Dissertations / Theses: 'Standard of care'

1

Joyner, Kate. "Health care for intimate partner violence : current standard of care and development of protocol management." Thesis, Stellenbosch : Stellenbosch University, 2009. http://hdl.handle.net/10019.1/2515.

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Thesis (DPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: The World Health Organisation recognises intimate partner violence (IPV) to be of major consequence to women’s mental and physical health, yet in South Africa it remains a neglected area of care. Within a professional action research framework, this study implemented a previously recommended South African protocol for the screening and holistic management of IPV in women in order to test its feasibility and to adapt it for use in the primary health care (PHC) sector of the Western Cape. It also aimed to identify the current nature of care offered to female survivors of IPV. Thirdly, it aimed to learn from the process of training and supporting (nurse) researchers who were new to the action research paradigm and methodology. Successfully implementing and evaluating a complex health intervention in the current PHC scenario required a flexible methodology which could enable real engagement with, and a creative response to, the issues as they emerged. Guided by the British Medical Research Council’s framework for development and evaluation of randomised controlled trials for complex health interventions (Medical Research Council, 2000, p.3), this study was positioned within the modelling phase. Professional action research used a co-operative inquiry group process as the overarching method with the usual cycles of action, observation, reflection and planning. Altogether five co-researchers were involved in implementing the protocol and were members of the inquiry group. A number of techniques were used to observe and reflect on experience, including participant interviews, key informant interviews, focus groups with health care providers at each site, quantitative data from the medical records and protocol, field notes and academic literature.
AFRIKAANSE OPSOMMING: Die Wêreld Gesondheidsorganisasie erken dat geweldpleging in intieme verhoudings (“intimate partner violence”, of IPV) ‘n groot impak het op vroue se geestes- en fisiese gesondheid, terwyl dit ŉ verwaarloosde area van sorg in Suid-Afrika is. Binne ‘n professionele aksie-navorsingsraamwerk, implementeer hierdie studie ‘n voorheen aanbevole Suid-Afrikaanse protokol vir die sifting en holistiese hantering van IPV by vroue om die uitvoerbaarheid daarvan te toets en om dit aan te pas vir gebruik in die primêre gesondheidsorgsektor (PGS) van die Wes-Kaap. Die projek poog ook om die huidige aard van sorg wat aan vroulike oorlewendes van IPV beskikbaar is, te identifiseer. Derdens het dit ook ten doel om te leer van die proses van opleiding en ondersteuning van (verpleeg-) navorsers vir wie die aksie-navorsingsparadigma en methodologie nuut was. Suksesvolle implementering en evaluering van ‘n komplekse gesondheidsintervensie in die huidige PGS scenario vereis ‘n buigsame methodologie wat betrokkenheid met, en ‘n kreatiewe respons tot, kwessies soos wat dit ontwikkel, moontlik maak. Gelei deur die Britse Mediese Navorsingsraad se raamwerk vir die ontwikkeling en evaluering van ewekansige gekontroleerde proewe vir komplekse gesondheidsintervensies (Mediese Navorsingsraad, 2000, bl.3), was hierdie studie binne die modelleringsfase geposisioneer. Professionele aksienavorsing het ‘n gekoördineerde ondersoekgroep as die oorkoepelende metode - met die normale siklusse van aksie, waarneming, reflektering en beplanning - gebruik. Altesaam vyf mede-navorsers wat lede van die ondersoekgroep was, was betrokke in die implementering van die protokol. ‘n Aantal tegnieke is gebruik om waar te neem en te reflekteer op ervarings, insluitend deelnemersonderhoude, sleutel-informant onderhoude, fokusgroepe met gesondheidsorgverskaffers by elke fasiliteit, kwantitatiewe data van die mediese verslae en protokol, veldnotas en akademiese literatuur.

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2

A, Westaway Jennifer. "A right to a minimum adequate standard of health care /." Full text available, 2007. http://adt.curtin.edu.au/theses/available/adt-WCU20071112.141831.

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3

Westaway, Jennifer. "A right to a minimum adequate standard of health care." Thesis, Curtin University, 2007. http://hdl.handle.net/20.500.11937/2156.

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This thesis undertakes a fresh inquiry into the status of the right to health care under international law, with a view to explaining how the right to health care has been variously interpreted. Previous studies into the right to health care have primarily focused on its philosophical basis, and while these studies have contributed significantly to the ethical debate on the existence of such a right, this thesis has as its foundation, the fact that there has been legal recognition of its existence in the form of its inclusion in international conventions and supporting documents, as well as, a in particular, domestic Constitutions and related Bills of Rights. It should be noted that this thesis will not examine in detail all documentation in which a right to health care in its various forms is mentioned. Rather a purposely selective examination has been instituted.In respect to this selective examination, the process of selection was a deliberate one, specifically in relation to the case studies undertaken. The choice of countries to be of focus was based upon the different nature of the documentation in which the right to the health care could be said to be founded: Constitution, Charter or Bill of Rights, International Convention only, other legislative basis, or, as will be seen in the case of Tibet, International Convention but effectively in name only. In the opinion of the writer, this selection will provide a representative overview of the status of a right to health care in international law. The thesis is centrally concerned with the idea that the legal recognition of a socio-economic right, such as the right to health care, does not ensure that it is capable of enforcement. Rather, this thesis proposes that the legal recognition of a socio-economic right, specifically, a right to health care, has value, and can only claim validity from what the existence of the right can provide from a moral or ethical perspective. Further, this thesis proposes that the 'definability' - in other words, for justiciability' of socio-economic rights depends on their a right to be the subject of judicial scrutiny, it must be capable of sustaining a definition sufficient in substance to allow for judicial determination as to whether or not there has been a breach in its provision.

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4

Westaway, Jennifer. "A right to a minimum adequate standard of health care." Curtin University of Technology, School of Public Health, 2007. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=17409.

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This thesis undertakes a fresh inquiry into the status of the right to health care under international law, with a view to explaining how the right to health care has been variously interpreted. Previous studies into the right to health care have primarily focused on its philosophical basis, and while these studies have contributed significantly to the ethical debate on the existence of such a right, this thesis has as its foundation, the fact that there has been legal recognition of its existence in the form of its inclusion in international conventions and supporting documents, as well as, a in particular, domestic Constitutions and related Bills of Rights. It should be noted that this thesis will not examine in detail all documentation in which a right to health care in its various forms is mentioned. Rather a purposely selective examination has been instituted.
In respect to this selective examination, the process of selection was a deliberate one, specifically in relation to the case studies undertaken. The choice of countries to be of focus was based upon the different nature of the documentation in which the right to the health care could be said to be founded: Constitution, Charter or Bill of Rights, International Convention only, other legislative basis, or, as will be seen in the case of Tibet, International Convention but effectively in name only. In the opinion of the writer, this selection will provide a representative overview of the status of a right to health care in international law. The thesis is centrally concerned with the idea that the legal recognition of a socio-economic right, such as the right to health care, does not ensure that it is capable of enforcement. Rather, this thesis proposes that the legal recognition of a socio-economic right, specifically, a right to health care, has value, and can only claim validity from what the existence of the right can provide from a moral or ethical perspective. Further, this thesis proposes that the 'definability' - in other words, for justiciability' of socio-economic rights depends on their a right to be the subject of judicial scrutiny, it must be capable of sustaining a definition sufficient in substance to allow for judicial determination as to whether or not there has been a breach in its provision.

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5

Davies, Kylie. "Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient an exploratory study /." Connect to thesis, 2009. http://adt.ecu.edu.au/adt-public/adt-ECU2009.0001.html.

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6

Kausar, Farah. "Maternal health care utilisation among the urban poor of Maharashtra, India." Thesis, University of Southampton, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340665.

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7

Muijen, Matthijs Frederik. "The first year of the Daily Living Program : a controlled study comparing home based care with standard hospital care." Thesis, Imperial College London, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.320707.

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8

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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9

Shaw-Battista, Jenna Cleave. "Optimal outcomes of labor and birth in water compared to standard maternity care." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3378507.

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10

Fiander, Matthew Thomas. "Model fidelity of UK assertive community treatment practice and comparison with standard care." Thesis, St George's, University of London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250696.

