Thesis (M. Phil. Med.)--University of Sydney, 2008. / Title from title screen (viewed Jan. 22, 2009) Includes tables and questionnaires. Submitted in fulfilment of the requirements for the degree of Master of Philosophy in Medicine to the School of Public Health, Faculty of Medicine. Includes bibliography. Also available in print form.

Thesis (M.S.)--State University of New York at Binghamton, Department of Systems Science and Industrial Engineering, 2007. / Includes bibliographical references.

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Οι δημογραφικές, επιδημιολογικές, κοινωνικές και πολιτισμικές τάσεις στις ευρωπαϊκές χώρες αλλάζουν τους παραδοσιακούς τρόπους περίθαλψης. Στις επόμενες δεκαετίες θα παρατηρήσουμε την αύξηση του αριθμού των ηλικιωμένων ανθρώπων όπου οι περισσότεροι θα είναι πλήρως εξαρτημένοι από την ιατρονοσηλευτική φροντίδα. Η διάλυση της παραδοσιακής οικογένειας ως ομάδα και η αστικοποίηση δημιουργεί κενά στην φροντίδα των ηλικιωμένων και στην φροντίδα των ατόμων με ειδικές ανάγκες. Αυτές οι αλλαγές στις ανάγκες και στην κοινωνική δομή απαιτούν μια διαφορετική προσέγγιση στον τομέα των υπηρεσιών υγείας και της κοινωνικής πολιτικής, δεδομένου ότι μια προσέγγιση βασισμένη αποκλειστικά στην «νόσο» δεν είναι πλέον κατάλληλη. Μια απάντηση σε αυτά τα θέματα μπορεί να αποτελέσουν οι κατ’ οίκον υπηρεσίες υγείας και συγκεκριμένα η κατ’ οίκον περίθαλψη ως μια βιώσιμη προσέγγιση για την διατήρηση της ιδιωτικής ζωής των ασθενών στα σπίτια τους για την αποφυγή της ανάγκης που προκύπτει για ιδρυματοποίηση. Οι τεχνολογικές καινοτομίες μαζί με τις νέες και σύγχρονες μορφές οργάνωσης παροχής υπηρεσιών μπορεί να αντιπροσωπεύσουν μια βιώσιμη λύση για την ανάπτυξη της κατ’ οίκον περίθαλψης υπό την προϋπόθεση ότι τα συστήματα υγειονομικής περίθαλψης μπορούν να ενισχύσουν περεταίρω την ενοποίηση και το συντονισμό τους. Θα πρέπει να παρέχονται υψηλής ποιότητας υπηρεσίες υγείας και ως στόχος θα πρέπει να είναι η κατ’ οίκον περίθαλψη όσο το δυνατόν περισσότερων ασθενών, ηλικιωμένων και ατόμων με ειδικές ανάγκες. Στην εργασία αυτή παρουσιάζονται στοιχεία για την αποτελεσματικότητα της κατ’ οίκον περίθαλψης καθώς και τρόποι για την βελτίωσή της. Στόχος της είναι να διευρύνει την ευαισθητοποίηση του κοινού και την προώθηση της δράσης προς αυτήν την κατεύθυνση. / The demographic, epidemiological, social and cultural trends in European countries are changing the traditional ways of treatment. In the next decades we will observe an increase of the number of elderly people where most of them will be completely dependent on medical care. The dissolution of the traditional family as a group and the urbanization creates gaps in the care of the elderly and of people with disabilities of the family. These changes in the needs and the social structure require a different approach to health and social policy and services, as an approach based solely on the "disease" is no longer appropriate. An answer to these questions can be the home-health services and, specifically, the home care as a viable approach to avoid the need arising for institutionalization and to maintain the privacy of patients in their homes. Technological innovations with new and modern forms of service may represent a viable solution for the development of home care, provided that health care systems can further enhance their integration and coordination. High quality health services should be offered and the objective should be the home care of as more as possible patients, elderly, and people with disabilities. In this essay, you will find information on the effectiveness of home care and how it can be improved. The aim is to broaden public awareness and promote action in this direction.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Background: In Africa, internet access and use is plagued by numerous barriers. Whilst South Africa (SA) boasts a better population penetration than the rest of Africa there is a lack of regulation regarding the internet and e-mail use amongst health professionals and their patients. The aim of this study was to assess the use of the internet amongst dietitians and medical doctors (MDs) in clinical practice in SA and draft a policy on such usage amongst health professionals and their patients. Methods: A cross-sectional analytical web-based survey was conducted amongst registered dietitians and MDs. A cover letter including a hyperlink to the self-administered questionnaire was e-mailed to all dietitians and a proportionate, stratified random sample of MDs with contactable e-mail addresses. The