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Burns can represent devastating injuries surgically, psychologically and socially. A multidisciplinary team approach to patient management is requisite to successful patient management. Burns education is currently under-represented in national undergraduate surgical curricula with a resultant graduating workforce with sub-optimal burns management knowledge. There is therefore a drive to improve burns education nationally. In order to develop burns teams to perform with skill and efficiency, it is important to develop and advance their technical and non-technical skills. Simulation has proven to be a powerful modality to augment surgical training. Recreating authentic clinical challenges is crucial in optimising simulation-based team training. The majority of such team-based simulation takes place in dedicated simulation facilities or centres which are static and can be costly. This thesis presents eight peer-reviewed publications that chronologically represent a thematic series of publications in simulation and surgical education with an ultimate focus on burns education. The theoretical framework explores simulation strategies in light of educational theory, culminating in the development of "The Burns Suite" (TBS); a novel modality to advance the delivery of interprofessional burns education. TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. It facilitates the delivery of an interprofessional realistic burn resuscitation scenario based on "advanced trauma and life support" (ALTS) and "emergency management of severe burns" (EMSB) principles. Scenarios were refined utilising expert opinion through cognitive task analyses. Participants considered TBS experience authentic due to its high psychological and social fidelity. This thesis contributes to burns surgical education by providing a better understanding of educational theory underpinning successful simulation and facilitating its interprofessional delivery via TBS. This approach can facilitate the design of future simulation scenarios that provide unique educational experiences where team members can learn with and from other specialties and professions in a safe, controlled environment. Addressing economic and practical limitations of current immersive surgical simulation is important. The low-cost approach of TBS has major implications for surgical education as a whole, particularly given increasing financial austerity. This thesis proposes that alternative, complex, and challenging scenarios and/or procedures can be recreated within TBS, providing a diverse educational immersive simulation experience that can be extrapolated into other surgical specialities and interprofessional arenas.

This study examines effects of a hospital-based psychiatric day program on eight subjects over a six month period. Each subject underwent a semi-structured interview at admission to the Program, and then at three and sixth months or on discharge with concurrent Psychometric testing. Quantitative and qualitative data were compared with information from "significant others" and unit staff reports to determine changes in subjects' behaviours over the study period. To consider any effects of the Program on psychiatric re-admissions, relevant data dating back to 1980 from both regional admitting centres were examined for patients who were identified as having had multiple re-admission for psychiatric care as well as a minimum of twenty-four days attendance at the Day Program ( n = 73 ). The results indicated a trend towards improved quality of life, improvement in selfcare, social supports, ability to form relationships and in the quality of family relationships. Reduction in number and intensity of symptoms, and improvement in coping skills was reported for 88% of subjects. Subjects were found to agree in their perception of the most and least helpful elements of the Program. Re-admission data showed that the Program was most beneficial for number of admissions, rate of admissions, length of stay and rate of length of stay for the diagnostic group of Depressions and for the group as a whole. There were also positive effects in some of these areas for the diagnostic groups of Anxiety Disorders and Personality Disorders (confidence level of 95%).

This study explored the quality of life (QOL) of advanced cancer patients before and after receiving hospital-based palliative shared care; also compared their quality of life with those of terminal ill patients in palliative care units. Sixty-eight cancer patients in a southern Taiwan hospital were selected, purposive sampling, as our study samples. Among these 68 patients in our study were under three care models; 20 patients were under general care, 17 patients were under hospital-based palliative shared care, and 31 patients were under palliative care. One week after their admission into care units, we evaluated their QOL using MQOL ¡VTaiwan version. The QOL data of these three groups of advanced cancer patients ,then grouped and compared as in general care unit, hospital-based palliative shared care unit, and palliative care unit. All data collected were analyzed using SPSS for Word 10.0 statistic software. Furthermore, we have in-depth interviewed with four chiefs of general care units, five patient caretakers, and one professional of hospital-based palliative share care. Contents of the in-depth interviews focused on in what aspects hospital-based palliative shared care provided help to terminally ill patients in terms of quality of life or life difficulty. Contents of the discussion were then analyzed and interpreted. Results of our analysis, measured by MQOL ¡V Taiwan version, showed there is no significant difference in QOL of advanced cancer patients between hospital-based palliative shared care and general care. But results of our in-depth interview with caretakers and caregives showed interesting aspects: 1. Physical symptoms of advanced cancer patients was brought under control. 2. Psychological symptoms of advanced cancer patients or their family was taken care of. 3. Advanced cancer patients or their family are all benefited from continued advice and instructions. 4. Provide cancer patients and their family with guidance and instructions as to preparing for death. 5. Support the emotional needs of family of advanced cancer patients. 6. Hospital-based palliative shared care offered palliative consultation, supporting patient caretakers and providing improvement QOL for cancer patients. 7. Mindset change to doctors: inform cancer patients or their family of developing cancer symptom so that early intervention can be ensued. 8. Caretakers of general care unit and hospital-based palliative shared care unit formed a joint team, enabling cancer patients and their family feel secured in treatment. In conclusion, hospital-based palliative shared care benefits patients and their family. Comparing with hospital-based palliative shared care, palliative care showed significant improvement in physical symptom domain, psychological domain, and the mean of four domains. In all palliative interventions, palliative care has better effect in improving QOL of cancer patients than hospital-based palliative shared care. By this study, we examined and evaluated the effectiveness of ¡§Hospital-based Palliative Shared Care Program¡¨ promoted by Bureau of Health Promotion, Department of Health, R.O.C. With the in-depth information revealed, we can improve this promotion program and ensure that patient¡¦s needs have been taken care of. We would also recommend any promotion program must focus on patients, and a model of combined effort of palliative shared care should be on top of all.

