This dissertation evaluated the provision of two different one-to-one educational interventions, randomly assigned, to two separate groups of medical practitioners at a health maintenance organization (HMO), Cigna Healthplan of Tucson, Arizona. A control group received no intervention. Each group consisted of seven physicians and one nurse practitioner. The intervention was aimed at improving the prescribing of the anti-ulcer drugs, cimetidine, ranitidine, and sucralfate. The theoretical basis for the study involved the cognitive principle of vividness, which implies that more vivid information has greater effect on decisions. For this research, the vivid intervention included case scenarios, while the non-vivid intervention included statistical information of the results of a drug use review. Prescribing data, consisting of percentages and cost of inappropriate prescriptions, were collected for one month prior to and for two months after the intervention. Analysis of covariance was employed with the pre-intervention measures of prescribing as the covariate in each test and post-intervention measures as the dependent variables. No differences were found between the two interventions, but the control group was significantly different from the intervention groups. For the first post-intervention month, it was found that the interventions resulted in significantly lower percentages of prescriptions written inappropriately for indication, dose, or duration (P = 0.001). These percentages decreased by 36% for the intervention groups, while increasing by 14% for the control group. Costs of inappropriate prescribing per study prescription and per patient encounter were also significantly lower for the intervention groups than for the control group (P = 0.001 and P = 0.019, respectively). In the second post-intervention month, inappropriate prescribing increased slightly in the intervention groups and were no longer significantly different from the control group. The research demonstrated the effectiveness of a one-to-one educational intervention in improving drug prescribing at an HMO. The lack of differences between the two interventions may have been due to the overall effectiveness of the one-to-one educational discussion, the interpretation of the statistical information as prescribing feedback by the practitioners, or the inadequate presentation of vividness in the case scenarios.

This thesis examines how an integrative and preventative healing center is necessary for the wellness of our society and military personnel by understanding how food can react positively or negatively to someone's health depending on their blood type and the lifestyle they lead. The Health care profession predominantly focuses on curing disease while the preventative solutions are often overlooked and underestimated. Those who have food allergies' and what may seem to be a simple reoccurring sickness have very few places to go for guidance or real help since their problems are not considered a disease'. But the years of contamination could cause a complete immune system failure leading to cancer or some other life threatening disease. Our world once lived as one with nature relying on the earth's natural healing plants and foods. We were once fully dependent on it for healing but now we have isolated ourselves causing pain and confusion to not only our mind and body but to our earth and our environment. Misguided, lost and alone. This thesis responds to the problem of medical physicians overlooking or ignoring the natural healing aspects of plants and food and how our nation has become a fast food' processed nation that has caused an increase in health problems and blood disorders. A holistic healing arts center and resort. will combine the traditional medical practices with the alternative therapies to provide a treatment facility that is in search for the answers on an individual level. The patient or visitor will be the educated on their blood type and what types of food and fitness will be best to enhance their lives and create a daily balance for optimum wellness. / US Navy (USN) author.

Background: Physician migration is gaining attention worldwide. Despite increasing numbers of foreign physicians in Germany, their perceptions on working in Germany remain unexplored. Within a large survey on Saxon physicians, the aim of this study was to elucidate whether foreign-national physicians’ job satisfaction differed from German physicians' job satisfaction. Methods: The study was designed as a comprehensive cross-sectional survey. All physicians ≤40 years and registered with the State Chamber of Physicians of Saxony (n = 5956) were mailed a paper-pencil questionnaire, of which 2357 were returned (response rate = 40 %). Questionnaires addressed socio demographics and assessed job satisfaction by asking participants to rate their satisfaction with the overall job situation and 20 different aspects on a 5-point Likert scale (1 = very dissatisfied to 5 = very satisfied). Results: Ten percent of participants were foreign-national physicians. The three main countries of origin were the Czech Republic, Slovakia, and Poland. Foreign-national physicians were more satisfied with aspects related to patient care, such as "possibility to treat patients as you deem optimal" and "relationship with patients". However, they were less satisfied with aspects related to human relations, such as "work atmosphere", relationship with co-workers, and "social status". Foreign-national physicians were also less satisfied with the aspect "work enjoyment". Conclusions: Further research on determinants promoting foreign-national physicians' job satisfaction is needed as their professional well-being may influence quality of patient care. Measures teaching cross-cultural competence and awareness may be beneficial for both foreign-national and German physicians.

MEDICAL PRESCRIPTIONS IN CYPRUS Author: Papadopoulos V. Philippos Tutor: RNDr. Jana Kotlářová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis is to get: current knowledge about medical prescriptions (MP) in Cyprus and rules of their use their basic division according their kinds, formal look, practical handle, payment knowledge of the current Health system of Cyprus Results: The Health system of Cyprus is a unique arrangement in the EU since is a simultaneous participation of public and the private sector which has many phenomena of inequality and non- accessibility mainly from the economically weaker. In the future plans of Ministry of Health is the complete redesign of entire Health System in a direction of electronic services for all the parts of health system chain including doctors, pharmacists and insured patients. The basic and significant informations about medical prescriptions in Cyprus according aim of diploma thesis are demonstrated in the Summary Table at chapter 11. All prescriptions in Cyprus are in common form for all type of drugs and there is no rule for size and color of the paper. Pharmacist is checking the signature of the doctor as well as name of the patient and...

