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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
21

Cross-cultural adaptation of a child oral health-related quality of life measure

Al Ghadeer, Abdulraof January 2013 (has links)
Introduction and background: Oral health-related quality of life (OHRQoL) marks a shift in the perception of health from the mere absence of disease and infirmity to complete physical, mental and social wellbeing. The impact of both general and oral health on quality of life has received increasing attention in recent years. OHRQoL assessments are used in oral health research, surveys and studies evaluating the outcome of oral care. If researchers have no appropriate health-related quality of life (HRQoL) measure in their own language, they have two options: to develop a new measure or to modify a measure that has previously been validated in another language, in a process known as cross-cultural adaptation. Aim of thesis: To assess the validity and reliability of Arabic versions of two OHRQoL questionnaires – the Child Perceptions Questionnaire for 8-10-year-olds (CPQ8-10) (Jokovic et al, 2003) and Parental Perceptions of Child Oral Health-related Quality of Life (P-CPQ6-14) (Jokovic et al, 2004) among Saudi children aged 8-10 years and their parents respectively. Method: Culturally equivalent Arabic forms of the CPQ8-10 and P-CPQ6-14 were created following the guidelines of Guillemin et al (1993). Seventy-five children aged 8 to 10 years and their parents attending three dental clinics in Alhasa, Saudi Arabia, completed the questionnaires. A further 75 children and their parent from a dental clinic in London and a community clinic were recruited in England. Results: The score means and psychometric properties were similar to the original development scale in the parental and child questionnaires obtained by Jokovic et al (2003) and Jokovic et al (2004) respectively. The Saudi version of the CPQ8-10 also showed good internal consistency for all subscales and the total scale (all Cronbach’s alpha > 0.50). There were no significant differences in OHRQoL for children in the two national samples for the total scale and subscales (p > 0.05), except for social wellbeing (p = 0.018). Comparison of Saudi and English parents found no significant differences on the total scales or any subscales (all p > 0.05). Conclusion: The Arabic versions of the CPQ8-10 and Parental/caregiver Perceptions Questionnaire developed for the study demonstrate cross-cultural equivalence according to the criteria provided by Guillemin et al (1993). The Arabic version of the CPQ8-10 also shows good internal consistency and discriminant validity. In order to assess the change of oral health status and quality of life over time, a prospective study with appropriate sample size is recommended.
22

Interprofessional collaborative practice in healthcare : perceptions and experiences of healthcare students undertaking accelerated pre-registration programmes in the practice placement setting

Evans, Amanda January 2012 (has links)
This study investigates experiences of accelerated pre-registration healthcare students of collaborative interprofessional working and examines their perceptions of the factors which influence this, including the interprofessional education they have undertaken. It is set in context of current NHS policy, where professional collaboration is advocated as a means of addressing issues of quality, efficacy and efficiency in patient care. Design: Mixed Methods Study Method: Three studies were undertaken. 1. Longitudinal panel survey examining students’ attitudes to interprofessional learning, (questionnaire administered at three points during the course) 2. Survey study using critical incident technique to explore examples of ’good’ and ’poor’ collaborative practice 3. Interview study examining beliefs and attitudes in depth. Subjects: Total sample of 207 students, from two cohorts of accelerated learning students (nursing, physiotherapy and dietetics) attending one university. Analysis: Descriptive statistical analysis was performed to describe the population characteristics, the context of their practice and reported practice incidents. Thematic content analysis, employing triangulation between data sources, was applied to the qualitative data. Results: This accelerated group was similar to standard pre-registration students, entering university with a strong professional identity and openness to interprofessional learning, which attitudes declined over time. ’On the job’ learning was identified as the predominant way students learned about working collaboratively. Five factors were identified as key in influencing interprofessional activity of which Communication and Teamwork were the most important.
23

