M.Tech. / Mammography is most important in the detection of breast cancer but due to its intimate nature and the perception that it is uncomfortable and painful, many women do not optimally support mammography as a diagnostic and screening tool for breast cancer. Many factors influence the mammogram experience of patients. This research explored the preferences and perceptions of patients regarding mammographer gender and personality traits as well as student involvement in mammogram procedures. To promote positive perceptions of mammography and to ensure the availability of adequately trained mammographers to meet the future demands of the profession, the preferences and perceptions of patients and training needs of students should be carefully balanced. The study was empirical in nature and data was collected using a valid and reliable self-formulated questionnaire. The approach was quantitative and a small qualitative component added dimension to the quantitative results. A nonprobability, convenience sampling method was employed and questionnaires were distributed in radiography training centres affiliated to the University of Johannesburg. Data analysis indicated that while many women accept males in the mammography setting, most prefer female mammographers and -students. In general, women accept student presence during mammogram procedures. Personality traits that enhance effective communication and promote patient emotions such as trust, being safe and being cared for are favoured by patients. This research adhered to stipulations of the South African Patients' Rights Charter and the call of the Breast Cancer Advocacy Coalition for South African research into breast health care. The findings serve as benchmarks for patient opinions regarding mammography staff and will be of use in various fields concerning mammography, such as human resources, training and education and quality assurance of care.

D.Cur. / Psychiatric nurses are constantly in interaction with psychiatric patients, families, psychiatrists, auxiliary nurses and other multidisciplinary team members. Psychiatric nurses, during their basic training, have to complete the course in interpersonal skills and methods. However, some psychiatric nurses during their interaction with psychiatric patients, families, psychiatrists and auxiliary nurses behaved aggressively and passively towards them. This has led to this research study aimed at describing a model for facilitation of continuous assertiveness for psychiatric nurses. A theory-generative design which is qualitative, explorative, descriptive and contextual in nature was followed. The research method were dealt with in four steps in theory generation in the following manner: Step 1 - Concept analysis This step was dealt with in two phases namely concept identification and concept definition. During concept identification a qualitative research strategy which is explorative, descriptive and contextual was used. This was attained through field research conducted in a specified urban psychiatric hospital in Gauteng Province. The sample consisted of twelve psychiatric nurses and were purposively selected. Four different scenarios were role-played, each scenario was role-played twelve times. Each scenario lasted approximately forty-five minutes. One advanced psychiatric practitioner from a different hospital took the role of psychiatric patient, family psychiatrist and auxiliary nurse. Videotaped recordings, transcripts of videorecordings, non-participating observational field notes as well as written feedback were used as methods of data collection. Data were analysed according to the protocol of Tesch 1990 (in Creswell, 1994 : 155) and Bottorff (in Schurink & Poggenpoel, 1998 : 329) in analysing the videotape recordings. An independent coder helped in coding the results of videotapes. The researcher concluded from the results obtained from the fieldwork that psychiatric nurses are unable to facilitate interaction through assertive behaviour. This research was characterised by repetitive aggressive and passive behaviour of psychiatric nurses when in interaction with others. The result was validated through literature control. The major concept of the model was identified as "facilitation of continuous assertiveness" for psychiatric nurses. The concept was analysed thoroughly by looking at different dictionaries (see bibliography) and subject usage. The defining attributes were identified and synthesised through a definition. The other related concepts were identified and classified by using a survey list of Dickoff, James and Wiedenbach (1968: 430). Step2 This step dealt with the creation of interrelationship statements between concepts identified in Step 1 so that concepts were able to stand in relation to one another. Step 3 This step dealt with the description of the model by using strategies proposed by Chinn and Kramer (1991 ). Step 4 This step dealt with the description of guidelines for model operationalisation in psychiatric nursing practice, psychiatric nursing education and psychiatric nursing research. The proposed model was evaluated by a panel of independent experts. To ensure valid results a model of trustworthiness proposed by Guba (Lincoln & Guba 1985) was used. The following criteria for trustworthiness were applied in all the steps of theory generation : truth-value, applicability, consistency and neutrality. Ethical measures were applied right through the research. An unique contribution in the model description is the facilitation of continuous assertiveness for psychiatric nurses by the advanced practitioner in psychiatric nursing.

