Thesis (MPH)--University of Limpopo, 2010. / The management of tuberculosis has undergone a lot of changes from fixed dose tuberculosis regimen, directly observed therapy short-course strategy (DOTS) to the introduction of international standards to tuberculosis care (ISTC) in order to reduce the burden of tuberculosis. The study investigated and described the experiences of private general practitioners regarding the knowledge of diagnosis and management of tuberculosis in Tshwane, Gauteng Province. The purpose of the research was addressed within a quantitative approach applying descriptive designs. A self-administered questionnaire was used to collect the data that fit the objectives of the research. In this study, the population applied to ninety-nine doctors of the Private General (Medical) Practitioners’ profession in a specific urban area, namely the municipal area Tshwane, Gauteng Province, with the following inclusive criteria as study units: practicing as a General Practitioner in Tshwane, which includes the city centre (Pretoria Central), Atteridgeville, Pretoria suburbs, Atteridgeville, Mamelodi, Eersterus, Garankuwa, Mabopane, Odi and Soshanguve and sessions appointment at public hospitals. The researcher drew a representative sample of the private medical practitioners with a random selection process whereby the first general practice in each area was selected randomly, and from there onwards the first three practice rooms, skipping the fourth practice room throughout the Guateng area where 90 private medical practitioners was reached. A total of 90 questionnaires were distributed to General Practitioners in the identified areas of Tshwane, Gauteng Province. A response of 59/90 (66%) was obtained, which compares favourably with the experience of other researchers. The study reveals that national TB guidelines are not properly followed by the respondents and that there is a need for public-private partnership in order to improve and enhance the diagnosis and management of tuberculosis in Tshwane, Gauteng Province.

The environment in which medical practitioners in South Africa and elsewhere in the world currently function demands more of them than did any previous period. Medical practitioners have to cope with the demands that arise from fulfilling various roles - often with limited resources. Tracking and addressing their effectiveness in coping with new demands and stimulating their growth in areas that could possibly impact on individual well-being and organisational efficiency and effectiveness are therefore crucial. Burnout and engagement of medical practitioners are specific focus areas for research and intervention in this regard. The objectives of this study were to conceptualise burnout and engagement from the literature and to determine the association between job stress, burnout and engagement. A survey design was used to reach the research objectives. The specific design is the cross-sectional design, whereby a sample of medical practitioners was drawn from a population at one time. An accidental sample (n = 68) was taken from medical practitioners in South Africa. Three questionnaires were used in this study, namely the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), the Utrecht Work Engagement Scale (UWES) and the Job Stress Indicator (JSS). Descriptive and multivariate statistics were used to analyse the data. Effect sizes were used to determine the significance of findings. The results showed that there is a correlation between vigour and personal accomplishment. The medical practitioners tested proved to be absorbed in their work and have high levels of vigour. It shows that stress because of a lack of resources and high job demands leads to emotional exhaustion. Medical practitioners who do not have relevant resources seem to become negative, callous and cynical. It also concluded that if medical practitioners do not have relevant resources and high job demands, the results can be lower energy levels and a lack of enthusiasm, inspiration and pride in their work. There was a practically significant relationship between burnout and engagement. Recommendations for future research are made. / Thesis (M.Com. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2004.

The environment in which medical practitioners in South Africa and elsewhere in the world currently function demands more of them than did any previous period. Medical practitioners have to cope with the demands that arise from fulfilling various roles - often with limited resources. Tracking and addressing their effectiveness in coping with new demands and stimulating their growth in areas that could possibly impact on individual well-being and organisational efficiency and effectiveness are therefore crucial. Burnout and engagement of medical practitioners are specific focus areas for research and intervention in this regard. The objectives of this study were to conceptualise burnout and engagement from the literature and to determine the association between job stress, burnout and engagement. A survey design was used to reach the research objectives. The specific design is the cross-sectional design, whereby a sample of medical practitioners was drawn from a population at one time. An accidental sample (n = 68) was taken from medical practitioners in South Africa. Three questionnaires were used in this study, namely the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), the Utrecht Work Engagement Scale (UWES) and the Job Stress Indicator (JSS). Descriptive and multivariate statistics were used to analyse the data. Effect sizes were used to determine the significance of findings. The results showed that there is a correlation between vigour and personal accomplishment. The medical practitioners tested proved to be absorbed in their work and have high levels of vigour. It shows that stress because of a lack of resources and high job demands leads to emotional exhaustion. Medical practitioners who do not have relevant resources seem to become negative, callous and cynical. It also concluded that if medical practitioners do not have relevant resources and high job demands, the results can be lower energy levels and a lack of enthusiasm, inspiration and pride in their work. There was a practically significant relationship between burnout and engagement. Recommendations for future research are made. / Thesis (M.Com. (Industrial Psychology))--North-West University, Potchefstroom Campus, 2004.