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11

Monti, Elisa. "Valutazione dell'efficacia del protocollo riabilitativo nel Fast-Track dell'artroprotesi totale d'anca vs "Standard care"." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2019. http://amslaurea.unibo.it/19333/.

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BACKGROUND: Il protocollo Fast-track nell’artroprotesi d’anca è costituito da un intervento educativo collettivo pre-ricovero, da controllo adeguato delle perdite ematiche e del dolore pre- peri- e post-operatorio e dall’intervento riabilitativo accelerato ed intensivo. La presente tesi si inserisce all’interno di uno studio randomizzato controllato in aperto, prospettico. L’obiettivo dello studio effettuato presso l’Istituto Ortopedico Rizzoli è quello di valutare se, rispetto alla normale pratica clinica, l’applicazione del protocollo Fast-track riduce i tempi di ospedalizzazione e consente la ripresa precoce e ottimale delle funzionalità e delle principali attività di vita quotidiana. METODI: La popolazione è costituita da 33 pazienti affetti da artrosi primaria dell’anca con indicazione ad intervento di artroprotesi totale con tecnica mini-invasiva. 17 persone vengono reclutate per il protocollo Fast-track e 16 persone per il protocollo standard. Le persone vengono valutate in termini di riduzione dei tempi di recupero secondo la scala ILOA e di raggiungimento degli esiti funzionali secondo le scale WOMAC, HHS e NRS, nel pre-operatorio, alla dimissione ed ai controlli ambulatoriali fino a 6 settimane post-operatorie. RISULTATI: Dallo studio si evince una significatività statistica per diverse misure di outcome: la durata della degenza, il dolore in seconda e in terza giornata post-operatorie, gli esiti funzionali rappresentati da scala ILOA, HHS e WOMAC a 6 settimane post-intervento. CONCLUSIONI: I risultati dello studio confermano che l’applicazione del protocollo Fast-track nella chirurgia di artroprotesi totale d’anca è in grado di far ottenere una ripresa precoce e ottimale delle funzionalità e delle principali attività di vita quotidiana. Risulta però necessario uno sviluppo, in collaborazione con il paziente, nel piano di cura e di riabilitazione post-dimissione con lo scopo di andare incontro ai bisogni individuali della persona e alle sue preferenze.

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12

Enblom, Anna. "Nausea and vomiting in patients receiving acupuncture, sham acupuncture or standard care during radiotherapy." Doctoral thesis, Linköpings universitet, Omvårdnad, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17237.

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Background and aim: Many patients with cancer experience emesis (nausea and vomiting) during radiotherapy. The overall aim of this thesis was to improve the situation for patients with risk for emesis during radiotherapy, by evaluating emesis in patients receiving verum (genuine) acupuncture, sham (simulated) acupuncture or standard care during radiotherapy. Methods: In study I, a cross-sectional sample (n=368) treated with radiotherapy over various fields answered a study-specific questionnaire. In study II, 80 healthy volunteers were randomized to receive needling with verum acupuncture or non-penetrating telescopic sham needles by one of four physiotherapists. In study III, 215 patients were randomly allocated to verum (n=109) or non-penetrating telescopic sham (n=106) acupuncture during their entire radiotherapy period over abdominal or pelvic fields. The same 215 patients were also included in study IV. They were compared to 62 patients irradiated over abdominal or pelvic fields, selected from study I. Results: In study I, the weekly prevalence of nausea was 39 % in all radiotherapy-treated patients and 63 % in abdominal or pelvic irradiated patients. Age younger than 40 years and previous experience of nausea in other situations were characteristics associated with an increased risk for nausea. Of the 145 nauseous patients, 34 % considered their antiemetic treatment as insufficient. Patients with nausea reported lower level of quality of life compared to patients free from nausea. In study II, most individuals needled with verum (68 %) or sham (68 %) acupuncture could not identify needling type, and that blinding result varied from 55 to 80 % between the four therapists. In study III, nausea was experienced by 70 % (mean number of days=10.1) and 25 % vomited during the radiotherapy period. In the sham group 62 % experienced nausea (mean number of days=8.7) and 28 % vomited. Ninety five percent in the verum and 96 % in the sham group believed that the treatment had been effective for nausea. In both groups, 67 % experienced other positive effects, on relaxation, mood, sleep or pain-reduction, and 89 % were interested in receiving the treatment again. In study IV, the weekly prevalence of nausea and vomiting was 38 and 8 % in the verum group, 37 and 7 % in the sham group and 63 and 15 % in the standard care group. The nausea difference between the acupuncture and the standard care cohort was statistically significant, also after overall adjustments for potential confounding factors. The nausea intensity in the acupuncture cohort was lower compared to the standard care cohort (p=0.002). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (Relative risk 1.6). Conclusions and implications: Nausea was common during abdominal or pelvic field irradiation in patients receiving standard care. Verum acupuncture did not reduce emesis compared to sham acupuncture, while reduced emesis was seen in both patients treated with verum or sham acupuncture. Health-care professionals may consider identifying and treating patients with increased risk for nausea in advance. The telescopic sham needle was credible. Researchers may thus use and standardize the sham procedure in acupuncture control groups. The choice of performing acupuncture during radiotherapy cannot be based on arguments that the specific characters of verum acupuncture have effects on nausea. It is important to further study what components in the acupuncture procedures that produce the dramatic positive but yet not fully understood antiemetic effect, making it possible to use those components to further increase quality of care during radiotherapy.

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13

Austin, Jacky. "A comparison of cardiac rehabilitation versus standard care in elderly patients with heart failure." Thesis, University of South Wales, 2003. https://pure.southwales.ac.uk/en/studentthesis/a-comparison-of-cardiac-rehabilitation-versus-standard-care-in-elderly-patients-with-heart-failure(c61f6019-a868-46dc-a828-6fac2ba27b8d).html.

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Heart failure, a condition predominantly affecting the elderly, represents an ever increasing clinical and financial burden for the NHS. Patients with symptomatic heart failure have a poor prognosis and a high degree of morbidity. Current research findings suggest that enhancement of self-care through education, optimisation of pharmacological therapy, exercise training, lifestyle modification and counselling improves patient outcomes and reduces hospitalization. Cardiac rehabilitation, a service that incorporates all the aforementioned components, has yet to be evaluated in heart failure management. Set in a district general hospital with a primary catchment area of 500,000 inhabitants, this study is among the first of its type in the U.K. The study evaluates the effects of a cardiac rehabilitation programme on a range of outcome measures: mortality, health related quality of life, functional change, health care utilisation and clinical status. The design is a randomised controlled trial, comparing cardiac rehabilitation to standard care. Two hundred patients (60 - 89 years, 66% male) were recruited from hospital clinics, wards, and general practice. Patients with NYHAII or in heart failure confirmed, by echocardiography, were randomly allocated to control or experimental groups. Both patient groups attended out patient appointments to see the specialist nurse and cardiologist every eight weeks. In addition, patients in the experimental group attended cardiac rehabilitation classes twice weekly for eight weeks, followed by weekly exercise sessions for 16 weeks. Intervention consisted of exercise prescription, education, dietetics, occupational therapy and psychosocial counselling. A selection of measures were used to collect data over six months: Minnesota Living with Heart Failure (MLHF), New York Heart Association (NYHA) functional classification, EuroQol (EQ-5D), the six-minute walk test, Borg's rating of perceived exertion (RPE), medication compliance monitored by ACE inhibition, routine biochemisty, prescribed medication, coronary risk factor status, medical records and patient diaries. Results show statistically significant improvements for the experimental group in comparison to control patients. Improvements were identified in health related quality of life, functional status, metrs walked and patient cost utility; a reduction in hospital admissions attributable to heart disease was evident. No statistical difference between patient groups was evident in mortality, contact with primary health care professionals, compliance and clinical status. The findings are discussed in terms of previous rehabilitation studies. In conclusion, this study describes the necessary infrastructure and provides an evidence base for implementing a successful multidisciplinary cardiac rehabilitation programme in a district general hospital.

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14

Euteneuer, Joshua C. "Large Variability of Morphine Exposure during Standard of Care Dosing in Critically Ill Neonates." University of Cincinnati / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1459528713.

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15

Overland, Jane Elizabeth. "Factors that affect the delivery of diabetes care." Thesis, The University of Sydney, 2000. http://hdl.handle.net/2123/365.

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Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.

