The study sought to analyse the perception of HIV/AIDs by clients attending a community clinic in Mutale area in Limpopo province by interviewing them as they are attending the clinic. The study sought to determine ideas, beliefs or images clients have as a result of how they see or understand HIV/AIDS. The major inferences drawn from this study are that clients still need information on the rights of HIV/AIDS client and the immune system. Feedback from the study is indicative of culture and beliefs playing a major role in diseases epidemic. / Health Studies / MA (HEALTH STUDIES)

Communication errors are frequent during the perioperative period and cause clinical incidents and adverse events. The overall aim of the thesis was to study communication – the transfer of information, especially the postoperative handover – between healthcare personnel in an anaesthetic clinic and the effects of using the communication tool SBAR (Situation-Background-Assessment-Recommendation) from a patient safety perspective. The thesis is based on studies using a correlational (Paper I), quasi-experimental (Paper II and III) and descriptive (Paper IV) design. Data were collected using digitally recorded and structured observations of handovers, anaesthetic records, questionnaires, incident reports and focus group interviews. The results from baseline data showed that lack of structure and long duration of the verbal postoperative handover decreased how much the receiver of postoperative handover remembered; the item most likely not to be remembered by the receiver was anaesthetic drugs. The variation in remembered information showed that there were room for improvement (Paper I). Implementing the communication tool SBAR increased memorized information among receivers following postoperative handover. Interruptions were frequent during postoperative handover, which negatively affected memorized information (Paper III). Furthermore, after implementation of SBAR, the personnel’s perception of communication between professionals and the safety climate improved, and the proportion of incident reports related to communication errors decreased in the intervention group (Paper II). The results of the focus group interviews revealed that the nurse anaesthetists, anaesthesiologists and post-anaesthesia care unit nurses had somewhat different focuses and views of the postoperative handover, but all professional groups were uncertain about having all information needed to secure the quality of postoperative care (Paper IV). The findings indicate that using a predictable structure during postoperative handover may improve the information memorized by the receiver, perception of communication between professionals and perception of safety climate. Incidents related to communication errors may also decrease. Long duration of the handover and interruptions may negatively affect the information memorized by receiver. To ensure high quality and safe care, there is a need to achieve a shared understanding across professionals of their work in its entirety.

全民健保自開辦以來，財務一直存在入不敷出之隱憂，醫療院所頻頻呼籲健保的給付不足，將造成經營困難。除此之外，醫師人口逐年增長、診所成本入不敷出、人口老化迅速及新醫療設備之引進及各政策之影響下，本研究想瞭解在競爭及不確定的環境中，診所應如何以創新經營。本研究導入資料採礦之觀點，將商業智慧用於眼科診所之案例，利用忠誠度分析、流失度分析、獲利貢獻度分析、就診時段分析，想瞭解診所客戶之特性並且針對其習性及特點，並加上SWOT分析，清楚瞭解診所內部之優缺點及外部的機會與威脅，作好準備以謀取事業的永續發展。忠誠度分析之結果發現，其特點為家庭來診人數最多，性別比例較其他集群平均，案類分佈則以一般案類為主，年齡層為22歲以下及35歲以上居多；而在獲利貢獻度中，高利潤收入之地區分佈為竹北市、新竹市明湖路、福德街等；在流失度分析當中，研究發現客戶群在22歲以下，案類為一般案類，且兩人看診家庭的流失比例最高；最後就診時段分析當中，發現所有病例之地區時段、看診日分析看診人數除星期四外，皆以早上時段為最多。資料採礦是很好的輔助工具，將商業智慧應用於診所之經營上，可依照不同的分析集群搭配不同的行銷策略，增加競爭力，規畫創新之營運模式，以追求更好的發展。 / Since its start, expenditure exceeding income has always been a hidden concern in the finance of the National Health Insurance (NHI). Medical clinics have repeatedly said insufficient payment from the NHI will result in difficulty in their management. Moreover, other factors are affecting the clinics, namely, the growing number of doctors statewide, the income shortage of running a clinic, the rapidly aging population, the introduction of new medical equipment, and the various new policies. This paper intends to explore some innovative management plans for the clinics in a competitive and uncertain environment. Business intelligence is applied in the case study of an eye clinic. The analysis of client the degree of loyalty, run off, profit contribution, and visiting time help understand client habits and characteristics. A SWOT analysis further helps the clinic clearly understand its own strength and weakness, and the opportunities and threats from outside. Thus it can better prepare itself for a long term business. The analysis of client the degree of loyalty shows the following: most of the clients are family members; there is an even male/female ratio while in other categories it is not so; most medical cases are general cases; most of the clients aged under 22 or above 35. The analysis of the degree of profit contribution reveals that the districts related to higher profit are Zhubei City, and Minghu Road and Fude Road of Hsinchu City. In the analysis of The degree of run offs, it is found that most of them are under 22, most medical cases are general cases, and most of the clients are two people from a same family. Lastly, in terms of visiting time, analysis shows that most of the clients, regardless of their residential areas, visit in the morning except on Thursday. Business intelligence is an helpful tool. According to the analysis a clinic can match different client groups with different marketing policies, enhance it competitive edge, plan for an innovative management model, and pursue a better development.

