Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Chiropractic in Israel has become a more integrated part of many aspects of health care policies, in that it is practised in multidisciplinary medical teams, is now included in HMOs and hospitals services, and has contributed to research and military programmes. However, the chiropractic profession still has its problems. Without laws or legitimate recognition to protect chiropractors, the playing fields could never be levelled for all chiropractors in Israel. Patient use and demand for complementary and alternative practitioners, including chiropractors, is gradually increasing. However, there has been no research to investigate the perceptions of chiropractors, medical doctors and chiropractic patients (i.e. key stakeholders) regarding the integration of the chiropractic profession in the Israeli health care system. The purpose of this study was to explore and describe the perceptions of a selected group of stakeholders about the integration of the chiropractic profession in the Israeli health care system. Such an exploration might help the profession to secure its position and claim a higher status in society. This is desirable to educate the public and the authorities on the many positive advantages of chiropractic, include access to chiropractic services for people who traditionally have not been able to use these services because of economic barriers or internal government and authorities limiting laws, as well to enhance its public image such as honesty, integrity and objectivity in the health care, and to avoid any criticism of organized medicine. It therefore stands to reason that the factors that might contribute to this type of development should be considered as soon as possible in those countries where chiropractors practise. This type of investigation is important not only in the Israeli setting, but indeed in every country where the profession is aiming toward increased recognition and awareness of the contribution of chiropractic to health care. Chiropractic now has the opportunity to expand its influence and take a more active role in health care issues. Therefore, although geographically removed, South Africa stands to gain interesting and useful information from an investigation of this nature. The investigation was carried out within a post positivist approach close to that of critical realism, using an interpretive methodology. The sampling was purposive as individuals were targeted for their knowledge in three main topics, these being the scope of chiropractic practice, inter-professional relations between Doctors of Chiropractic (DCs) and Medical Doctors (MDs), and developmental issues. The participants included five chiropractors, three medical doctors and three chiropractic patients, who all resided in the metropolitan area of Tel Aviv. were presented in tabular form in order to facilitate analysis and interpretation. Although there were some discrepancies regarding the knowledge and background of the participants about the topics discussed, all the participants met the inclusion criteria. The results show that chiropractic stands at the crossroads of mainstream and alternative medicine. Therefore it is important to establish a leading statement on identity, which must be clear, concise and immediately relevant to both the public and the profession. Although inter-professional relations between MDs and DCs in Israel are improving, further research should be conducted to provide suggestions on how chiropractors can overcome barriers and improve communication with MDs and other health care professionals in the Israeli health care system. In general, the participants agreed that governmental legislation, recognition and support are important endorsements with respect to the societal relevance and development of the profession. Therefore issues such as public awareness of chiropractic education and scope of practice, research and evidence-based practice must be emphasized accordingly in order to facilitate the development of chiropractic practice in Israel.

Submitted in partial fulfilment of the requirements for the degree of Masters in Business Administration (MBA), Business Studies Unit, Durban University of Technology, 2008 / The pharmaceutical industry is in the midst of a fundamental transformation. Time and cost constraints are forcing marketers to search for new ways to maintain and grow brand awareness. The amount of time that doctors allow for representatives to market their products is becoming less and less and as a result products are not getting the exposure they used to. Organisations that find innovative ways to maintain exposure of their products may gain a competitive advantage over those organisations that rely on traditional marketing methods. The prolific increase in the use of the internet may provide pharmaceutical organisations with a complementary channel to market their products. The objective of this study is to determine the levels of internet technology adoption among general practitioners. The Technology Acceptance Model (TAM) is one of the most influential research models in studies of the determinants of information systems/ information technology (IS/IT) acceptance. In TAM, perceived usefulness and perceived ease of use are hypothesised and empirically supported as fundamental determinants of user acceptance of a given IS/IT. Using TAM, this study sets out to determine general practitioners’ intention to use the internet as a source of pharmaceutical information. The literature review provides an extensive evaluation on the development of TAM and its application in different technologies. Based on these findings, the researcher developed this study to investigate internet technology acceptance in the pharmaceutical industry. Use is made of the descriptive survey method and data is retrieved from a sample of 105 general practitioners in Kwazulu-Natal. The observation is made via the benefit of a questionnaire. The process of sampling is that of convenient sampling. The analysis is quantitative and makes use of statistical analysis appropriate for the data. Analysis of the survey results produces useful insights into the factors influencing internet technology adoption by general practitioners. When analysing the independent variables, respondents were not in strong agreement about the perceived usefulness nor the perceived ease of use of internet technology as a source of pharmaceutical information. However, positive results from the relationships between the independent (perceived usefulness and perceived ease of use) and dependent variables (attitude and intention to use) provide valuable data with which organisations may develop internet-based marketing strategies. Based on the survey findings, recommendations using the Beynon-Davies (2004) Internet Adoption Model are suggested.