Thesis (M.D.)--University of Adelaide, Dept. of Public Health, 1998. / Includes bibliographical references.

M.Fam.Med., Faculty of Health Sciences, University of the Witwatersrand, 2009 / Trauma is a pandemic that has a significant negative impact on the lives of its victims and national economies. This descriptive study was conducted on 103 private medical general practitioners in Limpopo Province. Ethical approval for the study was obtained from the University of the Witwatersrand Committee for research on Human Subjects (Medical). Approval protocol number M050230. The aim of the study was to determine the state of pre-hospital trauma care: training and preparedness of and practice by private medical general practitioners (GPs) in Limpopo Province. Data was collected by means of an anonymous, confidential, self-administered questionnaire. The objectives were to determine demographic features of the respondents; determine the status of emergency pre-hospital trauma training, preparedness and practice amongst the respondents; and to determine their incentives and disincentives to trauma medicine training, preparedness and practice in Limpopo province. The response rate was 36%. Fifty five per cent (55%) of the respondents had received trauma training since they commenced work as GPs. The proportion of GPs who said that they received trauma training while working in hospitals casualty departments was 52%. The number of respondents who completed ATLS was 24 (23%). Five (21%) of those who had completed ATLS updated their qualifications during years 2001 to 2005. Of the GPs surveyed 46% were not aware of ATLS course offered by the College of Emergency Care at Polokwane City. The majority of the respondents graduated as medical practitioners from the university of Pretoria (38%) and MEDUNSA (31%). But undergoing trauma management training was not associated with the medical schools from which 4 respondents graduated as medical practitioners (p=0.767; Fisher’s exact=0.827; Pearson chi2 = 4.9075). The medical schools from which respondents graduated as medical practitioners was also not related to the amount of private medical practice that comprised emergency care (p= 0.372). Undergoing trauma training was not associated with the age of a GP (p value= 0.120; Fisher exact=0.127). Sex was not found to be associated with trauma training (p=0.895; Fisher exact=1.000). Sex also had no link to the proportion of medical practice comprising emergency care (p-value=0.153; Fisher ‘s exact=0.214; Pearson Chi2). Even though location of GP’s practice was reported to be both an incentive and disincentive to trauma management training it was found not to be associated with trauma management training (p=0.393; Fisher exact=0.426; Pearson chi2 =1.5687) There was no association between location of GP’s practice and preparedness for trauma management. The exception to the finding was in terms of availability of chest drains where the p-value was 0.001. It was found that 31% of respondents who indicated that they had chest drains were based in rural areas while about 6% were practicing in urban areas. Availability of morphine and other analgesics (p-value=0.025, Fisher’s exact=0.038, Pearson Chi2 (1)=5.0165) were associated with preparedness for trauma. There was no association between type of GP practice and trauma management training (Pearson Chi2 (2) =2.1242. p- value = 0.346. Fisher’s exact = 0.429). Almost 95% of those who stated that they spent at least 50% of their time in private general medical practice were full-time. Being in full-time private general medical practice did not necessarily translate into a higher proportion of the practice that comprised trauma care. It was found that 64% of the respondents who were in full-time private general medical practice had an emergency trauma care burden of less than 10% compared to 36% that had a proportion of 10% and more. Amongst part-time practitioners the percentage of those whose burden of trauma care was less than 10% was equal to that of those with 10% and more. The findings implied lack of an association between time spent in private general medical practice and proportion of the practice that constitutes trauma care (p=0.621). The commonest method of updating trauma management skills was through personal study (37% of respondents) followed by attendance of trauma meetings (24% of respondents). Trauma trained GPs tended to have a higher proportion of their practices that comprised emergency trauma care (p-value = 0.030; Fisher’s exact =0.050) than those who had not. The frequently used sources of trauma management information were personal experience (58%) of the respondents followed by continuing medical education (50% of respondents). Almost 50.8% of the respondents reported that they were fairly skilled to manage in a pre-hospital setting various types of injuries. Minor soft tissue injuries were the type of trauma that 68% of the respondents said that they could manage excellently. Incentives factors to both trauma training and practice were high trauma prevalence (33.3% of respondents-training: and 20.7% of respondents-practice); performance improvement (20% of respondents-training: 12.1% of respondents respectively-practice); adequate and managed trauma care facilities (17% of respondents-training: 10.4% of respondents-practice); trauma care support (6.7% of respondents-training: 6.9% of respondents-practice); the need to improve trauma knowledge and skills (17% of respondents-training: 17.2% of respondents-practice) and; strategic GP practice location (7% of respondents-training: 6.9% of respondents-practice). Major disincentives to both trauma training and practice were lack of time for trauma care (28.9% respondents-training: 14.9% respondents practice); unsupportive staff (10% respondents-training: 14.9% respondents-practice); perceived high cost of trauma care and poor rewards (15.6% respondents-training: 11.7% respondents-practice); substandard and inaccessible trauma care facilities (15.6% respondents-training: 24.5% respondents-practice); under-utilized trauma knowledge and skills (6.7% respondents-training: 4.3% respondents-practice); 6 restrictive healthcare regulations and policies (2.2% respondents-training: 2% respondents-practice); and low number of trauma patients seen (11.1% respondents-training: 3.2% respondents-practice). In terms of preparedness for trauma the respondents were ill-prepared for trauma as evidenced by insufficient trauma equipment and drugs. Whereas almost all the respondents (frequency 102 or 99%) had stethoscopes only 7% had cricothyrotomy set. Only 18% of them had needle with one-way valve and chest drains. The trauma drug that appeared to have been the most widely stocked was adrenaline with a frequency of 96 or 93%. It was followed by aspirin with a frequency of 95 or 92%. Ketamine and zidovudine were drugs that were least stocked by the respondents. Their frequencies were 27 or 26%) and 33 or 32% respectively. The other equipment that was infrequently available at GPs’ rooms was goggles (frequency 46%) suggesting poor adherence to safety measures. There were low levels of preparedness to manage trauma patients independently with 43% reporting that they could independently adhere to universal safety measures. Whereas 52% of the respondents stated that they had received training in CPR 54.5% stated that they were equipped and prepared to open and protect the airway; 43% could independently provide adequate breathing while 45% of them could restore and maintain sufficient circulation, indicating a need to improve levels of CPR training. It was recommended that more general practitioners in Limpopo province should be trained and involved in trauma care. It was further recommended that awareness should be raised about the ATLS offered at the College of Emergency Care in Polokwane City. Further research is needed to explore how trauma trained GPs could be better equipped, prepared and supported in the management of trauma. There was also a need to address the disincentive factors to trauma training, preparedness and practice while strengthening the incentives. Given the critical shortage of advanced emergency practitioners (such as paramedics) in Limpopo province, there was perhaps a need to consider how GPs, with their 7 advanced medical qualifications and strategic positioning within communities, could be better deployed in pre-hospital trauma care.

