Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Thesis (M.A.)--The Master's College, 2001. / Includes bibliographical references (leaves 161-165).

Thesis (M.Psych.Clin.) - University of Queensland, 2004. / Includes bibliographical references.

Thesis (M.D.)--University of Hong Kong, 1984. / Also available in print.

Thesis (Ph.D.) - University of Queensland, 2006. / Includes bibliography.

Abstract Chronic wounds afflict millions worldwide, incurring significant health care costs and chronic suffering. Clinicians are often unsure about treatment, resulting in poor outcomes. Objective To determine the scope of knowledge possessed by fifth year medical students, general practitioners (GP’s) and surgical registrars, concerning chronic wound management. Design Cross sectional study Methods Deans of eight South African medical schools received letters requesting information regarding time devoted to wound-care training. Knowledge-based questionnaires were distributed to final-year students at two universities, surgical registrars at three universities and general practitioners attending refresher courses. Result. Four medical schools replied, of whom only two offered formal teaching. 162 medical students, 45 GP’s and 47 surgical registrars completed questionnaires. The overall median (25th–75th percentiles) knowledge scores for registrars, GP’s and students were 65%;(55%–70%), 55%;(45%–65%) and 45%;(35%–50%) respectively. Whereas the scores of registrars and GP’s did not differ, the student scores were significantly less. Only 32% of registrars and 18% of GP’s attained scores of 70% or more. 96% considered training to be inadequate. Interest in wound-care was only mild to moderate, with more GP’s than registrars requesting literature. Conclusions Very little, if any training on chronic wounds is offered in South Africa. The levels of knowledge cannot be considered adequate for successful treatment, nor for teaching to undergraduates. This preliminary study cannot reflect the attitudes and knowledge throughout the country; however it is clear that there is a need for improved education about these conditions that have huge clinical and economic consequences.

A hermeneutical model of doing research is adopted to investigate the process of coping and self-management in the experience of recovering from Chronic Fatigue Syndrome (CFS). Three research participants who consider themselves as recovering or recovered from CFS were interviewed to obtain data for analysis. The findings are that once the participants cope with the uncertainty about the meaning of the onset of symptoms by defining themselves as ill in somatic terms, the participants use external social and treatment resources to cope with the onset of symptoms and being chronically ill with CFS. As a consequence of feeling stigmatised in relation to social and professional scepticism about initially being ill and subsequently, being chronically ill with CFS, the participants become uncertain about the meaning of having CFS. Coping shifts to using internal resources by adopting self-management practises. In this process, firstly, existing self-management shifts in such a way that the participants view themselves as recovering or recovered from CFS, and secondly, the participants come to the understanding that difficulties with self-management cause and maintain CFS. The findings are discussed to conclude that CFS may be a misdiagnosis of difficulties with self-management. CFS itself may not be an 'objective' disorder, but a constituent of social processes. Becoming diagnosed with CFS arises as a consequence of the search for meaning in relation to the lay and professional assumption that psychological illness does not constitute 'real' illness, operating at both the levels of popular society and the doctor-patient relationship. Difficulties with self-management rather than the diagnosis of CFS provide a more adequate understariding of the participants' illnesses. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

Introduction: Activity pacing is often advised as a coping strategy for managing chronic conditions (such as chronic low back pain, chronic widespread pain and chronic fatigue syndrome/myalgic encephalomyelitis). Despite anecdotal support for activity pacing, there is limited and conflicting research evidence regarding the efficacy of this strategy. Pacing has not been clearly operationalised, and existing descriptions are diverse and include strategies that encourage both increasing and decreasing activities. Moreover, there are few validated scales to measure activity pacing. Aim: To develop an activity pacing questionnaire (APQ) for adult patients with chronic pain and/or fatigue, and to determine its psychometric properties and acceptability. Methods: The study had a three stage mixed method design. Stage I, the Delphi technique involved a three-round consensus method to develop the initial items of the APQ using an expert panel of patients and clinicians. Stage II, the psychometric study, implemented a cross-sectional questionnaire design study, involving a large sample of patients with chronic conditions. This stage assessed the underlying pacing themes of the APQ using factor analysis, internal and test-retest reliability using Cronbach’s alpha and intraclass correlations (ICCs); and validity using correlations with validated measures of pain, fatigue, anxiety, depression, avoidance, and mental and physical function. Stage III, the acceptability study, explored patients’ opinions of the APQ, together with the concept of activity pacing via telephone interviews. The qualitative interview data were analysed using framework analysis. Results: Forty-two participants completed Stage I, the Delphi technique (4 patients, 3 nurses, 26 physiotherapists and 9 occupational therapists). The resulting APQ contained 38 questions involving a number of different facets, including breaking down tasks, gradually increasing activities and setting goals. Stage II, the psychometric study, was completed by 311 patients, of whom 69 were involved in a test-retest analysis. Following factor analysis, eight items were removed from the APQ. Five themes of pacing were identified in the 30-item APQ: Activity limitation, Activity planning, Activity progression, Activity consistency and Activity acceptance. These demonstrated satisfactory internal consistency, test-retest reliability, and construct validity against validated measures. Activity limitation, Activity planning, Activity progression and Activity acceptance correlated with worse symptoms, and Activity consistency correlated with improved symptoms. Sixteen patients participated in Stage III, the acceptability interviews. The APQ was found to be generally acceptable. Four activity behaviour typologies emerged through the interviews: Task avoidance, Task persistence, Task fluctuation (boom-bust) and Task modification (activity pacing).Conclusion: This is the first known study that has engaged both patients and clinicians in the development of an activity pacing questionnaire. Developed to be widely used across a heterogeneous group of patients with chronic pain and/or fatigue, the APQ is multifaceted, comprehensive and contains more themes of pacing than existing pacing subscales.