Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: All services should use quality assurance mechanisms to evaluate performance. To this end, studies have been completed in various settings including teaching clinics. Little attention has been placed on rural communities and community clinics with regards to satisfaction. This is an important aspect to investigate as these locations are valuable teaching sites. The aim of this study was to determine patient satisfaction levels at the Durban University of Technology Chiropractic Satellite Clinics (Marburg Haven Centre for the Aged [MHCA] and Narain Jeawon Vedic Centre [NJWC]). Methods: This cross sectional study (ethical approval IREC 35/15) surveyed patients with regards to their service delivery satisfaction via a researcher developed questionnaire dealing with knowledge of the clinic, environmental questions, reception and waiting area, finance, the student doctor, the assessment, treatment, overall care and future care. The study aimed to recruit the majority of patients that presented at the two clinics. The population at the was 123 files, of which 19 were active and 104 were dormant. The population at the MHCA was 237, of which 78 were active and 159 were dormant. A minimum response rate of 70% of active patients for each clinic was set for this study. This resulted in a minimum sample of 55 MHCA patients and 14 NJVC patients. The minimum response rate was achieved for this study. Data was analysed using IBM SPSS version 23. Results: The majority of patients at both clinics were satisfied although reservations were expressed regarding disabled facilities. Satisfaction was not influenced by age (p = 0.034), ethnicity (p = 0.773), gender (p = 0.169), type of visit (p = 0.355), pain rating (p = 0.058) or venue (p = 0.361). Satisfaction was influenced by the year of the student doctor (p = 0.011) and the anatomical site of injury. The overriding factor of income levels for this study neutralised the satisfaction of these patients, as the majority of patients came from poor backgrounds and were more than likely to be satisfied with the care provided. Conclusion: Patients surveyed at both clinics were satisfied. Repeated evaluations in the future would be good indicators to see if the standard of chiropractic care is upheld, and would also aid in improving facilities at both clinics. / M

This mini-dissertation was submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Durban University of Technology, 2007. / Tertiary education students are present and future health care consumers, and as such it is important that they are well educated in both mainstream and complementary health practices. Prior to this study, no data was available on the perceptions of tertiary education students towards homoeopathy in South Africa. The aim of this study was to bridge this gap in the database of knowledge by determining the perceptions and awareness that students at Durban University of Technology (D.U.T.) have towards homoeopathy and the Homoeopathic Day Clinic (H.D.C.) that exists on the D.U.T. campus. This survey-based study was conducted by administering 1080 questionnaires to fulltime registered students at D.U.T. who were in at least their second year of study at the university. A stratified random sample method was employed, based on the demographic variables of faculty, gender and race so as to generate a suitably representative sample. Of the 1080 questionnaires distributed, 1054 (97.6%) were returned and 1005 (93%) met the inclusion criteria to be used in the final sample. The responses showed that the students at D.U.T. have a fairly poor level of knowledge about homoeopathy. Only 48% of them had ever heard of homoeopathy and around 95% said that they had either never heard of it, had heard only of the name, or said they knew a little bit about it. In terms of practical experience with homoeopathy, only 6% have ever consulted a homoeopath personally before, and 9% said that they have family members who have / M

Premature termination is a substantial problem with significant adverse effects for clients, therapists, and treatment organizations. Unfortunately, it is also a relatively common phenomenon within mental healthcare settings. Across varied mental healthcare settings, rates of premature termination have reportedly ranged from 19.7 % to 40 %. Perhaps not surprisingly, the rate of premature termination in training clinics is substantially higher than in community mental health settings and private practice, with 75 to 80 % of clients ending treatment services prematurely. The purpose of this study was to explore the combined effect of intake therapist continuity or discontinuity, and quality of the therapeutic relationship on premature termination. Intake therapist continuity, measures of working alliance, and termination outcome from 524 clients at the University of North Texas Psychology Clinic were utilized for adults receiving individual therapy services between August 2008 and August 2013. Results of the study suggest intake therapist continuity did not predict subjective termination status (X2(2, n = 524) = 1.61, p = 0.45), nor did it predict change in symptomology status (X2(3, n = 453) = 1.14, p = 0.77). Additionally, working alliance predicted subjective termination status (X2(6, n = 212) = 21.17, p < 0.01), but not change in symptomology status (X2(9, n = 208) = 6.27, p = 0.71). The findings of the current study are discussed, as well as suggestions for further research related to client, therapist, treatment, and procedural variables and their impact on premature termination.