Background Evidence-based medicine (EBM) involves the care of patients using the best available evidence from the results of good quality clinical research to guide clinical decision making 1 – 3. By incorporating the principles of Evidence-based Medicine (EBM), the family practitioner would be able to treat a patient according to the best clinical research available. This principle is implemented widely in the USA, Canada, the United Kingdom and Europe. In South Africa, however, EBM is not yet as widely incorporated into family practice. This is so despite the plethora of websites available to practitioners and the relative ease with which applicable research evidence can be found. Very few published studies are available regarding EBM or Evidence–based Practice (EBP) in the South African context. The findings of this study would thus highlight reasons and/ or barriers preventing family practitioners from implementing EBM in their respective practices. This could also lead to further research into possible methods of implementation of EBM into South African family practices. Aim: The aim of the study was to describe the perceptions, knowledge and attitudes of private practitioners regarding evidence based practice and to identify the barriers encountered in evidence based practice. Methods A questionnaire survey of general practitioners in Gauteng, South Africa, was conducted. Questionnaires were distributed to a random sample of practitioners in the Gauteng region. Two hundred and twenty one (221) practitioners participated in the survey and responded to questionnaires mailed to them. The questionnaire was mailed, faxed or e-mailed to the practitioners, which they then completed and returned for statistical analysis. Study design The study design is that of quantitative, statistical analysis (descriptive cross-sectional survey). Setting General practitioners were randomly selected from a list of practitioners in the Gauteng Province. Doing a nationwide survey would have been a mammoth undertaking. It was therefore decided to limit the research to one province and therefore it was only concentrated on practitioners practicing in the Gauteng area. Results It is interesting to note that of the two hundred and twenty one participants in this study; only 10% of the practitioners were against using EBM in their practices. This, however, stands in stark contrast to the 56% of practitioners who do not implement EBM in their practices or make use of the EBM principle at all. The major barriers preventing practitioners from implementing EBM is depicted in the following graph: Lack of time and the training in aspects of Evidence-based medicine were the main barriers preventing the full scale implementation of EBM in family practices in Gauteng. Conclusion Participating Gauteng doctors were in principle, very positive towards the implementation of EBM in their respective practices. Most of the participants agreed that EBM would benefit their patients’ care and treatment. Very few of the participants, however, make use of EBM in practice. A lack of training and time constraints were the main barriers with regards to the implementation of EBM. Proper training of medical students at undergraduate level at faculties of health sciences, would go a long way assisting prospective doctors in mastering the concept of EBM and increasing their overall awareness of EBM. Further definitive research would assist in establishing whether such awareness would be associated with improved implementation of evidence in the form of evidence based guidelines in practice.

