Introduction: While the antiretroviral (ARV) coverage has been scaled- up in the last 3 years in South Africa, there is limited data on the operating costs and financial sustainabihty of an anti- retroviral programme. Study Aim: To conduct a cost analysis of the stepdown ARV programme at the Kwadukuza Municipality Clinic (KMC) in the Ilembe district from a healthcare providers' perspective for the period 1st April 2005 to 31st March2006. Study Objectives: To determine the total costs and cost per patient per visit for outpatients attending the ARV, Wellness and VCT clinics respectively at KMC. Study Methods: Study location: This study was conducted at the Kwadukuza Municipality Clinic located in the Ilembe district in Kwazulu- Natal, South Africa. Study population: The population that is included in this study for the purposes of costing comprised: all the patients who received ARVs for the period under study; all the patients who attended the Wellness and VCT clinics and all the staff attached to the ARV programme at the KMC clinic Study design: This is a retrospective and cross- sectional study with both a descriptive and analytical component. Results: Seventy- one percent of the patients on ARVs were female with 50% of the patients being between 31 and 40 years of age. The total operating costs of running the ARV programme was R2 439 940- 90. The total cost accrued to the ARV clinic was R 1 698 003- 60. The Wellness clinic had a total cost of R 460 279- 68 and the VCT clinic accounted for the least total operating cost of R 281 657-77. The cost per patient visit was R440- 13 for the ARV clinic; R133- 05 for the VCT clinic and an amount of R61- 71 for the Wellness clinic. Conclusion This study provides the basis for determining the three cardinal cost components of the ARV programme, namely human resources, the cost of ARVs and the costs of viral load testing for the purposes of future planning and sustainability. The cost- effectiveness of ARV drugs can be improved if the healthcare providers negotiate a lower price for these drugs. The high cost due to monitoring tests can be lowered by decreasing the frequency of these tests but this may allow ARV drug resistance to be undetected. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

