Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 1992. / Typescript. Includes bibliographical references (leaves 112-117).

M.A. (Psychology) / The aim of this dissertation is to investigate the services and methods provided by the various medical and psychological professions within an inpatient psychiatric hospital setting. While working at a psychiatric hospital, the researcher was struck by the high readmittance rate of patients. This tended to create a general feeling of disappointment, frustration and impotence amongst the professions. The importance of such an investigation was therefore required, in order to help facilitate and improve current methods. A thorough investigation of the literature with regard to the current treatment methods at psychiatric hospitals, both on an international and national level, were undertaken. An in-depth case study was described and analysed to indicate the recurrent procedures, methods and treatment modalities that were being instituted within the hospital setting. The aim of this thesis was also to propose an alternative method to the current procedures, using an in-depth case study to indicate the use thereof.

Healthcare today has become a competitive industry, not only locally, but on a global level as well. In the South African economy the healthcare sector presently offers healthcare seekers two options to satisfy their healthcare needs – either through private business enterprises in the private sector or public enterprises in the public sector. Likewise, in the healthcare sector's hospital environment, patients can receive treatment from either private or public hospitals. As private business enterprises offering a relatively 'pure', but generally unsought-after service, private hospitals compete aggressively to attract patients. Patients are a hospital's lifeblood and they rightfully expect a high standard of customer service throughout the stay. With today's consumers being better informed, more sophisticated and more demanding than in the past, experts agree that the key to survival in the service industry today, almost without exception, is the quality of the service. The cornerstone of the service industry is without doubt the ability to deliver superior service quality that results in customer satisfaction. And the healthcare industry is no exception. Most consumers will experience a need for healthcare services at some time in their lives, but in South Africa, escalating medical costs in general and private hospitals in particular, have made private healthcare increasingly more expensive for the majority of the country's healthcare seekers. This situation raises the question of customer service in the private hospital industry and how patients' perceive service quality and evaluate customer satisfaction after a hospital stay. There is a growing body of empirical evidence from United States studies to show that service quality and customer (patient) satisfaction positively influence patients' behavioural intentions to reuse the hospital or recommend it to others (word-of-mouth endorsements). However, in South Africa, empirical studies to investigate these relationships have not been adequately addressed. This study was therefore an attempt to address the lack of scientific evidence and debate in the area of patient satisfaction. Against this background, the primary objective of this study was to measure patients' perceptions of service quality and customer satisfaction with a private hospital experience and to estimate the effect that each of these constructs will have on future behavioural intentions. More specifically, the present study was an attempt to assess empirically the most important dimensions of service quality and transaction-specific customer satisfaction dimensions that drive both patient loyalty and ‘overall’ or cumulative satisfaction in the South African private hospital industry. For the purpose of this study, buying intentions was used as a surrogate measure of loyalty as measured by willingness to reuse the hospital and/or willingness to recommend it to others (word-of-mouth endorsements). Initial exploratory research was conducted with the aim of assessing the views of three private hospital stakeholder groups, namely former patients, doctors and management about what the quality of service and customer satisfaction meant to each individual interviewed. A service enterprise that specialises in patient satisfaction surveys in the US provided particularly useful information during this phase of the study. Several case studies of patient satisfaction programmes, mostly at US hospitals, provided additional insights in this area. The study was conducted nationally at private hospitals owned by one of South Africa's three major hospital groups. Five private hospitals in four major centres were selected on a non-probability convenience basis to participate in the study. The hospital group's senior management and the management at each selected hospital gave their full commitment to ensure that the survey was successfully conducted in their hospital wards. Data were collected by means of a quantitative study using a selfadministered, structured questionnaire. Patients had to meet certain qualifying criteria which included being of adult age, in the hospital for an operation and at least one overnight stay. A total of 3 800 questionnaires was distributed to patients on a random basis in selected wards at the five hospitals by senior hospital staff designated for this task. From this distribution, 425 questionnaires were returned of which a final sample of 323 could be statistically analysed. To confirm the internal reliability of the measuring instrument, Cronbach alpha coefficients were calculated for each of the factors identified by the exploratory factor analysis. In order to assess the discriminant validity of the measuring instrument used to measure both service quality and customer satisfaction, the items were subjected to an exploratory factor analysis. The factors that emerged after the exploratory factor analysis were then used as independent variables in the four subsequent multiple regression analyses to assess the study's four hypothesised relationships. The findings revealed that the service quality dimensions that impact positively on both loyalty and cumulative satisfaction are Empathy of nursing staff and Assurance. The customer satisfaction dimensions to impact positively on both loyalty and cumulative satisfaction are Satisfaction with the nursing staff, Satisfaction with meals, and Satisfaction with fees charged.

