M.P.H., Faculty of Health Sciences, University of the Witwatersrand 2011 / Background: The Employee Health and Wellness (EHW) Centre at the Kimberley Hospital Complex (KHC) started off as a staff clinic, rendering nursing services to staff members with occupational injuries and minor ailments such as influenza, colds and headaches. Since the EHW Programme was introduced in 2004 there has been no evaluation of the services provided. There is no information about referrals and current usage of the service, which compromises further planning. Study aim: The aim of the study was to describe the extent and patterns of utilization of the Employee Health and Wellness Services at the Kimberley Hospital Complex for the period 1 January 2008 to 31 December 2009. Methodology: This was a cross sectional descriptive study, involving a retrospective record review at the EHW Centre. Data extraction from various data sources was recorded on data collection tools using coding instead of names to protect the identity of the employees. The study setting was the EHW Centre at Kimberley Hospital Complex, which is the only hospital with a Centre for Employee Health and Wellness in the Northern Cape Province. Conclusion: The utilization rate of the EHW services at KHC is generally low (6.2% and 6.4%) in 2008 and 2009 respectively. There is a need for further research to determine the reasons for low utilisation through employee and employer interviews and focus group discussions. An interesting fact is the steep increase in the number of employees with multiple visits. It would be interesting to conduct a study that will determine the reasons for multiple visits in one month. There was no significant difference between the age and utilization of EHW services but there was a significant association between gender and components of services used, (chi-square test, p<0.001) for both PHC and OHS components. More males used the PHC component whilst more females used the OHS component of the services. While the reasons have not been established, it may possibly be related to a larger number of female employees in the professional category in the health sector. Thus there is a need for further research to explore the gender mismatch in utilising PHC and OHS components of the services. The Wellness programme was minimally used. There was no significant association between age and medical aid status and the usage of service components. The average length of employment for employees who visited the EHW centre was less than 10 years; there was no significant difference in usage of the service between more experienced and less experienced staff. There is a need for further studies to explore reasons for the low utilization rate of the EHW services as well as the perceptions of service providers and employees regarding the utilisation of these services at Kimberley Hospital Complex.

No description available.

INTRODUCTION: Maternity services are a priority for all health care services but in most cases there have been serious challenges experienced through service performance. The National District Hospital (NDH)‟s key performance indicator is bed occupancy rate which showed an underutilization of this facility. The maternity services statistics, especially did not give a clear picture of the performance of the unit. Various studies have been conducted to identify management challenges in maternity units of district hospitals, but no formal study has been done to systematically document this problem at the National District Hospital (NDH), although there has been anecdotal evidence of problems in the performance of the unit. It was therefore important to investigate the functioning of the maternity unit of the NDH and identify problems that hinder it from functioning effectively. AIM: To evaluate the performance of maternity services in the maternity unit at the National District Hospital. METHODOLOGY: A cross sectional study design was used comprising of a retrospective record review. The setting of this study was the maternity unit at National District Hospital. Data was collected on various variables that are relevant to the performance of maternity services. ANALYSIS: The data collected was analyzed and revealed that the factors contributing to the poor performance of the maternity services were:  Poor record keeping, such as incomplete recording of partograms.  Non adherence to guidelines and protocols, such as poor management related to HIV and AIDS care and poor management of patients in the advanced labor phase.  Failure to make informed decision due to information mismanagement.  Poor supervision in the unit. No adherence to objectives of peer review meetings. RECOMMENDATION: The recommendations based on the findings are: - Establish patient centered maternity services - Train and retraining of health care providers in the maternity unit - Review existing strategies to improve quality of care in the maternity unit - Improve information management and functioning of the Maternal Morbidity Review meetings CONCLUSION: The recommendations given can be used to improve maternity services within district hospitals as well as provincial and national maternity services.

The purpose of this pilot study was to investigate the effect of preferred recorded music versus preferred live music provided as procedural support by a music therapist on reducing problem behaviors and increasing positive behaviors exhibited by persons with dementia during bathing procedures. Carrying out bathing procedures with persons who have dementia has been identified as one of the most challenging tasks faced by caregivers. Persons with dementia often exhibit aggressive and hostile behaviors when engaged in bathing procedures with their caregivers. Because of the lack of previous research designed to address these problem behaviors, and the personal nature of bathing procedures, an experimental probe was carried out with five individuals in the later stages of dementia living in a nursing facility. The designated caregivers of these five individuals volunteered their loved ones to serve as participants in this pilot study. Participants were observed for a total of three showers: one with no music, one with recorded preferred music, and one with music therapy with live preferred music. During the three showers, the music therapist and the staff member administering the bath observed the durations of both problem and positive behaviors. Results were mixed among the five participants; though preferred live music was generally more effective than recorded preferred music or no music in reducing problem behaviors and increasing positive behaviors. / A Thesis submitted to the College of Music in partial fulfillment of the Master of Music. / Fall Semester 2015. / October 26, 2015. / Bathing, Music therapy, Procedural Support / Includes bibliographical references. / Alice-Ann Darrow, Professor Directing Thesis; Dianne Gregory, Committee Member; Jayne Standley, Committee Member.