Title: Case Management and Clinical Outcomes of People Living with HIV and Admitted to a State-aided District Hospital in Durban, South Africa in 2007. Introduction: A proportion of the many patients who have advanced AIDS in South Africa present for the first time requiring admission to hospital, the number of which are limited by the availability of beds. Novel ways were developed to offer subacute inpatient care at Siyaphila, a facility linked to McCord Hospital in Durban to provide expedited or immediate antiretroviral therapy (ART) (exposed) for patients with advanced disease before their discharge (ART group) . Different components of palliative care were offered for those who did not enter the inpatient ART programme or who were terminally ill (non-ART group) (non-exposed) . Aim: The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted to Siyaphila in order to assist in developing appropriate protocols for inpatient care. Methods: This was an observational, analytic, cohort study using a convenience sample of all patients consecutively admitted to Siyaphila during nine months in 2006/2007. Prevalence of AIDS defining conditions at Siyaphila, time taken to progress from one stage of care to another and outcomes for the two groups before discharge were determined. Univariate and multivariate logistic regression analysis was performed on the ART group to identify risk factors for mortality before discharge. A comparison between the ART and non-ART group was also undertaken. Results: Among the cohort of 405 PLHIV enrolled at Siyaphila during the study period only 171 (42%) were initiated on ART immediately. In all patients, tuberculosis (251; 62%) was the most common opportunistic infection followed by cryptococcal meningitis (68; 17%) and Pneumocystis pneumonia (28; 7%). The mean baseline CD4 cell count was 84 celis/uL for the non-ART group and 55 celis/uL for the ART group. (p <0.01) The median time from initial admission until discharge was 13 days in the non-ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group. (p =0.001). The median number of days before ART was initiated was 14 days. Immune reconstitution inflammatory syndrome was diagnosed in seven patients (4%) among the admissions but caused no deaths. In the multivariate analysis, the odds ratio for mortality for patients under 40 years was 0.1 (95% Confidence Interval: 0.01 - 0.9). Conclusions: Subacute care offered at Siyaphila provides an entry point into the ART programme for non-ambulatory patients who in the KwaZulu-Natal context have low ART uptake after discharge. The findings of this study should be adopted as the best clinical practice for PLHIV and AIDS admitted in the late stages of the disease. 0Nords 423) Title: Case Management and Clinical Outcomes of People Living with HIV and Admitted to a State-aided District Hospital in Durban, South Africa in 2007. Introduction: A proportion of the many patients who have advanced AIDS in South Africa present for the first time requiring admission to hospital, the number of which are limited by the availability of beds. Novel ways were developed to offer subacute inpatient care at Siyaphila, a facility linked to McCord Hospital in Durban to provide expedited or immediate antiretroviral therapy (ART) (exposed) for patients with advanced disease before their discharge (ART group) . Different components of palliative care were offered for those who did not enter the inpatient ART programme or who were terminally ill (non-ART group) (non-exposed). Aim: The aim of the study is to describe the clinical condition, inpatient case management and outcomes before discharge of people living with HIV admitted to Siyaphila in order to assist in developing appropriate protocols for inpatient care. Methods: This was an observational, analytic, cohort study using a convenience sample of all patients consecutively admitted to Siyaphila during nine months in 2006/2007. Prevalence of AIDS defining conditions at Siyaphila, time taken to progress from one stage of care to another and outcomes for the two groups before discharge were determined. Univariate and mUltivariate logistic regression analysis was performed on the ART group to identify risk factors for mortality before discharge. A comparison between the ART and non-ART group was also undertaken. Results: Among the cohort of 405 PLHIV enrolled at Siyaphila during the study period only 171 (42%) were initiated on ART immediately. In all patients, tuberculosis (251; 62%) was the most common opportunistic infection followed by cryptococcal meningitis (68; 17%) and Pneumocystis pneumonia (28; 7%). The mean baseline CD4 cell count was 84 celis/uL for the non-ART group and 55 celis/uL for the ART group. (p <0.01) The median time from initial admission until discharge was 13 days in the non-ART group and 18 days in the ART group. The mortality before discharge among the non-ART group was 24% compared to 6% among the ART group. (p =0.001). The median number of days before ART was initiated was 14 days. Immune reconstitution inflammatory syndrome was diagnosed in seven patients (4%) among the admissions but caused no deaths. In the mUltivariate analysis, the odds ratio for mortality for patients under 40 years was 0.1 (95% Confidence Interval: 0.01 - 0.9). Conclusions: Subacute care offered at Siyaphila provides an entry point into the ART programme for non-ambulatory patients who in the KwaZulu-Natal context have low ART uptake after discharge. The findings of this study should be adopted as the best clinical practice for PLHIV and AIDS admitted in the late stages of the disease. (Words 423) / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

Laws in South Africa, such as the Children’s Amendment Act 41 of 2007(Government Gazette, Act 38 of 2005), is developed with good intentions of promoting prevention and intervention on various health-related issues. Laws also dictate, based on developmental and evolving capabilities, chronological ages at which children and adolescents may access certain healthcare services without parental consent, whilst limiting them in other areas such as decision-making for research participation. Of interest to this study is how specialists in health care, conceptualise, understand and apply “sufficient maturity” in their encounters with minors presenting for treatment, in order to identify key concepts of sufficient maturity. From the interviews conducted, themes were identified that were relevant to the construct of “sufficient maturity.”Results indicated that there were two primary perspectives participants used to assess “sufficient maturity” when minors presented for treatment.Health care practitioners, depending on the health care context, assess minors’ sufficient maturity in relation to, either a competency based or a deficiency model. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

Perceptions of health and illness which include the perceived cause and recourse play an important role in diagnosis and management of illness. Traditional and allopathic medicines are used simultaneously and sometimes without the knowledge of the health professional and this has an impact on clinical outcomes. Overlooking patients’ subjective experience, health providers’ biases and prejudice may pose a negative impact on clinical outcomes. This study explores patients’, traditional healers’ and psychological counselors’ perception of illness by conducting interviews and administering open-ended questionnaires. The data is analyzed both qualitatively and quantitatively through the use of content analysis and non-parametric statistical procedures. The results indicate that the concept of illness is complex and multidimensional with physical and socio-spiritual aspects. Effective management requires a joint approach between indigenous and western health systems. The results further show that traditional healers fully embrace the integrated health approach while there is some skepticism and uncertainty from psychological counselors which could be stemming from their training. There is still work to be done in terms of health planning and policy but also the training of health professionals. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