No description available.

In partial fulfilment of the requirements for the degree Masters of Arts in Clinical Psychology, 2006. / The purpose of this research was to describe the experience of working with patients with HIV/AIDS, in particular performing caesarean sections, from a medical practitioner's perspective. A phenomenological study method was employed in which each participant used in the research was interviewed in a single session. The original sample consisted of 9 participants. They were selected by means of criterion sampling from the gynaecology and obstetrics department of different public hospitals in Johannesburg, Pretoria and Cape Town. Six protocols were selected for phenomenological explication based on the interviews with the 9 original participants. The sample consisted of 3 females and 3 males, from different cultural backgrounds, who regularly perform surgical gynaecological procedures on patients with HIV/AIDS. The results were presented in the form of an integrative text, which accounted for all of the individual variations of the experience of working with patients with HIV/AIDS. Out of this text the researcher explicated natural meaning units, specific to each participant, which were used in formulating a specific description of experiencing the performance of a caesarean section on a patient with HIV/AIDS. This study concluded with a discussion of the results, as well as a formulation of a general description of experiencing the performance of caesarean sections on patients with HIV/AIDS for all 6 participants. Overall, this research explicated unique descriptions of individual experiences, and contributes to a general understanding of the experience of performing a caesarean section on a patient with HIV/AIDS. Operational definitions • Phenomenology - A department of the inductive sciences concerned with the facts that form the basis of its system. • Caesarean section - A mode of childbirth in which a surgical incision is made through a pregnant woman's abdomen and uterus to deliver a baby. • Human Immunodeficiency Vinis- A retrovirus that attacks and severely damages the body's immune system and for which there is presently no cure. • Life-wortd- The space occupied by any one person in the external, physical world, as well as the internal lived-in world, consisting of emotions and cognitions.

This work explores the development and use of patient satisfaction evaluation system in a family practice setting. The goal was to develop a system that would minimally interfere with the delivery of care while simultaneously disclosing sources of patient satisfaction and dissatisfaction. The information would then be used to improve aspects of patient care and service delivery.

The rapid adoption of Electronic Health Records (EHRs)--electronic versions of a patient's medical history--has been instrumental in streamlining administrative tasks, increasing transparency, and enabling continuity of care across providers. An unintended consequence of the increased documentation burden, however, has been reduced face-time with patients and, concomitantly, a dramatic rise in clinician burnout. Time spent maintaining and making sense of a patient's electronic record is a leading cause of burnout. In this thesis, we pinpoint a particularly time-intensive, yet critical, documentation task: generating a summary of a patient's hospital admissions, and propose and evaluate automated solutions. In particular, we focus on faithfulness, i.e., accurately representing the patient record, and completeness, i.e., representing the full context, as the sine qua non for safe deployment of a hospital-course summarization tool in a clinical setting. The bulk of this thesis is broken up into four chapters: §2 Creating and Analyzing the Data, §3 Improving the Faithfulness of Summaries, §4 Measuring the Faithfulness of Summaries, and, finally, §5 Generating Grounded, Complete Summaries with LLMs. Each chapter links back to the core themes of faithfulness and completeness, while the chapters are linked to each other in that the findings from each chapter shape the direction of subsequent chapters. Given the documentation authored throughout a patient's hospitalization, hospital-course summarization requires generating a lengthy paragraph that tells the story of the patient admission. In § 2, we construct a dataset based on 109,000 hospitalizations (2M source notes) and perform exploratory analyses to motivate future work on modeling and evaluation [NAACL 2021]. The presence of highly abstractive, entity dense references, coupled with the high stakes nature of text generation in a clinical setting, motivates us to focus on faithfulness and adequate coverage of salient medical entities. In § 3, we address faithfulness from a modeling perspective by revising noisy references [EMNLP 2022] and, to reduce the reliance on references, directly calibrating model outputs to metrics [ACL 2023]. These works relied heavily on automatic metrics as human annotations were limited. To fill this gap, in §4, we conduct a fine-grained expert annotation of system errors in order to meta-evaluate existing metrics and better understand task-specific issues of domain adaptation and source-summary alignments. We find that automatically generated summaries can exhibit many errors, including incorrect claims and critical omissions, despite being highly extractive. These errors are missed by existing metrics. To learn a metric which is less correlated to extractiveness (copy-and-paste), we derive noisy faithfulness labels from an ensemble of existing metrics and train a faithfulness classifier on these pseudo labels [MLHC 2023]. Finally, in § 5, we demonstrate that fine-tuned LLMs (Mistral and Zephyr) are highly prone to entity hallucinations and cover fewer salient entities. We improve both coverage and faithfulness by performing sentence-level entity planning based on a set of pre-computed salient entities from the source text, which extends our work on entity-guided news summarization ([ACL, 2023] and [EMNLP, 2023]).