Master of Public Health / Department of Diagnostic Medicine and Pathobiology / Katherine S. KuKanich / Hand hygiene by healthcare workers is an effective means of preventing healthcare-acquired infections. However, hand hygiene compliance can be low among healthcare workers. This study used introduction of a gel sanitizer and informational poster as interventional tools in attempt to improve hand hygiene in two outpatient healthcare clinics. Healthcare workers at two outpatient clinics were observed for frequency of hand hygiene (attempts vs. opportunities). Gel sanitizer and informational posters were introduced together as an intervention. Direct observation of hand hygiene frequency was performed during baseline, intervention, and follow-up. A post-study survey of healthcare workers was collected. In both clinics, baseline hand hygiene was poor (11% and 21%) but significantly improved (p[less than or equal to]0.0001) after interventions (36 and 54%), and was maintained (p>0.05) through the follow-up period (32 and 51%). Throughout the study, post-contact hygiene was statistically observed more than pre-contact hygiene. In both clinics, healthcare workers self-reported a preference for soap and water, yet observations showed that sanitizer use predominated over soap and water use when sanitizer was available after the intervention. Fifty per cent of the surveyed healthcare workers considered the introduction of gel sanitizer to be an effective motivating tool for improving hand hygiene. Hand hygiene performance by healthcare workers in outpatient clinics may benefit from promoting gel sanitizer and using informational posters. Direct observation by trained observers may provide more accurate information of hand hygiene tool preference compared with survey results.

Purpose: This study aimed to assess the feasibility of implementation of the Health Professions Council of South Africa's (HPCSA) clinic-based hearing screening subsection of its 2007 Position Statement on Early Hearing Detection and Intervention (EHDI) programmes in South Africa. Specific sub-aims included (a) establishing the prevalence of hearing screening conducted at Maternal Child Woman’s Health (MCWH) immunisation clinics; (b) determining the hearing screening procedures and protocols in use at MCWH immunisation clinics; (c) determining and exploring the possible concomitant personnel-associated factors which may influence the implementation of newborn and infant hearing screening programmes; (d) determining and exploring other factors that may have influenced implementation of newborn and infant hearing screening; and lastly, (e) comparing any hearing screening procedures and protocols in use to the HPCSA (2007) EHDI position statement clinic guidelines and associated clinic benchmarks Participants: Thirty primary healthcare immunisation clinic managers/acting managers were interviewed in two South African sample groups, in the North West province (NW) and Gauteng (GP). Design: An exploratory, non-experimental, qualitative research design was employed incorporating both quantitative and qualitative information within the two sample groups. Methods and Materials: An interview using a questionnaire was administered with primary health care (PHC) clinic nursing manager/acting manager, placed within the identified sites. The questionnaire encompassed areas such as work contexts, hearing screening contexts and information management systems, as well as quality control measures in place at these clinics. Data Analysis: Content analysis was used to code emergent themes into specific categories. Frequency calculations of the emergent themes were calculated and results described qualitatively. Results: No PHC clinics placed within the identified sites offered or provided formalised newborn/infant hearing screening and none of these facilities had equipment to do so. Most sites attributed the lack of formalised hearing screening to budgetary and human resource issues, staff training in particular. Non-formalised hearing screening protocols in place demonstrated inconsistencies in application across districts and none complied with HPCSA (2007) clinic guidelines. Most respondents were willing to implement formalised hearing screening to coincide with their immunisation schedules. The immunisation context was considered favourable for implementation of formalised hearing screening. Other factors such as reduced parental awareness of the importance of hearing screening, and caregiver cultural issues were considered surmountable by respondents. Conclusions: HPCSA (2007) implementation of clinic hearing screening protocols at PHC immunization clinics (level one) does not appear to be feasible based on current evidence. Results from the current study have assisted in identifying procedural and logistical assets and barriers to implementation of HPCSA (2007) clinic guidelines for EHDI at immunisation clinics in South Africa. Future research implications include formal investigations of central directorate versus district differences in PHC Package Integrated Management of Childhood Illnesses (IMCI); Otitis Media, and Road to Health Chart (RtHC) protocols; provincial and district inequities in funding as they impinge on hearing health care service delivery; costing of rudimentary protocols in place versus formalised HPCSA (2007) EHDI service delivery; research into parental awareness, education and willingness in specific reference to certain procedures such as otoacoustic emissions; and replication of the current study throughout the country for quantitave data with increased ability to draw causal inferences and generalize findings.