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16

Overland, Jane Elizabeth. "Factors that affect the delivery of diabetes care." University of Sydney. Medicine, 2000. http://hdl.handle.net/2123/365.

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Abstract:

Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.

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Ricotti, V. "Evolving natural history in Duchenne muscular dystrophy : implications for standard of care and experimental therapies." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1474132/.

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Duchenne muscular dystrophy (DMD) with an average global incidence of 1:5000 is an X-linked recessive disease, caused by mutations in the DMD gene encoding dystrophin. Lack of dystrophin isoforms results in progressive muscle weakness and cardiomyopathy, leading to loss of ambulation and premature death secondary to cardiac/respiratory complications. At present, there is no curative treatment. However, implementation of standards of care has significantly shifted life expectancy and the natural history of DMD has considerably evolved. Moreover, a number of promising therapeutic approaches are under development, some reaching phase II-III clinical trials. These experimental therapies will further contribute to the transformation of the disease trajectory. The projects of my thesis intended to address specific research questions, which have an impact not only on the clinical care of DMD patients, but also advice on clinical trial design. I studied the effect of steroid therapy on the motor function in DMD boys >7 years, more specifically profiling benefits and side effects of the most commonly used regimens: intermittent and daily prednisolone. I analysed the impact of starting steroids at an earlier age than what is standard of care. I explored the role of different dystrophin gene (DMD) genotypes in the motor progression of the disease, further defining the genotype-phenotype correlations. All results obtained are of particular interest for clinical trials of pharmaco-gene therapies targeting specific DMD mutations. Dystrophin isoforms also play an important role for the CNS and their lack causes morbidity in DMD. My investigations expanded the genotype-phenotype profile specifically in relation to neuropsychiatric co-morbidities in DMD. In conjunction with the CNS profile of DMD, I characterized abnormalities of retinal function and developed electroretinography as a potential and non-invasive CNS endpoint for future clinical trials. Addressing the non-ambulant DMD population, I studied quantitative magnetic resonance imaging and novel functional measures of the upper limb. These results allow for the first time to evaluate disease progression and response to treatment in non-ambulant DMD. All the results obtained in this thesis therefore enlarge our knowledge of the disease evolution under current standard treatment and contribute to trial readiness by developing new endpoints.

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Walsh, B. M. "A randomized controlled trial comparing nurse-led with standard care for post-acute medical patients." Thesis, University of Southampton, 2000. https://eprints.soton.ac.uk/57952/.

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Walsh, Bronagh Mary. "Comparing nurse-led with standard care for post-acute medical patients : a randomised controlled trial." Thesis, University of Southampton, 2000. https://eprints.soton.ac.uk/50634/.

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This study was carried out in the context of increased pressure on acute medical beds, increasing demand for alternatives to acute medical care and the need to reduce junior doctors' working hours. Nurse-led in-patient care has been advocated as a response to these pressures that also has the potential to improve patient outcomes. However, evidence to support the safety and effectiveness of this model of care was limited and came from Nursing Development Units, making it difficult to predict how well the model of care would perform in routine NHS practice. The nurse-led in-patient service was compared with standard care on the acute wards via a randomised controlled trial. Recruitment for the trial took 17.5 months. Key outcomes were length of stay following randomisation, discharge destination and change in physical functioning. Secondary outcomes were mortality, re-admissions within thirty days of discharge, falls, complications of hospitalisation. The process of care was explored by comparing medical reviews, therapy reviews, changes to medication and numbers of tests and investigations during the trial period. The nurse-led service did not demonstrate any improvement in outcomes, but substantially increased the length of stay in the treatment arm of the trial. The apparently higher rate of therapy reviews and rates of some complications were diminished when these outcomes were controlled for length of stay. Daily rates of medical reviews, medical investigations and changes to medications were lower for the treatment arm of the trial. The findings of this study do not support the limited benefit reported in previous studies. The widespread introduction of this model of care cannot, therefore, be advocated on the basis of improved outcomes for post-acute patients. However, the nurse-led intervention was not shown to be worse than standard care and may result in organisational benefits, such as reduced medical input. From the poor outcomes observed in this study, it would appear that neither nurse-led nor standard care is meeting the needs of this patient group. Further research is needed to identify and evaluate appropriate nursing interventions for post-acute medical patients.

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Sutherland, James Eric. "Telesonography Adoption and Use to Improve the Standard of Patient Care Within a Dominican Community." Diss., Virginia Tech, 2009. http://hdl.handle.net/10919/26251.

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Teleradiology has far-reaching implications for the health of remote and underserved populations. With coordination of radiographic evaluation and diagnosis from a distance, teleradiology has the potential to raise the standard of patient care throughout the world. Perhaps the safest and most cost-effective mode of teleradiology today is telesonography. The current research determined that telesonography improves the standard of care at a rural, government-run primary clinic within the Dominican Republic. The work reported herein is intended to compare the use of telesonography to the current standard of sonographic examination which is referral to government hospital 60km from the clinic. the following research questions were addressed: When compared to the standard of care, (1) To what extent does the use of asynchronous telesonography increase the percentage of received sonographic reports based on the total number of ultrasound referrals (sonographic reports / total number of referrals)? (2) To what extent does the use of asynchronous telesonography increase the rate of successful follow-up visits based on the total number of ultrasound referrals? (3) To what extent does the elapsed time between ultrasound referral and sonographic report delivery decrease with the use of asynchronous telesonography? (4) To what extent does the elapsed time between ultrasound referral and patient follow-up decrease with the use of asynchronous telesonography? Research methodology included randomly assigning 100 patients with clinical indications for sonographic examination into experimental and control groups during a 9-week implementation period. Findings from this study indicate that the implemented telesonography system, along with patient awareness of such a system, while not having an appreciable effect on the time to patient follow-up, provided a 4-fold increase in the proportion of patient follow-ups and a 6-fold increase in the proportion of returned radiological reports, and delivered those reports to the referring physician 6-times faster than in the control group. This study demonstrates the feasibility of utilizing a store-and forward telesonography system within this setting. Additional research focusing on the impact of telesonography on patient outcomes within this setting is recommended.
Ph. D.

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Slavin, Valerie J. "Evaluating Maternity Care: Implementation, Testing and Feasibility of a Standard Set for Pregnancy and Childbirth." Thesis, Griffith University, 2020. http://hdl.handle.net/10072/398874.

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Unwarranted variation in clinical practice contributes to inconsistent perinatal outcomes and poor quality maternity care. Value-based healthcare aims to address unwarranted variation and drive quality improvement but requires the systematic and rigorous measurement of outcomes and costs. Traditional maternity measures are insufficient to inform the value of maternity care. The ICHOM (International Consortium for Health Outcomes Measurement) Standard Set for Pregnancy and Childbirth is a core outcome set developed to measure value in maternity care, but the quality of the set has not been tested. This program of work aimed to evaluate the validity, reliability and feasibility of the ICHOM Standard Set for Pregnancy and Childbirth. The thesis follows a traditional structure with introduction, methods, results and discussion chapters. Thesis findings are presented as a series of five published papers, two submitted papers currently under review, and two unpublished papers. First, a systematic literature review evaluated the quality of maternal and neonatal core outcome set development. The review is presented in two parts: (I) prospective protocol, and (II) findings. Exponential growth in core outcome set development was identified and no core outcome set met all minimum standards for development. The ICHOM Standard Set for Pregnancy and Childbirth met 75 percent of the minimum standards for development. Although findings highlight a need for more transparency in reporting, results indicate the ICHOM Standard Set was developed using robust methods. A narrative review evaluated the quality and psychometric performance of the person-reported outcome measures (PROMs) included in the ICHOM Standard Set. Nine PROMs were evaluated against COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) standards for study design methodology and criteria for good measurement properties. The review identified major gaps in the literature regarding the psychometric performance of five included PROMs in relation to childbearing women. To address some of these gaps, a prospective, longitudinal cohort study was conducted with 309 childbearing women. Participants were asked to complete five online surveys at ICHOM’s prescribed time-points from booking to 26-weeks postpartum and included the ICHOM Standard Set and additional measures chosen to facilitate psychometric analysis. A series of studies then aimed to: (i) assess psychometric performance, (ii) refine PROMs to improve psychometric performance, (iii) offer recommendations, and (iv) offer an alternative if inclusion of the PROM could not be supported. The first two studies evaluated the psychometric properties of the PROMIS® (Patient-Reported Outcomes Measurement Information System) Global Short Form (health-related quality of life), the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) and the Wexner Scale (urinary and anal incontinence). The third study developed and evaluated a framework to facilitate standardised reporting of perinatal incontinence. The fourth study compared the screening accuracy of the Patient Health Questionnaire (PHQ-2) using two case-identification methods to detect probable depression. The fifth study evaluated the construct validity of the Single Item Measure of Social Supports (SIMSS) to measure social support. The results of these studies supported the inclusion of all but one of the included PROMs in the ICHOM Standard Set for Pregnancy and Childbirth but under the caveat of some refinements and recommendations. The final study evaluated the feasibility of the ICHOM Standard Set in practice. High recruitment, response, and completion rates and high retention at 6-months post-birth supported feasibility of the ICHOM Standard Set. The revised ICHOM Standard Set for Pregnancy and Childbirth is a robust set of outcomes and measures that is acceptable to childbearing women. Universal embedding of the Standard Set into routine clinical practice has the potential to inform value-based healthcare, and drive quality improvement and is recommended. Further research is needed to inform the optimal approach for successful implementation of the Standard Set in the real-world setting.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing & Midwifery
Griffith Health
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Čibera, Roman. "Privátní a veřejná zdravotnická zařízení a jejich ocenění v podmínkách ČR." Master's thesis, Vysoká škola ekonomická v Praze, 2008. http://www.nusl.cz/ntk/nusl-15697.