Prevention of HIV following sexual assault is an important aspect of rape care. This includes taking Post Exposure Prophylaxis for 28 days. The present study aimed to provide an in-depth understanding of social and environmental factors that predisposed, promoted and also served as barriers to adherence to post exposure prophylaxis to prevent HIV infection after sexual assault in women in the Eastern Cape Province. The study involved a purposive sample of women who were offered Post Exposure Prophylaxis (PEP) after a sexual assault. Sixteen women were accessed at the Sinawe Referral Centre and participated in the study. Their ages ranged from 16 to 73 years. An interview guide was developed to assist the researcher, and semistructured, in-depth interviews were used to collect data. These women were interviewed at the end of 28 days of taking the prophylactic medication. The data were analyzed inductively using grounded theory. Only three women completed the 28 days of PEP treatment. Participants gave different explanations for why they did not complete the treatment with only four participants returning to the centre for their medication. Some reported having no money for transport; others mentioned deciding to discontinue the medication because of its side-effects. Poor support systems, both within the community and the health services, including the provision of conflicting information also played a role. The study showed that few women were able to complete their PEP medication and knowledge about the service and access to it were the main factors that lead to non-adherence. There is an urgent need for the improvement of PEP services particular in the support to the women during the period of taking the PEP treatment to ensure protection from HIV after a sexual assault. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

The study sought to determine what palliative care services were provided to offenders at Medium B correctional center, which is located at Durban Management Area. It identified the perceptions of offender-patients about the services they received. The study also identified challenges that staff and offender-volunteer caregivers faced in rendering services within a correctional context in South Africa. The sample consisted of three stakeholders, namely, offender-patients who were terminally ill with AIDS at the prison hospital, staff and offender volunteer caregivers. The methods of data collection comprised of content analysis, semi-structured interviews with offender-patients and focus group discussions with staff and offender volunteer caregivers. The study revealed that efforts were made by the Department of Correctional Services to provide services to terminally ill AIDS patients. Legislation and policy frameworks were consistently being developed by the Department to meet the needs of patients and to keep abreast with international best practices. Some services were in accordance with the theoretical framework of palliative care. However, many challenges were experienced because of the contextual constraints in which the services were being rendered. Recommendations to improve the delivery of services were made by all participants in the study. The study concludes with the recommendations by the researcher and suggestions for future research. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2006.

Kokybė apima kiekvieną ir visas veikas, atliekamas sveikatos priežiūros įstaigoje. Šio darbo tikslas yra iš įvertinti sveikatos priežiūros kokybės sistemų diegimo aspektus privačioje gydymo įstaigoje medicinos darbuotojų požiūriu. Sveikatos priežiūros kokybę užtikrinančių sistemų diegimas – pagrindinė įstaigos sritis, siekiant pelningos veiklos. Baigiamajame darbe, analizuojami Lietuvos Respublikos teisės aktai, įvairi mokslinė literatūra bei anketinės apklausos metodu vertinama UAB „Kardiolita“ medicinos darbuotojų požiūrį apie šios įstaigos kokybės vadybos sistemų diegimą. Išnagrinėta, jog privačios sveikatos priežiūros įstaigos akcininkai bei vadovai suinteresuoti diegti sėkmingas kokybės vadybos sistemas, tačiau dėl nepakankamo dėmesio atskiriems etapams – informacijos darbuotojams stokos, kontrolės organizavimo, nepakankamo darbuotojų mokymo bei supažinimo su kokybės vadybos sistemos nauda bei neanalizuojant kokybės kaštų – aptinkami trūkumai, kurie trukdo gerinti kokybę minimaliomis išteklių sąnaudomis. Efektyvus sveikatos priežiūros kokybės vadybos sistemos valdymas pasiekiamas, kai dalyvauja visų lygių darbuotojai ir analizuojami kokybės kaštai, o visam procesui vadovauja atatinkamą išsilavinimą turinti sveikatos vadybininkas. / The title of the final work – is implementation of the system of quality management with the attitude towards the workers of private medical institution. Key words: quality, quality of medical care, systems of quality management, quality management, the rate of medical workers, education of workers, quality cost outlay. Summary. Quality covers all and each action performed at a medical institution. The aim of this work is to evaluate the aspects of the quality of implementation of the system in medical care with the attitude towards the workers of medical institution. The implementation of the systems which quarantee the quality of medical care – is the main sphere of the institution in order to reach profitable activy. The acts of Lithuanian Republic law are being analysed in the final work as well as a varied scientific literature. The system of the implementation of quality management at the stock company „Cardiolita“ was evaluated by a survey with the attitude of its workers. It was analysed that the shareholders and managers are interested in the successful implementation of the quality management system.

