Introduction Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows. Aim The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC implementation process at the ETSU-FM clinic, identify gaps, and provide recommendations to address those gaps. Methods A scoping review was conducted using three databases (PubMed, Web of Science, and PsycINFO) searches while following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist to identify different components of TCCs and the associated outcomes. Additionally, a mixed-methods study was conducted using patients and providers from the ETSU-FM clinic to identify different factors associated with patients’ no-shows to scheduled TCC appointments. Results Eighteen studies were analyzed and TCC components and patients’ outcomes were assessed. Predischarge communication with patients and caregivers, early post-discharge contacts, etc. were identified as some of the effective components of TCC. Our review also highlighted that TCC resulted in lower readmissions, lower ED visits, and cost-effectiveness. For the mixed-methods study, we included 520 patients in our quantitative analysis and interviewed 10 providers for the qualitative analysis. Several patient-level and system-level factors were found to be associated with TCC no-shows. A few of the factors that were deemed modifiable by the clinic have been identified and recommendations provided accordingly. Conclusion TCCs play a vital role in ensuring smooth care transitions of patients following discharge. It is crucial to conduct context-level studies to identify factors that are associated with TCC no-shows and design interventions accordingly. Doing so could lead to pursuit of the triple aim of healthcare: improving patients’ experience of care, improving the health of populations, and reducing the per capita cost of health care.

Boys in their middle childhood placed in clinic schools experience severe emotional and behavioural problems. Most of these boys have been sexually abused. The trauma of this sexual abuse may contribute to their problem behaviour. If the learners can be effectively supported in addressing the trauma of the male child sexual abuse during their time at the clinic school, some of their emotional and behavioural problems may also be addressed. Without these emotional and behavioural problems they may be able to develop without hindrance of the male child sexual abuse and may be integrated into the mainstream educational setting before they reach the age of twelve years. This study consisted of three phases. During the first phase the experiences of seven sexually abused boys placed in clinic schools in Gauteng Province in South Africa were explored in order to develop a better understanding of their support needs. It was achieved by means of three in-depth interviews with each participant. For the purpose of the first phase a qualitative design was used, which was of a phenomenological, descriptive and exploratory nature in order to explore and describe the phenomenon of male child sexual abuse. To obtain a clear picture of the unique view and subjective experiences of a participant in a clinic school, the phenomenon of male child sexual abuse was investigated. From the results it was clear that sexually abused boys placed in clinic schools exhibit intensified emotional reactions, as well as certain problems associated with male child sexual abuse. The intensified emotional reactions include a deep sense of sadness and helplessness, a sense of guilt and shame, a sense of dissociation and numbness, avoidance of situations associated with male child sexual abuse, fear of recurring incidents and the re-experiencing of the trauma. The problems associated with male child sexual abuse include concerns regarding their own sexuality, difficulties in interacting with other people, dealing with anger and aggression, displaying self-destructive behaviour and difficulties to cope with schoolwork. During the second phase of the study twenty-four psychologists, social workers, counsellors, teachers and child and youth care workers were included. Semi-structured individual interviews were conducted with each of them to identify critical aspects to support victims of male child sexual abuse. For the purpose of the second phase the interpretive descriptive design was used. The results suggest that the following critical aspects should be considered in the conceptualisation of a proposed support strategy: Relationships as basis for support; strengthening the male child sexual abuse victims to deal with behavioural and emotional challenges; facilitating the safety of the male child sexual abuse victims to avoid continued exposure to abuse; providing a structured environment and coordinated support efforts to ensure sustainability. The third phase of this study consisted of the conceptualisation of a support strategy for male child sexual abuse victims. Two focus groups were conducted with fourteen psychologists, social workers, counsellors, teachers and child and youth care workers to conceptualise the support strategy. The proposed support strategy suggests the incorporation of different role players in a collaborative team approach for a multilevel support approach. The proposed support strategy involves three main facets, namely strengthening of the male child sexual abuse victim as an individual, sustaining a deep/trusting relationship, as well as the facilitation of a supportive context for the male child sexual abuse victim. / PhD (Psychology), North-West University, Potchefstroom Campus, 2015