"The purpose of this study was to find out whether there are observable differences between the social characteristics and problems of civilian and military families that use a child guidance clinic. The subjects consist of twenty-six military and twenty-six non-military families using the services of the Escambia County Child Guidance Clinic, Pensacola, Florida"--Introduction. / Typescript. / "August 1959." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Robert Lansdale, Professor Directing Study. / Includes bibliographical references.

The need to expand access to and availability of quality and comprehensive sexual and reproductive health care (SRH) to help close the gaps in existing health disparities and health inequities in the United States is a pressing public health concern. The emergence of alternative primary care settings (i.e., retail-based clinics [RBCs]) has recently proven to be an effective model for the delivery of acute care in lieu of more traditional medical services. Indeed, RBCs could be an agent for greater SRH care access with the integration of more services; however, barriers exist that inhibit this maximization of care. Providers play a central role in the utilization of SRH in RBCs, whether through their intent to recommend or biases about RBCs. Provider recommendation is a strong indicator for patient compliance. However, little is known about how providers’ attitudes and beliefs influence the uptake of SRH in RBCs. This cross-sectional study collected survey data from a large sample of 341 advanced practice clinicians (APC) to (1) understand the benefits and barriers of SRH integration in RBCs; and (2) identify the relationship between the attitudes of APCs regarding RBCs and their influence on barriers and benefits of SRH integration into RBCs. Items were adapted from existing valid and reliable measures. Survey data were analyzed primarily using descriptive statistics. Comparative analysis between demographic factors and identifier variables that led to several themes: a majority of APCs believe the integration of SRH into RBCs would expand access to and availability of quality and comprehensive SRH care for prevention and intervention; hesitancy to recommend SRH services is chiefly founded in lack of confidence in quality assurance, professional training and quality of services offered; overall APCs had a generally positive attitude towards the integration of SRH in RBCs but attitudes differed among the types of SRH services offered at RBCs. These findings provide insight for the identification of barriers and benefits in the integration of SRH in RBCs. This may create opportunities to address barriers for the expansion of prevention and intervention services among women while capitalizing on benefits to advance awareness, education and access to care.

Thesis (MTech (Environmental Health))--Cape Technikon, 2003 / This is a retrospective (descriptive) study ofclinic delivery trends rendered in Cape Town Central District between July 1995 and June 2002. The study describes the history of clinic service delivery in Cape Town Central District, which includes the Primary Health Care model, as well as the District Health system. Clinic delivery trends for the following three periods are determined: I:] Before the implementation ofthe New Health Plan: July 1995 - July 1996; I:] During the implementation of the New Health Plan: July 1997 - June 1998; I:] After the implementation of the New Health Plan: July 1998 - June 2002. The study also determines and compares the nature ofpublic health clinic services delivered during the study period. No official annual health reports were compiled by Cape Town Administration since July 1997. This study therefore serves to determine disease and clinic trends for the periods where no such aonual reports are available. It is important to determine health delivery trends for future strategic plaoning purposes. Changes to the nature and extent ofservices rendered by public health clinics were brought about by the following factors: Cl One approach of Primary Health Care is to refer more patients to public health clinics in order to release pressure from the major tertiary hospitals. If this Primary Health Care (PHC) model is provided appropriately, about 80% ofhealth problems should be solved without referral to another level of care; Cl A number of free public health clinic services have been introduced since the democratization of South Africa in 1994, such as free services to expectant mothers as well as free clinic services to children younger than six years; Cl New clinic services have been added, such as provision ofmedication to stabilized mental health patients; Cl HIV/AIDS has become an international pandemic over the past decade and has shown a 660.8% increase in Cape Town Central District; Cl A limited (19.8%) increase in the population for that area during the study period; Cl Clinic services have been legislated as a nurse driven service since 1997, with an additional emphasis on the curative roles of nurses (traditional roles of nurses at public health clinics were largely preventive and promotive).