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This text considers a possibilities of using business valuation methods in an evaluation of the private and public health care institutions in the Czech Republic. It tries to explain the specifics associated with the functioning of health care institutions and their influence on the choice of the valuation standards, valuation methodology and the selection of the final method of valuation. The first part describes health care institutions and their operation in the health care market. Other parts deal with the possibilities of the evaluation separately for private and public health care institutions. Differences are summarized in the conclusion.

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Innes, Michael Anthony. "Determining the process of telephone consultations in primary care: development of a standard measure for the process of telephone consultations in primary care." Thesis, University of Birmingham, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487506.

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AIM To develop and validate a method of measuring elements ofthe process of telephone consultations in primary care. BACKGROUND There is an unrecognised confusion about telephone consultations in healthcare. There is virtually no research that has considered the difference between consulting on the telephone and consulting face-to-face. Work on face-to-face consultations points the way forward, suggesting the need to develop a tool to measure process in telephone consultations. METHODS Qualitative approaches were used: a narrative analysis ofextant instruments for face-to-face consultations and Discourse Analysis for the telephone consultations. Using this combined knowledge, a new instrument was designed. Brief reliability testing was undertaken. RESULTS There were no instruments for face-to-face consulting that were sufficient for use with telephone consultations. Several important features were identified that informed design of a new instrument. Discourse Analysis of the 43 telephone consultations from primary care, revealed newly described elements of linguistic structure: 'Advise' and 'Request' exchanges and highlighting structure in narrative passages. From this the Instrument for Measurement of Telephone Process (IMoTeP) was developed. Argument was made for its construct and face validity. Reliability testing was limited to two people with eight consultations. This highlighted promising perfonnance, though there is need for further testing. CONCLUSION It has proved possible to develop an instrument to measure process in telephone consultations based on sound theory and real life observations. Further work should consolidate the reliability and validity while also looking for attributes oftelephone consultations that lead to positive outcomes.

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Allen, Miranda. "There's Just No Accounting for Healthcare: A look at the differences between standard GAAP accounting and accounting for healthcare clients." Kent State University Honors College / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ksuhonors1367851476.

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Kelliher, Leigh J. "The stress response following open liver resection with an enhanced recovery programme or standard perioperative care." Thesis, University of Surrey, 2015. http://epubs.surrey.ac.uk/809490/.

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The widespread introduction of enhanced recovery (ER) programmes for surgical patients is driven by the need to improve their outcomes. One of the principles of ER is to use specific perioperative measures that modify the surgical stress response. However, the impact of a complete enhanced recovery programme (ERP) on the stress response has never been examined in a randomised controlled trial (RCT). The primary hypothesis of this study was that, after open liver resection, an ERP alters the stress response compared with standard perioperative care. Ninety-one patients (45 control; 46 ERP) were enrolled in an RCT. The concentration of stress response markers were analysed in perioperative blood samples, i.e.: IL-6, IL-1β, IL-4, IL-8, IL-10, GM-CSF, IFN-γ, TNF-α, VEGF, CRP, cortisol, insulin and glucose. Samples were also analysed in 24 patients per group for immunological response markers; i.e. white cell, lymphocyte, CD3, CD4, CD8, CD16, CD19, CD56, HLA-DR cell counts. Patients randomised to the treatment group received a comprehensive ERP: pre-admission counselling, preoperative nutritional supplements, preoperative oral carbohydrate loading, goal-directed fluid therapy, early postoperative feeding and mobilisation. The control group received standard perioperative care. Postoperative morbidity data were collected for all patients and complications graded for severity. ERP and control data sets were compared by ANOVA and appropriate parametric or non-parametric tests, categorical values were tested with chi-squared tests In the treatment group, there were more patients with colorectal metastases, who had received preoperative chemotherapy and a higher P-POSSUM operative severity score, otherwise groups were well-matched. There was no significant difference in IL-6, IL-1β, IL-4, IL-8, IL-10, GM-CSF, IFN-γ, TNF-α, VEGF or CRP responses between groups. Peak serum cortisol was significantly reduced and serum insulin was significantly higher in the treatment group. The incidence and severity of medical complications were significantly less in the treatment group. CD3 counts were significantly lower, but CD19 counts were significantly higher in the treatment group. The study aimed to measure the stress response following liver resection using an ERP compared with standard care and to demonstrate a physiological basis for any clinical outcomes. The significant reduction of postoperative morbidity with an ERP correlated with, and may result from, significant alterations of cortisol and insulin responses, but not cytokine levels, including IL-6.

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Phillips, Alicia Jane. "An investigation of long day care services in Australia that are Exceeding the National Quality Standard." Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/22869.

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The National Quality Framework (NQF) was introduced in 2012 to raise quality and drive continuous improvement in early childhood education and care (ECEC) services. Under the NQF, ECEC services are assessed and rated using the National Quality Standard (NQS), through an assessment and rating process. This study investigated the characteristics of long day care (LDC) services rated as high-quality, and the extent to which these characteristics are assessed in the assessment and rating process. The study adopted a qualitative, multiple case study design to examine and compare five LDC services rated as Exceeding the NQS and explore educators’ perceptions of the NQS assessment and rating process. Triangulation of data collection methods (observations, educator interviews and document analysis) elicited rich meanings of ‘high-quality ECEC’ in LDC centres. Foucauldian ideas of discourse, power/knowledge and regimes of truth, and a theorising of quality as subjective, informed data analysis. The quality characteristics identified in this study were consistent across the five LDC services. However, the routes to achieving quality were markedly different and dependent on each service’s context. Findings also showed variation in each service’s provision of quality ECEC to elements in the NQS. Applying Foucault’s work on discourse to these findings, it is suggested that quality in ECEC is in part being produced and disseminated through policy discourses and policy texts such as the NQF and NQS. The educators in this study had mixed perceptions about the assessment and rating process. Findings suggest the need for an improved system to better measure quality ECEC. However, enhancing service quality requires a greater focus on additional policy levers such as improving work conditions, minimising staff turnover and increasing professional recognition through equitable wages.

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Davies, Kylie. "Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient: An exploratory study [thesis]." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2008. https://ro.ecu.edu.au/theses/15.

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Endotracheal tube (ETT) suction is a common nursing procedure within the paediatric intensive care (PIC) setting. Significant side effects associated with this procedure can dramatically affect the stability of the critically ill ventilated paediatric patient. A comprehensive literature review failed to establish clear standards for determining when the procedure is warranted, especially in the paediatric population. This can present difficulty for the inexperienced paediatric intensive care nurse when assessing a patient's need for ETT suction. The aim of the research was to design an evidence based endotracheal suction assessment tool (ESAT) for use by nurses caring for paediatric patients. The use of the ESAT aims to improve patient care within paediatric intensive care units by improving nursing practice for patients with an artificial airway in situ.

