attempts to adapt health care systems to a changing context. By taking a long historical view of the changes in health care systems, it becomes evident that the changes towards privatisation do not occur overnight or as a result of a ‘punctuated equilibrium’. Rather, the increasing privatisation in health care is the accumulated effect of several small step policy changes, which, over time, result in rising levels of privatisation. Some scholars have suggested that neo-liberal policies, such as privatisation of service provision, will ultimately lead to the end of the welfare state. In this study, I come to a different conclusion. Rather than undermine the welfare state, privatisation in health care may help the welfare state survive. Privatisation can be seen as a way of adapting welfare state services to a changing political context.
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Wilcock, J., S. Iliffe, S. Turner, M. Bryans, R. O'Carroll, J. Keady, E. Levin, and Murna G. Downs. "Concordance with clinical practice guidelines for dementia in general practice." 2009. http://hdl.handle.net/10454/6235.
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NoBACKGROUND: Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care. AIM: To determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. Design: Unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. METHODS: Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. RESULTS: We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing. DISCUSSION: The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.
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Snaith, Beverly, Maryann L. Hardy, and A. Walker. "Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes." 2011. http://hdl.handle.net/10454/7022.
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NoThis study aimed to compare ultrasound examinations performed within a land ambulance (stationary and moving) with those completed in a simulated emergency department (ED) to determine the feasibility of undertaking ultrasound examinations within the UK prehospital care environment. The findings suggest that abdominal aortic aneurysm and extended focused assessment with sonography in trauma emergency ultrasound examinations can be performed in the stationary or moving land ambulance environment to a standard consistent with those performed in the hospital ED.