"Thesis--University of Southern California. / Includes bibliographical references.

The research focused on the experiences of casualty doctors regarding their role in the management of gender-based violence victims at the Intermediate Hospital Oshakati, Namibia. A qualitative, exploratory, descriptive and contextual research design was utilized and data were collected by means of semi-structured interviews. These were audio-taped, transcribed verbatim and analyzed using the Tesch’s method of qualitative data analysis by the researcher in conjunction with an independent coder. The research findings revealed that the study participants experienced gender-based violence as a common and recurrent public health issue. Participants indicated that the majority of the victims presented with a wide range of physical injuries as well as significant emotional trauma. With further exploration, it emerged that participants identified alcohol abuse, low socioeconomic status and several relationship problems as prevalent factors associated with gender-based violence. They also recognized that the current programme managing gender-based violence provides a measure of safety for victims by making emergency services available. In addition, these services could be accessed free of charge and victims identified as ‘high-risk’ were offered sanctuary in the ward to prevent further harm. Study participants further observed that the presence of a multi-disciplinary team of care-givers also contribute positively to the management of gender-based violence victims. However, participants experienced several challenges that impair their role in the management of gender-based violence victims. Notable among these are high workload (arising from shortage of personnel and offering services to non-emergency cases in casualty), lack of collaboration among team members and a lack of proficiency in psychosocial intervention strategies. Based on the study findings, it is hereby recommended that clear guidelines for the management of gender-based violence victims should be established and a better collaboration among all cadres of professionals involved in this issue should be promoted. In addition, campaigns to sensitize the community about values that can help in the prevention of gender-based violence and dangers of alcohol abuse as well as strengthening the legislative framework vis-à-vis implementing punitive measures against culprits, should be vigorously pursued.

The work content and style of practice of family physicians in British Columbia has been evolving since the second world war. Since the late sixties, a reassessment of the role of family physicians has been underway, both in Canada and the United States. Primary health care has recently been given greater recognition in North America. The development of family practitioners’ tasks in the last twenty years is reviewed from the point of view of a practitioner. In Canada, the health care system has been changing since the forties, as a result of a series of federal-provincial agreements. It had become apparent that, despite constitutional deeding of health care to the provinces, federal incentives and funding were required to develop an appropriate nationwide system of health care. What was a joint private enterprise and local community sponsored health care system in the thirties, has now become a complex government-funded operation. Government involvement in third party payment schemes, for doctors particularly (the last of a series of national health insurance programs), has changed the relationship of doctors to their patients, because both became subject to the new rules of the Medical Care Act of 1967. Government involvement in payment for services has led to questions about accountability for spending. Subsequently, this led to the need for better planning, especially health manpower planning, which began to be considered very important in the early sixties. At that time, the Royal Commission on Health Services examined the prospects of bringing physicians’ services and allied health manpower services to all Canadians. The attempts to plan physician manpower in Canada and British Columbia in the sixties and seventies are considered and criticized. Conclusions are drawn regarding the prospects for future manpower planning for primary care to be given by family practitioners in British Columbia. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

No description available.

Physicians are usually the first contact in the health care system for persons with dementia and their family caregivers. Although specialists typically make the diagnosis, it is the family physician who is key to confirming the diagnosis for dementia, explaining what it means physically, emotionally, and describing what to expect as the disease progresses. Our knowledge about interaction between persons with dementia and their physicians is based largely on the caregiver's view while few studies have investigated the physician's perspective. Persons with dementia have been underrepresented in research pertaining to the issue of diagnosis disclosure. The aim of this exploratory study was to examine the attitudes of family physicians and individuals with early stage dementia about the diagnostic process. The effects of a companion on a medical encounter were also investigated. Data were compiled from responses of 14 family physicians to a structured questionnaire containing highly selective questions, as well as in-depth interviews with 9 individuals with dementia. Using a conflict theoretical framework, the results show that family physicians do inform patients of a diagnosis for dementia. Although the majority of individuals with dementia are satisfied with their family physicians' communication, they were dissatisfied in terms of referral to community resources. Persons with dementia also felt that they received less than ideal care, particularly from specialists, in terms of how the diagnosis was disclosed. Overall, physicians and persons with dementia rated the influence of a third person in the medical encounter as positive. Physicians in this study continued to use an illness-centered approach rather than a patient-centered approach that acknowledges the patient as a person with unique needs and a life-story. Future research thus needs to address the development of a patient-centered model in which the understanding of the subjective experience of the person with dementia is essential. / Thesis / Master of Arts (MA)

