No description available.

No description available.

Families play a key role in psychiatric emergency services (PES). Given the cost of PES in terms of dollars and restrictiveness, clients, families, providers, payers, and policymakers involved in these services need more understanding of how families affect these key PES outcomes. Marriage and family therapy theories offer frameworks for understanding family and provider system dynamics in PES. This study explores how family presence and family quality influence restrictiveness and cost of PES dispositions, and how they moderate the effect of suicide risk, homicide risk, and inability to care for self on those outcomes. The sample of 306 clients and 33 clinicians was drawn from the records of a mobile PES unit serving a rural area. A regression-based, quantitative methodology, Hierarchical Linear Modeling (HLM), was employed to explore associations between restrictiveness and client risk and family factors, as well as differences in dispositions between PES clinicians. In order to extend practical implications, the same questions were also examined in monetary terms by translating restrictiveness into cost of dispositions. Results show inability to care for self and suicide risk to be the strongest predictors of increased restrictiveness and cost. Family quality appeared to reduce restrictiveness but not cost and only when not considering interactions with individual risk factors. When interactions were considered, family quality exhibited a statistically significant disordinal interaction with inability to care for self. That is, when clients were unable to care for self, positive family quality worked toward increasing restrictiveness and cost, perhaps due to families seeking help for the client. However, when clients were able to care for self, positive family quality worked in the opposite direction (i.e., toward reducing restrictiveness and cost). Theoretical and practical implications of this interaction were considered. There was found no significant variability in dispositions and associated costs between clinicians, which may be evidence of standardized clinician training and procedures. Non-standardized instrumentation, lack of comparison with other programs or sites, and limited cell sample size are limitations of the study. This study shows the complexity of family systems in PES and provides basis for recommendations for future research and clinical practice. / Ph. D.

Masters of Science - Msc (Physiotherapy) / The roles of doctors and nurses in clinical supervision and clinical education are well defined in literature. However, the role of the physiotherapist in clinical education has not been clearly defined. This could be because the understanding of a clinical supervisor varies from discipline to discipline.

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The study aimed to explore and describe factors which impacted on the satisfaction of patients using the curative component of primary health care in the Ekurhuleni Metropolitan area. A qualitative, explorative and contextual design was followed in this study. Focus group interviews were used to collect data from clients, nurse clinicians and community health committee members. Findings indicated that there was lack of facilities, resources and supplies, lack of safety and security measures, negative attitudes of nurse clinicians, lack of community involvement and lack of clinic management involvement. Suggestions were made by the groups on how to improve the curative primary health care service and intervention strategies were identified from the suggestions made. The implementation of these strategies will help with the improvement of the service delivery at the clinic for primary health care. / Health Studies / (M.A. (Health Studies)

The supply of non-physician clinicians (NPCs), such as physician assistant (PAs), could significantly influence demand requirements in medical workforce projections. This study predicts supply of and demand for PAs from 2006 to 2020. The PA supply model utilized the number of certified PAs, the educational capacity (at 10% and 25% expansion) with assumed attrition rates, and retirement assumptions. Gross domestic product (GDP) chained in 2000 dollar and US population were utilized in a transfer function trend analyses with the number of PAs as the dependent variable for the PA demand model. Historical analyses revealed strong correlations between GDP and US population with the number of PAs. The number of currently certified PAs represents approximately 75% of the projected demand. At 10% growth, the supply and demand equilibrium for PAs will be reached in 2012. A 25% increase in new entrants causes equilibrium to be met one year earlier. Robust application trends in PA education enrollment (2.2 applicants per seat for PAs is the same as for allopathic medical school applicants) support predicted increases. However, other implications for the PA educational institutions include recruitment and retention of qualified faculty, clinical site maintenance and diversity of matriculates. Further research on factors affecting the supply and demand for PAs is needed in the areas of retirement age rates, gender, and lifestyle influences. Specialization trends and visit intensity levels are potential variables.

The purpose of this study was to determine the effect of a single-session group music therapy songwriting session on grief processing in hospice clinicians. The study design was quasi-experimental. Participants were cluster randomized into a control group and a treatment group. The researcher led a 50-minute songwriting session focused on sharing and processing experiences of grief-related stress and burnout in hospice work. Grief processing was measured using a self-report survey for n=25. Overall differences between control and treatment groups were not found to be statistically significant. Significant differences were also not found in treatment score differences for type of hospice clinician or years of experience. For future research with hospice clinicians, a new measurement tool should be developed that is more specific to measuring an actual difference before and after a treatment. The current measurement tool is best used as an inventory for stress and grief levels that result from caregiving. Any new measurement tool should be kept under twenty questions. A single-session, though convenient for busy hospice clinicians, may not provide a complete treatment for grief and stress. Further research with hospice clinicians may require several treatment sessions to achieve a more complete grief processing experience.

Background: RTW after work-related injuries is a multifactorial process. Factors affecting clinicians to make RTW-recommendations for patients with WRSEI have not been studied in the literature. Purpose: We investigated the associations between group of factors chosen from different domains (Personal/Environmental) and clinicians’ RTW-recommendations for patients with WRSEI. Methods: Study design was cross-sectional. Data were collected from self-reported surveys and clinical charts of 130 adult workers (not working at the time of visit and referred to WSIB-Shoulder & Elbow Specialty Clinic-Toronto) with chronic (≥6-months) injuries. Results: Population mean age was 43.5-years. 52% were female. The average time-since-injury was 20.4-months (45%>12-months). 70% received RTW-recommendations (regular/modified-job). 30% received a No-RTW-recommendation. 42% had education≥college-level. 18% had heavy (>20kg) job-demands. Higher MCS-scores had a significant association (p=0.0003) with clinicians’ RTW-recommendations. Conclusion: In patients with chronic WRSEI(s), poor general health-status and high disability, workers with better mental-health were more likely to receive a RTW-recommendation by clinicians.

Background: RTW after work-related injuries is a multifactorial process. Factors affecting clinicians to make RTW-recommendations for patients with WRSEI have not been studied in the literature. Purpose: We investigated the associations between group of factors chosen from different domains (Personal/Environmental) and clinicians’ RTW-recommendations for patients with WRSEI. Methods: Study design was cross-sectional. Data were collected from self-reported surveys and clinical charts of 130 adult workers (not working at the time of visit and referred to WSIB-Shoulder & Elbow Specialty Clinic-Toronto) with chronic (≥6-months) injuries. Results: Population mean age was 43.5-years. 52% were female. The average time-since-injury was 20.4-months (45%>12-months). 70% received RTW-recommendations (regular/modified-job). 30% received a No-RTW-recommendation. 42% had education≥college-level. 18% had heavy (>20kg) job-demands. Higher MCS-scores had a significant association (p=0.0003) with clinicians’ RTW-recommendations. Conclusion: In patients with chronic WRSEI(s), poor general health-status and high disability, workers with better mental-health were more likely to receive a RTW-recommendation by clinicians.