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Community cohesion in Britain has been an issue of policy concern in recent years in which the role of migrants in the UK has been scrutinised in terms of their sense of belonging, integration and their economic and social contribution to society. However, much of the existing literature, in this area relates to the experiences of low/unskilled labour migrants. This thesis redresses this imbalance and examines the experiences of overseas-trained South Asian doctors. It provides unique insights into the debates about integration, cultural identity and community cohesion based on an empirical study of overseas-trained South Asian General Practitioners who are elite migrants. A mixed method approach was employed that included secondary data analysis of the GP Workforce Statistics and in-depth interviews with 27 overseas-trained South Asian doctors in three different geographical locales in England with varying ethnic populations. The quantitative analysis shows that a significant and increasing proportion of NHS doctors continue to be overseas-trained South Asian doctors. It also provides evidence of geographical clustering with South Asian doctors being over represented in deprived areas with high and low ethnic minority concentrations. The case studies and interviews with the GPs reveal a complex intertwining of macro-, micro- and meso- structures in the migratory process, related, in part, to the legacy of empire and also to the inner workings and opportunities provided by an organisation such as the NHS. In order to overcome blocked social mobility within the NHS hospital structure, entry into General Practice appears to be an entrepreneurial step for overseas-trained South Asian doctors, also facilitated by regional NHS institutional structures like Primary Care Trusts. Evidence shows that doctors have integrated their cultural/religious values creatively in their adaptation to Britain importing innovation into their everyday experiences. The findings show that there are parallels to be drawn with the experiences of low/unskilled South Asians, in particular, in the area of structural integration. However, there is variation as to how these elite professionals approach issues related to socio-cultural integration thus adding a new dimension to our existing understanding of community cohesion in the UK.

This diploma thesis addresses the ongoing reform of psychiatric care in the Czech Republic. The primary pillars of reform are presented here and all projects through which individual steps of reform are implemented are elaborated in detail. There are four projects from the Czech Republic Ministry of Health: Deinstitutionalization of inpatient psychiatric facilities; Introduction of a Multidisciplinary Approach to the Mentally Ill; New Services; and CDZ I, II, III. And there are two projects from the National Institute of Mental Health (NÚDZ): Destigmatization of psychiatric issues and VIZDOM, and the ÚZIS Project. Examples of best practices from Italy, the United Kingdom, and France are also presented. This diploma thesis captures the current state of psychiatric care reform in the Pilsen region. In the context of the Czech Republic Ministry of Health's "Introduction to a Multidisciplinary Approach to the Mentally Ill", this thesis addresses the involvement of general practitioners in interdisciplinary community. The theoretical section includes chapters devoted to primary care reform within the strategic framework HEALTH 2030 and a SWOT analysis of general practioners' involvement in the community network. The practical part of this thesis contains a survey given to general practitioners and...