Locational decisions based on stigma and low funding have handicapped the efficiency of community based mental healthcare in the United States since 1963. However, the pattern of services in the 21st century American South remains largely unknown. This thesis addresses this gap in knowledge by using a mixed methodology including location allocation, descriptive statistics, and qualitative site visits to explore the geography of community clinics offering both physical and mental health services. The City of Houston has proposed using these facilities to anchor new supportive housing, but introducing more fixed costs to a mismatched system could create more problems than solutions. The findings of this study suggest the presence of an unnecessary concentration of services in the central city and a spatial mismatch between accessible clinics and the poor, sick people in need. Furthermore, this research reveals a new suburban pattern of vulnerability, calling into question long-held assumptions about the vulnerability of the inner city. Building supportive housing around existing community clinics, especially in the central city, may further concentrate vulnerable people thereby contributing to intensifying patterns of service-seeking drift and the continued traumatization of mentally ill homeless persons in Houston.

Compared to the general population, socially disadvantaged patients have higher rates of chronic illness and require more complex medical care. They also endorse higher levels of psychological distress and tend to engage in behavioral risk factors such as poor diet, physical inactivity, and smoking. These issues are particularly concerning given that this population tends to adhere less to medical recommendations, has limited access to health resources, and receives poorer treatment from providers. In an effort to address this disparity, The Affordable Care Act will expand health care access to an additional 23 million uninsured and 17 million underinsured Americans. However, simply expanding access to health care without examining and improving upon factors related to the physician-patient relationship would not fully address the health care needs of this population. This study sought to improve the quality of care received by socially disadvantaged patients by better understanding the role of race and gender on the physician-patient communication process and patient outcomes in a safety net primary care clinic. The study sample consisted of 330 low-income, uninsured/underinsured African American and White patients and 41 resident physicians. Overall, African American patients and their doctors and White doctors and their patients were viewed as engaging in the highest levels of communication. South Asian physicians, and male South Asian physicians in particular, had the lowest levels of communication and the patients of these providers experienced less improvement in their physical health. Patient education level influenced physicians’ perceptions of their patients to the extent that patients with higher educational levels were viewed as engaging in lower levels of communication. Last, indicators of a good physician-patient relationship were associated with higher levels of patient reported adherence. Practice implications and areas for future research are discussed.

Protective therapy and preventive detention The Diploma thesis is concerned with two types of protective measures one being protective therapy and the other being preventive detention. The objective of this paper is to examine in a comprehensive manner the current law that concerns these two institutes of criminal law and to determine their faults and to include a supplemental recommendation. The paper also included a general overview of the protective measures according to the legal order of the Czech Republic. There are a compare and contrast of the penalties and interpretation of the legal terms as well as what both protective therapy and preventive detention have in common. Also, listed legislation for both institutes of preventive detention and protective therapy will be individually defined and under which conditions they are imposed. There is also stated the forms of the measures and their duration. The detention facilities in Brno and Opava are described as being a part of preventive detention. Legislation for the institute Terbeschikkingstelling (TBS) and forensic hospitals and how it deals with patients in the Netherlands also is mentioned. Decisions made on extension therapy and duties of the hospital staff related thereto are described within protective treatment. Generally, individual...

Le but de cette étude est d'apporter un éclairage sur la contribution peu reconnue des assistantes maternelles à titre non permanent dans le développement psychoaffectif du jeune enfant. Notre objectif a été de mettre en évidence le développement de « l'intelligence au travail » (C. Dejours, 1993) des assistantes maternelles à partir d'un paradigme « d'ergologie clinique » (Y. Clot, 1999). Pour cela, nous avons posé 3 hypothèses de travail : 1) les assistantes maternelles développent une intelligence secondaire à l'expérience au travail dans les « fonctions de maternage » (D.W. Winnicott, 1969). 2) Les assistantes maternelles développent une intelligence secondaire à l'expérience au travail dans les « fonctions tierces » (F. Dolto, 1984). 3) Les assistantes maternelles développent une intelligence secondaire à l'expérience au travail sous la forme de « stratégies défensives » (C. Dejours, 1993 ; P. Molinier, 2006). La population a été constituée en 2 groupes : 3 assistantes maternelles « novices » et 3 assistantes maternelles « expertes ». La méthodologie consistait en une méthode qualitative de recueil de données (entretiens semi-directifs avec consigne d' « instruction au sosie » et « auto-confrontation croisée ») et une méthode qualitative de traitement des données (analyse clinique thématique et analyse linguistique de l'énonciation). Cette analyse a permis de valider les hypothèses de recherche et d'identifier les qualités, savoir-faire et stratégies défensives aboutissant à l'efficience au travail auprès des jeunes enfants. / The purpose of the study is to shed light on the unknown contribution of the childminders in the psycho-emotional development of young children. Our goal was to highlight the development of « intelligence at work » (C. Dejours, 1993) of the childminders from a paradigm of « ergology clinic » (Y. Clot, 1999). For this, we asked three working hypotheses : 1) the childminders develop a secondary intelligence at work experience in the « functions of mothering » (D.W. Winnicott, 1969). 2) The nurses develop a secondary intelligence at work experience in the « paternal function » (F. Dolto, 1984). 3) The childminders develop a secondary intelligence at work experience in the form of « defensive strategies » (C. Dejours, 1993; P. Molinier, 2006). The population was incorporated into 2 groups : 3 childminders « novices » and 3 childminders « expert ». The methodology consisted of a qualitative method of data collection (semi-structured interviews with « instruct the double » and « self-confrontation cross ») and a qualitative method of data processing (clinical thematic analysis and analysis of the linguistic utterance). This analysis was used to validate the research hypotheses and identify the qualities, knowhow, skills and defensive strategies leading to efficiency in working with young children.