This study examined healthcare providers’ adherence to the national Tuberculosis guidelines (NTG) during the diagnosis and treatment of TB in Addis Ababa, Ethiopia using a descriptive, cross-sectional study design. Data were collected from 233 medical records using checklists. Adherence of healthcare providers to the NTG during the diagnosis of TB was 60.9% (n=67) for female and 56.1% (n=69) for male TB patients. However, 91.8% (n=101) female and 90.2% (n=111) male TB patients had been prescribed the correct numbers of anti-TB pills, complying with the NTG recommendations. There was an over-diagnosis of smear negative pulmonary Tuberculosis (PTB) as only 2.6% (n=2) of the 76 smear negative PTB patients were diagnosed correctly. Healthcare providers’ compliance with the NTG could be enhanced by providing appropriate in-service education, maintaining accurate records of all TB patients and providing supportive supervision to identify and address shortcomings.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Medical error and patient safety have become important issues. It is clear that medical error is more influenced by systemic factors rather than human characteristics. Communication patterns, in particular interruptive communication, maybe one of the systemic factors that contribute to the burden of medical error. Objective: An exploratory study to examine interruptive communication patterns of healthcare staff within an intensive care unit during ward rounds. Methods: The study was conducted in a tertiary hospital in Sydney, Australia. Nine participants were observed individually, for a total of 24 hours, using the Communication Observation Method (COM). The amount of time spent in conversation, the number of conversation initiating and number of turn-taking interruptions were recorded. Results: Participants averaged 75% [95% confidence interval 72.8-77.2] of their time in communication events during ward rounds. There were 345 conversation-initiating interruptions (C.I.I.) and 492 turn-taking interruptions (T.T.I.). C.I.I. accounted for 37% [95%CI 33.9-40.1] of total communication event time (5hr: 53min). T.T.I. accounted for 5.3% of total communication event time (56min). Conclusion: This is the first study to specifically examine turn-taking interruptions in a clinical setting. Staff in this intensive care unit spent the majority of their time in communication. Turn taking interruptions within conversations occurred at about the same frequency as conversation initiating interruptions, which have been the subject of earlier studies. These results suggest that the overall burden of interruptions in some settings may be significantly higher than previously suspected.

The United States population continues to increase and diversify. The cultural composition within the United States embodies a multitude of people from a variety of belief systems, religious backgrounds, and ethnicities. Within current biomedical practice, many of these differences are often marginalized, leaving populations with unsatisfactory experiences in seeking health care. Cultural competency attempts to address those differences in health care delivery. Many health care institutions are striving to become more culturally competent yet there is not a common understanding of what cultural competency means. In addition, there are many obstacles that limit the implementation of cultural competency in health care delivery. This thesis examines the need for cultural competency in health care, addressing the lack of understanding between institutions regarding cultural competency and assessing its understanding at one particular institution. Recent research at Oregon Health & Science University in Portland, Oregon has provided new insight to the discussion of cultural competency and how uniquely it can be defined in a single institution. Qualitative interviews were conducted with medical students, physicians/physicians-in-training, administrators and nurses/CMA in order to uncover how cultural competency is defined as well as the issues that are involved when delivering culturally competent health care. By being aware of an institution's cultural composition and understanding of cultural competency can help that institution enact health programs and policies that have a better chance of representing and respecting the populations they serve. / Graduation date: 2003