MEDICAL PRESCRIPTIONS IN GREECE Author: Naoum I. Panagiotis Tutor: RNDr. Jana Kotlářová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis: The aim of diploma thesis is: to get current knowledge about medical prescriptions (MP) in Greece and rules of their use; to prepare its basic division according their kinds, formal look, practical handle with them and their payment; to get sample of different MP and finally to describe the current Greek health, pension and insurance system as a secondary aim. Results: In this diploma thesis it has been described the existing model of medical prescriptions in Greece and have been given adequate information about their basic divisions, their kinds, their formal look, and their compensation. Also it is described the course of the prescription, from the doctor to the pharmacist, harmonized with modern electronic prescribing. In the recent years (from 2009), Greece started the pilot implementation of e-prescribing for the modernization of public administration. This reform was established in order to fight against impunity and seemingly anti-ethical actions. The measure was certified by the laws of the Greek State, whereas the first results are starting to show...

This study deals with the development of the number and the age and sex structure of Czech physicians according their medical specialty in the period 2000-2010. The aim of the study is to identify which medical specialties are already problematic or could face the lack of physicians and demographic ageing in the future and on the other hand which medical specialties are popular among young physicians. Firstly, the Czech health system and particular groups of health workforce are introduced. After that follows the analysis of the number and the sex and age structure according their medical specialty. The cluster analysis which produces groups of medical specialties with similar characteristics of development of the number and the structure was used for schematic overview. The second part of the study is focused on the most numerous fourteen medical specialties. The number of medical school graduates, the number of attestations and the development of workload of physicians regarding the number of ambulant treatment and hospitalization is taken into account.

Background: In 2007, occupational specific dispensation (OSD) was introduced for public sector employees in South Africa which is unique to each identified occupation in the public service. The OSD for doctors was later introduced in 2009. The purpose of the OSD was to improve government's ability to attract and retain skilled employees, through increased remuneration. Previously, employees in the public service were remunerated by a single salary structure which did not adequately address the diverse needs of occupational categories in the public service (DPSA, 2009). Although the South African government has been investing a significant amount of resources to attract and retain medical doctors in public service, no formal study has been done to evaluate its impact in reducing the vacancy rate and retention of medical doctors in public hospitals in South Africa. This study aimed to assess the vacancy rate and the profile of doctors working at the Dr George Mukhari Hospital (DGMH) a public sector tertiary academic hospital for last three years (2007-2010) to determine the impact of OSD. Aim: To determine the impact of OSD on the vacancy rate and the profile of doctors working at the DGMH during a three year period (2007 to 2010) Methodology: A cross sectional study design was used to extract retrospective data routinely collected from the Personnel Salaries (PERSAL) system. Variables for the study included: Number of posts per category (Medical officer/ Registrar/ Specialist) funded/ filled and vacant, Profile (age, gender, ethnicity, nationality). The data was exported to MS EXCEL for storage and analysis. No primary data collection was done. The study commenced after obtaining approval from the University of the Witwatersrand ’Human research Ethics Committee (Medical) and Gauteng Department of Health and Social development. Results: The vacancy rate for doctors at the DGMH did not show any significant change after the introduction of ODS. The Hospital employed around 40% female doctors. The majority of doctors were Black and Coloured doctors, although certain department were still staffed by White doctors. There were no significant changes in the mean age of the doctors working in the Hospital. As expected the specialists were generally older than the registrars and medical officers. More South African doctors were appointed in 2010 in comparison to 2008. Conclusion: OSD did not have the intended effect of decreasing the vacancy rate of doctors at the DGMH. This might be because unfunded posts did not get additional funding to free them and therefore the status quo would have remained the same with or without OSD. It suggests that the additional funding should be considered for vacant unfunded posts. Hopefully, the funding model for NHI will dramatically increase the funding in the public sector allowing for OSD and an increase in funded vacant posts simultaneously.

A research report submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, November 2015 / The aim of this study was to give an account of what it means to be a hospital consultant in a national health service that has been undergoing change for almost three decades. Classic grounded theory was used to identify the main concern of hospital consultants sampled for the study and how they resolved this concern on a routine basis. Data were obtained from three sources: interviews, observation and document analyses. Classic grounded theory procedures of constant comparison and theoretical sampling were used and Rolling with the Punches emerged as the pattern of behaviour through which the hospital consultants dealt with their main concern, which was managerialism. Rolling with the Punches involves four modes: Stabilising Temporarily, Resisting, Limiting the Impact and Adjusting to/Living with. The mode of behaviour was contingent on a central and on-going Weighing-up process, in which the hospital consultants used their personal narratives, beliefs and commitment structures to make sense of what was happening and what they could possibly do about it. Hence, the mode of behaviour was contingent, historicised and in flux. The Weighing-up process can set off triggers that can lead to a change of mode that need not be linear. Key words: doctors, managers, grounded theory, weighing up, stabilising temporarily, resisting, subverting, quibbling, limiting the impact, lying low, faking it, living with, adjusting to, going with the flow, complying, waiting it out. / MB2016