The primary interest of this investigation concerned the self-injurious thoughts and behaviors (SITBs) of inpatient adolescents. Previous researchers have provided descriptive information regarding either automatic (or intrinsic) and social components using the Self-Injurious Thoughts and Behaviors Interview (SITBI). However, the presence and trends of these components have not firmly been established, suggesting the need to explore this area further. Eighty-two adolescent inpatients were selected and interviewed using the SITBI to evaluate the predictive ability of self-reported self-injurious behavior with regard to social and automatic, negative and positive functions. Results showed that depending on the type of thought or behavior displayed one could discern the motivation behind their actions. Automatic-Negative was seen to have the strongest relationship across all SITB behaviors while Automatic-Negative was not found to be relatively low compared to other SITB behaviors. Both Social-Positive and Social-Negative were found to be present in moderate relationships compared to Automatic in general.

The purpose of the study was to describe the relationship between in-home health care services for elderly patients who were recently discharged from inpatient care and re-hospitalization rates. The design was descriptive and the hypothesis was that the provision of in-home health care services would mitigate a decline in the health status, of an elderly patient, following discharge from inpatient care and prevent re-hospitalization.

Simulation is a powerful technique to study complex problems and systems. This thesis explores two different problems. Part 1 (Chapters 2 and 3) focuses on the theory and practice of the problem of simulating graphs with a prescribed degree sequence. Part 2 (Chapter 4) focuses on how simulation can be useful to assess policy changes in emergency medical services (EMS) systems. In particular, and partially motivated by the COVID-19 pandemic, we build a simulation model based on New York City’s EMS system and use it to assess a change in its hospital transport policy. In Chapter 2, we study the problem of sampling uniformly from discrete or continuous product sets subject to linear constraints. This family of problems includes sampling weighted bipartite, directed, and undirected graphs with given degree sequences. We analyze two candidate distributions for sampling from the target set. The first one maximizes entropy subject to satisfying the constraints in expectation. The second one is the distribution from an exponential family that maximizes the minimum probability over the target set. Our main result gives a condition under which the maximum entropy and the max-min distributions coincide. For the discrete case, we also develop a sequential procedure that updates the maximum entropy distribution after some components have been sampled. This procedure sacrifices the uniformity of the samples in exchange for always sampling a valid point in the target set. We show that all points in the target set are sampled with positive probability, and we find a lower bound for that probability. To address the loss of uniformity, we use importance sampling weights. The quality of these weights is affected by the order in which the components are simulated. We propose an adaptive rule for this order to reduce the skewness of the weights of the sequential algorithm. We also present a monotonicity property of the max-min probability. In Chapter 3, we leverage the general results obtained in the previous chapter and apply them to the particular case of simulating bipartite or directed graphs with given degree sequences. This problem is also equivalent to the one of sampling 0–1 matrices with fixed row and column sums. In particular, the structure of the graph problem allows for a simple iterative algorithm to find the maximum entropy distribution. The sequential algorithm described previously also simplifies in this setting, and we use it in an example of an inter-bank network. In additional numerical examples, we confirm that the adaptive rule, proposed in the previous chapter, does improve the importance sampling weights of the sequential algorithm. Finally, in Chapter 4, we build and test an emergency medical services (EMS) simulation model, tailored for New York City’s EMS system. In most EMS systems, patients are transported by ambulance to the closest most appropriate hospital. However, in extreme cases, such as the COVID-19 pandemic, this policy may lead to hospital overloading, which can have detrimental effects on patients. To address this concern, we propose an optimization-based, data-driven hospital load balancing approach. The approach finds a trade-off between short transport times for patients that are not high acuity while avoiding hospital overloading. To test the new rule, we run the simulation model and use historical EMS incident data from the worst weeks of the pandemic as a model input. Our simulation indicates that 911 patient load balancing is beneficial to hospital occupancy rates and is a reasonable rule for non-critical 911 patient transports. The load balancing rule has been recently implemented in New York City’s EMS system. This work is part of a broader collaboration between Columbia University and New York City’s Fire Department.