questionnaire consisted of open and closed questions, including demographics, influence of the internet on the quality of care of patients, quality control with web resources and aspects of information technology (IT) which were recommended by health professionals to be incorporated as part of undergraduate health science education Results: A total of 176 health professionals participated in the study (106 dietitians and 70 MDs). The mean age of the dietitians was 32.6± (8.0) and the MDs 50.5± (8.9). The majority of the respondents in this study population were White (82%) females (67%). On average, practitioners had been in practice for 9.1(8.0) years. The majority of dietitians (58%) and MDs (68%) had access to the internet at both their practice or workplace and their home. More dietitians (65%) than MDs (41%) were using e-mail or internet. MDs did not use the internet for research purposes, whilst a fifth of dietitians (21%) reported using the internet as a research tool. A greater percentage of the sample [MDs (69%) and dietitians (82%)] reported that, the internet had improved the quality of care of their patients. The dietitians (60%) and MDs (53%) in this study sample were unclear about how to source information and determine the reliability or accuracy of the information obtained from internet resources. Conclusion: Internet is incorporated into the practice of most dietitians and to a lesser extent by MDs. In this study, the need for training amongst health professionals regarding the use of the internet was highlighted. The study reflects that even though health professionals were unsure of the credibility of the internet information resourced, it did not stop the use of the internet in the practice. This is an area of concern, since it could potentially result in the distribution of misinformation. This warrants regulation on the use of the internet in health practices in SA. A policy on the use of IT in health care practice has been drafted. Further research on the use of IT in the healthcare practice is required before the policy can be finalized. The advantage is that some elementary information is now available. The challenge is to ensure that the time lapse between additional research, policy finalization and policy implementation is kept to a minimum. / OPSOMMING: Agtergrond: In Afrika is internet toegang en gebruik met baie hindernisse belas. Alhoewel Suid-Afrika (SA) met ‘n beter bevolkingspenetrasie as die res van Afrika spog is daar ‘n gebrek aan regulasie in verband met internet en e-pos gebruik tussen gesondheidswerkers en hul pasiënte. Die doel van hierdie studie was om die gebruik van die internet deur dieetkundiges en mediese dokters (MDs) in kliniese praktyk in SA te assesseer en om ‘n konsepbeleid rakende sulke gebruik tussen gesondheidswerkers en hul pasiënte op te stel. Metode: ‘n Dwarssnit analitiese web-gebaseerde opname is met geregisteerde dieetkundiges en MDs onderneem. ‘n Dekkingsbrief met ‘n webskakeling (hyperlink) tot die selfgeadministreerde vraelys is aan alle dieetkundiges en aan ‘n eweredig, gestratifiseerde ewekansige steekproef van MDs met kontakbare e-pos adresse gestuur. Die vraelys het uit oop en toe vrae bestaan, insluitend demografie, invloed van die internet op die kwaliteit van sorg van pasiënte, kwaliteitskontrole met web-hulpmiddels en aspekte van informasie tegnologie (IT) wat deur gesondheidswerkers aanbeveel was om deel te word van voorgraadse gesondheidswetenkaplike onderrig. Resultate: ‘n Totaal van 176 gesondheidswerkers het aan die studie deelgeneem (106 dieetkundiges en 70 MDs). Die gemiddelde ouderdom van die dieetkundiges was 32.6± (8.0) jaar en die MDs 50.5± (8.9) jaar. Die meerderheid respondente in hierdie studie populasie was blank (82%) en vroulik (67%). Oor die algemeen was praktisyne vir 9.1± (8.0) jaar in praktyk. Die meerderheid dieetkundiges (58%) en MDs (68%) het toegang tot die internet by beide hul praktyk of werkplek en hul huis. Meer dieetkundiges (65%) as MDs (41%) het e-pos of internet gebruik. MDs het nie die internet vir navorsingsdoeleindes gebruik nie, terwyl ‘n vyfde van dieetkundiges (21%) raporteer het dat hulle die internet vir navorsingsdoeleindes gebruik het. ‘n Groot persentasie van die populasie [MDs (69%) en dieetkundiges (82%)] het gerapporteer dat die internet tot ‘n verbetering in sorg van hul pasiënte gelei het. Die dieetkundiges (60%) en MDs (53%) in hierdie studie was onseker hoe om informasie te verkry en die betroubaarheid en akuraatheid van die informasie vanaf internetbronne