This work is the continuation of previous research by A. Raza and other contributors to the field of fibre optic plethysmography. Plethysmography is defined as the volume estimation of an object according to its external dimensions. fu particular, this technique can be used to produce an estimation of the respiratory volume of a human subject according to the dimension of his chest, measured at the thoracic and abdominal levels. A respiratory plethysmograph simply attempts to deliver a signal being the closest possible estimation of the true respiratory volume, as measured by a spirometer or a pneumotachometer. There are essentially two instrumental approaches to respiratory plethysmography: 1) The Respiratory Inductive Plethysmograph (RIP) estimates the cross section area of the chest by monitoring the variation of inductance in an electrical wire encircling the chest. 2) The Fibre Optic Respiratory Plethysmograph (FORP) sees the contribution of fibre optic sensors to measure the chest's circumference variations. The purposes of the present investigation were to improve the performance of previous FORP prototypes, and to extend its capabilities to cardiac monitoring. Both these targets have been reached, and the new prototype is now demonstrating the potential of plethysmography as a sound investigation technique for both cardiac and respiratory monitoring. Overall, the improved sensor and acquisition system permitted the resolution of details of the plethysmographic waveforms that were beyond the reach of the previous prototype. The new FORP prototype is generally more reliable and more precise, if not less compact. From a medical point of view, research carried out with the new FORP prototype has had two major outcomes: 1) The increased temporal resolution-of the new acquisition system has given us the possibility to precisely measure the phase shifts between the plethysmographic signals, and the spirometric signal. Such measurements have contributed. to producing a better estimation of the spirometric signal, therefore increasing the credibility of the FORP as a non-invasive, respiratory volume monitoring device. 2) The increased amplitude resolution of the new acquisition system, coupled with the better linearity, better precision and smaller hysteresis of the new sensor, has enabled the FORP to detect body circumference variations due to cardiac activity around head, neck, thorax and abdomen of a patient. Observations of heart movements at thoracic level had already been reported with the RIP, the direct analogue of the FORP. The signal processing required by the RIP for such monitoring only permitted offline, Electro-Cardio-Gram (ECG) assisted interrogation of cardiac displacements. However, thanks to better signal processing, the FORP has been made capable of real time cardiac position monitoring, without referencing to a simultaneous ECG signal. The combined impact of this research and previous research by A. Raza and A. Augousti on respiratory gating with the FORP, is potentially important in the field of cardiac imaging with Magnetic Resonance and Computed Tomography scanners. The FORP should permit better synchronisation with cardiac movements, while helping the patient to maintain stable chest position, subsequently increasing the image resolution by limiting motion blur.

ABSTRACT Introduction In Southern Botswana, an expected advantage of the decentralisation and integration of mental health services into general health services was the potential to allow for the district hospitals to manage a larger number of mentally ill patients thus decreasing the patient load of Lobatse Mental Hospital. However, the number of admissions to the referral hospital for the south of Botswana is increasing. The objective of the study was to describe the capacity of district hospitals to care for mentally ill patients in terms of the provision of relevant inpatient, outpatient and outreach mental health services as well as the availability of trained workers who agree with the principles of decentralisation of mental health services. Materials and methods This was a descriptive cross sectional study involving a self-administered questionnaire survey of key informants and health care providers conducted in five district hospitals in the south of Botswana. There were a total of 5 Chief Medical Officers, and 75 ward staff (12 doctors and 63 nurses) in the study. The quantitative data was entered using the Statistical Package for Social Scientists (SPSS version 13) and analyzed by this software. The qualitative data was coded and thematically analysed and reported. Results In all five hospitals, all the doctors and nurses had undergraduate training in psychiatry and were expected to manage mentally ill patients. There were eighteen health workers (1 doctor and 17 nurses) with postgraduate training in psychiatry/mental health.

Hospitals are joining multihospital systems (MHSs) with growing frequency. About 80% of MHSs are small, composed of 2-7 hospitals. An important management issue in MHSs is the extent to which member hospitals retain control over their own strategic directions. Using a contingency framework, this study uses both system and hospital—level determinants to explain the extent to which hospital members of MHSs control their own strategies. Survey and secondary data from 272 member hospitals of 62 small multi hospital systems (size 2-7 hospitals) are analyzed. System dispersion, size, ownership, strategic type, and age along with hospital occupancy, size, relationship to the MRS, and market factors are determinants of hospital control of strategy. Two types of hospital strategic decisions were revealed by factor analysis: tactical and periodic. For tactical decisions, such as those relating to hospital budgets, service additions, and formulation of strategies, Catholic system ownership is a significant predictor of greater hospital control. Prospector system strategy and older system age are significant predictors of reduced hospital control. For periodic decisions, such as appointment of hospital board members, sale of hospital assets, and changes in bylaws, older system age is negatively associated with hospital control, and a hospital which is owned by the system has significantly less control. The results are analyzed using the framework of the Hickson, Butler, Cray, Mallory, & Wilson (1986) typology of strategic decisions. Thus the results of this work can be useful to managers in identifying the nature of a decision and understanding its associated decision process.