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Clarke, Jennifer E. "Sustainable pedagogical leadership in early childhood education and care: Implementing the 2012 Australian national quality standard." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/114123/1/Jennifer_Clarke_Thesis.pdf.

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This historical case study combined two quality areas in early childhood education and care (ECEC), sustainability and pedagogical leadership, introducing the new term Sustainable Pedagogical Leadership in ECEC (SPLE). SPLE includes principles embedded in sustainability and Education for Sustainability (EfS) combined with contemporary approaches to pedagogical leadership unique to ECEC settings. This represents an innovation in the way that pedagogical leadership can be framed in ECEC. Key characteristics of SPLE identified were providing clear vision, mentoring, professional learning, critical reflection and distributed leadership opportunities. SPLE led to an exceptional organisational culture. Enculturated practices were observed in EfS as a result.

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Jones, Tiffanie D. "Do Youth Coaches and High School Coaches Meet the Minimum Standard for Concussion and Cervical Spine Management?" Ohio University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1399502323.

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Prince, Kim Didi. "A comparison of standard C-reactive protein laboratory measurement to point of care C-reactive protein test in a neonatal intensive care unit setting." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22823.

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Background: Laboratory biomarkers are important adjuncts to clinical data in diagnosing neonatal sepsis. Available diagnostic tests often provide results 6 to 48 hours later. A bedside C-reactive protein (CRP) test may be able to exclude or diagnose sepsis within minutes. Objectives: The objectives were to validate the Alere AfinionTM point of care test (POCT) CRP in a tertiary neonatal unit against the gold standard CRP assay in use by the National Health Laboratory service and to determine the difference in time to obtaining a result between the two systems. Methods: A prospective observational study was conducted between February 2015 and June 2015. Neonates who were clinically indicated to undergo CRP testing were simultaneously tested using the POCT and laboratory assays. The sensitivities, specificities and predictive values for the POCT, with the laboratory test as the reference test were determined. The time to results between the two tests was compared. Results: There were 139 measured CRP sample pairs from patients with suspected or proven neonatal sepsis. Using 10 mg/L as the cutoff value for both CRP tests, the sensitivity, specificity, positive predictive value and negative predictive value were 97.4%, 99%, 97.4% and 99% respectively. The area under the receiver operating characteristic curve was 0.99 (p<0.001). The time to point of care result was 4 minutes. Laboratory results were registered at a mean of 4.7 hours but only checked after a mean of 6.8 hours. Conclusions: The POCT CRP and laboratory CRP test have excellent correlation in neonates and may be a useful, quick, reliable method to rationalise antibiotic usage, reduce costs and allow for earlier patient discharge.

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Dunn, Nicholas Raymond. "Survey and audit of the standard of care of diabetic patients in the community of east Dorset." Thesis, University of Southampton, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266391.

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Alanis, Andrea Maria, and Andrea Maria Alanis. "Health Care Economics: Analysis of a Bundled Payment System Versus A Standard Fee-For-Service Payment System." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/621907.

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The Health Care reform has been a topic that has gained much attention in these past few years and has been widely studied and criticized within the United States. It is one of the biggest issues in present day and one of the most prominent concerns is how to make health care more economically efficient. This paper is research-based as I investigate different types of payment methods within healthcare, specifically within Medicare. Some of these payments are already widely used; others have only recently been implemented, while others are completely new proposals. With the help of my thesis advisor, Dr. Joiner, I have found the necessary documents in order to successfully analyze the differences and possibilities of a change from a fee-for-service payment to a bundled system payment. I discuss the potential economic benefit from changing payment method systems as well as breaking down the proposed alternative payment methods that are being implemented, or may soon be implemented, within the United States.

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Pryce-Brown, Tim. "Wrongful trading and the standard of skill and care for corporate directors : a comparative study of corporate governance." Thesis, University of South Wales, 1998. https://pure.southwales.ac.uk/en/studentthesis/wrongful-trading-and-the-standard-of-skill-and-care-for-corporate-directors(fa2a99b2-27ae-4ca7-aa83-5ef1e3a7dbdd).html.

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The advent of popular capitalism has initiated many debates surrounding the role of the corporations and their officers both in the UK and the international community. In particular, the relationship of the director with his shareholders, creditors, employees and the broader community have been subject to greater scrutiny. This has developed the concept of the "director corporation" and redefined their role and objective in relating to all the nexus groups within and without the corporation. The objective of each nexus group will invariably differ and even involve conflict with others in the same corporate entity. The role of the law in formulating new standards of directors' duties and creating general objectives for the corporation is to seek to balance all interests within the corporate nexus. Insolvency law in England and Wales has been harnessed to achieve some progress in raising standards of director behaviour. With its unique evolution English insolvency law is seen not just as an efficient means of liquidating company assets. It is also a basis for providing the commercial world with legal devices which 'punish' those in that community who fall short of the standard of care demanded by the ever broadening shareholder base. The position is clarified by Peter Totty, a partner in Alien & Overy who, commenting on the Insolvency Service stated: "Insolvency law ... underpins all commercial law."' In the far reaching legislative reform programmes illustrated in the Companies Acts 1985, 1989 the Insolvency Acts 1986, 1994, The Company Directors Disqualification Act 1986 and the Royal Commission Report which led to the Acts2 the importance of policing directors and of developing their duties becomes increasingly apparent. The objective of this thesis is to analyse and explain the reasons for the particular development of section 214 IA 1986 and the broadening of its remit in the area of governance. In this respect I shall attempt to place in perspective its ability to act as a policing measure against the misconduct of directors in a society which is increasingly characterised by mass incorporation of business and the establishment of an entrepreneurial ethos.

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Matei, Mihaela. "Le soin courant et le standard de soin dans l'encadrement juridique de la recherche biomédicale." Thesis, Montpellier, 2016. http://www.theses.fr/2016MONTD032.

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La législation relative à la recherche biomédicale est fondée historiquement sur le principe selon lequel la recherche et le soin constituent deux activités distinctes. Perçu comme le garant éthique de tout encadrement normatif de la recherche, ce principe a conduit en France à la création d’un cadre juridique spécifique pour les pratiques médicales expérimentales. En pratique cependant, un protocole de recherche biomédicale est souvent constitué d’actes de recherche intriqués avec les interventions du soin. La distinction entre les pratiques médicales et les interventions expérimentales peut être brouillée par l’objet de la recherche (le soin courant), par la méthodologie employée (l’évaluation en conditions réelles) ou encore par le faible niveau de l’intervention ajoutée par le protocole. Tant les dispositifs juridiques passés que les modèles présents occultent cette évidence en invoquant la séparation du soin et de la recherche. Pourtant la coexistence du soin avec la recherche a créé des tensions que le cadre juridique actuel ne peut résoudre. Il est manifeste que ces dernières n'ont été évacuées en rien par la création de deux régimes juridiques distincts, l'un relatif au soin et l'autre relatif à larecherche biomédicale. De plus, la séparation nette au plan normatif entre les deux activités a empêché l’indispensable réflexion sur l’articulation entre les obligations qui relèvent de la relation médicale et celles qui sont liées à la recherche, telle l'obligation d'assurer la continuité des soins. Le législateur, soucieux de garantir cette frontière, ne traite pas spécifiquement de ces questions. Il est dès lors essentiel de déterminer avec précision le contenu et l’étendue des obligations de soigner ainsi que de mieux encadrer le « soin courant » et le « standard de soin» dans le contexte de la recherche biomédicale. Dans ces conditions, le paradigme juridique centré sur la distinction soin-recherche a-t-il encore un sens?
A biomedical research protocol includes both medical and research interventions. Since its origins, the legal framework has ignored this evidence under the pretext that research and care are two distinct activities. That is why it is all the more essential to determine the nature and the scope of the duty of care and the standard of care used in the context of biomedical research. In parallel, there is a need to distinguish, from a regulatory perspective, this "standard of care" from any equivalent notions used in the context of usual care

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Kierstead, Robert L. "Recommendation for a national standard for tactical emergency casualty care and Israeli hospital trauma protocols in the United States." Thesis, Monterey, California: Naval Postgraduate School, 2015. http://hdl.handle.net/10945/45883.