The rural health physician narrative is one of the most understudied genres in non-fictional Appalachian literature. Physician narratives are significant in the historical, social, and political contexts of twentieth-century Appalachian representation. These accounts provide insight into the social contexts in which physicians lived as they wrote about healthcare and Appalachian communities. New Historicism is an analytical tool used to better understand the complexity surrounding Appalachian representation, particularly in terms of the politics of representation, gender, and race that influenced these narratives in the twentieth century. I engage in close readings of narratives written by or about rural health physicians who practiced in Appalachian communities during the early and mid-twentieth century. The physicians include Drs. Mary Martin Sloop, Gaine Cannon, A.W. Roberts, and Anne A. Wasson. I provide a nuanced discussion of the emergence and reiteration of Appalachian stereotypes in physician narratives and consider the lessons they provide for current physicians.

A pesquisa qualitativa teve como objetivo estudar a autogestão de carreira ao longo da trajetória profissional dos médicos e relacionar as dimensões subjetiva e objetiva para ampliar a compreensão sobre a importância da subjetividade nas carreiras dos profissionais do conhecimento na atualidade. Como objetivos específicos foram definidos: entender o processo de gestão da carreira em seus diferentes estágios; investigar a relevância dos valores pessoais para as decisões e a percepção de sucesso na carreira; identificar a percepção do médico sobre a influência dos fatores intrínsecos e extrínsecos no seu desenvolvimento, buscando identificar diferenças e semelhanças entre os vínculos concomitantes; explorar a percepção do médico sobre as razões que levaram à escolha da profissão e aos diferentes vínculos na história de vida e entender os fatores relacionados às decisões sobre a carreira, tanto no que se refere a mudanças de emprego quanto a mudanças no trabalho realizado. A metodologia qualitativa foi empregada a partir do paradigma interpretativista e da construção social da realidade, adotando o pressuposto epistemológico do subjetivismo. Participaram doze médicos de especialidades clínicas, formados há mais de dez anos. A coleta de dados ocorreu em três fases: shadowing inicial com um sujeito, seguido de exame microscópico de dados e codificação axial, que geraram categorias iniciais utilizadas como parâmetro na análise das entrevistas em profundidade com doze sujeitos, realizadas em duas fases: entrevistas fase 1 e entrevistas fase 2. Da análise das narrativas dos entrevistados na fase 1 foram refinados os nós definidos inicialmente a partir do referencial teórico e do shadowing. Após cada entrevista foi feita a codificação aberta e axial. Ao final da fase 1 de entrevistas foi feita a codificação axial do conjunto dos dados, gerando um parâmetro para as entrevistas focalizadas na fase 2. Os códigos definidos foram refinados na análise conjunta com o entrevistado, em uma relação dialógica de criação de conhecimento. Os resultados apontam a importância do SUS como campo de produção de conhecimento e formador da reputação do médico; dificuldades ligadas à questão de gênero, associadas à falta de amparo social à maternidade; escolhas autoguiadas por valores trazendo satisfação e sucesso subjetivo. Conclui-se que a autogestão da carreira motivada por valores ligados à empatia e cuidado com o outro resultou em sucesso subjetivo mais intenso, além daqueles ligados a reconhecimento social, status e desenvolvimento do conhecimento. / Qualitative research purpose is to study the career self-management along the physicians\' professional journey and to relate the subjective and objective dimensions in order to broaden the knowledge on the importance of subjectivity in the career of the knowledge professionals nowadays. The specific objectives are: to understand the career management process in its different stages; to investigate the relevance of personal values in order to make decisions and to perceive the career success; to identify the perception of the doctor on the influence of intrinsic and extrinsic factors in their development in search of the identification of differences and similarities among several work contracts; to explore the doctors\' perception of the reasons which drove them to choose the profession, and the different bonds in their history of life and to understand the factors related to the decisions about their careers, both with regard to job changes as the changes in the workplace. The qualitative methodology was employed from the interpretive paradigm and the social construction of the reality, adopting the epistemological assumption of subjectivism. Twelve physicians of clinical specialty, with over ten years of graduation, took part in this research. Data collection occurred in three phases: initial shadowing with a physician, followed by microscopic examination of data and axial coding, which generated initial categories deeply used with twelve volunteers above as a parameter in the analysis of the interviews, that were carried out in two other phases: interview phases 1 and 2. The nodes initially defined from the theoretical review and shadowing were refined from the analysis of the narratives of respondents in phase 1. An open and axial coding was created after each interview. At the end of the first interview phase, an axial coding of all the data was done, generating a parameter for the phase 2, when the defined codes were refined in cooperation with the respondent in a dialogical relationship of knowledge creation. The results show the importance of the Sistema Único de Saúde (Unified Health System), known as SUS, as a field of knowledge production and creator of the doctors\' reputation; difficulties linked to gender, associated with lack of social support of motherhood; self-guided choices values by bringing satisfaction and subjective success. As a conclusion, the career self-management motivated by values linked to empathy and care for the other allowed a more intense subjective success, followed by social recognition, status and development of knowledge