Disertacijos tikslas yra įvertinti Kauno m. 25-64 metų gyventojų sergamumo ūminiu miokardo infarktu, medicinos pagalbos ir trumpalaikio bei ilgalaikio išgyvenimo pokyčius 1996 m. bei 2003-2004 m.: išanalizuojant 25-64 metų Kauno m. gyventojų sergamumo ūminiu miokardo infarktu, mirštamumo nuo ūminio miokardo infarkto ir mirtingumo nuo išeminės širdies ligos rodiklių pokyčius 1996-2004 m.; įvertinant medicinos pagalbos apimtį bei ypatumus Kauno m. 25-64 metų gyventojams, ištiktiems ūminio miokardo infarkto, 1996 m. bei 2003-2004 m.; nustatant 25-64 metų Kauno m. gyventojų, ištiktų ūminio miokardo infarkto, trumpalaikį išgyvenimą 1996 m. bei 2003-2004 m.; įvertinant 25-64 metų Kauno m. gyventojų, ištiktų ūminio miokardo infarkto, ilgalaikį išgyvenimą 1996 m. bei 2003-2004 m. / The aim of dissertation is to evaluate the trends in morbidity of acute myocardial infarction, medical care and the short term and long term survival in Kaunas population aged 25-64 years in 1996 and in 2003-2004: to analyze the trends in the rates of morbidity of acute myocardial infarction, lethality from acute myocardial infarction and mortality from ischemic heart disease in Kaunas population aged 25-64 years from 1996 to 2004; to evaluate the extent and peculiarities of medical care provided for Kaunas population aged 25-64 years, who experienced acute myocardial infarction, in 1996 and in 2003-2004; to determine the short term survival after acute myocardial infarction in Kaunas population aged 25-64 years in 1996 and in 2003-2004; to evaluate the long term survival after acute myocardial infarction in Kaunas population aged 25-64 years in 1996 and in 2003-2004.

The purpose of this thesis is to explore the phenomenon of spiritual nurturing as experienced by students in their fourth-year of an undergraduate baccalaureate nursing education program in Canada, using van Manen’s (2002) approach to phenomenology. The goal of this study is to describe the lived experience of spiritual nurturing of fourth-year nursing students in order to reflect on how nursing students learn spiritual care. Data were collected via in-depth interviews with seven fourth-year nursing students and analyzed according to van Manen’s interpretive approach. Three themes of spiritual nurturing emerged: spiritual nurturing as exchanging energy (spirituality as relationship with others), spiritual nurturing as recharging energy (spirituality as relationship with self), and spiritual nurturing as receiving energy (spirituality as relationship with transcending). Spiritual nurturing as it applies to nursing education, nursing practice, administration of nursing programs and nursing research are discussed from the students’ perspectives. / vii, 142 leaves : ill. (col. ill.) ; 29 cm

In Nunavik, the question of self-determination in health care is becoming increasingly embedded in the community health discourse, which is used by both health planners and Inuit alike to negotiate diverging positions. While health planners envision northern health care as a subset of the Quebec system, Inuit perceive it as a vehicle to ends that transcend conventional health issues. This thesis will provide an overview of the development of Nunavik health services since the James Bay agreement, focusing on how the use of the community health discourse serves to promote, but also shapes and limits regional and community self-determination.