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Approved for public release; distribution is unlimited
This research asks the following question: Why are tactical emergency casualty care (TECC) rescue task force (RTF) and Israeli hospital trauma programs the best approaches to addressing the current gaps and weaknesses in trauma management in the United States in the context of terrorist attacks and/or active shooter incidents? The purpose of this thesis is to ascertain why existing tactical emergency medical service protocols in most public safety jurisdictions are deficient and to analyze which types of resources jurisdictions need in order to ensure that they have optimal programs in place for mass casualty incident response. Active shooter and terrorist attacks have been on the rise since the 1990s. This thesis found that most public safety organizations in the United States are unprepared to provide emergency medical services during these incidents. Provision of tactical emergency medical services in hostile environments require that emergency medical services personnel train and deploy using TECC RTF guidelines and the Israeli hospital paradigm. This thesis recommends the implementation of a national standard to ensure that these programs are instituted in jurisdictions across the United States.

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Doire, Terry L. "Evaluating the Knowledge and Attitudes of Orthopedic Nurses Regarding the Use of SPHM Algorithms as a Standard of Care." NSUWorks, 2019. https://nsuworks.nova.edu/hpd_con_stuetd/63.

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Background: Healthcare workers are ranked among one of the top occupations for musculoskeletal disorder (MSD) injuries that affect the muscles, the bones, the nervous system and due to repetitive motion tasks (Centers for Disease Control and Prevention, 2017). Numerous high-risk patient handling tasks such as lifting, transferring, ambulating and repositioning of patients cause injuries that can be prevented when evidence-based solutions are used for safe patient handling and mobility (SPHM) tasks. Purpose: The purpose of this quality improvement project was to evaluate the knowledge and attitudes of orthopedic nurses regarding the use of SPHM algorithms as the standard of care when transferring patients. Theoretical Framework. Lewin’s Theory of Change Methods. A quasi-experimental pretest-post-test design was utilized in this evidenced-based practice project. Results. Descriptive statistics that evaluated pre and post questionnaires of the orthopedic nurses noted nurses displayed behavioral and attitudinal intent to use the SPHM algorithms as the standard of care to improve patient outcomes by decreasing falls. Although the behavioral beliefs and attitudes reflected acknowledgement of SPHM skills and knowledge, nursing did not improve in their documentation of SPH fall risk as two separate tools were required on each patient. Conclusions: SPHM evidenced-based standards do guide staff to critically examine how to safely transfer and mobilize a patient. Patient fall rates did decrease during educational sessions, prompting the need for on-going education of all staff on the unit that transfers patients. The findings from this quality project may encourage future practice approaches to use of the safe patient handling (SPH) fall risk assessment tool for all patients to prevent patient falls.

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Moore, Ryan. "International Normalised Ratio Monitoring in Children: Comparing the accuracy of portable point-of-care monitors to standard of care laboratory monitoring at Red Cross War Memorial Children's Hospital." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32880.

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Background. There is an increasing trend in the use of long-term oral anticoagulation therapy in children. Monitoring the international normalised ratio (INR) is an integral part in management of these patients, but standard laboratory testing of the INR presents challenges in this age group. Point-of-care INR monitors such as the Mission® PT/INR monitor provide advantages in efficiency and accessibility but have not been evaluated for accuracy in the South African paediatric setting. Objectives. This is a feasibility study with the aim to evaluate the accuracy of the Mission® PT/INR Monitor in comparison to standard laboratory INR measurement, in children presenting for INR testing. Methods. We compared the accuracy of the Mission® PT/INR monitor to the Sysmex Cs2100i laboratory analyser in 37 children aged between 1 year and 17 years, who presented for INR testing. The sample size was limited due to time constraints. 40 paired POC INR and laboratory INR values were obtained. Results. The majority of participants in the study were outpatients (62%) and required INR testing as part of screening in non-cardiac disease (81%) - the majority had chronic liver disease, and a minority were on warfarin therapy (13.5%). The mean INR value on the Mission® PT/INR was 1.49 (standard deviation (SD) 0.73) and was comparable to the Sysmex Cs-2100i (mean INR value 1.39 with SD 0.69). The Bland-Altman difference plot revealed good agreement. Bias between the two methods was 0.13 (SD 0.23). In total, 92.5% of POC INR values were within 0.5 units of laboratory INR value. Conclusion. The Mission® PT/INR point-of-care monitor has a clinically acceptable level of accuracy in children when compared with laboratory INR measurement, but larger studies are needed in the paediatric setting to evaluate patient safety and clinical outcomes. There is a need for implementing POC INR monitoring in outpatient settings but this practice will require robust assessment of infrastructure and quality control before application.

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Hogan, Elizabeth. "A Comparison of Pharmacist Led Collaborative Drug Therapy Management to Standard Physician Provided Therapy for Type 2 Diabetes Mellitus." The University of Arizona, 2005. http://hdl.handle.net/10150/624750.

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Class of 2005 Abstract
Objective: To determine the effect that a pharmacist run diabetes mellitus (DM) care clinic has on glycemic control, as measured by glycosylated hemoglobin (HbA1c) levels. The baseline comparison group is the current standard of care consisting of physician only treated DM patients. Methods: This project is a retrospective cohort analysis of clinical data obtained from patient charts, patients were matched on age. The pharmacist treated group, from a community health center clinic with a collaborative care agreement for the treatment of DM (Group 1), provided comprehensive DM treatment based upon a prearranged treatment protocol with clinic physicians. The physician treated group, is from an outpatient clinic situated at a community hospital (Group 2). The primary outcome was change in HbA1c over at least a 6 month period of time. Patients from both groups were diagnosed with type 2 diabetes mellitus, >18 years of age, and enrolled in an Arizona Health Care Cost Containment System (AHCCCS) Medicaid insurance program. Patients could be treated with oral antidiabetic medication, an insulin product, or a combination of both. Results: A total of 321 patients were included in the study, Group 1 n=161, Group 2 n=160. Ages were similar, mean age=57.7 (SD=12.2) for Group1 and mean age=57.4 (SD=12.3) for Group 2. Gender (male=33.5% and 37.5% respectively) and ethnicity were also similar (p>0.45). The average HbA1c levels at baseline and at the end of treatment were as follows; Group 1 (9.8 and 7.8), and Group 2 (8.8 and 8.9) p<0.001 for post treatment comparison. Implications: This study indicates that physician pharmacist collaborative care improves glycemic control, as shown by significantly lower HbA1c levels than the physician treated group.

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Pereira, Fernanda Maria Vieira. "Adesão às precauções-padrão por profissionais de enfermagem que atuam em terapia intensiva em um hospital universitário do interior paulista." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-19012012-105417/.