This study investigated the financial performance of not-for-profit hospitals in 10 Southern states acquired by either the for-profit or not-for-profit multihospital systems between the years 1978 through 1982. The impact of system affiliation on acquired hospitals was investigated by looking at average financial performance from the two years before acquisition to 1984/1985. Differences between the performance of hospitals acquired by for-profit and not-for-profit multihospital systems were examined as well. with regard to the latter, major findings revealed both for-profit and not-for-profit multihospital systems increased debt in acquired hospitals and made improvements to plant and equipment. For-profit multihospital systems additionally increased profitability and appeared to operate their acquisitions in a more business-like fashion than the not-for-profit multihospital systems did. Comparing acquired hospitals with matched independents revealed that both for-profit and not-for-profit multihospital facilities used more debt and had newer plant and equipment than the not-for-profit independents did. Multihospital systems decreased liquidity in acquisitions as compared with independent not-for-profit hospitals. Only for-profit multihospital system facilities showed increased profitability, and this was largely due to higher prices. Little or no improvement in efficiency was observed in either for-profit or not-for-profit multi hospital system hospitals; however, the financial indicators used to measure efficiency proved to be problematic.

This study was undertaken to address the need of professionals responsible for assuring the quality of hospital care for a framework for understanding and evaluating quality assurance mechanisms and their impact on hospital quality of care. Primary data were collected from 70 Virginia short term acute care general hospitals on the design and resources of their quality assurance programs in 1986. Adverse outcome data for 1986 were collected from the Medical Society of Virginia Review Organization. Hospital structural data were obtained from the American Hospital Association computer data base and the Federal Register. The intermediate outcome variables are: rate of unexpected return to the operating room, rate of treatment/medication problems, rate of in-hospital trauma, rate of medical instability at discharge, and rate of unexpected deaths. Exploratory analyses of hospital size and specialization demonstrate that size positively affects the numbers of RNs in quality assurance, the number of quality assurance professionals with academic degrees above the associate level, and negatively affect the ratio of quality assurance personnel full-time equivalents (FTEs) — both total and professional — to total hospital FTEs. Hospital specialization negatively affects the ratio of quality assurance personnel FTEs — both total and professional — to total hospital FTEs. Structural equation models, causally relating the adequacy of quality assurance design and resources to adverse outcomes of hospitalization, were used to test the causal relationships. The model supports the work of Donabedian and of Deming. The model demonstrates the effects of quality assurance constructs on perceived organizational commitment to quality assurance and commitments effect on process-related outcomes. Process-related outcomes are strongly and positively related to the terminal measure of unexpected deaths. When size and specialization are controlled, some changes are noted in the model. The R2 increases, the Chi-square/df ratio increases and the adjusted goodness of fit ratio decreases. This change was not unexpected due to the statistical significance of the percent of board certified physicians (BRDCERT) on the outcome variable unexpected death (DEDPROBR).

Posttraumatic stress disorder (PTSD) has a persistent nature: PTSD troubles patients even decades after the occurrence of traumatic events. The “health behavioral model” is adopted to examine the effects of external environmental, predisposing, enabling, and need for care factors on the use of VA post-discharge ambulatory care and readmissions. Data were obtained from the Patient Treatment File (PTF) and the Outpatient Care File (OPT), the Area Resource File (ARF), American Hospital Association data sets (AHA), and the Uniform Crime Report (UCR). The use of VA post-discharge ambulatory care is analyzed by using structural equation modeling (SEM). The readmission to VAMCs is evaluated by Cox regression with forward selection. A cross-sectional study is performed on 1,420 PTSD veterans admitted to Veterans Affairs Medical Centers (VAMCs) in 1994 and 1,517 veterans in 1998 in the Veterans Integrated Services Networks 6 (VISN 6). In both years, the most important determinants of the use of VA post-discharge ambulatory care is “prior use of outpatient care services.” For the 1994 sample, prior use of inpatient services impeded the utilization of post-discharge ambulatory care. For the 1998 sample, barriers to access to care and the length of stay for other mental health encounters in the last year reduced the utilization of post-discharge ambulatory care. For readmission in both years, higher numbers of medical or mental VA post-discharge visits reduce the likelihood of readmission to VAMCs. The service lines program was found to increase the use of VA post-discharge ambulatory care and decrease readmission rates for PTSD veterans. The application of the “health behavioral model” can be extended to outcome research to investigate the contributing factors. A risk adjustment system can also be developed based upon the findings. Communities, VAMCs, and PTSD patients and their families should work to raise awareness of the factors that contributing to both use of care and outcomes, and should form a comprehensive network to improve the wellbeing of PTSD veterans.