Thesis (M.A. in English)--Vanderbilt University, May 2005. / Available in both PDF and MS-WORD file formats. Title from title screen. Includes bibliographical references.

This quality improvement project identified a need to improve patient placement between the Fast Track and the Emergency Department treatment areas of an urban Southern Arizona hospital. The current triage process at this hospital excludes patient past medical history, limiting the information given to triage nurses when assigning patient acuity scores and determining placement in the ED. This project sought to improve patient to nurse communication during the triage interview process by educating nurses to ask a ‘targeted history’ question: a question created to obtain concise past medical history information related to the patient’s chief complaint. This targeted history question was worded as “Have you been treated for [chief complaint] before?” Chart audits were performed to gather quantitative data on patient placement, ESI scores, triage interview times, and nursing compliance rates. Stakeholders were also asked open-ended questions regarding their perceptions of triage and the integration of the targeted history question. These interviews were recorded, transcribed, and coded for common categories. Results show low nursing compliance with asking the targeted history question. However, almost two-thirds of triage notes mentioned some form of past medical history – showing that triage nurses assess for pertinent past medical history without prolonging total triage times. Additionally, stakeholder interviews showed healthcare personnel felt the targeted history question helped with gathering useful information and patient placement, and that past medical history is an important part of triage.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: To describe and compare attitudes, lifestyle behaviors, and cardiometabolic risk factors between individuals with and without a relative with type 2 diabetes mellitus (T2DM) living in the same household. Methods: A secondary analysis of baseline data from an implementation study in Peru was conducted. The outcomes were attitudes towards changing lifestyle behaviors (e.g. intentions towards losing weight, increasing physical activity, reducing salt consumption, etc), profiles of health lifestyle behaviors (e.g. daily smoking, heavy drinking, and physical activity), and cardiometabolic risk factors (e.g., overweight [body mass index ≥25 kg/m2] and hypertension); whereas the exposure was the presence of at least one relative with known diagnosis of T2DM living in the same household. Multilevel logistic mixed effect regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Results: A total of 2298 records, 1134 (49.4%) males, mean age 43.3 (SD: 17.2) years, were analyzed. There was no evidence of a difference in lifestyle-changing attitudes, smoking, alcohol drinking, physical activity levels, and hypertension between individuals with and without relatives with T2DM. Overweight was 63% more common among individuals having a relative with a T2DM in multivariable model (OR = 1.63; 95% CI: 1.03–2.61). Conclusions: Individuals with relatives with T2DM have higher probabilities of being overweight compared to those who did not have relatives with T2DM in the same household. The absence of differences on lifestyle-related attitudes and behaviors highlight the need of involving relatives of patients with T2DM on intervention strategies to further enhance diabetes prevention and management efforts. / National Heart, Lung, and Blood Institute / Revisión por pares / Revisión por pares

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This research about women’s caregiving experiences in Jamaica uses the conceptual frameworks of intersectionality and anti-racist feminist perspectives to interpret and analyze the experiences of informal and formally trained nurses and folk healers in post-slavery Jamaica. This study explores how race, colour, class, gender, citizenship, and national identity intersected to define and shape women’s experiences as caregivers in Jamaica between the 1850s and the 1910s. By integrating scholarly interpretations about a plural health system with case studies about the management of diseases and developments in nursing, this research presents an inclusive analysis of female caregivers (British, Euro-American, and Afro-Jamaican nurses and folk healers) in post-slavery Jamaica. The late nineteenth to the early twentieth centuries was the period of the “new” imperialism characterized by the growth of caregiving and medical philanthropy in aiding the expansion of imperial pursuits and the civilizing mission of empires (British and US). Caregiving reveals how gender, race, class, and national identity intersected to shape the management of diseases in post-slavery Jamaica. On the one hand, formal caregiving was a tool for empire-building through colonial medical policies that aimed to heal the bodies and “civilize” the mentality of colonized peoples. On the other hand, informal caregiving empowered oppressed people to reshape cultural customs by adapting healing and religious practices to challenge British imperialism and claim citizenship. / Dissertation / Doctor of Philosophy (PhD) / This study examines the management of epidemics and disease in post-slavery Jamaica by highlighting the contributions of female caregivers, such as informally and formally trained nurses and Afro-Jamaican folk healers. It argues that caregiving provided by the government medical system and Afro-Jamaican folk healing developed from the mid-nineteenth to the early twentieth century in response to the challenges of adjusting to emancipation, frequent epidemics and encounters with disease. However, the government’s efforts to contain epidemics and disease were inadequate because of a shortage of medical practitioners, insufficient medical infrastructure, and white medical elites’ racial and class prejudices toward the labouring class. Nursing developed in parallel with establishing public hospitals and medical institutions in the urban centre as sites to control the labouring-class to mitigate epidemics and disease in post-slavery Jamaica. British, Euro-American, and Afro-Jamaican female caregivers deployed religious and medical services (caregiving) that reinforced and challenged racial, class and gender hierarchies during the post-slavery period in Jamaica.