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As Unidades de Terapia Intensiva atendem pacientes críticos, que demandam cuidados de alta complexidade. Com isso, a freqüente realização de procedimentos invasivos favorece a exposição do profissional e dos pacientes a riscos biológicos. Para diminuir os riscos associados ao trabalho dos profissionais que atuam nessas unidades, é imprescindível utilizar medidas preventivas durante a assistência das quais destacamos as precauções-padrão. Objetivos: Avaliar os fatores individuais, relativos ao trabalho e organizacionais relacionados à adesão às precauções-padrão por profissionais de enfermagem que atuam em terapia intensiva em um hospital universitário do interior paulista. Metodologia: Trata-se de um estudo de corte transversal, desenvolvido no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de dezembro de 2010 a junho de 2011. A população de estudo constituiu-se por 178 profissionais da equipe de enfermagem - enfermeiros, técnicos e auxiliares de enfermagem- que atuavam na assistência a pacientes em terapia intensiva, de duas unidades distintas da instituição. Os instrumentos para a coleta de dados foram escalas psicométricas do tipo Likert desenvolvidas por Gershon et al. (1995), traduzidas e validadas por Brevidelli e Cianciarullo (2009), somando 57 questões divididas em 10 escalas, que compreendem fatores individuais, do trabalho e organizacionais. A análise estatística foi feita por meio do software Statistical Package for Social Science (SPSS), versão 15.0., utilizando-se estatística descritiva e teste de correlação de Pearson. Resultados: A maior parte dos profissionais foi do sexo feminino 171 (79,2) com predomínio da categoria de auxiliar de enfermagem com 94 (52,8%). Obteve-se que 79 (44,4%) dos profissionais trabalhavam 50 horas ou mais durante a semana. Na escala de adesão às precauções-padrão obteve-se um escore de 4,45 (DP=0,27) classificado como intermediário para as duas unidades. Houve correlação quando comparada com fatores individuais, para Escala de Personalidade de Risco (r=- 0,169; p=0,024) e fatores relativos ao trabalho representada pela Escala de Obstáculos para Seguir as precauções-padrão (r=-0,359; p=0,000). Para a unidade B os fatores organizacionais com a Escala de Clima de Segurança (r=0,243; p=0,014) apresentaram correlação estatisticamente significante quando comparados com a Escala de Adesão. Conclusão: Para as unidades A e B de terapia intensiva, a adesão às PP foi intermediária entre enfermeiros, técnicos e auxiliares de enfermagem, ou seja, não ocorreu em sua totalidade. O comportamento individual, a identificação de obstáculos e a organização do trabalho são aspectos que devem ser revistos, pois fatores individuais, relativos ao trabalho e organizacionais influenciaram na adesão às precauções-padrão por profissionais que atuam em terapia intensiva.
Introduction: Intensive Care Units serve critically ill patients requiring highly complex care. Thus, frequent invasive procedures promote the professional and the patients exposure to biological hazards. To reduce the risks associated with the work of professionals working in these units, it is essential to use preventive measures for the assistance of which we highlight the standard precautions. Objectives: To assess the individual factors related to work-related and organizational adherence to standard precautions for nurses working in intensive care at a university hospital in the interior of São Paulo. Methodology: This is a cross-sectional study, developed at the Hospital das Clinicas of the Faculty of Medicine of Ribeirao Preto, University of Sao Paulo in the period of December 2010 to June 2011. The study population consisted of 178 professionals of the nursing staff - nurses, technicians and nursing assistants who worked in patient care in intensive care, two distinct units of the institution. The instruments for data collection were the psychometric Likert scales developed by Gershon et al. (1995), translated and validated by Brevidelli and Cianciarullo (2009), totaling 57 questions divided into 10 scales, which include individual factors, and organizational work. Statistical analysis was performed using the Statistical Package for Social Science (SPSS) version 15.0., Using descriptive statistics and Pearson correlation test. Results: Most professionals were 171 females (79.2) with a predominance of the category of nursing assistant with 94 (52.8%). It was found that 79 (44.4%) of the professionals were working 50 hours or more during the week. On a scale of adherence to standard precautions we obtained a score of 4.45 (SD = 0.27) classified as intermediate for the two units. There was a correlation when compared with individual factors to Risk Personality Scale (r =- 0.169, p = 0.024) and factors related to the work represented by the scale of Obstacles to follow the standard-precautions (r =- 0.359, p = 0.000). For the B unit the organizational factors with Safety Climate Scale (r = 0.243, p = 0.014) showed statistically significant when compared with the adherence scale. Conclusion: For the A and B intensive care units, adherence to SP was intermediate between nurses, technicians and nursing assistants, or did not occur in its entirety. The individual behavior, identification of obstacles and work organization must be reviewed because individual factors, related to work and organizational influence on adherence to standard precautions by professionals working in intensive care.

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Wyatt, Stefanie Michele. "A Retrospective Chart Review: Are Gastrointestinal Complications Associated With Formula Brand and Rate Changes Outside of the Standard Protocol in a Random Sample of Pediatric Burn and Trauma Patients?" The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1352900178.

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Ramraj, Varun. "Computational analysis of clinical practice guidelines : development of a software suite and document standard for storage and analysis of care maps." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/28760.

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Clinical Practice Guidelines (CPGs) guide optimal utilization of clinical delivery of health care through evidence-based medicine, where care procedures are rigorously evaluated and improved through the examination of evidence. Care mapping is the technique of using flowcharts to graphically capture CPGs as discrete, actionable steps. Health professionals can create and use care maps to expedite and ensure excellence in optimal process workflow in patient care. Analysis of care maps would provide insight into similarities and differences in care procedures. However, quantitative analysis of care maps is difficult to perform manually, and becomes impossible as the set of care maps for comparison increases. Computational methods could be employed to obtain the required quantitative data, but current document standards for developing, sharing and visualizing care maps are not rigorous enough for computational analysis to take place. By using Bioinformatics approaches, we can solve these problems. Firstly, we can develop a standard care map file format for electronic storage. Systems Biology Markup Language (SBML), a document format used to describe biological pathways, can be used to develop the required file format. This method works because care maps are notionally very similar to biological pathways. It allows use of multiple alignment algorithms (traditionally used to align and cluster biological pathways) with these transformed care maps in order to derive quantitative data. This project involved the development of a software suite that is able to generate care maps in the SBML format and align them using an existing global multiple pathway alignment algorithm. It is part of a larger project that examines efficacy of CPGs. This would allow for two important studies to be conducted: a breadth study across multiple EDs and a longitudinal study over time within a single ED to see how it has been able to implement and adapt to the CPGs. By utilizing Bioinformatics approaches in care mapping, two important objectives were realized: the creation of a document standard for care maps, and computational comparison and contrast of CPGs. This opens up the exciting new field of Translational Informatics, which applies existing Bioinformatics concepts to e-Health, e-Medicine and Health Informatics.

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Watts, Caroline Gay. "The cost-effectiveness of skin surveillance through a specialised clinic for patients at high risk of melanoma, compared with standard care." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15626.

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Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance, as prognosis is better if melanomas are detected at an early stage. In this thesis, I conducted a systematic review of international clinical practice guidelines for identification, screening and follow-up of individuals at high risk of primary cutaneous melanoma, and analysed population-based data on their characteristics and actual management practices using data from the New South Wales Melanoma Patterns of Care study. I found a high degree of variation in international guidelines regarding identification and follow-up recommendations, mainly due to low levels of evidence. From the MPOC study, I found that age at diagnosis and body site of the melanomas differed according to patients’ specific risk factors. The main body of work in this thesis concerned the evaluation of the costs and benefits of a specialised ‘High Risk Clinic’ for surveillance of people at very high risk of melanoma, using data from the Clinic and a population-based dataset comprising linked data from various sources. My research built on a previous study that found melanomas were detected at an early stage and excision rates were reduced using the High Risk Clinic protocol. First, I undertook a micro-costing study to understand service delivery and costs of a High Risk Clinic. The mean annual health system cost of $1,009 per patient was comparable with the societal costs of $972 reflecting the time patients spent attending the clinic. Then, to examine the cost-effectiveness of the High Risk Clinic, I built a decision-analytic model to compare the costs and benefits of the Clinic compared to standard care in the community. I found that surveillance through the High Risk Clinic was both less expensive and more effective than standard care. Over ten years, the mean saving was AUD $8,451 (95% CI $7,174-$9,719) per patient, and the mean quality-adjusted life year (QALY) gain was 0.31 (95% CI 0.27-0.35). The main drivers of the differences were detection of melanoma at an earlier stage resulting in less extensive treatment, and a lower annual mean excision rate for suspicious lesions in the High Risk Clinic compared to standard care. The findings in this thesis have important policy and practice implications for the management of people at high risk of melanoma.

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Engelbrecht, Mari. "An audit of referring patterns for cancer patients to the Palliative Care Unit in 2 Military Hospital, by means of a retrospective evaluation of the percentage of referrals adhering to a given standard, and evaluation of possible barriers." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/10469.

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Includes bibliographical references.
The 2 Military Hospital Palliative Care unit seeks to provide high quality, holistic palliative care to all patients suffering from life-threatening diseases. This care should be initiated early after diagnosis, to prevent unnecessary suffering and allowing the patient and the family to be part of the decision making process. However, the majority of the cancer patients are either referred very late in the disease process or are not referred at all. The purpose of this study was to enumerate the percentage of patients who were not referred to the palliative care unit; to identify possible barriers to referral within referring doctors and to promote the role of the palliative care unit.

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Mengal, Muhammad Hashim. "Infectious disease control knowledge and practice among health care workers in Bolan Medical College Hospital Quetta Pakistan." Thesis, Södertörns högskola, Institutionen för naturvetenskap, miljö och teknik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-27097.

