The exercise of autonomy and self-regulation is seen in the literature as one of the basic criteria of professionalism. Since in modern states Medicine has generally been the occupational grouping which has most completely attained that status, it is seen as the model or archetype of professionalism. This study focuses on just one aspect of medical autonomy, that relating to the right of medical professionals to be accountable only to their fellow professionals as far as the maintenance of practice standards are concerned. In this thesis, the theory underlying this system of "peer review" is examined and then its application during the course of the 20th century is traced in one particular jurisdiction, that of the State of New South Wales in Australia. The reason for the focus on NSW is that in this jurisdiction, medical autonomy existed and was exercised in a particularly pure and powerful form after it was instituted in 1900. However, it was also in NSW that for the first time anywhere in the world, an institutional challenge to medical disciplinary autonomy emerged with the establishment in 1984 of the "Complaints Unit" of the Department for Health. The thesis of this study is that as a result of this development, which within a comparatively short space of time led to the emergence of a system of "co-regulation" of medical discipline, medical disciplinary autonomy and peer review had within a decade, been so severely challenged as to be almost extinct in this State. In the light of theoretical frameworks provided by Weber, Habermas and the American scholar Robert Alford, the study examines the long drawn out struggle to institute medical autonomy in NSW in the 19th century, its entrenchment by subsequent legislation over the next eight decades and the "counter-attack" staged by the emergent forces of consumerism, supported by the forces of the ideology of "Public Interest Law" in the last two decades of the century. The study concludes with a discussion of the implications for definitions of professionalism which might result from the loss by Medicine in NSW, of its right to exclusive control of medical discipline and the consequent disappearance of medical peer review.

Doctor of Philosophy(PhD) / Indigenous health is one of the most pressing issues confronting contemporary Australian society. In recent years government officials, medical practitioners, and media commentators have repeatedly drawn attention to the vast discrepancies in health outcomes between Indigenous and non-Indigenous Australians. However a comprehensive discussion of Aboriginal health is often hampered by a lack of historical analysis. Accordingly this thesis is a historical response to the current Aboriginal health crisis and examines the impact of colonisation on Aboriginal bodies in Queensland during the early to mid twentieth century. Drawing upon a wide range of archival sources, including government correspondence, medical records, personal diaries and letters, maps and photographs, I examine how the exclusion of Aboriginal people from white society contributed to the creation of racially segregated medical institutions. I examine four such government-run institutions, which catered for Aboriginal health and disease during the period 1900-1970. The four institutions I examine – Barambah Aboriginal Settlement, Peel Island Lazaret, Fantome Island lock hospital and Fantome Island leprosarium – constituted the essence of the Queensland Government’s Aboriginal health policies throughout this time period. The Queensland Government’s health policies and procedures signified more than a benevolent interest in Aboriginal health, and were linked with Aboriginal (racial) management strategies. Popular perceptions of Aborigines as immoral and diseased directly affected the nature and focus of government health services to Aboriginal people. In particular the Chief Protector of Aboriginals Office’s uneven allocation of resources to medical segregation facilities and disease controls, at the expense of other more pressing health issues, specifically nutrition, sanitation, and maternal and child health, materially contributed to Aboriginal ill health. This thesis explores the purpose and rationales, which informed the provision of health services to Aboriginal people. The Queensland Government officials responsible for Aboriginal health, unlike the medical authorities involved in the management of white health, did not labour under the task of ensuring the liberty of their subjects but rather were empowered to employ coercive technologies long since abandoned in the wider medical culture. This particularly evident in the Queensland Government’s unwillingness to relinquish or lessen its control over diseased Aboriginal bodies and the continuation of its Aboriginal-only medical isolation facilities in the second half of the twentieth century. At a time when medical professionals and government officials throughout Australia were almost universally renouncing institutional medical solutions in favour of more community-based approaches to ill health and diseases, the Queensland Government was pushing for the creation of new, and the continuation of existing, medical segregation facilities for Aboriginal patients. In Queensland the management of health involved inherently spatialised and racialised practices. However spaces of Aboriginal segregation did not arise out of an uncomplicated or consistent rationale of racial segregation. Rather the micro-histories of Fantome Island leprosarium, Peel Island Lazaret, Fantome Island lock hospital and Barambah Aboriginal Settlement demonstrate that competing logics of disease quarantine, reform, punishment and race management all influenced the ways in which the Government chose to categorise, situate and manage Aboriginal people (their bodies, health and diseases). Evidence that the enterprise of public health was, and still is, closely aligned with the governance of populations.