Background: Concerns about burnout, and its consequences, among German physicians are rising. However, data on burnout among German physicians are scarce. Also, a suspected association between burnout and German physicians’ wishes to leave remains to be studied. Therefore, the extent of burnout, and the association between burnout and wishes to leave clinical practice or to go abroad for clinical work was studied in a sample of young physicians in Saxony. Methods: In a cross-sectional survey, all physicians ≤40 years and registered with the State Chamber of Physicians of Saxony, Germany (n = 5956) received a paper-pencil questionnaire inquiring about socio-demographics, job satisfaction, and wishes to leave clinical practice or to go abroad for clinical work. Response rate was 40 % (n = 2357). Burnout was measured with the German version of the Maslach Burnout Inventory - Human Services Survey (MBI) consisting of the subscales emotional exhaustion (feeling emotionally drained), depersonalization (feelings of cynicsm) and personal accomplishment (feelings of personal achievement in job). Variables associated with burnout, and the association between burnout and wishes to leave were assessed in multivariate logistic regression analyses. Results: For emotional exhaustion participants reached a mean of 21.3 [standard deviation = 9.74], for depersonalization a mean of 9.9 [5.92], and for personal accomplishment a mean of 36.3 [6.77]. Men exhibited significantly higher depersonalization than women (11.3 [6.11] versus 9 [5.62], p < 0.001). Eleven percent of participants showed a high degree of burnout on all subscales, while 35 % did not show a high degree of burnout on any subscale. Confirming that one would become a physician again, and higher satisfaction with the components \"work environment\" and \"humaneness\", were associated with a lower chance for a high degree of burnout on all subscales. Higher emotional exhaustion and lower personal accomplishment were associated with an increased chance of wishing to leave clinical practice. Higher emotional exhaustion and higher depersonalization were associated with an increased chance of wishing to go abroad for clinical work. Conclusions: Preventing physician burnout may not only benefit the affected individual. It may also benefit the health care system by potentially preventing physicians from leaving clinical practice or from going abroad for clinical work.