Worldwide, patients who visit health-care facilities generally have to wait very long to be attended by physicians and professional nurses. In South Africa, the Cape Triage Score system was implemented with great success in Emergency departments in the Cape Metropole. In primary health-care clinics the concern is that patients have to wait too long for service delivery, even if they are very ill and need hospitalisation. In this research study the role of triage in reducing waiting times in primary health-care clinics was examined. The Cape Triage Score system that was used in Emergency departments in the private sector and also in public hospitals was adapted for a pilot intervention study. This was done to determine if the utilisation of this system can reduce the waiting times of patients visiting primary health-care clinics. The researcher utilised a quantitative design with an intervention, after measuring the baseline waiting time. The strategies applied included an exploratory, descriptive and contextual strategy. The study was carried out in three steps according to the objectives set for the study. Firstly, the baseline assessment of the current waiting times in two PHC clinics in a sub-district of the North West Province was done. A waiting-time survey checklist was used to determine the baseline waiting time of patients visiting primary health-care clinics. These waiting-time survey checklists consisted of a few components that assessed different aspects of waiting time. The second objective was to explore and describe literature in order to understand primary health-care waiting times, triage and related constructs. The third objective was to pilot an adapted Cape Triage Score system to determine if the intervention contributed to reducing waiting times for patients visiting primary health-care clinics. Data was analysed according to Cohen’s effect sizes. The comparison between the baseline waiting times and pilot intervention waiting-time assessment was done according to Cohen’s effect sizes. The analysis of the data indicated a practical significance for the component where the pilot Cape Triage Score system was applied, as patients were referred to the physician and professional nurse according to the severity of their condition. The outcome of the study indicated no reduction in the overall waiting time of patients visiting primary health-care clinics due to the different components of the waiting-time survey checklist. Finally, the research was evaluated, limitations were identified and recommendations were stipulated for nursing practice, education, research and policy. / MCur, North-West University, Potchefstroom Campus, 2014

Boys in their middle childhood placed in clinic schools experience severe emotional and behavioural problems. Most of these boys have been sexually abused. The trauma of this sexual abuse may contribute to their problem behaviour. If the learners can be effectively supported in addressing the trauma of the male child sexual abuse during their time at the clinic school, some of their emotional and behavioural problems may also be addressed. Without these emotional and behavioural problems they may be able to develop without hindrance of the male child sexual abuse and may be integrated into the mainstream educational setting before they reach the age of twelve years. This study consisted of three phases. During the first phase the experiences of seven sexually abused boys placed in clinic schools in Gauteng Province in South Africa were explored in order to develop a better understanding of their support needs. It was achieved by means of three in-depth interviews with each participant. For the purpose of the first phase a qualitative design was used, which was of a phenomenological, descriptive and exploratory nature in order to explore and describe the phenomenon of male child sexual abuse. To obtain a clear picture of the unique view and subjective experiences of a participant in a clinic school, the phenomenon of male child sexual abuse was investigated. From the results it was clear that sexually abused boys placed in clinic schools exhibit intensified emotional reactions, as well as certain problems associated with male child sexual abuse. The intensified emotional reactions include a deep sense of sadness and helplessness, a sense of guilt and shame, a sense of dissociation and numbness, avoidance of situations associated with male child sexual abuse, fear of recurring incidents and the re-experiencing of the trauma. The problems associated with male child sexual abuse include concerns regarding their own sexuality, difficulties in interacting with other people, dealing with anger and aggression, displaying self-destructive behaviour and difficulties to cope with schoolwork. During the second phase of the study twenty-four psychologists, social workers, counsellors, teachers and child and youth care workers were included. Semi-structured individual interviews were conducted with each of them to identify critical aspects to support victims of male child sexual abuse. For the purpose of the second phase the interpretive descriptive design was used. The results suggest that the following critical aspects should be considered in the conceptualisation of a proposed support strategy: Relationships as basis for support; strengthening the male child sexual abuse victims to deal with behavioural and emotional challenges; facilitating the safety of the male child sexual abuse victims to avoid continued exposure to abuse; providing a structured environment and coordinated support efforts to ensure sustainability. The third phase of this study consisted of the conceptualisation of a support strategy for male child sexual abuse victims. Two focus groups were conducted with fourteen psychologists, social workers, counsellors, teachers and child and youth care workers to conceptualise the support strategy. The proposed support strategy suggests the incorporation of different role players in a collaborative team approach for a multilevel support approach. The proposed support strategy involves three main facets, namely strengthening of the male child sexual abuse victim as an individual, sustaining a deep/trusting relationship, as well as the facilitation of a supportive context for the male child sexual abuse victim. / PhD (Psychology), North-West University, Potchefstroom Campus, 2015