Thesis (DScPT)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed on June 23, 2009). Includes bibliographical references (p. 33-37).

Thesis (M.S.)--Brandeis University, 2009. / Title from PDF title page (viewed on May 29, 2009). Includes bibliographical references.

Thesis (M.D.) - Yale University, 1991. / Title from PDF t.p. (viewed June 15, 2005). Includes bibliographical references.

Thesis (Ph. D.)--UCLA, 2009. / Vita. Description based on print version record. Includes bibliographical references (leaves 321-350).

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1438489. ProQuest document ID: 1240705311. Includes bibliographical references (p. 33-34)

Until recent years research into medieval hospitals of England, Scotland and Wales has been a topic that has been somewhat neglected by historians and archaeologists. The majority of work carried out to date has focused on individual institutions, small geographical areas, or specific types of hospital. Whilst many of those studies have been well researched and highly informative, few have provided an insight into regional differences or similarities throughout these three countries. This thesis compares and contrasts a variety of aspects of medieval hospitals, such as the layout of the buildings, the saint(s) to whom they were dedicated, the type of people cared for in them, and the people who founded and ran them, in an attempt to identify any regional patterns that may have existed in medieval times. As the length of period studied spans almost five hundred years, it is possible to examine the changes in development of medieval hospitals. Rising and waning popularity for those saints who were venerated in connection with care for the poor and the sick is tracked throughout the centuries covered in these pages. Likewise, the choices of design for hospital buildings from the 11 th century to the 16th century are explored, along with the changes in the status of founders, and the number, type and gender of staff and inmates during that time frame. Periods of growth and decline in hospitals were apparent, the most notable being the falling number of hospital foundations across most of Britain in the late 13 th century and the early 14th century. This is examined on a regional scale, as well as nationally, with a view to gaining a better understanding of the causes that may have resulted in such a decline.

Orientador: Iscia Teresinha Lopes-Cendes, Carmen Passos Lima / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T07:38:24Z (GMT). No. of bitstreams: 1 Viana_DaniloVilela_M.pdf: 17449794 bytes, checksum: 5628cf41f1e3b3dae3d2ad85bb64f5d4 (MD5) Previous issue date: 2006 / Resumo: O câncer de cólon e reto é a quinta causa de mortalidade por câncer no Brasil. Sua taxa de mortalidade vem apresentando um aumento contínuo desde 1979. Entre os fatores de risco mais importantes para essa doença está a história familial de câncer de cólon e reto ou de pólipos adenomatosos. O propósito do presente estudo foi investigar a qualidade das histórias familiais (HF) registradas nos prontuários médicos e estimar a freqüência dos agregados familiais e das síndromes hereditárias de câncer nos pacientes com diagnóstico de câncer de cólon e reto atendidos no Hospital de Clínicas da UNICAMP. Um estudo retrospectivo foi delineado para avaliar os prontuários dos pacientes que tinham confirmação histopatológica do diagnóstico de adenocarcinoma de cólon ou reto. Inicialmente, 415 prontuários que apresentavam codificação para a doença foram selecionados a partir do livro de cirurgias e de uma lista de pacientes atendidos nos ambulatórios de oncologia clínica, radioterapia e proctologia. Foram excluídos 104, sendo realizada a revisão de 311 prontuários. Numa segunda fase do estudo todos esses pacientes foram convocados para um entrevista com médico geneticista para obtenção de nova história familial, e comparação subseqüente dos dados, na qual a história familial previamente registrada foi classificada como completa ou incompleta. Dentre os 311 prontuários revisados, 193 (62%) tinham HF de câncer registrada. No total, 95 pacientes compareceram à entrevista, dos quais 66 tinha HF registrada no seu prontuário para que fosse feita comparação. Dessas 66 HF, 21 (32%) puderam ser consideradas completas e 45 (68%) incompletas. Pelo menos um critério clínico para câncer hereditário foi preenchido por 39 pacientes. Agregação familiar de CCR foi encontrada em 19% dos indivíduos entrevistados. Estes achados demonstram que a coleta e o correto preenchimento das histórias familiais nos prontuários dos pacientes com câncer são freqüentemente negligenciados, o que poderia influenciar negativamente na qualidade da assistência médica a eles prestada. As formas hereditárias de câncer hereditário, em especial a síndrome de Lynch (câncer colorretal hereditário sem polipose - HNPCC), são subdiagnosticadas, impossibilitando que medidas preventivas e diagnóstico precoce sejam oferecidos às suas famílias. / Abstract: Colorectal cancer is the 5th mortality cause by cancer in Brazil, and has been showing a continuous increase in mortality since 1979. Among the most important risk factors for this disease is family history of CRC or adenomatous polyps. The purpose of the present study was to investigate family histories (FH) recorded in medical charts for completeness and accuracy and to estimate the frequency of cancer aggregates and cancer syndromes in colorectal cancer patients treated in a general hospital. A retrospective study was assembled to evaluate archived charts of patients with pathological diagnosis of colorectal adenocarcinoma. Four hundred and fifteen medical records with ICD-10 coding of colorectal cancer were selected from the list of pacients who had had consultation in the clinical oncology, radiation oncology or proctology clinics, from which 104 were excluded because of misclassification or unconfirmed diagnosis. 311 charts were fully reviewed, and these patients invited for a personal interview by a medical geneticist. FH obtained from chart reviews were compared to data obtained from personal interviews and subsequently classified as complete or incomplete. Among the 311 charts, 193 (62%) had FH of cancer recorded. Overall, 95 patients attended the interviews, 66 of whom had a FH recorded in their hospital charts allowing accuracy comparisons. Of these, 21/66 (32%) FH could be considered complete and 45/66 (68%) incomplete. Thirty-nine patients met at least one criterion for hereditary cancer. Familial aggregates of colorectal cancer were found in 18 families (19%). In conclusion, the data in this study showed that FH in medical charts were often flawed or carried important omissions, which could influence negatively medical attention delivered to patients, and that hereditary forms of cancer, especially hereditary non-polyposis colorectal cancer, were underdiagnosed, making it impossible to extend the benefits of early diagnosis and preventive measures to at risk family members. / Mestrado / Genetica Medica / Mestre em Ciências Médicas