Thesis (MPhil)--Stellenbosch University, 2000. / Some digitised pages may appear illegible due to the condition of the original hard copy. / ENGLISH ABSTRACT: Medicine in our country is under severe stress, brought about by internal and external forces that need a response from the medical profession. The profession's attempts and response will fall short unless the profession itself is aligned with the new social ethos and the responses are based on the profession's inherent values. Problem Statement: Medical doctors have always been highly valued in society because of the duty they have when illness and disease set in. As individuals, doctors have fulfilled other important roles in the communities where they work. These include giving advice to young people on career choices, counseling on various matters and provision of material help where there is need. This profession has for a long time been shrouded in mystery, being a trade learnt by a few. All these factors contributed to their social standing increasing phenomenally. There is a view that this has also led to public perceptions that doctors are the rich untouchable elite who have no interest or are unconcerned about problems faced by society. The medical profession faces a challenge that is more significant because of the value placed on it by society. The numerous submissions by the victims of human rights abuses to the Truth and Reconciliation Commission have cast a shadow of doubt on the medical profession for its complicity in these acts. The present government has declared transformation of health care as one of its top priorities. The response of the medical profession to this initiative has so far not led to any significant changes of public perception that the profession is unwilling to participate in the transformation of our society. The challenge and subject of discussion in this thesis therefore is: "What is the ideal role of the medical profession in a transforming South African society?" The medical profession, being the nerve centre of health care, has a big responsibility in social transformation. Doctors stand accused as a collective for failing to protect the human rights of patients and not living up to the standards of ethics required of them when patients' rights were violated. The Truth and Reconciliation Commission record of the hearings into the role of the professional organisations in health is used in this thesis to illustrate how serious society views the medical profession's role in the human rights abuses of the past. Based on the T. R. C's report and the assumption that society traditionally places high value on the medical profession, I conducted a survey among South African doctors to test their attitudes towards a range of policy and transformational issues. The unit of analysis was the medical doctors who are in active practice in South Africa in whatever mode of practice. The survey sought to explore the awareness of the respondents about a range of transformation policy changes and invite their comments on the role that they envisage for the medical profession in the process of transformation of society. There is unfortunately scarcity or a lack of applicable South African literature on this topic thus limiting local material for referencing. The search of international literature only yielded the subject of the study of professional values and not necessarily the role of a medical profession in a transforming society. The medical profession has to re-visit its foundations, analyse its history and map out its future in the context of the South African realities. It must find a way of aligning itself with the new ethos and diverse cultures South Africa possesses. Medicine has its own traditional goals and values derived and adapted from society's diverse cultural value systems. With its national and international networks, the inherent knowledge and skills that it possesses, guided by an ethical code, the Hippocratic Oath that serves as a public promise, it influences policy on the country's health care system - a mechanism that government uses to provide a basic human need. The medical profession therefore has to be responsive to the needs of society as much as society needs to support the profession. This thesis explores the role that the profession should play in a transforming South African society. The argument is that this can only be done through the profession examining its values and aligning itself with broader societal value systems, the moral and social norms. It is further argued that visible realistic commitment by the profession to public health will lead to an improvement in its public image. It is the actions or non-actions of the majority that the public notices. The majority of respondents to the survey have indicated that they approve of the transformation policies in health but that they may differ in the way they were introduced. / AFRIKAANSE