Made available in DSpace on 2016-04-28T18:23:07Z (GMT). No. of bitstreams: 1 Iara Maria Ferreira Santos.pdf: 755335 bytes, checksum: 1a39cc5a78aca25183742d31eb262826 (MD5) Previous issue date: 2015-08-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The so-called echolalia was the subject discussed in this paper. I was interrogated due to the fact that every child starts speaking by incorporating the speech of others, but there are those, especially the ones within the psychopathology group, who are stuck in this position and, practically, only repeat their interlocutor s words. Thus, I found it intriguing and stimulating that the same event the repetition of their interlocutor s words would be children s gateway to language but also being present in complex clinical cases. So as to prompt reflection upon this theme I visited the interactionism, as proposed by De Lemos, who took the repetition of one s speech as a privileged space of theorization (De Lemos, 1982, 1992, 2002 amongst others). In clinical literature, only a few papers have explored the articulation of this phenomenon with the subjective structuring, to this end, I chose for interlocution the researchers from Grupo de Pesquisa Aquisição, Patologias e Clínica de Linguagem who had already approached the subject: Lier-DeVitto (1998, 2006 amongst others), Arantes (2001a, 2011) and Oliveira (2001). In regards to methodology, to illustrate the discussion, I based myself in data by authors that dealt with the speech of children who insisted in blocks (Arantes, 2011; Oliveira, 2011). Overall, this paper explores the effects of repetition regarding the subjective structuring. Thus, taking the individual for their unconscious marks, I found it necessary to visit the concept of repetition and holophrase as they appear in psychoanalyses (Freud, 1914, 1920; Lacan, 2008), aiming to distinguish repetition as incorporation of the interlocutor s speech in the cases when they have success from the ones when the children fail. From psychoanalysis, I could gather that in a trajectory without accidents, repetition is a consequence of the operations of alienation and separation. When problems arise in the period of the subjective structuring, the scenario is totally different. In the case of the children mentioned in this dissertation, I concluded that we cannot speak of repetition, since the alienation and separation operations are not concluded / As ditas falas ecolálicas foram objeto de discussão neste trabalho. Fui interrogada pelo fato de que toda criança entra no campo da fala pela via da incorporação da fala do outro, mas há aquelas, especialmente no campo das psicopatologias, que ficam aprisionadas nessa posição e, praticamente, apenas repetem a fala de seu interlocutor. Assim, considerei intrigante e instigante que um mesmo acontecimento - a repetição da fala do outro - fosse porta de entrada da criança na linguagem, mas que fizesse, também, presença em quadros clínicos complexos. Para empreender uma reflexão sobre o tema visitei o interacionismo, conforme proposto por De Lemos que tomou o espelhamento da fala do outro como espaço privilegiado de teorização (De Lemos, 1982, 1992, 2002 e outros). Na literatura clínica, poucos são os trabalhos que têm se dedicado a buscar a articulação desse fenômeno ao da estruturação subjetiva, assim, elegi para interlocução os pesquisadores do Grupo de Pesquisa Aquisição, Patologias e Clínica de Linguagem que já haviam abordado o tema: Lier-DeVitto (998, 2006 e outros); Arantes (2001a, 2011) e Oliveira (2001). Metodologicamente, para ilustrar a discussão, me baseei em dados da literatura de autoras que também trabalharam com dados de fala de crianças que insistiam em blocos (Arantes, 2011; Oliveira, 2011).Em suma, este trabalho problematiza os efeitos da repetição no que concerne à estruturação subjetiva. Assim, ao tomar o sujeito a partir da marca do inconsciente, considerei necessário visitar o conceito de repetição e de holófrase conforme comparecem na psicanálise (Freud, 1914, 1920; Lacan, 2008), visando com isso distinguir a repetição, enquanto incorporação da fala do outro, nas trajetórias em que há sucesso daquelas em que as crianças fracassam. Do encontro com a psicanálise, pude apreender que, numa trajetória sem acidentes, a repetição é decorrência das operações de alienação e separação, quando há percalços no tempo da estruturação subjetiva a situação é bastante distinta. No caso das crianças apresentadas nesta dissertação, concluí que não se pode falar em repetição, dado que as operações de alienação e separação não se completam