M.Tech. / Objective: Translation and validation of the Afrikaans version of the Roland Morris Disability Questionnaire and the Oswestry Disability Index. Methods: The English questionnaires were translated into Afrikaans. The translations were then scrutinized by a focus group in order to determine its face validity. After face validity was established, the content validity was determined by two subject experts. Both the original and the translated versions of the questionnaires were given to a study group to complete on two separate occasions. The results from the study group were then put through various psychometric evaluations in order to determine its concurrent validity and reliability. Results: Results indicated that the Oswestry Disability Index had a significant level of reliability (α=0.830) and although the reliability of the Roland Morris Disability Questionnaire was below a significant level (α<0.7) it was still deemed reliable as it corresponded with its English counterpart. Both the Roland Morris Disability Questionnaire and Oswestry Disability Index indicated significant levels of concurrent validity; however the Roland Morris Disability Questionnaire seemed to have a higher level of concurrent validity. Conclusion: Both the Roland Morris Disability Questionnaire and the Oswestry Disability Index were translated successfully and can now be used within the Afrikaans population as an alternative to the English versions. Low back pain is a very common medical problem with a great impact on a patient’s health and quality of life. According to a review conducted by Papageorgiou et al. (1995), 60-80% of the general world population will suffer from low back pain in some stage of their life. In South Africa, De Wet, Losco and Moodley (2003) conducted a study on the incidence and prevalence of low back pain on 355 ABSA Bank and Unibank employees. The results of the study showed that the lifetime incidence of low back pain was 63%, the 6 month prevalence of LBP was 41% and the point prevalence of LBP was 9.6%. Treatment was sought by 46.94% of the sample population primarily from pharmacies, chiropractors, medical doctors, and physiotherapists. In addition, the study also showed that this condition is costing the South African economy millions each year due to lost working days as a result of absenteeism. As a result, disability questionnaires are increasingly used for clinical assessment, outcome measurement of treatment of low back pain. However, the use in different cultural groups has led to the need for the translation and the cross-cultural adaptation of these questionnaires to aid practitioners in the accurate assessment of low back pain.