Includes bibliographical references. / 2 v. ; / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Primarily a study of the reasons for the rise, after 1840, of the medical profession in South Australia. The principal argument is that the basic power and influence of the medical practitioner derived from statute. Of almost equal importance was the organised profession's adoption of, and association with, science and technology. / Thesis (M.D.)--University of Adelaide, Dept. of Public Health, 1998

Thesis (MBA (Business Management))--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Recent years have been witness to the co-existence of incredible advances in human well-being and healthcare development on the one hand and extreme deprivation and a significant drop in numerous health indicators on the other. Central among this paradox lies the key to accessible, comprehensive and dedicated healthcare - the health workforce and the numerous factors impacting on health professionals and health professional data. Key to health care human resource planning is a comprehensive understanding of the environment and demands that health professionals are faced with. This must be supported by knowledge of the profile of health professionals in a specific country and should lead to detailed health resource planning, based on benchmarks and analytical interpretation of the factors that both determine and influence the number of health professionals. This research report provides an abbreviated background to the local and international health sectors, profiles the current number and distribution of medical practitioners and selected medical specialists in the country and internationally, identifies the key factors for consideration in projecting the number of medical practitioners and medical specialists required for South Africa and proposes a framework for taking the process forward. The research showed that, while there are positive aspects to the South African health professional environment, the country faces dire regional disparities and does not compare favourably to many of its international peers in terms of health professional resources. The key aspects that influence health human resources were identified and it became clear that sustainable and comprehensive health resource planning is not a mere matter of ratios, but is indeed dependent on a number of critical success factors. It is critical that health human resource planning in South Africa requires urgent and comprehensive attention. Failure to address this urgently will result in a health care system continuing to struggle to meet the health care needs of the population. A structured approach is possible, but requires dedication and careful planning. / AFRIKAANSE OPSOMMING: Die laaste paar jare is gekenmerk deur die kontras van indrukwekkende vooruitgang in lewenskwaliteit en gesondheidsorg aan die een kant en ekstreme tekortkominge en die verswakking van gesondheidstatistieke aan die ander. Sentraal tot hierdie paradoks is die sleutel tot toeganklike, omvattende en toegewyde gesondheidsorg - die gesondheidswerkers en die vele faktore wat gesondheidswerkers en - data beinvloed. Die kern van gesondheidsorg menslike hulpbronne beplanning is 'n omvattende begrip van die omgewing en vereistes waaraan gesondheidswerkers blootgestel word. Dit moet ondersteun word deur in diepte kennis van die gesondheidswerker profiel binne in 'n spesifieke land en behoort te lei tot gedetaileerde gesondheidsorg menslike hulpbronne beplanning, na aanleiding van toepaslike verwysingsraamwerke en 'n analitiese interpretasie van die faktore wat die aantal gesondheidswerkers beide bepaal en noodwendig beinvloed. Hierdie navorsingsverslag verskaf 'n sinoptiese agtergrondskets van die nasionale en internasionale gesondheidsektore, gevolg deur die profiel (getalle en verspreiding) van die algemene praktisyns en geselekteerde mediese spesialiste, beide in Suid Afrika en internasionaal. Dit identifiseer die belangrikste faktore vir oorweging in die projeksie van die aantal algmene praktisyns en mediese spesialiste benodig en sluit af met 'n voorgestelde raamwerk vir voortgesette omvattende beplanning. Die navorsing het getoon dat, alhoewel die Suid Afrikaanse gesondheidswerker omgewing deur positiewe aspekte gekenmerk word, die land steeds onderworpe is aan daadwerklike streeks ongelykhede en boonop nie besonder positief vertoon teenoor ander soortgelyke lande nie. Die kern kwessies wat gesondheidswerkers beinvloed is geidentifiseer en dit is duidelik dat onderhoudende en omvattende gesondheidsorg beplanning nie bloot die toepassing van ratios is nie, maar dat dit onderhewig is aan 'n groot verskeidenheid kritiese sukses faktore. Dit is van kritiese belang dat gesondheid menslike hulpbronne beplanning in SA daadwerklike aandag geniet. Die nalaat van hierdie verantwoordelikheid, sal lei tot 'n gesondheidsisteem wat nie in staat is om aan die behoeftes van die land te voldoen nie. 'n Gestruktureerde benadering is moontlik, maar verdien toewyding en beplanning.