Objectives. To describe the qualitative aspects of the notifiable diseases surveillance system of the Gauteng Province, South Africa; to conduct a cross-sectional survey on knowledge and practices pertaining to disease notification among private sector primary health care providers in Gauteng Province; to measure the degree of underreporting of notifiable diseases versus positive laboratory diagnoses using malaria as a cases study; and to identify the correctible short-comings in the Gauteng Health Department’s diseases surveillance system and to recommend ways of addressing these to improve the system and its performance. Design. This is an evaluation study consisting of both the qualitative aspects and quantitative descriptive components of the notifiable disease system in Gauteng Province. The study designs used for the qualitative description were literature and policy review and a semi-structured interview with communicable disease coordinators. The quantitative research comprised of a telephonic questionnaire administered to a random sample of private general practioners and secondary data analysis comparing malaria cases notified to the Gauteng Provincial Department of Health with public and private sector laboratory data and clinical surveillance data. Setting. The study setting was the Gauteng Provincial Health Department and public and private health care service providers in Gauteng Province. The study period extended from 1 January to 30 June 2006. Subjects. The subjects of the study were the Gauteng Health Department’s disease surveillance system, public and private sector health care providers including private primary health care practitioners. Outcome measures. Outcome measures for the qualitative system description were the status of selected system attributes namely usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness and stability. Outcome measures for the knowledge and practice survey of private general practitioners were reporting compliance and knowledge of notifiable conditions. The primary outcome measure for the secondary data analysis was the proportion of laboratory diagnosed cases of malaria notified to the provincial health department. Results. The notifiable disease surveillance system in Gauteng is deemed useful by the public sector communicable disease coordinators but less so by the private sector general practitioners. Data quality as indicated by completeness of residential detail reporting on meningococcal notifications varied between 29% and 57% by district. Thirty seven percent of general practitioners report compliance with notifications and the mean score for knowledge on notification status of medical conditions was 56%. The sensitivity of notifications of malaria compared with laboratory notifications was 26% with relatively higher notification rates where cases occurred in children under 15 years of age. Conclusions. The notifiable disease surveillance system in Gauteng Province is relatively flexible and reasonably structured however this research suggests that there is suboptimal use of the information for local action in certain areas. Private General Practitioners self-report a low level of compliance citing time constraints and lack of motivation; knowledge of the notification status of selected medical conditions is lower than expected. The completeness and accuracy of notification data, as demonstrated in malaria notifications, is insufficient to gauge a true picture of burden of disease in the province. / Dissertation (MMed)--University of Pretoria, 2007. / School of Health Systems and Public Health (SHSPH) / Unrestricted

The impact of the pharmacist in elderly patient healthcare management is developing. In our study, the interventions made by community pharmacists in the RESPECT study (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) were analysed and evaluated. In our study, the study sample was chosen according to specific criteria. The outcomes of these pharmacist interventions were measured by a clinical panel which scored and categorised each intervention into one of five categories. The study also investigated the percentage of interventions implemented or not implemented by GPs. In our study, initially 398 patients and of these 52 were excluded because their files did not contain the entry criteria information, leaving 346 patients who were identified with a mean (SD) of 8.9 (3.3) pharmaceutical care plans which contained mean (SD) 8.2(7.2) pharmaceutical care issues. Of these 43% were males and 57% were females with a mean (SD) age of 81(3.7) years. There were many missing data about drugs prescribed due to poor documentation by community pharmacists in the RESPECT study particularly at post study period (T5). The mean (SD) for all drugs prescribed was 35.9 (12.38) for each patient and for the whole study period including the post period (T5). In our study a total of 2879 individual pharmaceutical care issues were identified. A clinical panel judged that 43% of the interventions prevented harm, 31% improved the efficacy of management, 3% were detrimental to the patient¿s management plan, 12% only provided information and there was insufficient information to make a decision on the remaining 11%. For the classifications prevented harm to the patient and improve efficacy of management, the panel gave a score of 7 or more to 264 and 103 respectively which were classed as potential prevented hospital admissions. The outcome of 1628 could not be determined from the data and the pharmacist did not intervene on 361 occasions. Of the remaining 890 (30.9%) GPs accepted 715 and did not accept 175. The cost effectiveness of providing pharmaceutical care to older people by community pharmacists could be estimated (£620,000) by calculating reduction in expenditure of hospital admissions. In addition, there would be the possibility of reduced pressure on other NHS resources such as availability of hospital beds. The involvement of a clinical pharmacist in elderly patient health care, within the setting of a community pharmacy, provided positive healthcare outcomes and therefore should be encouraged in line with the new white paper for England "Building on strengths-delivering the future" (2008). The study emphasises the importance of revising the nature and period of postgraduate training for community pharmacists who are going to provide pharmaceutical care for elderly patients. This raises the possibility of specialised competency based postgraduate training for community pharmacists with a special interest in the care of older people (PhwSI). This would enable community pharmacists practising as generalists to become advanced practitioners in the specialist clinical area of older people and ensure a consistent level of service for elderly patients in line with government expectations.