The Charter of rights of children in hospital (the EACH Charter) is an international document authored by the European Association for Children in Hospital (EACH) in the eighties of the twentieth century. The Charter can be perceived as a response to the fact that a child's stay in hospital - and paediatric hospital as an institution - is strongly influenced and formed by economical, technological and administrative aspects prevailing over the ethical ones. The Charter highlights specific situations where the health care profession - by neglecting children's needs and ignoring and/or tolerating avoidable suffering - becomes unethical. The aim of my thesis is to scrutinize the ethical appeal of the EACH Charter and to explore the Charter's ethical implications for contemporary paediatric practice in the Czech Republic.

This thesis focuses on the comprehensive approach to human health. She attempts to shed more light on this topic, to document current circumstances related to the psychosomatic medicine and the so called holistic medicine, and to clarify the manner of understanding these concepts nowadays. The theoretical part of the diploma thesis constitutes a rough summary of the comprehensive approach to human treatment, a view of fundamental theories of psychosomatic medicine and its current position in the Czech health system. The thesis also includes an outline of applied terms which are connected to the comprehensive approach to human treatment, especially in the specialized literature. The practical part of this diploma thesis monitors the way in which the media use the terms of holistic medicine and psychosomatic medicine. Further, a general understanding of these concepts is demonstrated by the means of a questionnaire survey on a sample of 454 respondents. Moreover, the practical part is completed by interviews with two specialists of the Czech psychosomatic scene. The thesis is concluded by the author's polemic regarding the topic of this diploma thesis itself. Powered by TCPDF (www.tcpdf.org)

The purpose of this study was to explore alcohol use among psychiatric in-patients in a mental hospital in Ethiopia. A quantitative, descriptive, cross-sectional study design was used. Data were collected through face to face structured interviews and a document analysis checklist. A researcher-modified interview-version of the Alcohol Use Disorder Identification Test (AUDIT) questionnaire was used to measure alcohol use. The study population comprised of 70 psychiatric in-patients. Data analysis showed that being male, living in an urban area, being diagnosed with schizophrenia, and having parents who drink alcohol had a statistical significant association with the alcohol use of the respondents. Respondents reported that it was difficult to abstain or stop using alcohol. They also felt discriminated against when forbidden by relatives to drink. It was alarming to find that thioridazine, which has been discontinued in most countries for the treatment of psychosis, was still being prescribed in Ethiopia. The study highlighted the need for health education to strengthen patients’ perceptions about the negative consequences of alcohol use. Care should be taken when prescribing psychotropic drugs such as thioridazine to psychiatric in-patients because of possible cardiotoxic effects. / Health Studies / M.A. (Public Health)

Bibliography: pages 103-119. / The aims of this study were (a) to examine the profile of hospital admissions for selected respiratory illnesses for two major hospitals in Cape Town, and (b) to analyse the association of such admissions with air pollution indicators and meteorological variables. The first part of the study investigated the admission patterns of coloured and African children under twelve years of age who were diagnosed as suffering from asthma or acute respiratory infections at two major teaching hospitals in Cape Town. Computerized hospital admission records covering the years 1988-1990 from the overnight holding wards of the Red Cross War Memorial Children's Hospital and Tygerberg Hospital were used to determine patterns with respect to diagnosis, gender, race, age and date of admission. During the three year study period, respiratory admissions at both hospitals accounted for 15 078 (47.3%) out of a total of 31 887 admissions. Acute respiratory infections accounted for 63.6% and asthma 37.4 % of these respiratory admissions. Two factors of interest were noted: (1) Considerably more males than females were admitted with both asthma and acute respiratory infections. (2) Asthma admissions to Red Cross Hospital among African children were proportionally much less than those of coloured children when compared to the proportions of admissions for acute respiratory infections. After removal of the seasonal effect, a multiple linear regression model was fitted to the data to determine the individual associations between admissions and ambient environmental variables. Significant associations were found between: (1) acute respiratory infections and oxides of nitrogen, soiling index, and temperature; (2) asthma and oxides of nitrogen (3) total admissions and soiling index, average temperature and minimum temperature (negative). The study concluded that despite generally low levels of air pollution in Cape Town, childhood respiratory admissions to Red Cross War Memorial Children's Hospital and Tygerberg Hospital were statistically significantly associated with some ambient air pollutants as well as temperature. However, given the nature of both the exposure and admissions databases, these results should be treated with caution. More representative site selections for air pollution monitors, as well as searching and controlling for possible confounding factors (i.e. indoor air pollution, parental smoking, overcrowding), would allow a better understanding of the current air pollution problem and the possible effects on the respiratory health of children in metropolitan Cape Town.