This retrospective exploratory study examined demographic variables in a sample of anorexia nervosa patients hospitalised from January 1987 to December 1996. The researcher undertook an extensive literature review of the history and epidemiology of anorexia nervosa, and found that, while changes in the demography of anorexia nervosa patients are evident in industrialised and developing countries, there is a paucity of equivalent data for South Africa. The archival records of 254 anorectics admitted for the first time to an in-patient tertiary referral centre were reviewed. Descriptive and inferential statistics were computed to determine the demographic profile of the sample, to ascertain changes in demographic variables over the ten-year period of study, and to explore the relationships between these variables. Results reflect the typical anorectic admitted to the hospital of study as a white, female, between the ages 15 to 20, and from the upper to middle social classes. The mean weight at admission for the sample was 39.24 kilograms, while the mean body mass index was 14.78 kilograms/metre2. While no significant increase in admission rates within the ten-year period was found, a marked increase in admission rates is seen when the present study's findings of 254 first admissions over ten years (averaging 25 admissions per year) is compared to a previous study's findings of 54 admissions over a three-year period (averaging 18 admissions per year) at the same institution. Over the ten-year period of study, no significant trends or relationships were found with regard to the following variables: sex; race; age at admission; and socioeconomic status. However, a significant decreasing trend in weight and body mass index was found from 1987 to 1996, and a significant relationship was found between mother's socioeconomic status, and subject's weight and body mass index, respectively. Results also show evidence of an increasing number of males, Indians, children, and individuals over the age of 40 becoming vulnerable to anorexia nervosa. The extent to which these findings are generalisable to a broader-based South African cohort are questionable, due to the fact that the study was conducted in a single setting, and due to the influence of the historical context of the setting. / Thesis (M.Ed.) - University of Natal, Pietermaritzburg, 1999.

Technological advances mean that medical education bodies can now teach doctors in training using sophisticated engineering systems. Clearly, it is important to establish the efficacy of such innovative educational methods. This study was undertaken primarily to determine whether or not an interactive computerised teaching programme could train medical students and junior house officers to impart effectively distressing information. Subjects were fifth year medical undergraduates at the University of Aberdeen during the 1997/98 academic year. Subjects were separated into two groups. One group had access to the teaching programme during their final undergraduate year, whilst the other did not. Subjects conducted simulated interviews toward the end of their fifth year at medical school and toward the end of their pre-registration year. All subjects were assessed on one of three cases. Subjects were assessed on the same case at both assessment points. All interviews were videotaped. Performances were scored independently by two raters. Subjects rated their own performances. Of 132 medical undergraduates, 94 (71%) conducted interviews toward the end of their fifth year. Of the 63 who could participate one year later, 45 (71%) conducted a second assessment interview. The interaction teaching programme did not improve subjects' ability to give bad news at either test point. Regarding subjects' ratings, at the undergraduate test point, the two significant differences favoured those subjects given access to the teaching programme. At the postgraduate assessment point, the four significant differences favoured those subjects not given access to the teaching programme. Analyses indicated that the skills of doctors in training could be reliably evaluated using three ten-minute interviews. Subjects were poor at evaluating their own communication skills. Those who gave bad news more frequently as junior house officers performed at a similar level to those who gave bad news less frequently. The implications for medical education are discussed.

As multiple trauma is ubiquitous, affects predominantly young people and is attended by a high mortality, it seemed a fruitful area for study in an effort to reduce morbidity and mortality. One of the main problems in trauma research has been accurate description of the severity of injury and associating severity with subsequent outcome. While a number of scoring systems have been proposed the Injury Severity Score has been the most widely adopted and validated. The Injury Severity score was adopted with a number of other systems of scoring infection and other complications in a retrospective study of multiple trauma patients admitted to an Intensive Therapy Unit. This study revealed an unexpected increased in mortality in the latter two years of the study period which was not associated with an increase in injury severity as assessed by the ISS nor by any other change in patient characteristics which might explain this finding. Eventually it was noted that the introduction of a hypnotic drug etomidate for use in sedation of ventilated patients seemed to be associated with the increased mortality. Clinical evidence suggested that etomidate might inhibit adrenocortical function and an experimental study indeed confirmed that etomidate had a direct effect on adrenal steroidogenesis such that cortisol and aldosterone production were completely suppressed. Following analysis of the retrospective clinical study etomidate was withdrawn from use in our unit. Analysis of mortality rates both for trauma patients and the general patient population indicated a reversion to the rate which pertained prior to introduction of etomidate. The results of retrospective and prospective clinical studies strongly implied that the administration of etomidate was associated with an increased mortality among trauma patients. The experimental study based on clinical observations clearly demonstrated that etomidate infusion was a potent inhibitor of adrenal steroidogenesis. It seems highly likely that the detrimental effect of etomidate was mediated by its direct inhibitory effect on the production of cortisol and aldosterone by the adrenal gland. Subsequent clinical and experimental studies from other authors tend to confirm these findings.