This thesis describes medical aspects of the expeditions of the Heroic Age of Antarctic exploration (1895-1922). It is divided into three sections. Section 1 describes the drugs and medical equipment taken to the Antarctic by these expeditions. There is an introductory discussion followed by papers on ophthalmic drugs, injections, inhalations and suppositories, oral drugs and topical preparations. Sledging medical cases are considered separately. Brandy was often used as a medicine and the medical uses of alcohol are described. Some expeditions took what were described as “medical comforts”. This term was sometimes used as a euphemism for alcoholic beverages but, in fact, encompassed a wide range of foods for invalids. Burroughs Wellcome and Co. supplied many of the expeditions with drugs and their medical chests. They used the expedition link in their advertising and the relationship between the expeditions and drug companies is described. Section 2 describes some of the medical problems encountered. The most serious problems were scurvy and a condition often called “polar anaemia”, which seems to be the same as a condition known at the time as “ship beriberi” and what is now described as “wet beriberi”. The controversy as to whether Captain Scott and his colleagues died of scurvy is also discussed. Other problems included frostbite and snow blindness. At least 11 general anaesthetics were given, including two for amputation of frostbitten toes. Psychological problems were common and there was some serious psychiatric illness including alcohol abuse. Section 3 describes the doctors and some of the research that they carried out. The most common research done by doctors was bacteriological. Most doctors collected biological data on the explorers including weights and haemoglobin measurements. This was largely for health monitoring but one doctor pursued physiological research. Three doctors and a medical student studied geology.

This thesis examines the influence of Galen (b. 129 AD) on medicine in England between 1618 and 1794, approaching the study of his authority and the use of his work through three case-studies: histories of medicine, pharmacology, and surgery. The histories of medicine illustrate the variety of ways in which Galen is referred to, both as a historical figure, and as an ongoing contemporary influence. His importance in terms of accessing the knowledge of the ancients, and as a fixed point in time around which to discuss the history of medicine, and to situate other practitioners over a broad time period, underlines the significance of his role within medicine. Similarly, the pharmacological texts examined provide a more tangible sense of the influence of Galen, and their varied, but formulaic structures enable specific remedies to be traced over time and their corresponding associations and details compared between different editions. Identifying the role of Galen within surgical treatises also allows for a more theoretical aspect of surgery to be explored, providing a different perspective on an area more frequently portrayed as a manual art. The use of Galenic texts within each case-study, in particular the histories of medicine, demonstrates a significant and nuanced engagement with the content of his works, reiterating the importance of his contribution, and showing the value ascribed to the simplicity offered by past approaches. It is evident that a shift had occurred from the acceptance of ancient authority based on convention, to evaluating the simplicity and utility of information on an individual basis. The value ascribed to utility in the assessment of medical knowledge is evident throughout these texts, which also demonstrate the importance of the experience and observations of the practitioner in facilitating the ongoing and significant use of the influence of Galen.

Genetic counselors today are at the forefront of helping clients interpret genetic information to help them make decisions, often about childbearing, based on testing and medical histories. Scholars of medicine, reproduction, and gender in the United States have traced the medicalization of pregnancy and interactions between parents and medical authorities. These works explore the interplay of medicine, society, and reproduction, but they do not address the history of genetic counseling. I argue that doctors and patients reciprocally shaped each other's thinking about reproduction in the mid-twentieth century. Parents' desires for normal, healthy children shaped the development of genetic counseling by motivating them to seek the services of genetic counselors. These prospective parents' expectations and desires had an outsized influence on the development of genetic counseling because counselors were sensitive to possible associations with eugenics and were careful not to tell parents what to do with the genetic information they provided.