Learning from the investigation of incidents in primary care

Rogers, S. January 2007 (has links)
Accident investigation is widely used to learn from adverse events occurring in industry. The conclusions of such investigations are typically used to inform the design and function of socio-technical systems and organisational management. This tradition is less well developed in healthcare, though evidence is growing that similar approaches may be applicable. The first part of the thesis reports a systematic review and evaluation of methods for the investigation of incidents in healthcare with further work then conducted to pilot an approach in primary and community care settings. The second part of the thesis describes the application of the approach within the framework of a study designed to understand the problem of medication related admissions in older people. The research maps the epidemiology of the problem and then moves beyond it through depth investigations of individual cases. The methods selected have provided an opportunity to understand the immediate and the contributory causes of adverse medication related events in older people. More particularly, the approach provided a framework for understanding general practice as a whole system, where there are interactions between people, processes and policies that can bring untoward consequences. This level of understanding of general practice identifies broader themes that characterise the organisation of primary care and point to areas for development that could bring substantial benefits to patients in the care they receive.
24

Valuing health states for use in economic evaluation : an investigation of validity and realibility

Robinson, Suzanne Marie January 2007 (has links)
Economic analysis is increasingly being employed in formal resource allocation decision-making processes in health care. The consequence is that the methods being employed by economic analysts are increasingly subject to close scrutiny. One such area of methodology concerns the instruments used to elicit preferences for various health states for use in the construction of quality-adjusted life years (QALYs). There are a number of techniques, which can be used to elicit preferences with different techniques producing different results. The empirical work of this thesis explores issues around the reliability and validity of two techniques: Time Trade Off (TTO) and Person Trade Off (PTO). There was little convergence between the PTO and TTO techniques, with TTO weights tending to be lower than PTO. Semi structure interviews conducted with respondents highlighted a number of issues around technical aspects such as framing effects, administration and process issues. The other area of interest is around the theoretical and psychological underpinnings of the QALY approach and relate solely to the issue of the content validity of an instrument.
25

Enacting patient safety on the frontline : an ethnographic study of rescue work with acutely illpatients

MacKintosh, Nicola January 2012 (has links)
International concerns over ‘failure to rescue’ acutely ill patients on hospital wards have led to the widespread implementation of rapid response systems. Despite these system level changes, management of deterioration in such patients’ conditions remains problematic. Rescue is a complex process and only partially understood. This study aims to explore the nature of ‘rescue work’, drawing on theoretical insights from medical sociology to illuminate relationships between organisational systems, department and individual level processes. Data collection involved ethnographic fieldwork over a 12 month period in two UK NHS Trusts, including observations (180 hours), interviews (35) with health care assistants, nurses, doctors and managers, and documentary analysis. The findings expand understandings of rescue beyond reified, linear trajectories to include overlapping structural, technological and diagnostic influences. The thesis draws attention to the adaptability and intelligence displayed by frontline staff to handle clinical uncertainty, and the significance of hidden articulation work for minding gaps in patient trajectories. Technological monitoring tools open up aspects of rescue work for scrutiny, facilitating the development of a shared management approach for caring for acutely ill patients. Tools such as the track and trigger system perform a valuable bridging function between occupations. However, these tools also reinforce hierarchies and occupational boundaries. Relations between the domains of critical care, medicine and management influence the organisation and provision of services, and organ specialism assumes a hierarchical superiority over generalist services. Structural processes such as access to critical care, and transfer of responsibility between medical firms influence patient pathways. This thesis helps to explain why organisations struggle to effectively manage acutely ill patients on the ward. The analysis suggests that priorities and solutions for the acutely ill should include greater recognition of the significance of the mundane routine of rescue work, structural and professional influences and inequalities, and diagnostic categorisation regarding escalation of care.
26

Using a phylogenetic approach that combines laboratory and clinical data to enhance understanding of HIV transmission events among men who have sex with men