During the past century, lawyers in New Orleans created a number of organizations to provide legal services for the poor, as lawyers did throughout the country. Most of those organizations provided routine service directly to individual clients and received quiet acceptance within the city and the state. However, more aggressive lawyers in other legal services offices engaged in law reform or challenged politically powerful interests. These offices found themselves embroiled in controversy and facing impediments that were placed in the way of their work. This dissertation introduces nonprofit legal services in New Orleans, but focuses on and investigates the experiences of four organizations – the New Orleans Legal Assistance Corporation, the Tulane Environmental Law Clinic, the Louisiana Capital Assistance Center, and the Advocacy Center – that were involved in controversies. This investigation differs from most prior studies of legal assistance in several ways. First, it discusses a variety of local legal service organizations rather than concentrating on the legal aid movement of the first half of the twentieth century, or the later Legal Services Program and its successor Legal Services Corporation. Secondly, it provides detailed discussion of several New Orleans legal services, which had previously been limited to scrutiny of the Tulane Environmental Law Clinic. Most importantly, it goes beyond description to provide causal explanation for the controversies by reference to social structure, and the social mechanisms and social processes at work. The dissertation presents access to law by the poor as being a form of "largesse" or charity or gift, which is granted when it is convenient for the powerful, but withheld when it is inconvenient for the powerful. From this perspective, the controversies resulted from the opposing interests of the two major social classes in modern capitalist society, with the politically powerful objecting to certain legal victories or gains achieved by the poor. In addition to the New Orleans cases, the dissertation refers to other legal services offices throughout the country that experienced similar problems. This demonstrates that the underlying issues are not limited to the city of New Orleans or the state of Louisiana, but are national in scope.

The purpose of the study was to evaluate the health education for clients diagnosed with diabetes mellitus by nurses working in the diabetes clinic of the specific hospital. The quantitative descriptive cross sectional design used two questionnaires to collect data from all 20 nurses working in the diabetes clinic and from a convenient sample of 132 clients diagnosed with diabetes mellitus, making use of the health services at the diabetes clinic of the hospital. Data was analysed by a computer program, statistical package for social science (SPSS). Measures were taken to ensure acceptable ethical practice, validity and reliability of the study. Findings revealed the absence of official documents to guide the health education and other factors, such as not knowing the learning needs of the clients, not utilising teaching methods optimally. Recommendations address the development of standard procedures, lesson plans, recording of health education sessions and education skills development for the nurses. / Health Studies / M. A. (Nursing Science)

O presente trabalho tem como objetivo problematizar os modos pelos quais a história da psicanálise se posiciona à luz da analítica do poder segundo Foucault. Primeiramente, contextualizou-se a relação crítica estabelecida entre Foucault e a psicanálise. Tendo isso em vista, buscou-se estabelecer uma definição operacional da categoria de poder na qualidade de método, de um ponto de vista foucaultiano. Desta definição, privilegiou-se o papel da liberdade enquanto condição fundamental para as relações de poder, liberdade esta entendida nas superfícies da cura, da linguagem e da relação entre sujeito e verdade. Assim sendo, procurou-se interpelar a função das biografias e dos casos clínicos por meio de um posicionamento comparativo com os conceitos foucaultianos de arquivo e acontecimento. Por fim, procurou-se defender o papel crucial da singularidade do caso para a tessitura das relações de poder na historiografia erudita da psicanálise / This study aims to problematize the ways in which the history of psychoanalysis positions itself in light of Foucaults analytics of power. Firstly, it contextualizes the critical relationship established between Foucault and psychoanalysis. With this in mind, it then seeks to establish an operational definition of the category of power as a method, from a foucaultian point of view. From this definition, we favored the role of freedom as a fundamental condition for power relations, freedom as understood on the cure surface, on the language surface and in the relationship between subject and truth. As such, we sought to question the role of biographies and clinical cases by means of comparisson with the foulcautian concepts of archive and event . Finally, we sought to defend the crucial role of a cases singularity in the fabric of power relations inside the erudite historiography of psychoanalysis