This dissertation examines how certain epidemic outbreaks become "global threats", that is, diseases that become the focus of international regulations and organized responses while others do not. To answer this question, this dissertation draws upon archival data collected at the World Health Organization (WHO) archives in Geneva, the Western Cape Archives in Cape Town, the British Library, British National Archives, the Wellcome Library Archives in London, and twelve qualitative interviews with senior global health actors in order to analyze five cases when disease threats were prioritized internationally as well as how these constructions patterned responses to outbreaks. I begin by exploring the formation of the first international disease controls in the 19th century, the International Sanitary Conventions, created to prevent the spread of three diseases- plague, cholera and yellow fever. I probe how these earliest conventions patterned responses to diseases covered under them and limited responses to those beyond their scope. Examining how these conventions transformed, I explore why the same disease priorities were maintained by the WHO in their International Sanitary Regulations of the 1950's. Finally, I analyze the transformation of the International Health Regulations in 2005 and its effects on the assessment of disease threat. This dissertation shows that three factors structure the construction of disease threat: epidemic orientalism, economic concerns and field dynamics. Epidemic Orientalism, a discourse motivating the construction of disease threat that first emerged in the 17th, 18th and 19th centuries, positioned the colonized world as the space from which Europe and the Imperial powers needed to be protected. This orientalist gaze prioritizes the control of diseases emanating from colonial sites that threaten international trade and commerce and has been re-inscribed in all past and present regulations. These factors explain how and why plague, cholera and yellow fever came to be maintained as the primary diseases of international concern until the 21st century. As the WHO has recently been challenged in its authority to manage disease threats, these two factors are also mediated by the WHO's manipulation of symbolic power within a new field of infectious disease management which conditions responses to outbreaks today.

Cheng Po Chu. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references. / ABSTRACT --- p.1 / Chapters / Chapter I. --- BACKGROUND --- p.2 / Chapter II. --- OVERVIEW OF HISTORY-TAKING EXPERT SYSTEMS --- p.3 / Chapter II.1 --- Structure of Diagnostic systems --- p.3 / Chapter II.2 --- Present Design --- p.4 / Chapter III. --- LOGICAL APPROACH TO HISTORY TAKING --- p.5 / Chapter III.1 --- Objectives of Taking a Medical History --- p.5 / Chapter III.2 --- Process of History Taking --- p.6 / Chapter III.3 --- The Art of Asking Questions --- p.8 / Chapter III.4 --- Implementation Problems --- p.9 / Chapter III.4.1 --- Question of Users --- p.9 / Chapter III.4.2 --- Question of the End Point --- p.10 / Chapter III.4.3 --- Analysis Problems --- p.10 / Chapter IV. --- DESIGN OF THE SYSTEM --- p.11 / Chapter IV.1 --- DATA REPRESENTATION --- p.11 / Chapter IV.1.1 --- Diagnosis --- p.11 / Chapter IV.1.2 --- Symptoms --- p.12 / Chapter IV.1.3 --- Patient History --- p.14 / Chapter IV.2 --- KNOWLEDGE --- p.15 / Chapter IV.3 --- INFERENCE ENGINE --- p.19 / Chapter IV.4 --- TEACHING MECHANISM --- p.24 / Chapter IV.4.1 --- Diagnostic Module --- p.24 / Chapter IV.4.2 --- Teaching Module: --- p.24 / Chapter V. --- STATISTICAL STUDY --- p.26 / Chapter VI. --- SAMPLE RUNNING OF THE PROGRAM: --- p.27 / Chapter VI.l. --- DIAGNOSTIC MODULE --- p.28 / Chapter VI.1.1 --- "Demographic Data, Chief Complaint and History of Present Illness" --- p.28 / Chapter VI.1.2 --- Related Symptoms --- p.30 / Chapter VI.1.3 --- Symptom Descriptors --- p.30 / Chapter VI.1.4 --- Deduction and Ask Cycle --- p.30 / Chapter VI.1.5. --- Summary --- p.31 / Chapter VI.1.6 --- Record in casebook --- p.32 / Chapter VI.2 --- THE TUTORING MODULE --- p.32 / Chapter VI.2.1 --- Demographic Data and Chief Complaint --- p.32 / Chapter VI.2.2 --- Advises and History of Present Illness --- p.33 / Chapter VI.2.2.1 --- Advises --- p.33 / Chapter VI.2.2.2 --- Summary --- p.34 / Chapter VI.2.2.3 --- History of Present Illness --- p.34 / Chapter VI.2.2.4 --- Advises again --- p.35 / Chapter VI.2.2.5 --- History of Present Illness again --- p.36 / Chapter VI.2.2.6 --- Advises again --- p.36 / Chapter VI.2.2.7 --- Summary again --- p.37 / Chapter VI.2.2.8 --- History of Present Illness again --- p.37 / Chapter VI.2.2.9 --- Offer of advice and Summary again --- p.38 / Chapter VI.2.3 --- Termination --- p.38 / Chapter VI.3 --- RETRIEVING CASES AND SUMMARIZING --- p.39 / Chapter VII. --- PERFORMANCE OF THE SYSTEM --- p.43 / Chapter VIII. --- FURTHER DEVELOPMENT --- p.44 / CONCLUSION --- p.46 / REFERENCES: --- p.46 / ACKNOWLEDGMENT: --- p.46