Background The focus of this study is on how far GPs¿ perceptions of dementia map onto the components and contributing factors to stigma as described by Link and Phelan (2001; 2006) and Jones et al. (1984). Aim The study explores GPs¿ perceptions of dementia as a stigma, develops a specific conceptualization of the stigma of dementia and considers implications for timely diagnosis. Methods Data from twenty-three GPs in northern England were collected by semistructured telephone interviews. Within the context of a qualitative design, a combined process of grounded theory and framework analysis was adopted to collect and analyse data. Results The findings reveal that GPs¿ perceptions of dementia map onto Link and Phelan and Jones¿ identification of contributing factors and components of stigma and may hinder timely diagnosis. Three themes emerged reflecting a dynamic process of making sense of dementia, relating perceptions to oneself and considering the consequences of dementia. Within those themes, certain categories had particular salience for GPs, namely the characteristics of the attribute, existential anxiety and discrimination. The themes and categories are inter-related and can be considered as parts of a system. Perceived lack of reciprocity could be detected in most categories which suggests that it is influential in the social construction of the stigma of dementia. Conclusion The data suggest that current conceptualizations of stigma are insufficient to fully account for the stigma of dementia. A specific conceptualization of the stigma of dementia is proposed and the implications of GPs¿ perceptions for timely diagnosis are discussed.

Yes / Objectives The New Medicines Service (NMS) is provided by community pharmacists in England to support patient adherence after the initiation of a new treatment. It is provided as part of the National Health Service (NHS) pharmacy contractual framework and involves a three-stage process: patient engagement, intervention and follow-up. The study aims to explore community pharmacists’ experiences and perceptions of NMS within one area of the United Kingdom. Methods In-depth semi-structured telephone interviews were conducted with 14 community pharmacists. Interviews were audio-recorded, independently transcribed and thematically analysed. Key findings Pharmacists gave a mixed response to the operationalisation, ranging from positive opportunities for improving adherence and enhancement of practice to difficulties in terms of its administration. Pharmacists generallywelcomed opportunities to utilise their professional expertise to achieve better patient engagement and for pharmacy practice to develop as a patient resource. There was a perceived need for better publicity about the service. Different levels of collaborative working were reported. Some pharmacists were working closely with local general practices most were not. Collaboration with nurses in the management of long-term conditions was rarely reported but desired by pharmacists. Where relationships with general practitioners (GPs) and nurses were established, NMS was an opportunity for further collaboration; however, others reported a lack of feedback and recognition of their role. Conclusions Community pharmacists perceived the NMS service as beneficial to patients by providing additional advice and reassurance, but perceptions of its operationalisation were mixed.Overall, our findings indicate that NMS provides an opportunity for patient benefit and the development of contemporary pharmacy practice, but better collaboration with GPs and practice nurses could enhance the service.

No / This study explores GP tutor views of a nationally derived list of quality criteria for undergraduate and postgraduate practice-based teaching. Whilst these published criteria provided a means of benchmarking locally, an evaluation of utility in practice required further exploration. This educational evaluation was conducted within a West Yorkshire locality as a means of supporting their practice-based primary care education. A survey approach using an online Likert scaled questionnaire was distributed to all GP tutors with an additional opportunity for free text qualitative comments. Data were analysed using an online reporting package for survey results (MarketSight) and thematic analysis of qualitative data. Key findings were that in general all the criteria were rated having a high level of importance with 83% of GPs claiming they would find such a list important in directing their learning and teaching approach. The opinions on out-of-hours experiences for medical students were also interesting as they differed greatly. These findings will be of interest to those involved in the organisation and delivery of medical education within primary care as the list of criteria could act as a structural guide for directing medical student teaching, learning and its quality assurance. Implications for further research include the utility of core criteria and the exploration of out-of-hours experience for medical student education.