OPSOMMING: Die geneeskunde in ons land is onder geweldige druk as gevolg van interne en eksterne faktore en dit is nodig dat die mediese beroep reageer. Dit sal die beroep egter nie help om te reageer indien sy lede hulle nie met die nuwe maatskaplike etos vereenselwig nie en die reaksie op die inherente waardes van die mediese beroep geskoei word nie. Probleemstelling Mediese dokters is nog altyd baie hoog geag deur die gemeenskap as gevolg van die verpligting wat hulle het om na mense om te sien wanneer hulle siek word. In hulle individuele hoedanigheid het dokters ook ander belangrike bydraes tot hulle gemeenskappe gelewer. Dit sluit in: advies aan jong mense oor loopbaankeuses, berading en die verskaffing van finansiele hulp waar nodig. Die beroep as sulks was egter vir baie lank ietwat van 'n misterie omdat dit 'n vakrigting is waarin baie min mense hulle kon bekwaam. Al hierdie faktore het die maatskaplike aansien/waarde van dokters geweldig verhoog. Daar is ook diegene wat van mening is dat hierdie faktore aanleiding gegee het tot die openbare mening dat dokters 'n ryk en onaantasbare elite is en glad nie in die probleme van die gemeenskap belangstel nie. Die etlike voorleggings deur die slagoffers van menseregtevergrype aan die Waarheids- en Versoeningskommissie het ook vrae rondom die beroep se betrokkenheid by sodanige gevalle laat ontstaan. Die huidige regering het die transformasie van gesondheidsorg as een van sy grootste prioriteite verklaar. Die reaksie van die beroep hierop het tot dusver nie tot enige noemenswaardige veranderinge in die openbare mening dat dokters nie bereid is om aan die transformasie van ons gemeenskap deel te neem gelei nie. Wat is die ideale rol van die mediese beroep in die transformasie van die Suid- Afrikaanse gemeenskap? As die senusentrum van gesondheidsorg het die mediese beroep 'n groot verantwoordelikheid in maatskaplike transformasie. Dokters word kollektief beskuldig dat hulle nagelaat het om die menseregte van pasiente te beskerm en nie voldoen het aan die nodige etiese standaarde wat van hulle verwag word in die tyd toe pasienteregte geskend is nie. Die rekord van die verhore van die Waarheids- en Versoeningskommissie oor die rol van professionele gesondheidsorganisasies is vir die doeleindes van hierdie tesis gebruik om te illustreer hoe ernstig die gemeenskap voeloor die mediese beroep se rol in die menseregte vergrype van die verlede. Gegrond op die WVK-verslag en die aanname dat die gemeenskap die mediese beroep hoog ag, het ek 'n meningsopname onder 300 Suid-Afrikaanse dokters gedoen om hulle houding jeens 'n aantal beleids- en transformasiekwessies te toets. Die eenheid van analise was mediese dokters wat in die aktiewe praktyk staan, ongeag hulle praktykgebied. Die opname het gepoog om te bepaal wat die vlak van bewustheid by die respondente oor 'n aantal beleidsveranderinge gerig op transformasie is, en hulle uit te nooi om kommentaar te lewer op die rol wat hulle meen die mediese beroep behoort in die proses te speel. Ongelukkig is daar nie toepaslike Suid-Afrikaanse literatuur oor die onderwerp beskikbaar me. 'n Internasionale literatuursoektog het net studies rondom waardes opgelewer, en nie oor die rol van 'n mediese beroep in die transformasie van 'n gemeenskap nie. Die mediese beroep moet die grondslag van sy wese in oenskou neem, die geskiedenis analiseer en sy toekoms in die konteks van die Suid-Afrikaanse realiteite uitstippel. Die beroep moet 'n manier vind om homself met die nuwe etos en uiteenlopende kulture van Suid-Afrika te vereenselwig. Die geneeskunde het sy eie tradisionele doelwitte en waardes gekry en aangepas vanuit die uiteenlopende kulturele waardestelsels van die gemeenskap. Deur middel van sy nasionale en internasionale netwerke, inherente kennis en vaardighede, die leiding van 'n etiese kode, die Eed van Hippokrates wat as 'n belofte aan die publiek dien, beinvloed die mediese beroep die land se gesondheidsorgstelsel - 'n meganisme van die regering om in 'n basiese menslike behoefte te voorsien. Die mediese beroep moet daarom ingestel wees op die behoeftes van die gemeenskap in dieselfde mate as wat die gemeenskap die beroep behoort te ondersteun. Hierdie tesis ondersoek die rol wat die mediese beroep behoort te vervul in 'n Suid-Afrikaanse gemeenskap waar transformasie besig is om plaas te vind. Daar word geargumenteer dat dit net gedoen kan word indien die beroep sy waardes ondersoek en hom met die breer maatskaplike waardestelsels vereenselwig. Daar word verder geargumenteer dat 'n sigbare realistiese verbintenis van die mediese beroep tot openbare gesondheid tot die verbetering van sy openbare beeld sal lei. Dit is die optrede of nie-optrede van die meerderheid wat die publiek raaksien. Die meerderheid respondente in die meningsopname het aangedui dat hulle die transformasiebeleid vir gesondheid ondersteun, maar dat hulle verskil van die wyse waarop dit in werking gestel is.