Brown, A. E. January 2010 (has links)
A phylogenetic approach combining HIV pol sequences with laboratory and clinical data was undertaken to explore HIV transmissions between men who have sex with men (MSM). Combining putative transmission events (reconstructed through phylogenetic analyses of pol sequences) with clinical (e.g. viral load) and diagnostic (e.g. recently-acquired infection) data can enhance understanding of HIV transmission more than can be gleaned from each individual source. The thesis: assessed the consistency of phylogenetic reconstructions of HIV transmission events; explored transmissions from recently HIV-infected MSM at diagnosis and critiqued such analyses; and ascertained which groups of diagnosed HIV-infected MSM are generating HIV transmissions. Sensitivity analyses demonstrated that phylogenetic reconstructions of transmission events were 80% consistent as sample sizes were varied. Previous phylogenetic reconstructions overestimated transmission from recently HIV-infected MSM through failing to recognize that this infection stage is transitory. Comparison of infection dates between recently HIV-infected MSM involved in transmission events revealed only half of the transmissions were generated during recent infection. Through allowing infection stage (and other markers of transmission risk) to reflect the course of HIV infection it was established that the recently HIV-infected have a transmission risk of 3.04 (compared to the chronically HIV-infected population). Transmission rates were elevated among the untreated population; 72% (28/39) were generated from treatment-naïve MSM and 23% (9/39) from MSM interrupting treatment. Overall, 69% (27/39) of transmissions occurred from MSM with CD4 counts >350 cells/mm3. BHIVA guidelines recommend treatment discussions start when patients‟ CD4 counts reach 200-350mm3. This work contributes to the debate on the public health benefit of treating all HIV-diagnosed individuals, regardless of clinical need. Behavioural interventions need to increase awareness of recent HIV infection, and the elevated transmission risk from untreated populations. Phylogenetics has enormous potential to contribute to public health, but remains in its infancy; methods need rigorous assessment and results require cautious interpretation.
27

How an internet intervention works to achieve benefit for patients with coronary heart disease

Kerr, C. E. P. January 2010 (has links)
Internet interventions have the potential to support patient self-management of long term conditions. However, their mechanisms of action are unclear. There is also a concern that lack of equity of internet access may limit their benefits. The aim of this thesis was to develop a greater understanding of the potential of internet interventions for patients with a long term condition, in this case coronary heart disease (CHD), and their mechanisms for supporting patient self-management. Mechanisms of action were explored using constructs from psychological theories. Literature reviews of internet and CHD self-management interventions identified illness perceptions, self-efficacy and social support as psychological constructs that may explain mechanisms of action of internet interventions for patients with CHD. These constructs were evaluated in a prospective study with 168 patients with CHD. Participants, with or without home internet access or prior internet experience, had unlimited access to a CHD internet intervention over 9 months. Use of the intervention and changes in psychological constructs, behavioural, emotional and quality of life outcomes were evaluated using a mixed quantitative and qualitative design. Only a small proportion of eligible patients with CHD participated. Participants were predominantly male, highly educated and had better internet access and/or internet experience than was likely in the wider CHD population. Few had experienced recent problems with their condition. Overall use of the intervention was low compared to other internet interventions. Participants who were older, had more recently experienced a cardiac event or diagnosis, had home internet access and prior internet experience made greater use of the intervention. Most participants were positive about the intervention but no significant changes in psychological constructs or health outcomes were found. This implementation of an internet intervention to support CHD self-management appears to have limited potential, particularly for those without home internet access or confidence using computers.
28

Quality end of life care for people with dementia : the views and experiences of family carers

Davies, N. January 2014 (has links)
Background: Many have reported the difficulty of defining ‘quality’ with several concepts emerging to characterise quality end of life care. People with dementia have been described as the ‘disadvantaged dying’ with poor end of life care. Towards the end of life people with dementia cannot report on the care they receive. It is therefore important to talk to carers; however, few have explored the views about end of life care from the carers’ perspective. Aim: To explore the features of ‘good’ and ‘bad’ quality end of life care for people with dementia from the perspective of family carers. Method: 1) A systematic review of qualitative studies which explored family carers’ views of quality end of life care for people with dementia. 2) A qualitative study with 46 in-depth interviews with carers analysed using thematic analysis methods. Purposive sampling was used to recruit 1) family carers of someone who had recently received a diagnosis of dementia, 2) family carers currently caring for someone with dementia, and 3) bereaved family carers. Results: Many elements to ‘good’ care were identified including: tailoring care, attention to the individual, respect and dignity. Participants perceived some basic principles such as compassion were lacking, particularly from nurses. The finer details of care such as clothing and appearance were important manifestations of social identity and personhood. Care for the carer was also important, with carers often being left to act as a care manager and navigate the health and social care systems. Conclusion: At end of life not everyone with dementia will require input from specialist palliative care services; there are many basic principles to good quality end of life care. This study suggests that end of life care for someone with dementia may not be that different to dementia care in general.
29