te bevestig. Opsomming: In hierdie studie word internet in die praktyke van die meerderheid dieetkundiges en tot ‘n mindere mate in die van MDs geinkorporeer. Die noodsaaklikheid vir opleiding in die gesondheidsberoepe met betrekking tot die gebruik van die internet is aan die lug gebring. Hierdie studie weerspieël dat alhoewel gesondheidswerkers onbewus was van die geloofwaardigheid van internet informasie, dit nie die gebruik van die internet in hul praktyk gestop het nie. Dit is ‘n area van kommer aangesien dit potensieel na die verspreiding van misinformasie kan lei. Dit motiveer dus reguleering van die gebruik van die internet in gesondheidspraktyke in SA. ‘n Beleid oor die gebruik van IT in gesondheidspraktyke is in konsepvorm opgetrek. Verdere navorsing oor die gebuik van IT in gesondheidspraktyke word benodig om die konsepbeleid te finaliseer. Die voordeel is dat basiese inligting nou beskikbaar is. Die uitdaging is om te verseker dat die tydsduur tussen addisionele navorsing, beleidsfinaliseering en beleidsimplementering tot ‘n minimum gehou word.

The aim of this thesis is to understand the experiences of eight American high school students who have been diagnosed with cancer. By increasing understanding of the challenges that adolescents in cancer survivorship experience, better support can be identified. The experience of cancer survivorship influences the physical, psychological, and social experiences of patients. As the survival rate of childhood cancers continues to increase, death becomes less likely making the need to maintain educational engagement during survivorship increasingly important. The research questions for this study were designed to address two main gaps in the current field of research. The first research question aims to address how the physical and psychological effects of cancer and treatment impact the participants' engagement with school. The second research question aims to understand the role that school plays for adolescents in cancer survivorship, including how participants experienced supplemental education during and after cancer treatment. This study uses a qualitative research methodology to address the research questions utilizing primarily semi-structured interviews and an adjusted version of the Adolescent Coping Scale. When used in combination with the interviews, the scale provides a picture of what the participants experienced and how they have been able to cope with the challenges they have faced. Interpretive phenomenological analysis was used to provide structure to the interview analysis. The results of this study show that fatigue and a compromised immune system have an impact on school attendance more than other physical effects during cancer treatment. As a result, adolescents are most at-risk of experiencing challenges in educational engagement during treatment. The results of this study also show that the feeling of uncertainty throughout cancer survivorship promotes fear and the feeling of a loss of control. Once treatment ends, fear of relapse is common. Physical and psychological effects were felt to improve as time passed. Another key result of this study is that the cancer experience results in a shift in perspective that becomes incorporated into the formation of identity. Participants feel different from peers as a result of the physical and psychological effects of the cancer experience. The results from the Adolescent Coping Scale indicate that school achievement, relapse and the worsening of physical side effects, and being treated different by peers were common concerns for the participants regarding their school, illness, and social concerns, respectively. Lastly, the participants view supplemental education as successful if it meets their personal academic and physical needs, is implemented consistently, and helps them to feel emotionally supported and socially connected. However, more research is needed that focuses on the implementation of policy at the state and district levels to discern whether this is a common challenge unique to this population of students with a physical or medical disability. The sample available for this research topic is not only limited to an extremely small population, but they are also a highly guarded population, making access for recruitment challenging. However, while generalization is difficult with a study of this size, the evidence collected on the participants' experiences during and after treatment provides valuable data on aspects of supplemental education implementation.