Thesis (MPhil)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: This evaluation serves the purpose of illuminating concepts and ideas behind the moral impact of business values in healthcare and to establish a framework for the analysis of moral dilemmas found in the sphere ofbio-medical ethics. The historic developments of business in healthcare are examined, looking at how and why business became an integral part of the health care system. The concept of "managed healthcare" is introduced and used as the context in which the different institutional role-players are brought together. Managed healthcare is defined by a discussion of the different organisational structures through which it manifests itself. The policies, procedures and regulations that managed healthcare organisations implement and control to fulfil their general function are also examined. Some normative aspects pertaining to the concept of managed health care are explored, including the institutional values of business and that of medicine. A brief discussion of the economic system in which the business agents or role players function are included in the evaluation of the institutional values of business. Further arguments are made to show how the healthcare system with all its role players displays the characteristics of a complex system. Discussions on the fundamental values of medicine concentrate on the basic ideas behind virtues and principles of medical ethics. It is argued that the development of these virtues and principles are important foundations on which the medical profession stands. The moral impact of combining these institutional values within the context of managed healthcare relationships is examined and some important moral dilemmas or conflicts are identified. It is further argued that the fundamental relationships between all the role players in the health care system have changed as all the agents function within a complex system, giving rise to new organisational structures and relationships, with new conceptual roles, ideals, values and practices. / AFRIKAANSE OPSOMMING: Hierdie evaluasie het dit ten doelom sekere konsepte en idees agter die morele impak van besigheidswaardes in gesondheidsorg te illumineer en om 'n raamwerk daar te stel vir die verdere analise van morele dilemmas in die sfeer van bio-mediese etiek. Die historiese ontwikkeling van besigheid in gesondheidsorg word verken deur die redes aan te voer waarom besigheid deel van die gesondheidsorgsisteem geword het. Die konsep "bestuurde gesondheidsorg" word gebruik as die konteks waarin die verskillende institusionele rolspelers bymekaar gebring word. Bestuurde gesondheidsorg word gedefinieer deur die verskillende organisatoriese strukture waardeur dit manifesteer. Die prosedures, regulasies en bereid wat bestuurde gesondheidsorgorganisasies implementeer om hul funksies te vervul word ook verken. Normatiewe aspekte van bestuurde gesondheidsorg word verken, waarby ingesluit word die institusionele waardes van besigheid sowel as dié van medisyne. 'n Kort beskrywing van die ekonomiese sisteem waarin die besigheidsagente, of rolspelers funksioneer word ingesluit by die evaluasie van die institusionele waardes van besigheid. Verdere argumente word gevoer om te wys daarop hoe die gesondheidsorgsisteem met al sy rolspelers die karakter toon van 'n komplekse sisteem. Die basiese idees agter deugsaamheid en morele beginsels van bio-mediese etiek word bespreek om die fundamentele waardes van medisyne te beskryf. Daar word geargumenteer dat die ontwikkeling van hierdie waardes 'n belangrike fondament is waarop die mediese professie staan. Die morele impak van die kombinasie tussen die institusionele waardes van besigheid en medisyne binne die konteks van bestuurde gesondheidsorg word geevalueer en belanrike morele dilemmas en konflikte word geidentifiseer. Verder word geargumenteer dat die fundamenrele verhouding tussen al die rol spelers in die gesondheidsisteem verander het danksy die funksionering van die agente binne hierdie komplekse sisteem. Dit lei op sy beurt na veranderinge in organisatoriese strukture en verhoudinge met nuwe konsepsuele rolle, idiale, waardes en praktyke.