Paternal depressed mood and child behaviour and development

Dave, Shreya January 2009 (has links)
Introduction: Fathers are important to child development and behaviour. Maternal depression is associated with adverse child development and behaviour, but there is relatively little research on paternal depression and child outcome. Methods: A pilot phase assessed feasibility of recruiting fathers of young children via healthcare settings (N=194), and explored the association between paternal depressed mood and infant temperament (N=19). A cross-sectional study of biological fathers, mothers and 4-6 year old children assessed prevalence of a DSM IV paternal depressive syndrome (N=365); compared father and mother ratings of child behaviour on the Strengths and Difficulties Questionnaire (SDQ) (N=248); and assessed associations between a paternal depressive syndrome and child behaviour problems on the SDQ, and child consultations with health professionals for behaviour and developmental problems (N=248). Finally, a qualitative and observational study explored parenting attitudes and behaviours among fathers with and without depressed mood (N=22). Results: It was cost-effective to recruit fathers via primary care (41% response, cost £3 per father) and hospital postnatal wards (76% response, cost £8 per father). Paternal depressed mood was associated with a difficult/fussy infant temperament at six months postpartum (coefficient 3.96, SE 0.99, p=0.003). Fathers of 4-6 year old children had a 3.3% and 4.7% prevalence for a DSM IV major and other depressive syndrome respectively. On the SDQ there was higher parental agreement on normal/borderline compared with abnormal child behaviours, however overall agreement was fair. A major paternal depressive syndrome was associated with child prosocial behaviour problems (adjusted OR 8.29, 95% CI 0.98-70.04, p=0.052) and peer problems (adjusted OR 36.31, 95% CI 1.66-792.70, p=0.022), and enhanced child consultations for speech and language (adjusted OR 8.67, 95% CI 1.99-37.67, p=0.004) and externalising behaviour problems (adjusted OR 6.98, 95% CI 1.00-48.76, p=0.050) among 4-6 year olds. Fathers with major depressed mood reported negative, detached and potentially intrusive parenting behaviours. Conclusion: A larger longitudinal study is recommended to investigate the trajectory of the effects of paternal depression on child behaviour and development, elucidate causal mechanisms and assess the individual and cumulative effects of paternal and maternal depression on children.
30

"Smart boys" and "sweet girls" : sex education needs in Thai teenagers : a mixed-method study

Vuttanont, U. January 2010 (has links)
This study aimed to inform the redesign of sex education policy in Chiang Mai (Thailand) by exploring the knowledge and attitudes of teenagers, parents, teachers, and policy makers and placing these in the wider social, cultural, educational, and economic context of modern-day Thailand. Six selected secondary schools with diverse characteristics in socioeconomic and religious backgrounds and locations were studied. This mixed method study included: semi-structured interviews and narrative interviews with 18 key stakeholders; analysis of 2 key policy documents; a survey of 2301 teenagers; 20 focus groups of 185 teenagers; a survey of 351 parents; one focus group of 8 teachers; and two focus groups of 23 parents. Qualitative and quantitative data were assessed separately with thematic and statistical analysis, respectively, and outcomes were compared, combined and discussed. Results suggested: school-based sex education was biologically focused and inconsistently delivered. Chiang Mai teenagers showed a reasonable knowledge of biological issues around reproduction but were confused and uncertain about how to obtain or use contraception, avoid pregnancy and transmission of STIs, negotiate personal and intimate relationships and find sources of support and advice. Many parents and teachers lacked the knowledge, confidence, and skills to offer meaningful support to their children. Five important influences on Chiang Mai teenagers' sexual attitudes and behaviours were noted in this research: ambiguous social roles leading to confused identity, heightened sexual awareness and curiosity, critical gaps in knowledge and life skills, limited parental input, and an impulsive and volatile approach to intimate encounters. Results of this study suggest several possibility approaches that could be developed to improve sex education.

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