Internet use is considered a lever for empowering patients, levelling inequalities and reducing healthcare expenditure. However, with digital inclusion, health provision quality and health system efficiency high on the UK and EU policy agendas, we need to better understand the relationship between Internet use and health outcomes to assess potential benefits and adverse effects. This research addresses the question of how Internet use influences individuals' health service use and their perceived health in the context of England. Focusing on health information-seeking, it analyses variations across different kinds of users, mechanisms between Internet use and both health outcomes, and the role of individual and contextual factors in this relationship. To answer this question, this research uses a mixed methods approach. Quantitative data from the Oxford Internet Surveys (OxIS), the English census and Hospital Episode Statistics (HES) was connected through spatial microsimulation based on output areas. Qualitative data was collected through semi-structured, face-to-face interviews, primarily with former OxIS participants from output areas in the quantitative strand. The quantitative data was revisited based on emerging interview themes. The results indicate that Internet use influences perceived health and health service use via various mechanisms based on the Internet's content, mediation and connection affordances. However, the boundaries between users and non-users are blurry and outcomes vary for different types of individuals, classified here as learners, pragmatists, sceptics, worriers, delegators and adigitals. Age, education, socioeconomic status, long-term health conditions, and geographic context influence Internet use and health outcomes separately, while the social context shapes their relationship too. These findings advance the theoretical understanding of Internet-based health outcomes, and provide practical implications for health professionals and policymakers with insights down to the local level. Moreover, this research demonstrates how novel insights for public wellbeing can be derived from qualitatively enriched secondary data in privacy-preserving and cost-effective ways.

Labour is a vital period for the labouring mothers, as it should bring with it the fulfilment of an expectation of having the baby that has been awaited. The health of the foetus which is to be born and that of the labouring mother are inextricably linked with each other which is why the labouring mother needs to be assessed and monitored carefully. The cardio-tocograph, which is a globally accepted method of diagnosis and assessment of the foetal status during labour is preferred to be used in monitoring labouring mothers, especially high- risk patients. Despite the evidence and information regarding the effectiveness of the use of the cardio-tocograph, midwives are still found not to be using it correctly, the reasons given that the women not always co-operate; do not keep the electrode and belt in place or cite the discomfort they experience from contraction. The objectives of this study were to: explore and describe the perceptions and current practice of Namibian midwives regarding the use of the cardio-tocograph as an informative labour- monitoring tool. Explore and describe how midwives working in labour wards in Namibia perceive informing laboring women of the use of the cardio-tocograph as an informative labour- monitoring tool and based on the results, develop an instruction guide for midwives working in the labour ward in intermediate hospital in Namibia that would serve as a guide on how to teach labouring women about the use of the cardio-tocograph as a labour- monitoring tool and enhance positive labor and delivery outcomes The study was conducted between May and June 2016, using a qualitative, explorative, descriptive and contextual design, following the necessary university approval and approval from other relevant authorities. The research population was midwives who work in labour wards at a public hospital in Namibia. Semi-structured interviews were used to collect data from purposively sampled participants using set criteria. A voice recorder was used to capture the interview with the permission of the participants. Seventeen midwives were interviewed of whom two were used for the pilot study. Data saturation determined the sufficient sample size. The collected data was analyzed using Tesch’s spiral method of data analysis with the assistance of an independent coder From the research findings, it emerged that midwives had varying perceptions regarding the use of the CTG machine. Midwives still perceive CTG interpretation as a challenge as a labour -monitoring tool and expressed a need for updates. Furthermore, midwives expressed the fact that they had limited communication with labouring women regarding the use of CTG. Based on the research findings and guided by Health Belief Model principles, three main guidelines were developed for midwives working in the labour ward in a public hospital in Namibia. These guidelines will serve as a tool to assist midwives in their teaching of labouring women about the use of the cardio-tocograph as a labour- monitoring tool, and the role to be played by labouring women during that monitoring period. Furthermore, recommendations for clinical nursing practice, nursing education and nursing research were developed. The researcher used literature control to ensure validation and integrity of the study. Trustworthiness, which was used to ensure rigour of the study, was guided by the principles of truth-value, transferability, dependability and confirmability. Ethical considerations were guided by the Belmont report adopting the principles of beneficence, respect for human dignity, justice and non-maleficence.