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This PhD study investigated the organisational structure of medical communicative facilities and the related communicative experiences of health care providers and patients in HIV and AIDS care centres where there is language discordance between physicians and patients. Such discordance refers specifically to communication in contexts where patients and health care providers speak a number of different, mostly mutually unintelligible first languages (L1s) and where speakers have varying levels of proficiency in a lingua franca such as English. This study considers key moments within the organisational communication structure to assess how well the structure meets its communicative aims. The sites of care that provided empirical data in this study, were a public health clinic which is a division of a state hospital, and a privately run day care clinic both located near Maseru, the capital city of Lesotho. The participants were drawn from four categories, namely physicians, nurses, lay interpreters and patients. Data collection was done through semi-structured interviews, focus group discussions and direct observations of the study sites. The data was later transcribed interpreted and analysed according to insights gained from Organisation Theory on the one hand and Thematic Analysis and Qualitative Data Analysis on the other hand. The most important result of the study is the recognition of organisational fragmentation of care into different units which helps to facilitate communication where patients and physicians show marked language discordance. Further results illuminate several challenges that are encountered by participants in mediating and making meaning where language diversity is such that physicians’ linguistic repertoire does not match the repertoires of patients and local HCPs. The study highlights several institutional and interpersonal strategies that are used to overcome these challenges and to assure effective communication in the particular institutions. It also shows how some of these strategies fail to fully address the communicative challenges identified. The findings of this study suggest that in multilingual clinical contexts there is a need for more dedicated attention to interpreting practices, to the kinds of material distributed among patients and, more generally, to make consultative decisions on improved systems to put in place in order to facilitate communication related to quality health care. / AFRIKAANSE OPSOMMING: Hierdie PhD-studie het die organisatoriese struktuur van mediese kommunikatiewe geleenthede en die verwante ervarings van beroepsmense in gesondheidsorg van pasiënte in HIV-versorgingsentra ondersoek, waar die taalvaardighede van dokters en pasiënte nie gesinchroniseer is nie. Die taaldissonansie verwys spesifiek na kommunikasie in kontekste waar pasiënte en beroepsmense in gesondheidsorg 'n verskeidenheid tale praat wat meestal onderling onverstaan-bare eerste tale (T1e) is van sprekers met ongelyke vlakke van vaardigheid in 'n lingua franca soos Engels. Die studie vestig aandag op sleutelmomente binne die struktuur van die kommunikasie van die organisasie om vas te stel hoe goed die bepaalde struktuur sy kommunikatiewe doelstellinge verwesenlik. Die terreine van gesondheidsorg wat empiriese data vir hierdie navorsing voorsien het, was 'n openbare kliniek wat verbonde is aan 'n staatshospitaal, en 'n privaat dagsorgkliniek wat albei naby Maseru, die hoofstad van Lesotho, geleë is. Die deelnemers behoort aan vier kategorieë, naamlik dokters, verpleegpersoneel, leke-vertalers/-tolke en pasiënte. Data insameling is gedoen deur middel van semigestruktureerde onderhoude, fokus groepbesprekings and direkte waarrneming by die betrokke instansies. Die data is later getranskribeer, geinterpreteer en geanaliseer volgens insigte uit Organisasie Teorie aan die een kant en Tematiese Analise en Kwalitatiewe Data Analise aan die ander kant. Die belangrikste bevinding van die studie is herkenning van die organisatoriese fragmentering van die sorg in verskillende eenhede wat help om kommunikasie te fasiliteer binne ‘n konteks waar pasiënte en dokters merkbare taaldissonansie vertoon. Verdere bevindinge werp lig op verskeie uitdagings wat deelnemers ervaar in die bemiddeling en skep van betekenis waar taaldiversiteit sodanig is dat die talige repertoires van die mediese praktisyns nie aangepas is by die talige repertoires van die pasiënte of plaaslike mediese beamptes nie. Die studie vestig aandag op verskeie institusionele en interpersoonlike strategieë wat gebruik word om uitdagings te oorkom en om effektiewe kommunikasie binne die betrokke instansies te verseker. Dit wys ook hoe sommige van hierdie strategieë misluk in die aanspreek van bepaalde kommunikatiewe uitdagings. Die bevindinge bevestig dat in die omgewing van ‘n veeltalige kliniek daar ‘n behoefte is aan meer toegewyde aandag aan tolkingspraktyke, aan die soort materiaal wat onder pasiënte versprei word, en in meer algemene terme, aan die neem van besluite gegrond op konsultasie sodat verbeterde stelsels geimplimenteer kan word om kommunikasie wat verband hou met goeie kwaliteit gesondheidsorg, te help bedien. / The African Doctoral Academy for financial support

