The aim of this Action Research study was to evaluate the development of an integrated nursing team delivering targeted interventions based on Health Needs Assessment in one primary health care team. The study was located within a Local Health Care Cooperative in an urban area of Scotland. Participants included 6 general practitioners, 2 health visitors, 3 district nurses, 2 practice nurses, 2 nursing auxiliaries and a treatment room nurse. The introduction of the integrated community nursing approach was mapped across a four Cycle design which took place over two years and two months. This included illumination of the integrated nursing team concept and the nature of the change required for its introduction drawing on a normative re-educative model of change. Data collection approaches included 18 focus groups, 20 individual interviews, participant observation, nursing diaries, and the Team Climate Inventory Questionnaire. Although effort was taken to progress in the collaborative spirit of action research, evidence of team ownership of integrated nursing did not emerge until the fourth and final action cycle. The study illuminates the complexities of achieving integrated nursing approaches and determinants for success. For example, role differences and the differing underlying philosophies for each of the nursing disciplines presented specific challenges. Health needs assessment used as a tool to support the development of integrated nursing, has proved to be of value as a means to overcome boundary issues and securing commitment to integrated working. The findings suggest that for integrated nursing to be effective greater emphasis needs to be placed on the identification of priority areas using a comprehensive health needs assessment where nurses are motivated and can lead developments. The study has demonstrated that the integrated nursing approach may involve complete role overlap or the contribution of specific expertise in the delivery of targeted interventions. The complexity of achieving integrated approaches however demands resources, appropriate facilitation, protected time for key stakeholders to engage in the change process and to optimise opportunities for interprofessional learning.

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The findings showed that nurses placed the greatest emphasis on issues related to drug injection techniques while the wider concerns of long term depot medication therapy, including monitoring drug side-effects and assessing general health and social well-being, were generally given a lower priority. Significant differences existed between the four Managerial Sectors of the main study area in terms of both the standards of nursing care observed and the Organisational Climates reported by nurses. The highest standards of care were found to exist in a Managerial Sector where nurses dealt with significantly smaller numbers of patients and where they had access to more comprehensive information. The relationship between Climate and standards of care was also found to be significant. Where there was a greater emphasis on innovation, standards of nursing care, and aspects of organisational structure, higher standards of nursing care were observed. The findings reveal important practical and theoretical concerns pertinent to the different standards of nursing care observed. The findings suggest that certain organisational characteristics appear to facilitate the delivery of a higher standard of nursing care. The utility of adopting an organisational approach in exploring nursing care issues is discussed. Recommendations for changes to the existing arrangements for depot drug administration within the study area are suggested.

This thesis presents four related pieces of research around the theme of how doctors present themselves to, and are perceived by, patients in the general practice consultation. The first study used photographs to examine patients' preferences for the way their general practitioners dress. It showed that patients preferred their doctors to dress in a formal or traditional way. Forms of dress associated with social success (a smart suit) and medical expertise (white coat) were found to be particularly popular. The second study used structured questionnaires to examine patients' preferences for how they wish to address and be addressed by their general practitioner. It showed that, while many patients were willing to have doctors refer to them by first name, they are unwilling to use the doctor's own first name. This may suggest willingness by patients to accord their general practitioner higher social status than themselves, or at least show deference to medical knowledge by use of the title. The third study also used structured questionnaires to explore patients' attitudes to the age of their doctor. The results of this study were inconclusive. Older doctors were accorded more positive attributes, and were considered to have more authority than younger doctors, but the distinction between age groups was most strongly influenced by the perception of younger doctors being up to date in their medical knowledge and the perceived greater experience of older doctors than any difference in authority. These three pieces of research suggested the possibility that, at least some patients, sought a doctor who presented as an expert or authoritative figure, and possibly a maternal/paternal figure, willing to take control of the consultation. This ran contrary to the prevailing view among medical educators that decision making in the consultation should almost always be shared between doctor and patient. This latter view appeared to be held on ideological grounds.

This thesis examined the changes that occur when a system of healing is transplanted from the East to the West. Ayurveda is both a system of healing and a way of life; though its origins are in India, it has moved across boundaries into many Western environments. The literature on global Ayurveda suggests that it has been promoted as a spiritualised system of healing as it addresses the mind, body and spirit. Currently, there is little research on the practice of Ayurveda in the UK. This research analysed how the practice of Ayurveda is changing and adapting to the UK environment, and analysed the role of religion and spirituality in the consultation. A qualitative approach was adopted. In-depth interviews were undertaken with a range of practitioners. In addition, participant observation data of Ayurveda events were inclined in the analysis. Analysis of the data showed that the lack of traditional remedies, together with regulatory restrictions impacts on the nature of the consultation and therapeutic recommendations in the UK. Practitioners are adapting their practice through the process of simplification and modification as well as creatively mixing healing techniques to produce ‘hyphenated’ approaches. The treatments have changed from standardised recommendations to individualised ones and practice has changed from drawing on learnt knowledge to applying principles. The results further suggest that religion and spirituality manifest in various forms in different Ayurvedic educational, social, political and professional environments, illustrating their ‘religious-cum-secular’ nature across the Ayurvedic contexts. Spirituality emerged as an important component of the practitioners’ definition of UK Ayurveda; however, it did not appear to be the key influence in shaping the consultation which tends to be aligned with the biomedical paradigm as it seeks to be perceived as a credible science. The findings suggest that a contemporary model of global Ayurveda needs to take into account and recognise its fluid nature as it changes and adapts to a new environment and culture. I interpret this fluidity as a necessary strategy for the survival of a system of healing that sits on the margins of mainstream healthcare in the UK. This research has significant implications for Ayurveda as a holistic system of healing. It suggests that education and training for UK Ayurveda needs to be in line with the changes taking place in consultations, rather than based solely on the Indian curriculum or classical texts. An adapted approach is required for research as UK practice is no longer standardised compared to that in India.