Worldwide, patients who visit health-care facilities generally have to wait very long to be attended by physicians and professional nurses. In South Africa, the Cape Triage Score system was implemented with great success in Emergency departments in the Cape Metropole. In primary health-care clinics the concern is that patients have to wait too long for service delivery, even if they are very ill and need hospitalisation. In this research study the role of triage in reducing waiting times in primary health-care clinics was examined. The Cape Triage Score system that was used in Emergency departments in the private sector and also in public hospitals was adapted for a pilot intervention study. This was done to determine if the utilisation of this system can reduce the waiting times of patients visiting primary health-care clinics. The researcher utilised a quantitative design with an intervention, after measuring the baseline waiting time. The strategies applied included an exploratory, descriptive and contextual strategy. The study was carried out in three steps according to the objectives set for the study. Firstly, the baseline assessment of the current waiting times in two PHC clinics in a sub-district of the North West Province was done. A waiting-time survey checklist was used to determine the baseline waiting time of patients visiting primary health-care clinics. These waiting-time survey checklists consisted of a few components that assessed different aspects of waiting time. The second objective was to explore and describe literature in order to understand primary health-care waiting times, triage and related constructs. The third objective was to pilot an adapted Cape Triage Score system to determine if the intervention contributed to reducing waiting times for patients visiting primary health-care clinics. Data was analysed according to Cohen’s effect sizes. The comparison between the baseline waiting times and pilot intervention waiting-time assessment was done according to Cohen’s effect sizes. The analysis of the data indicated a practical significance for the component where the pilot Cape Triage Score system was applied, as patients were referred to the physician and professional nurse according to the severity of their condition. The outcome of the study indicated no reduction in the overall waiting time of patients visiting primary health-care clinics due to the different components of the waiting-time survey checklist. Finally, the research was evaluated, limitations were identified and recommendations were stipulated for nursing practice, education, research and policy. / MCur, North-West University, Potchefstroom Campus, 2014

The purpose of the study was to assess the level of knowledge about glaucoma among the patients who attend the CBN staff eye clinic in Abuja. An exploratory, descriptive and cross-sectional study was conducted on adult CBN staff members and their eligible dependants. Data on demographics and knowledge of glaucoma were collected using a pre-tested structured questionnaire. One hundred and forty five respondents (100% return) participated in the study. Purposive sampling was done to recruit respondents. Of the total respondents’, 74.5% (n=108) claimed they had heard about glaucoma but only 14.5% (n = 21) had knowledge about glaucoma. Glaucoma knowledge was found to be independent of age, sex, ethnicity, educational level and respondents’ status within the CBN. Knowledge about glaucoma in this population is therefore according to the results, inadequate. Appropriate recommendations were made to improve glaucoma knowledge amongst patients who attend the clinic. / Health Studies

Background: Although immunisation services are provided free at all public health facilities in South Africa, immunisation coverage remains variable and disease outbreaks still occur. The coverage rate in the Overberg district is recorded as 75.8%, below the national target of 90% (Western Cape Government Provincial Treasury 2013:2). The researcher wanted to understand what the barriers to accessing immunisation services were and how this might relate to other primary health care services. Methods: The researcher visited 22 households and interviewed nine mothers who had brought their children to Zwelihle Clinic to be immunised and nine community health workers servicing the Zwelihle community in the Overberg district, Western Cape Province. Findings: A key finding is that the data does not reflect the actual situation – children in the community either are immunised at other facilities or have left the catchment area, hence strong relationships between the facility and the community and an electronic patient tracking system become important. Findings impacting access to services include the attitude of administrative staff, waiting times and the impact of migratory communities. Recommendations are made to improve the quality of data, provide training to administrative staff, improve patient education, reduce waiting times and improve the relationship between the clinic and the community in order to better track patient migration / Health Studies / M.A. (Public Health)