SammanfattningSyfte: Studiens mål var att uppnå kunskap angående olika interceptiva ortodontiska behandlingar, undersöka vilka ortodontiska behandlingar som är vanligast förekommande hos allmäntandläkare och rekommenderade av svenska ortodontister samt att undersöka om de vanligaste behandlingarna är de som lärs ut vid odontologiska fakulteten i Malmö. Potentiella skillnader mellan grupperna undersöktes också. Material och metod: En PubMed-sökning gjordes för att undersöka litteratur för de apparaturer som används mest frekvent. Ett frågeformulär utformades och skickades till 169 ortodontister med konsultationsverksamhet för att undersöka användningen av olika apparaturer som sker i samarbete med allmäntandläkare. Resultat: Totalt inkluderades 153 artiklar i litteraturstudien och frekventa behandlingar presenterades. Den mest använda apparaturen för behandling av:- Korsbett var Quad Helix- Frontal invertering var klammerplåt med Z-fjäder - Klass II malocklussion var van Beek aktivator.En signifikant skillnad mellan grupperna hittades; kvinnliga ortodontister rekommenderade allmäntandläkare aktivator med extra oralt drag vid behandling av Klass II malocklussion i större utsträckning än manliga ortodontister. Slutsats: Valet av apparatur överensstämde till största delen med vad som anses vara det mest effektiva enligt de artiklar som inkluderats i studien. Det var även dessa apparaturer som används i studentundervisningen vid odontologiska fakulteten i Malmö.Skillnaderna i valet av apparatur mellan de manliga och de kvinnliga ortodontisterna beror troligtvis på den ojämna könsfördelningen av nyutexaminerade ortodontister de senaste 50 åren. / AbstractObjective: The aim of the present study was to obtain knowledge about different interceptive orthodontic treatments, investigate which orthodontic treatments are most frequently used by general practitioners and recommended by Swedish orthodontists and to see if the most common treatments corresponded to the educational dental program in orthodontics at Malmö University. Potential differences among groups were also investigated. Materials and methods: A PubMed search was made to investigate the literature of the most frequently used appliances in orthodontic treatment concerning the diagnoses and the appliances used in general practices. A questionnaire was sent to 169 consulting orthodontists to investigate the use of different appliances in cooperation with general practitioners.Results: A total of 153 articles were included in the literature study and frequently used treatments were presented.The most common appliance for correction of: - Posterior crossbite was the Quad Helix.- Anterior crossbite was a plate with Z-springs.- Class II malocclusion was the headgear activator, according to van Beek.A significant difference between genders was found, i.e. that female orthodontists recommended headgear activator more often than males for Class II in general practise. Conclusions: The choice of appliances mostly corresponded to what is most effective according to the literature included in the study and these are used in the educational program for dental students in Malmö.The differences between the genders of the orthodontists in choice of treatment are most likely due to the gender distribution of becoming orthodontists during the last five decades.

BACKGROUND: Concern has increased worldwide with regard to the over-prescribing of antibiotics, as well as the fact that more bacteria strains are developing resistance to antibiotics. According to research, a great deal of this use is for what has been called “non-pharmacological” reasons. The reduction of unnecessary antibiotic use and exploration of the reasons for ”irrational prescribing” has become a public health priority. OBJECTIVE: To study the reasons cited by Icelandic general practitioners for their “non-pharmacological” prescribing of antibiotics. DESIGN: A qualitative interview-study with research dialogues guided by the Vancouver School of doing phenomenology. SETTING: General practice. PARTICIPANTS: 16 general practitioners: 11 in the maximum variety sample and 5 in the theoretical sample. RESULTS: The most important reasons for prescribing antibiotics in situations with low pharmacological indications (non-pharmacological prescribing) were an unstable doctor-patient relationship due to lack of continuity of care, patient pressure in a stress-loaded society, the doctor’s personal characteristics, particularly zeal and readiness to serve, and finally, the insecurity and uncertainty of the doctor who falls back upon the prescription as a coping strategy in a difficult situation. CONCLUSION:The causes of non-pharmacological prescribing of antibiotics are highly varied, and relational factors in the interplay between the doctor and the patient are often a key factor. Therefore, it is of great importance for the general practitioner to know the patient and to become better equipped to resist patient pressure, in order to avoid the need to use the prescription as a coping strategy. Continuity of medical care and a stable doctor-patient relationship may be seen as the core concepts in this study and the most important task for the GPs is to promote the patients’ trust. / <p>ISBN 91-7997-091-5</p>