Hensikt: Hensikten med oppgaven har vært å undersøke om sykepleierapport, epikrise og dagens samhandlingspraksis ved utskrivning fra alderspsykiatrisk spesialisthelsetjeneste oppleves som nyttig av leger og sykepleiere i kommunene. Metode: Tverrsnittsundersøkelse. Et spørreskjema ble utviklet og sendt til 497 leger og sykepleiere. Data ble analysert med både kvalitative og kvantitative metoder Resultat Informantene vurderer innhold i epikrise og sykepleierapport som nyttig for videre arbeid med pasienten. Dokumentene beskrives som grundige, nyttige og informative. Dagens samhandlingspraksis vurderes som nyttig. Ambulante pasientrettede tiltak, deltagelse i møter, pasientrettet undervisning og veiledning vurderes som positive tiltak kommunene ønsker mer av. Medarbeidere i kommunene har i varierende grad erfaring med og kjenn-skap til det tilbudet Seksjon for alderspsykiatri gir. Konklusjon Undersøkelsen viser at samarbeidspartnere i kommunene i Telemark er tilfreds med epikrise, sykepleierapport og dagens samhandlingspraksis. De ønsker enda bedre tilgjengelighet / Aim: This study aimed to examine the opinions of physicians and nurses in the municipalities in Telemark, Norway regarding information given in written reports from the old age psychiatri unit and to examine the usefulness of collaboration when patients leave the hospital. Methods: This study used a cross-sectional survey. A questionnaire was developed and sent to 497 health professionals. The data were analyzed by both qualitative and quantitative methods. Results: Physicians and nurses in the municipalities have different knowledge and experiences regarding the services offered by the old-age psychiatry hospital. They described the reports from the hospital as informative and useful for further treatment of the patient. Collaboration practices were also evaluated as useful. Ambulant examination of patients and participation in meetings, education and guidance were evaluated as positive approaches. Conclusions: Physicians and nurses in the municipalities in Telemark county expressed satisfaction with the information in the reports and the existing collaboration practice when old age psychiatry patients leave the hospital. They want more of the services offered today. / <p>ISBN 978-91-86739-24-9</p>

Pharmacovigilance in healthcare is essential for safe drug treatment. Spontaneous reporting is the most common source of information in the context of implementing label changes and taking a drug off the market. However, underreporting is found to be very prevalent. One way to decrease underreporting is to include different categories of healthcare professionals in such reporting and to investigate attitudes towards and incentives for reporting adverse drug reaction (ADR)s. As nurses form the largest group of health professionals, a sample of nurses were allowed and encouraged to report ADR during a 12 month period after they had received training in pharmacovigilance. A questionnaire posted to physicians and nurses investigated their knowledge and attitudes towards reporting. Spontaneous reports of torsade de pointes (TdP) and erectile dysfunction (ED) were scrutinized with respect to the reported drugs, risk factors and if the reaction was listed in the summary of product characteristics (SPC). After training, the nurses produced relevant reports and three years after the introduction of nurses in the reporting scheme, more than half of the responding nurses were aware of their role as reporters. Both nurses and physicians stated that the most important factor for reporting a suspected ADR was the severity of the ADR and an ADR arising in response to a newly approved drug. A web-based reporting system was deemed to facilitate the reporting. In spontaneous reports of TdP, citalopram was reported as a suspected drug. However, neither QT prolongations, nor TdP, were labelled in the SPC. ED was reported for all antihypertensive drugs including angiotensin II type I blockers. A positive information component (IC), assessing the disproportionality between the observed and the expected number of reports, was found indicating that ED was reported more often in association with antihypertensive drug classes, except for angiotensinconverting enzyme inhibitors. This thesis demonstrates the importance of pharmacoviglilance in healthcare in terms of capturing new signals. By including nurses as reporters, the overall safety of drugs might improve. Information and education are needed to secure safe treatment when applying drugs.

