Thesis (M.P.A.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 88-93).

Thesis (M.P.A.)--University of Hong Kong, 1992. / Also available in print.

Thesis (M.P.A.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 88-93). Also available in print.

Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1983.

Thesis (Ph. D.)--Oregon State University, 2007. / Printout. Includes bibliographical references (leaves 142-151). Also available on the World Wide Web.

Thesis (Ph. D.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.

<p> After decades of global intervention to conquer diseases, healthcare in many countries is still lacking. Assessments of medical laboratories in developing countries today find poor infrastructure conditions with no standardized processes or quality assurance to guarantee accurate results and enable quality healthcare. Bringing healthcare programs in developing countries up to international standards remains a challenge. </p><p> Currently, there is a scarcity of scientific research related to the determinants of success in implementing quality management systems (QMS). There has been little research dedicated to identifying the critical success factors for medical laboratories striving to improve the accuracy and reliability of their testing services in developing countries. </p><p> In over nine years of research, the author realized there was a need for incorporating Critical Success Factor (CFS) methodology into laboratory modernization efforts. This time frame included CDC sponsored trips to several African countries and collaborating with the Vietnam Administration for Medical Services/Ministry of Health (VAMS), Centers for Disease Control-Vietnam (CDC-vn) and seven universities to build laboratory capacity and initiate laboratory improvements to meet national and international laboratory standards. In 2017, VAMS approved a proposed study to identify CSFs in four laboratories in Vietnam. </p><p> The research question this study sought to answer was "What are the top five critical success factors for successful implementation of QMS into laboratories in Vietnam?" with an outcome of improved accuracy and reliability of testing results. This study utilized both qualitative and quantitative research methods employing principles of descriptive research. A demographic survey, semi-structured interview, content analysis, and benchmarking were utilized to identify the top five CSFs and barriers. Content analysis was employed to review CSF definitions and categorize all 220 listed CSFs into ten comprehensive and mutually exhaustive categories. Two research assistants assisted the researcher place each CSF into one of the ten categories. Rigorous and non-rigorous methods measured interrater reliability with the categorization of CSFs. Cohen Kappa values were > 0.85 indicating excellent reliability and accuracy between the assistants and the researcher. Chi-square values were all > 0.05 (p &lt; 0.05) indicating demographic variables did not statistically impact findings. </p><p> Qualitative responses were gathered through personal interviews, a demographic survey, and benchmarking. Using a stratified convenience sampling, participants represented four levels of stakeholders: laboratory staff, laboratory managers, hospital administrators, and clinicians utilizing laboratory services. </p><p> Data from this study found the top five CSFs were: staff knowledge of QMS, laboratory management leadership knowledge and skills, staff commitment to the QMS change process, mentorship, and hospital administration support. In addition to determining the top five CSFs, the study revealed information about encountered or perceived barriers to successful QMS implementation. The participants in this study identified lack of staff knowledge on QMS, lack of financial support from the hospital administration, ineffective laboratory manager leadership knowledge and skills, lack of laboratory infrastructure, and lack of sufficient resources. </p><p> The study&rsquo;s findings add to the body of knowledge in strengthening medical laboratory services and may serve as a basis for continued research in this area of health care. Local, national, and international partners may use this information to tailor training materials and activities to better meet the needs of participating laboratories across Vietnam.</p><p>

<b>Background</b> Antibiotic resistance is an important societal health issue. The greatest risk factor for developing a resistant infection is antibiotic use. Almost 75% of all antibiotics in the UK are prescribed in the community, and mostly for acute respiratory tract infections (RTIs). Yet, the majority of RTIs are self-limiting, viral and do not need antibiotic treatment, especially in young children. While the effects of antibiotic-resistant infections have been widely studied in hospitals (e.g. the MRSA 'superbug'), we know less about how antibiotic-resistant infections affect people in the community, even though this is where most antibiotics are prescribed. There is also widespread public misconception about antibiotic use and resistance despite several high-profile, multimillion antibiotic awareness campaigns. This is important to address because consultation behaviour and expectations for antibiotics are a significant determinant of antibiotic use in the community. <b>Methods</b> Three studies were conducted for this thesis. First, a systematic review and meta-analysis to assess the evidence of the impact of antibiotic resistance for patients with common infections in the community; second, a retrospective analysis of routinely collected primary care data to examine the relationship between antibiotic exposure and antibiotic 'response failure' in preschool children presenting with acute RTIs; third, a qualitative interview study to explore parents' perceptions and understanding of antibiotic use and resistance when they consider consulting in the community with their preschool child who has a respiratory tract infection. <b>Results</b> Antibiotic resistance significantly impacts on patients' illness burden for common infections in the community. Patients who presented in community health care settings with antibiotic-resistant E. coli urinary tract infections and S. pneumoniae respiratory tract infections were more likely to experience delays in recovery after antibiotic treatment. From routinely collected primary data (2009-2016), preschool children receiving two or more antibiotic courses in the previous year for acute RTIs had greater likelihood of antibiotic 'response failure' to treatment for subsequent acute RTIs compared to children that had received no previous antibiotics. When interviewing parents of young children, most parents were quite reticent about antibiotics for their children. However, very few considered antibiotic resistance as a possible harm of antibiotics. Parents thought their families were at low risk of antibiotic resistance because their families were 'low users' of antibiotics and did not perceive any association between their individual consumption of antibiotics and the development and spread of antibiotic-resistant bacteria in the community. They wanted future antibiotic awareness campaigns to have a universal message relevant to their families that fit into their daily lives. <b>Conclusions</b> The findings challenge the perception that antibiotic prescribing and resistance in the community poses little or no additional risk to patients in the community, or is remote from everyday prescribing decisions. Rapid diagnostic tests and other prognostic tools need to be promoted and evaluated to better identify patients who might need an antibiotic, and reduce the risk antibiotic response failures. Clinicians and parents should exercise caution about whether further antibiotics for acute RTIs are likely to be beneficial in those children who have received two or more antibiotic prescriptions for acute RTIs during the previous 12 months. Incorporating this into clinical practice guidelines and decision-support systems will help clinicians and parents consider a non-antibiotic strategy for acute RTIs. Future guidelines, campaigns and interventions around antibiotic resistance should tailor initiatives to outcomes that patients and clinicians in the community can relate to and slot into their daily lives. More research is needed to evaluate the impact of other common infections in primary care, and determine the relative contribution of antibiotic resistance to patients not responding to antibiotic treatment for common infections.