Vocabulary tests have long been used for estimating premorbid intelligence level in the neuropsychological assessment of dementia. However, doubts exist about the validity of such intelligence tests. The present study examines whether the Multiple-Choice Vocabulary Test – Version A (Mehrfachwahl-Wortschatz-Test – Version A, MWT-A) is valid for assessing premorbid intelligence level. Data from a total of 821 patients in a specialized outpatient clinic for dementia (memory clinic), covering the whole spectrum of cognitive impairment, were evaluated using analysis of variance with the dependent variable premorbid intelligence level (MWT-A) and the independent variable extent of global cognitive impairment (Mini-Mental-State Examination, MMSE: mean = 25.2, SD = 3.9). The latter was divided into six MMSE ranges or groups, respectively (29–30, 28–28, 27–27, 25–26, 22–24, 05–21). In the case of a pathologically relevant global cognitive impairment (24–26 MMSE points), the MWT-A underestimates the premorbid intelligence level. This effect is moderated neither by age nor education. Results indicate that the MWT-A is unsuitable for estimating premorbid intelligence level in neuropsychological assessments of cognitively impaired patients or demented patients.

Cette étude se référera au caractère contractuel de la responsabilité civile médicale en droit chilien comparé avec le droit français. Je commencerai donc par une analyse historique de la privatisation de la santé et du phénomène de la contractualisation de l’activité sanitaire au Chili. Le principal problème a été que les demandeurs ont échappé au caractère contractuel de la responsabilité et ce principalement à cause du problème du cumul des responsabilités. Ce problème présent en droit chilien peut être résolu à travers une étude approfondie du contrat médical, de ses conditions d'existence et de validité, de ses principales caractéristiques et des différentes théories qui ont tenté d'expliquer sa nature juridique. Nous analyserons également les cas où la relation médicale initiale n'a pas pour source le contrat médical, bien qu’il ait de toute façon été considéré par la jurisprudence et la doctrine comme ayant un caractère contractuel. Nous étudierons dans le même temps les différentes théories qui ont eu comme finalité de contractualiser la responsabilité des centres hospitaliers, tant publics que privés, par le fait de leurs salariés, pour ainsi éviter que la responsabilité de ces centres devienne effective conformément aux normes de la responsabilité extracontractuelle. / The contractual nature of the medical liability had no the same interest in chilean law that french law. However, the increasing privatization of health and the phenomenon of contracting activity for Chilean takes us a deal to make a further study to determinate the contours from the French law. The main problem was that the applicants have escaped the contractual liability and mainly because of the problem of overlapping responsibilities. This problem present in chilean law can be resolved through a thorough study of the medical contract, the conditions of its existence and validity of its main characteristics and different theories have attempted to explain its legal nature and it provide a legal regime that atypical contracts. On the other hand we have to deal with all cases where the initial medical relationship does not source the medical contract, although it has been considered anyway by courts and commentators as having a contractual, and why try to analyze the different theories that have had the purpose of contractualize responsibility for private and public hospitals,, by the fact of their employees, to avoid the responsibility of these centers become effective in accordance with standards of tort.

"The purpose of this study was to collect and compile data for prognostic purposes in determining which clients probably will not continue in treatment until--in the opinion of the agency--'services are completed.' It was hoped that this guide would be helpful in selecting those clients to whom to offer further service. Also, it might be useful in modifying agency policies and procedures to better meet the needs of those people who cannot use the services as presently offered"--Introduction. / Typescript. / "May, 1958." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: David L. Levine, Professor Directing Study. / Includes bibliographical references.