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Background Hospital-acquired infections are significant cause of morbidity and mortality among hospitalized patients worldwide. Healthcare workers during job are exposed to blood borne pathogens through contact with infected body parts, blood and body fluids. World health organization (WHO) estimated that globally about 2.5% of HIV and 40% of hepatitis viral infected cases are among health workers due to exposures. The most important mechanism of spread of these pathogens is through contaminated hands of the healthcare workers. Standard precautions measures are essential to prevent and control healthcare associated infection among healthcare workers and patients. In developing countries despite the development of detailed guideline for infection control the knowledge of standard precautions is low and not properly applied. The aim of this study is to assess the knowledge and practice of health care workers regarding standard precautions and hand hygiene to infectious disease control. Aim The aim of this study was to assess the knowledge and practice of health care workers regarding hand wash and standard precautions to control infectious diseases in BMCH. In addition create awareness among participants and encourage them to practice regularly hand hygiene and standard precautions to control or reduce nosocomial infections in health care facilities Methods The study design is cross-sectional evaluation of healthcare worker knowledge and practices about standard precautions and hand hygiene for infectious disease control. A questionnaire administered to health care workers (doctors and nurses). The questionnaire was divided in two parts and the first part concerns demographic information, asking knowledge and practice. The second part asked opinions about risk and prevention of HAIs. The questionnaire was developed with consultation of other studies of the same kind. It has been pre tested and is finalized for survey. The ethical approval was given by hospital superintendent and informs consent from all study participants. Statistic analysis was done on Excel and statistical software SPSS version 20. Data was described in numbers, percentages and Chi Square test done for association among categorical variables, significant level was considered P= <0.05. Results Two hundred questionnaires were distributed to HCWs in BMCH and 169 completely fill questionnaire were returned. The male gender respondents were 42% and female respondents were 58%. The basic questions about knowledge of hand hygiene and standard precautions were answered well in both categories; about 73% were with sufficient knowledge. The practice of hand hygiene and standard precautions was not satisfactory among both categories; about 47% found with good practice. Differences found in sub groups, young age none trained doctors and nurses answered wrong and shown lack of knowledge. This study found an association of age, profession and job experience with knowledge and practice regarding hand hygiene and standard precautions. Open handed questions described well the major issue regarding HAIs and participants emphasized on risk and prevention methods. Conclusions The respondents were HCWs (doctors and nurses) of both sex and this study found that majority of HCWs have good knowledge and practice about control of HAIs but difference were found in age groups, sex and profession. Above half of the HCWs were not trained for infection control in health facilities, thus getting training of infection control is important but more important is implementation of it during practice.

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Harder, Willemina Hendrika den. "Aanmerkelijk onvoorzichtig de ondergrens van de schuld in het verkeersstrafrecht = Driving without due care and attention : the minimum acceptable standard of driving /." [S.l. : Rotterdam : s.n.] ; Erasmus University [Host], 2006. http://hdl.handle.net/1765/8064.

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Zetta, Stella. "Randomised Controlled Trial Comparing a self-help, cognitive behavioral programme, The Angina Plan, with standard care for angina paitents admitted to hospital." Thesis, University of Dundee, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.500567.

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Nell, Sussarah Maria Elizabeth. "Exploring the experiences of social workers in private practice in care and contact disputes using the best interest of the child standard." University of the Western Cape, 2021. http://hdl.handle.net/11394/8351.

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Magister Artium (Child and Family Studies) - MA(CFS)
The changing landscape of parental responsibilities and rights, and the protection of children’s rights create an ever-changing phenomenon in social science. Limited research has been conducted regarding social workers in private practice, and in particular, regarding their professional and personal experiences in dealing with care and contact matters, pertaining to the South African Children’s Act 38 of 2005. This study aimed to provide insight and knowledge regarding the roles and experiences of social workers in private practice, particularly of those rendering services in the greater Gauteng area, in family law matters related to care and contact disputes.

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Katende-Kyenda, Norah Lucky. "A retrospective drug utilisation study of antimicrobials in a private primary health care group / Norah Lucky Katende-Kyenda." Thesis, North-West University, 2005. http://hdl.handle.net/10394/720.

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The commonest prescribed group of drugs is antimicrobials. Various studies have shown that they are overused globally. Since Primary health care represents the first tier of the health care system, evaluation of antimicrobial use in primary health w e settings is a necessity to ensure rational and cost-effective use of these agents in the treatment of infectious diseases. It has been reported by Hooton and Levy (2001 : 1088) that 20% to 50% of antimicrobials are inappropriately used in developing countries. According to Rebana et al. (1998: 175) the increasing overuse of antimicrobials has resulted in an enormous escalation in the total costs of drugs contributing to 15% to 30 % of the total health budget. Hooton and Levy (2001: 1087) reported in a study that inappropriate use and overuse of antimicrobials are risk factors for the emergence of antibiotic resistant bacteria. There is a high incidence of infectious diseases in developing countries that are due to the rapid spread of resistant strains through over-crowding, poor sanitation and unsafe sexual practices (Liu et al., 1999: 540). The general objective of the study was the analysis and interpretation of the usage and related costs of antimicrobial prescriptions in a private primary health w e setting in South Africa. The study is a non-experimental, quantitative, retrospective drug utilisation review of antimicrobial usage in a private primary health care setting. Data were obtained from the central database of a private primary health care service provider. Data of nine randomly selected clinics, situated in different geographical areas of South Africa, were extracted for the period 1st January to 31st December 2001. The study population was made of the total patient population of patients using antimicrobials during this one year period. Antimicrobial usage was analysed according to: number of patients, age and gender distribution, diagnosis, pharmacological groups. The total number of patients who visited the nine clinics during the year was 83 655 of which 59.50% were females and 40.22% males. In 0.28% of the cases gender was not indicated. Patients in age groups 6 (20-40 years) and 7 (40-60 years) accounted for the highest number of patients (66.31%, n = 54 964). A total of 515 976 medicine items costing R1 716 318.90 were prescribed, of these, 18.69%, (N=96 423) were antimicrobials costing 60.89%, (R1 045 108.00). Of the total number of patients that visited the nine clinics, 65.34% (N=54 663) were prescribed antimicrobials. The total number of diagnoses (140 723) where antimicrobials were prescribed accounted for 68.52% (N46 42 1). The highest number of antimicrobial prescriptions according to pharmacological and age groups were: penicillins followed by sulphonamides and tetracyclines. The diagnoses with the highest number of antimicrobial prescriptions were the respiratory tract infections (viral influenza, acute bronchitis and upper respiratory tract infection) and pelvic inflammatory disease The prescribing of antimicrobials in respiratory tract infections could indicate overuse and inappropriate use of these drugs. Because most of these infections are caused by viruses or other non-bacterial agents, are self limiting. Therefore, the use of antibiotics courses is neither necessary nor appropriate in these conditions. The overuse and inappropriate use of such drugs have an effect on the health of the patients needing cure, and the general budget on health care service. It is recommended that further studies are conducted on antimicrobial prescribing and use.
Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

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Lewis, A. "Does the inclusion of a problem-solving component to standard care improve concordance with the self-management programme for adolescents living with diabetes?" Thesis, University of the West of England, Bristol, 2014. http://eprints.uwe.ac.uk/24074/.

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To investigate if problem-solving activity, not used in the UK, could support UK adolescent’s living with diabetes to improve self-management of their condition leading to improvements in self-care and glycaemic control when delivered alongside usual care at paediatric and young adults’ diabetes clinics. Method: A pilot study incorporating 23 Adolescents (13-18 years) with a diagnosis of Type 1 Diabetes of at least a year and with English as a primary language were randomised into a two arm (intervention based on the International Treatment Effectiveness Protocol (ITEP) node-mapping approach that addressed common aspects of non-adherence to life style factors via scenarios and personal experience to encourage behavioural change + usual care vs. education control DVD + usual care) randomised control trial. Results: 23 participants completed a 3 month follow up within the required time scale. There was no change in the HbA1c levels for either group. The intervention group appeared to improve self-management on scores for the SCI following the intervention. Conclusion: The study did not recruit substantial participants for a full powered study and any changes has to be treated with caution. As a pilot study it has helped identify protocols and processes that could lead to the delivery of a powered study. It received a grant from the InDependant Diabetes Trust and generated a number of learning outcomes that will support further research on its outcomes.

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Cazzola, Paolo. "Utilizzo di IHE per garantire l'integrazione della cartella clinica oftalmologica ospedaliera." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2012. http://amslaurea.unibo.it/4054/.

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Dissertations / Theses on the topic 'Standard of care'

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