It has been well documented that providing informal care for a person with a traumatic brain injury can be burdensome. The goal of this research was to discover the effects of two stressors, severity of daily hassles and distress caused by the behavioral problems exhibited by the person with the brain injury, and two supports, social support and income, on the caregiver burden and quality of life felt by caregivers.Data were collected using questionnaires sent via postal mail to members of the Brain Injury Associations of Ohio, Michigan, and Indiana. Each packet contained a demographic questionnaire, the Social Provisions Scale, the Head Injury Behavior Scale, the Daily Hassles Scale, the Caregiver Burden Scale and the Satisfaction with Life Scale. Ninety-one respondents returned usable protocols. Hierarchical regressions were utilized to analyze the data.When controlling for demographic variables, stressors were found to account for a statistically significant proportion of the variance in subjective caregiver burden but not in satisfaction with life. When controlling for both demographic variables and stressors, supports were not found to significantly predict either subjective burden or satisfaction with life. Upon further investigation, it was found that behavioral distress was most predictive of caregiver burden and the severity of daily hassles was the next most predictive variable of burden.This research was limited by the Midwest location of the participants and their lack of ethnic and gender diversity. Additionally, each respondent had access to support groups and they all had time to fill out the questionnaires. It is likely the case that many caregivers do not have this kind of support or the time to complete unnecessary paperwork. Finally, all of the factors affecting burden and quality of life for caregivers could not possibly be accounted for. Future research should account for a more diverse group of caregivers and assess some of the less frequently researched predictors. Scales more specific to caring for a person with a brain injury could be developed and utilized to explore sources of satisfaction for caregivers. Finally, more attention could be paid to the overall quality of life of caregivers. / Department of Counseling Psychology and Guidance Services

The purpose of this study was to operationalize the coronary care patient's concept of hope. Analysis of 25 subjects' responses to an open interview format suggested that the sample's definition of hope revolved around five categories. These categories were: 1) theistic beliefs: 2) knowledge that they would not die, require surgery, or experience pain; 3) a wish not to die; 4) a wish to get better; and, 5) confidence that they would get better. Furthermore, significant differences in: 1) the sample's definition of hope: 2) the feelings associated with admission to the coronary care unit: and, 3) the factors that positively influenced the sample's level of hope were directly related to the subject's age.

One of the impacts of the rising demand for community health services, primarily used by seniors, is that hospitals are often faced with the challenge of having patients finish the acute phase of their treatment and yet are unable to discharge them due to the lack of a bed in a more appropriate community care setting. The frequency of this challenge has led to the designation of “alternative level of care” (ALC) being ascribed to patients who remain in the hospitals due to insufficient capacity downstream. The thesis focuses on a model that seeks to address patient flow through the community care network (CCN) and finding capacity allocation policies for the different facilities that resolves the ALC challenge using scenario analysis. A queuing network model with general routings and nodes’ blocking has been developed and a heuristic approximation method has been employed for solving the model. Blocking probabilities and the number of blocked patients are derived as performance metrics of the CCN. We test the accuracy of the queuing model through a simulation model and the behaviours of the system in different scenarios are investigated in the simulation model and our policy insights and conclusions are provided.

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Patients with severe back deformities can greatly benefit from customized medical seating. Customized medical seating is made by taking measurements of each individual patient and making the seat as per these measurements. The current measuring systems employed by the industry are limited to use in clinics which are generally located only in major population centres. Patients living in remote areas are severely affected by this as the clinics could be far away and inaccessible for these patients. To provide service of customized medical seating requires a new measurement system which is portable so that the system could be transported to the patients in remote areas. The requirements for a new measurement system are analysed to suite the needs of Equipment Technology Services of the Cerebral Palsy League of Queensland. Design for a new measurement system was conceptualised by reviewing systems and technologies in various scientific disciplines. Design for a new system was finalised by optimizing each individual component. The final approach was validated by measuring difficult models and repeating the process to check for process variances. This system has now been adopted for clinical evaluation by ETS Suggestions have been made for further improvements in this new measurement approach.

Thesis (M. P. H.)--University of Hong Kong, 2007.