Diss. (sammanfattning) Göteborg : Univ., 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Univ. , 2008. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

This study will describe Boston Medical Center's (BMC) Community Violence Response Team (CVRT) a program that provides mental health services to victims of interpersonal violence. Though these services are offered to all traumatic injury patients regardless of specific injury type, CVRT patients are almost exclusively victims of gunshot and stab wounds. This study focuses specifically on this patient population. CVRT counselors work in close collaboration with members of BMC's Violence Intervention Advocacy Program, as well as physicians and staff of the Emergency and Trauma departments. While many hospitals have violence intervention programs (VIPs), BMC is one of the first hospitals in the country to integrate mental health services into the hospital-based model of violence intervention and violent injury prevention. It is planned to conduct anonymous recorded interviews of people who have been through the violence intervention programs and received mental health services. A professionally licensed member of CVRT will screen the patient database for potential interview subjects. Subjects will be chosen based on when and for how long they were involved with our programs, as well as other factors such as injury type and language spoken. The subjects' anonymity will be protected and risks minimized as much as possible throughout the screening and interview process. Interview data will be examined for trends among the clients served. This will be a first look at evaluating CVRT, which was launched in 2011. The purpose of this study is to provide feedback on BMC's novel model for an integrated hospital-based violence intervention program and mental health services program for victims of interpersonal violence. The patient's perspective on these programs will provide valuable insight on this approach to violence intervention. The benefits of this model will be explored to identify any ways in which violence intervention services at BMC might be improved. Outcomes of the assessment of study data will be used to generalize the model for adaptation in other trauma centers. In addition, it is anticipated that this study will demonstrate the importance of seamless, integrated collaboration between community advocates of hospital-based intervention programs and trained professionals dedicated to providing mental health care to this vulnerable patient population and their families. It is hypothesized that BMC's integrated model for violence programming makes it easier for patients to take advantage of mental health services. This ease of access and comfortable transition from advocacy interventions to mental healthcare may translate into better long-term outcomes for patients. More patients may also use mental health services with this model than with a model that requires patients to access mental health services at another facility. A detailed explanation of BMC's programs complete with patients' experience will inform other institutions which may choose to adapt this integrated model to their practices. Finally, this pilot study will inform future research on violent injury patients and their treatment. This research has the potential to improve recovery and quality of life for future violent injury patients at BMC and other trauma centers.

As childhood obesity continues to increase, so do the comorbidities and related health issues, putting youth at a greater risk of developing adult-related diseases such as hypertension, Type 2 diabetes, and cardiovascular diseases. Current literature indicates that healthcare organizations have a significant role in the fight against this epidemic, yet most children's hospitals have no policy to accomplish this task. The purpose of this project was to develop a program proposal for a hospital-based, sustainable obesity program that will aid in improving patient and family awareness of the importance of maintaining an ideal body weight to decrease the incidences of obesity-related comorbidities in pediatric patients ages 2-19 with a Body Mass Index (BMI) greater than or equal to 30. Lewin's theory of planned change and the logic model were used as the theoretical framework to guide the change process for this project through its development. To that end, the proposal was accepted at the site by the executive leadership in consideration for full implementation and evaluation. Key stakeholders and content experts were brought together to create the proposal for the program which includes an algorithm to guide care. The results of this project, once adopted will promote positive change in the quality of life, decrease BMI to a healthy limit, improve overall population health, and reduce healthcare expenditure. Additionally, dissemination of results of the project may stimulate changes in other children's hospitals to adopt the measures of care in the fight against childhood obesity, and contribute to social change. .

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