No description available.

Objective The objective of this study was to use machine learning and health standards to address the problem of clinical data interoperability across healthcare institutions. Addressing this problem has the potential to make clinical data comparable, searchable and exchangeable between healthcare providers. Data sources Structured and unstructured data has been used to conduct the experiments in this study. The data was collected from two disparate data sources namely MIMIC-III and NHanes. The MIMIC-III database stored data from two electronic health record systems which are CareVue and MetaVision. The data stored in these systems was not recorded with the same standards; therefore, it was not comparable because some values were conflicting, while one system would store an abbreviation of a clinical concept, the other would store the full concept name and some of the attributes contained missing information. These few issues that have been identified make this form of data a good candidate for this study. From the identified data sources, laboratory, physical examination, vital signs, and behavioural data were used for this study. Methods This research employed a CRISP-DM framework as a guideline for all the stages of data mining. Two sets of classification experiments were conducted, one for the classification of structured data, and the other for unstructured data. For the first experiment, Edit distance, TFIDF and JaroWinkler were used to calculate the similarity weights between two datasets, one coded with the LOINC terminology standard and another not coded. Similar sets of data were classified as matches while dissimilar sets were classified as non-matching. Then soundex indexing method was used to reduce the number of potential comparisons. Thereafter, three classification algorithms were trained and tested, and the performance of each was evaluated through the ROC curve. Alternatively the second experiment was aimed at extracting patient’s smoking status information from a clinical corpus. A sequence-oriented classification algorithm called CRF was used for learning related concepts from the given clinical corpus. Hence, word embedding, random indexing, and word shape features were used for understanding the meaning in the corpus. Results Having optimized all the model’s parameters through the v-fold cross validation on a sampled training set of structured data ( ), out of 24 features, only ( 8) were selected for a classification task. RapidMiner was used to train and test all the classification algorithms. On the final run of classification process, the last contenders were SVM and the decision tree classifier. SVM yielded an accuracy of 92.5% when the and parameters were set to and . These results were obtained after more relevant features were identified, having observed that the classifiers were biased on the initial data. On the other side, unstructured data was annotated via the UIMA Ruta scripting language, then trained through the CRFSuite which comes with the CLAMP toolkit. The CRF classifier obtained an F-measure of 94.8% for “nonsmoker” class, 83.0% for “currentsmoker”, and 65.7% for “pastsmoker”. It was observed that as more relevant data was added, the performance of the classifier improved. The results show that there is a need for the use of FHIR resources for exchanging clinical data between healthcare institutions. FHIR is free, it uses: profiles to extend coding standards; RESTFul API to exchange messages; and JSON, XML and turtle for representing messages. Data could be stored as JSON format on a NoSQL database such as CouchDB, which makes it available for further post extraction exploration. Conclusion This study has provided a method for learning a clinical coding standard by a computer algorithm, then applying that learned standard to unstandardized data so that unstandardized data could be easily exchangeable, comparable and searchable and ultimately achieve data interoperability. Even though this study was applied on a limited scale, in future, the study would explore the standardization of patient’s long-lived data from multiple sources using the SHARPn open-sourced tools and data scaling platforms / Information Science / M. Sc. (Computing)