In recent years medical societies have begun to recognize the effects and benefits of good communication between physician and patient. Like any other relationship, the exchange of information with fluent understanding creates a stronger bond of trust. Most applied research conducted in the area of physician-patient communication concentrates on physician behaviors which the patient views as problematic. This thesis focuses on patient assertiveness and its relationship to physician-patient satisfaction in the consultation process. Specifically, the study focuses on the relationship between patient assertiveness and physician-patient satisfaction. For the study the researcher developed a patient questionnaire and pre- and post-physician questionnaires to assess patient assertiveness. This factor relates to outcomes of satisfaction from the physician-patient consultation. Twenty doctors and two hundred patients participated in the study. The implications of these finding should provide insight into the patient-physician consultation process.

Aim: During the last decades research has reported seemingly unjustified differences between how women and men are perceived as patients, medical students and physicians. Most studies have been performed outside Scandinavia. The overall aim of this thesis is to illustrate, analyse and discuss aspects of gender bias and gender awareness in clinical medicine, medical research and medical education, all in a Swedish setting. Material and methods: Physicians’ ways of reasoning and reflecting on different professional arenas were investigated from a gender perspective in three cross-sectional studies: A. Written answers from a national examination for 289 Swedish interns where the examinees were allocated to suggest management of a common health problem - irritable bowel syndrome - in either a male or a female paper-patient with identical case descriptions. B. Assessments from 682 physicians, in structured assessment forms, of the scientific quality of two fictive research abstracts - one with a quantitative and one with a qualitative design – where authorship was assigned to either a woman or a man. C. Answers from 303 physician teachers to a questionnaire where they, on scales, assessed the importance of gender in different professional relationships and also gave open-ended comments. Most analyses were quantitative, using chi2-tests and multivariate logistic regression as statistical methods. Differences were discussed in relation to gender theory. Qualitative method, by way of open and selective coding, was used to explore the open-ended answers in the questionnaire and to create codes from the written answers in the national exam. Results: A. There were differences in outcome for male and female cases in history taking and in proposed diagnoses, investigations and treatment, e.g. more questions about and tests for alcohol were suggested for men and more tests for thyroid function for women. Both men and women physicians contributed to the gender bias but showed different patterns. B. The quantitative abstract was judged the same regardless of the gender of the assessor or author. The qualitative abstract was not ranked as scientific as the quantitative, but as more accurate, trustworthy, relevant and interesting with a female author especially by women assessors. C. Men physicians, especially in the surgical group, expressed low awareness of gender compared to women physicians. The qualitative analysis rendered a picture of how the physicians perceive ‘gender’, problems they connect with gender and their attitudes to gender issues. Some important concepts identified were ‘inequity’, ‘difference’, ‘delicate situations’, and ‘resistance’. To get an overview and better understanding of various expressions of gender bias, a theoretical model was developed, on the basis of the findings in the qualitative analysis. The main findings of the thesis are discussed in relation to this model where equity/inequity and sameness/difference are important points of departure. Conclusions: The findings of gendered outcome in the national exam call attention to ‘knowledge-mediated gender bias’, a phenomenon implying that once knowledge of gender differences in a condition has been established this might cause gender biased assessments of individual patients in the clinical situation. Gender appears to affect scientific evaluations. This has implications for situations where research is assessed and interpreted: in medical tutoring, research guidance, peer reviewing, and in forming evaluation committees for research funding. Physician teachers seem little aware of gender as an area of competence and knowledge and tend to connect gender issues with women. Depending on how ‘difference’ and ‘equity’ are apprehended various forms of resistance to gender emerge, each with plausible bias risks. Educational programmes for faculty members, encouraging continuous reflections on gender attitudes and supporting male participation, are suggested. Besides providing a more comprehensive understanding of patients and their health problems, increased gender awareness among physicians might improve the working climate and help reduce the gendered division of labour in the medical profession.