Thesis (MScMedSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: A survey was conducted between 3 August and 5 October 2011 to test and evaluate the knowledge and attitudes of the military and civilian medical practitioners at the royal medical Service in the kingdom of Bahrain with regards to the clinical application of hyperbaric oxygen therapy. The survey consisted of a questionnaire and a semi-structured interview in which a total of 93 (out of a possible 302) medical practitioners were included (13 participated in the interviews). Similar to findings of previous studies, the knowledge of medical practitioners in Bahrain regarding hyperbaric oxygen therapy was low. Several practitioners were able to mention at least one indication for the therapy. No single factor had a statistically significant association with knowledge or the lack thereof. A large proportion of the participants had a positive attitude towards the use of hyperbaric oxygen therapy, felt that it is a valid treatment modality and they would refer their patients for such treatment. They would like to receive more information on hyperbaric oxygen therapy. Educational interventions to address the knowledge gap would likely be effective, since most participants have a positive attitude towards the therapy and believe that it is cost-effective.

Tuberculosis (TB) is a major public health problem in many parts of the world. Nigeria is one of the 30 countries in the world that has the highest burden of TB. Private medical practitioners in Nigeria play an important role in health care delivery. Motivating them to adhere to TB treatment guidelines in managing persons suspected of having TB or diagnosed with the disease is one of the strategies employed by the National Tuberculosis Program to Reduce the Burden of TB. Few studies were identified which used qualitative study approaches to study the perceptions of these practitioners towards the TB treatment guidelines. The overarching question asked the study participants centered on eliciting their perceptions towards the guidelines. Guided by the theory of planned behavior, this qualitative narrative study explored the perceptions of private medical practitioners in Anambra State, Nigeria towards the Nigerian National TB Treatment Guidelines. To elicit these perceptions, in-depth interviews were conducted on 11 purposefully selected practitioners. Data analysis comprised coding of data obtained and extracting themes from them. The QSR Nvivo 11 helped to manage data. The main finding of the study was that the practitioners perceived the treatment guidelines to be adequate to meet most of their needs in the diagnosis and treatment of TB patients. Other key findings were that provision of financial incentives and regular training will motivate collaboration with the TB program and adherence to the guidelines. Positive social change may occur by insight being gained into how private medical practitioners view the treatment guidelines and how this knowledge will lead to improved management of TB patients. This may in turn result in the reduction in the morbidity and mortality associated with TB in Nigeria.