Thesis (M.Ost.)--Unitec New Zealand, 2009. / Includes bibliographical references (leaves 88-92).

Applications of Telehealth in the practice, upgrading of knowledge, and communication of physicians with their colleagues and patients in Canada was explored in this study. The research used exploratory-grounded theory to investigate the opinions of practicing clinicians regarding the use of Telehealth. The study involved conducting semi-structured interviews with physicians who were using or might in the future use Telehealth in their practice. This study was designed to assess the major advantages and shortcomings that Telehealth has to offer in the field of medicine. The research found that clinicians predominantly had a very positive view of Telehealth, although some minor concerns were expressed with respect to the use of Telehealth in private offices and the home (rather than in the hospital). The data indicated that Telehealth can improve overall patient care by bettering the speed and accuracy of communication and diagnosis and the subsequent treatment of patients, saving physicians and patients time and money, reducing waiting lists, aiding the environment, reducing emergency visits and hospitalizations, addressing shortages of physicians (particularly in rural areas), increasing access to specialists, and enabling convenient distance education. These are just some of the many benefits of Telehealth which outweigh its disadvantages. This study also was designed to extract clinicians’ opinions on avenues for improving Telehealth, which thus led to implications for future research. Barriers to the use of Telehealth were found to include concerns about security and IT support, lack of public knowledge of Telehealth’s existence, and installation and maintenance costs for the necessary equipment in the private sector. The study suggests that Telehealth will become more widely available and accessible to the general public. The study also proposes that, through increased governmental support and funding, Telehealth should be advertised and promoted, researched in more depth (in part, to discourage misconceptions regarding Telehealth), collaborated on by stakeholders, and expanded. / Graduate

Introduction In Senegal, as in many countries, physicians are unevenly distributed. This situation leads to health inequalities, but the solutions adopted to distribute physicians equitably do not give satisfactory results. This situation pushes decision-makers and researchers to look for other solutions such as telemedicine. This technology-based solution is considered to be a good means to improve physician recruitment and retention in underserved areas, thus improving access to healthcare in these areas, but it is still underused in Senegalese health facilities. Objective This study aimed to identify the determinants of the use of telemedicine in Senegal. More specifically, it aimed to identify the individual (micro) and contextual (meso and macro) factors that influence the use of telemedicine in Senegal. Method The study involved mixed methods: a descriptive qualitative study involving individual interviews and a cross-sectional quantitative study involving questionnaires. The first method was used to study the individual (micro) factors such as physicians’ beliefs on the use of telemedicine and physicians’ perception of the impact of telemedicine on their recruitment and retention in underserved areas. It was also used to study the contextual meso (technical, organizational and ethical) and macro (financial, political, legal and socioeconomic) factors that influence the use of telemedicine. The second method was used to study participants’ intention to use telemedicine in their professional activities, another individual (micro) factor. This study included physicians working in public hospitals, those working in district health, and telemedicine projects managers. Qualitative data was collected through individual interviews, transcribed and imported into NVivo 10 where they were coded thematically. Quantitative data was collected by administering questionnaires and analyzed using SPSS 23. Results The results showed that telemedicine could contribute to, but could not guarantee the recruitment and retention of Senegalese physicians in underserved areas. It was found that physicians in Senegal have both positive and negative behavioural, normative and control beliefs that can encourage or discourage them from using telemedicine in their professional practice. The most salient behavioural beliefs were that telemedicine makes experts’ opinions accessible across distances (positive behavioural belief), but could lead to medical errors (negative behavioural belief). The most common normative beliefs were that their patients would most probably approve the use of telemedicine (positive normative belief) while their colleagues working in the public sector might disapprove of it (negative normative belief). The most reported control beliefs were that the use of telemedicine is easy (positive control belief), but could be time-consuming (negative control belief). For physicians in Senegal, the findings also demonstrate that the probability that they will use telemedicine in their professional activities is moderate and influenced by their perceived behavioural control which, in turn, is influenced by their positive and negative control beliefs. Finally, the results demonstrate that many contextual meso (technical, organizational and ethical) and macro (financial, political, legal and socioeconomic) factors influence the use of telemedicine in Senegal. Conclusion The results of this study can inform the choice of telemedicine development strategies. These strategies can help to promote the use of telemedicine in Senegal, which in turn can help to increase physician recruitment and retention in underserved areas, resulting in better access to healthcare and, and as a result improved population health.