Hyperbaric oxygen (HBO) therapy is the administration of 100% oxygen at more than one atmosphere. It greatly improves tissue oxygenation and facilitates mechanisms of wound healing, which in turn benefits some patients with chronic wounds. A prominent fact in therapeutic HBO is the acceleration of neoangiogenesis during granulation tissue formation. Angiogenesis is a highly orchestrated event, a diverse range of cells and angiogenesis factors are involved in the process. The formation of reactive oxidative species (ROS) during HBO has been controversially considered as signalling regulator for angiogenic factors, as well as harmful originator for oxidative stress-induced cyto- and geno-toxicity in cells. This thesis contributes to this interesting while challenging topic. The project starts with investigation the direct HBO effects on blood vessel in vitro under physiological conditions and pathological conditions. The data clearly show that a single HBO treatment does not induce oxidative stress and cell damage under physiological conditions. Nevertheless, under pathological conditions, HBO induces oxidative stress with more ROS formation and cell damage. Interestingly, no evidence has been shown that HBO alone or synergically promotes nitric oxide and vascular endothelial growth factor production in either condition. The response of blood vessel to HBO treatment is not explained by autocrine release of angiogenesis factors locally in the blood vessel. Next, HBO-induced intracellular calcium (Ca2) changes and DNA damage were investigated using cultured human umbilical vein endothelial cells. A single HBO treatment significantly elevates intracellular Ca2+ level without inducing cell damage. Furthermore, HBO treatment has small but significant effect on DNA migration when evaluated by comet assay (e. g. 6.8 ± 0.8 % comparing to 4.6 ± 0.2 % DNA in tail of air treatment). However, this effect is totally reversible after 24h recovery. Importantly, HBO treatment protects endothelial cells against subsequent oxidative stress attack, and an increased antioxidant capacity was found as reflected in higher ratio of GSH to GSSG. The findings suggest that the beneficial effect of HBO is possibly via HBO-induced adaptation in cellular redox status. However, the details of Ca2+ signalling and roles of antioxidants in HBO treatment are areas for further research. Keywords: Hyperbaric Oxygen, Oxidative Stress, Vascular Endothelial Growth Factor, Nitric Oxide, Endothelial Cells, Calcium, DNA Damage

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In the UK, international recruitment is one of the strategies adopted to tackle the shortage of nurses. It is predicted that the UK will continue relying on internationally recruited nurses (IRNs) in the future. There is high attrition among both national and overseas nurses. While factors determining the turnover of British nurses are generally understood there is not much evidence about overseas staff. Literature suggests that factors involved in the decision to emigrate and experiences during recruitment are essential in the development of professional and personal expectations. The extent to which expectations are met is related to job satisfaction and retention. This research aims to improve understanding about the interface between IRNs' expectations, initial experiences and turnover. The study uses a qualitative approach, asking IRNs from India and the Philippines and using analysis of their narratives to generate data about their expectations and experiences. The first group comprised 6 Indian nurses, who were interviewed three times over eight months since their arrival in the UK, and someo f their managersa nd mentors. The second and third groups comprised Filipina nurses recruited from two cohorts, 6 nurses recruited one and a half years before and 9 nurses recruited four years before. Findings validate results from other studies about the motivation to emigrate. Motives are often, but not exclusively, economic. Indian nurses come with their families to improve their lives in the UK while Filipino nurses come to help their families back home. Professional and economic expectations arc often not met. There are important professional disparities between their countries and the UK. Nurses perceived that there was not enough institutional support for professional and cultural adaptation. Often their experience and skills are neither recognized nor valued. Isolation, frustration and consequently low satisfaction were identified in most of the nurses what is known to be related to turnover.

The proposal of Vane (1971) that aspirin-like drugs exert their pharmacological actions via inhibition of prostaglandin (PG) biosynthesis is now widely accepted. It was the object of the present work to prepare PG synthetase from human rheumatoid synovial tissue in order to study its basic biochemical properties, and to study the interaction(s) between the enzyme and some of the aspirin-like drugs commonly used in the therapy of the rheumatic diseases. Using a radiometric technique PG synthetase activity was measured in vitro in the microsomal fraction of 31 synovial tissues taken from 27 patients with rheumatoid arthritis. Its biochemical properties and inhibition in vitro by low concentrations of aspirin-like drugs suggested that it did not differ radically from the well-studied enzymes prepared from animal tissues. While the enzyme preparation from patients receiving indo-methacin, naproxen or ibuprofen therapy possessed considerable activity in vitro, preparations from patients receiving aspirin, even in low doses, were incapable of PG synthesis. Aspirin may therefore be unique in being an irreversible inhibitor of the enzyme. A correlation was found to exist between the potency of the aspirin-like drugs as inhibitors of synovial PG synthetase in vitro and their known therapeutic potencies. The significance of interesting anomalies such as salicylic acid is discussed. Studies of the effects of copper and copper aspirin showed interesting quantitative and qualitative effects in vitro which may have therapeutic potential. Studies with human peripheral leucocytes showed that platelets contain a high level of synthetase activity and a comparison of the effects of aspirin and indomethacin, both in vitro and in vivo confirmed the results obtained with synovial preparations. The use of [acetyl-3H] aspirin of high specific activity showed the drug to be capable of acetylating a particulate fraction protein from both platelet and synovial preparations. The possibility that this protein is the cyclo-oxygenase component of the enzyme complex is discussed.