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-04-24T12:27:13Z No. of bitstreams: 1 Grácia Maria Garcia Silva.pdf: 1921629 bytes, checksum: 11acbb31f2a9d74c5cce8f0746ba8a8d (MD5) / Made available in DSpace on 2018-04-24T12:27:14Z (GMT). No. of bitstreams: 1 Grácia Maria Garcia Silva.pdf: 1921629 bytes, checksum: 11acbb31f2a9d74c5cce8f0746ba8a8d (MD5) Previous issue date: 2018-02-28 / The cancellation of surgeries is significant in many hospitals, not only in Brazil. The motifs are repeated in all studies, varying only by orders, and most are avoidable causes. All cancellation creates stress for the patient and burden the institution, also reflecting inefficiency in management. Faced with this reality, in which SUS (Health Unic System) patients are the most impaired, the work proposes a nursing intervention to reduce cancellations of surgeries for these patients. The study, conducted with 159 SUS patients with scheduled elective surgeries, consisted of a nursing consultation and an active search (telephone contact with the patient or family member) 48 hours before the surgery. A retrospective study was also performed on the surgical procedures performed and suspended, by specialty, reason for suspension and source of payment (SUS, Agreement and Particular) from January 2014 to November 2017. The average number of suspensions of research surgeries was 17.0%, above the historical average (10.4%) and the historical average of SUS (14.0%). The rate of suspension when there was contact with the patient or with a relative was 15.3%, lower than the rate when there was no contact (22.0%). As the percentages of patientrelated causes (44.4%) were similar to non-relative ones (55.6%), joint action is recommended between health teams and the institution, in order to reduce cancellation of surgeries / O cancelamento de cirurgias é significativo em muitos hospitais, não apenas do Brasil. Os motivos se repetem em todos os estudos, variando apenas as ordens, e a maioria são causas evitáveis. Todo cancelamento gera stress para o paciente e onera a instituição, refletindo também ineficiência na gestão. Diante desta realidade, na qual os pacientes do SUS são os mais prejudicados, o trabalho propõe uma intervenção de enfermagem para diminuir os cancelamentos das cirurgias para esses pacientes. O estudo, feito com 159 pacientes do SUS com cirurgias eletivas agendadas, foi composto de uma consulta de enfermagem e de uma busca ativa (contato telefônico com o paciente ou familiar), 48 horas antes da cirurgia. Foi feito, também, um estudo retrospectivo sobre as cirurgias agendas, realizadas e suspensas, por especialidade, motivo de suspensão e fonte pagadora (SUS, Convênio e Particular) de janeiro de 2014 a novembro de 2017. A média de suspensões de cirurgias da pesquisa foi de 17,0%, acima da média histórica geral (10,4%) e da média histórica do SUS (14,0%). A taxa de suspensão quando houve o contato com o paciente ou com um familiar foi de 15,3%, inferior à taxa de quando não houve o contato (22,0%). Como os percentuais de causas relativas aos pacientes (44,4%) foram semelhantes aos não relativos (55,6%), recomenda-se uma ação conjunta entre as equipes de saúde e a instituição, de modo a diminuir os cancelamentos de cirurgias