Thesis (M.Tech.: Homoeopathy)--Durban University of Technology, 2008. xix, 122 leaves / Discussion among homoeopaths in South Africa provides the impression that there is a degree of misunderstanding and ignorance about homoeopathy, and opinions are varied on its application and efficacy amongst the South African public. An over the counter (OTC) medicine, is a medicine which is sold without a prescription directly to the public, which includes homoeopathic medicines. OTC medicines may be sold at any retail outlet, i.e. a pharmacy or general store. There is much evidence pointed towards the growth and rise in over the counter sales in complementary and alternative medicine, a growth of more than 17% in total, homoeopathy is a major part of the complementary and alternative medicine group, having its own growth of more than 16% over a four year period. Self-medication in the form of over the counter medicines forms the main part of this industry (Caldis, 2000). The market was previously examined by the Mintel Group for complementary medicines and its growth in sales, in April 2003. Since then, the market has continued to expand, growing by 45% in real terms from 1999 to 2004. Greater consumer awareness of alternative medicines, an interest in healthy lifestyles, and the willingness to self-medicate certain conditions have all contributed to the increased value of sales (Mintel, 2005). Whenever the economic and public health benefits of self-medication are discussed, it is important to address inequalities in health. This means that not every citizen may feel sufficiently confident to practice responsible self-medication. It is also evident that not everybody has the financial means to do iii so. The whole notion of responsible self-medication both in a traditional sense and in the future is based on the concept of choice. Allowing individuals certain options when they suffer minor, self-limiting or chronic diseases is the fundamental consideration behind responsible self-medication (AESGP, 2004). Methodology A non-experimental descriptive survey was conducted to determine the perceptions of registered South African Homoeopaths regarding the availability of over the counter homoeopathic remedies. A self-administered questionnaire was distributed and 68 anonymous responses were obtained. Raw data was analysed using descriptive statistics and the relationships between variables tested for correlations. Results Respondents perceived homoeopathic OTC medicine sales and their availability in health shops and pharmacies, as contributing to the promotion of the profession as well as increasing its accessibility to the public. Other benefits perceived were the cost effectiveness of homoeopathic OTC medicines and convenience for home usage. The majority of respondents felt that there should be certain restrictions regarding the availability of OTC homoeopathic medicines, such as, the limitations regarding the availability of certain potencies. Participants also expressed concern over the degree of training held by retail outlet staff. Certain respondents felt that homoeopathic medicines should only be iv available with a prescription or used under the guidance of their practitioner. Other negative aspects of over the counter homoeopathic medicines were: incorrect use of medication, overdosing, and potential negative effects the patient may experience if the OTC medicine interacts with other medication, as well as the concern over the risks of self-medicating without the advice from a practitioner. Conclusions and recommendations The majority of respondents were in favour of the availability of homoeopathic OTC medicines to the public, provided that they are suitably regulated to ensure patient safety and quality control. Furthermore the regulation of the relevant retail outlets including education of staff in this regard was recommended. Respondents also were in favour of the awareness of the profession that homoeopathic OTC medicines created.