Hip fracture is the most common reason for an elderly person to be admitted to an acute orthopaedic ward. The main aim of this research is to provide a statistical evaluation of a hip fracture database, and then to use Operational Research (OR) techniques, using the statistical output, to model activities associated with the care of hip fracture patients. OR techniques employed in this thesis include simulation and queuing theory. This research focuses on hip fracture admissions to the University Hospital of Wales in Cardiff, with a primary aim of ascertaining whether the time between admission and surgical intervention has any impact upon patient outcome. Outcome is considered in terms of mortality, hospital length of stay and discharge destination. Statistical analyses are performed, via regression and CART analysis, to investigate length of stay and mortality variables. The results from these statistical tests are compiled, compared and investigated in more depth. Additionally, a principal component analysis is performed to investigate whether it would be feasible to reduce the dimensionality of the dataset, and subsequently principal component regression methodology is used to complement the output. Simulation is used to model activities in both the hip fracture ward and the trauma theatre. These models incorporate output from the statistical analysis and encompass complexities within the patient group and theatre process. The models are then used to test a number of ‘what-if’ type scenarios, including the future anticipated increase in demand. Finally, results from queuing theory are applied to the trauma theatre in order to determine a desired daily theatre allocation for these patients. Specifically, the M | G | 1 queuing system and results from queues with vacations are utilised. The thesis concludes with some discussion of how this research could be further expanded. In particular, two areas are considered; risk scoring systems and the Fenton-Wilkinson approximation.

No description available.

This thesis is about children's health and well-being as constructed and maintained by villagers in Upper Egypt. It is based on primary data collected during eighteen months of fieldwork in a small village in the district of Abnube in the east of Assiut Governorate in the south of Egypt. The thesis also relies on secondary statistical and qualitative sources. This work makes three propositions concerning children's health. The first proposition is that children's heal th is a distinct part of the traditional medical cultures of Egypt and one that should be integral to the analysis of medical culture, pluralism, and services. More over, the focus on child health and ill-health provides a critical commentary to on-going debates about health and healing in Egypt. The second proposition is that the study of child health and ill-health is an essential and missing component of the ethnography of rural Egyptians. An awareness of the relevance of children, and of the efforts of families to keep them healthy, to the cultural, social, political, and economic construction of family and village can significantly add to anthropological understanding of the Egyptian peasant and village. The third proposition is that the study of health as a socially and historically constructed category is as important, if not more so, than the study of ill-health. This work looks at processes whereby health is conceptualized and their relevance to the ensuing constructions of ill-health. The work also tries to establish the relationship between village discourses on health and the discourse dominant in the language, services, and structures of modern biomedicine in Egypt. In this thesis, health is viewed as an arena where cultural, historical, social, as well as economic relationships and structures come to shape family practices and choices.

No description available.

Volume I contains a literature review and an empirical paper. The literature review, which is presented first, reviews recent findings for a relationship between informational coping style and psychological adjustment in patients confronted with potential or real life threatening illness. Empirical data is systematically reviewed within the theoretical framework of Miller's (1995) Monitoring Process Model. Suggestions are made for future research on order to develop effective interventions for those individuals who are most vulnerable to psychological, social, and emotional complications secondary to their illness. The empirical paper examines psychological distress in patients undergoing stem cell transplantation in a prospective longitudinal design. Specific aims are to examine the degree of psychological distress over the course of transplantation, which pre-treatment demographic, medical and psychosocial factors predict psychological distress and adjustment after transplantation, and whether informational coping style was associated with distress levels before and after transplantation. The findings of this study illustrate the need for pre-treatment assessment and intervention, focusing on treatment related anxiety management, depression, and dysfunctional illness attributions which may help reduce post-treatment distress. [Volume II contains a series of clinical practice reports and is not available online.].

‘The capability approach is a broad, normative framework for the evaluation of well-being’(p.94)[1], which has attracted growing interest in health and health economics research. A broader measure of well-being may more accurately capture the effects of some interventions, than traditional health-related quality of life measures. The ICECAP-A and ICECAP-O are two measures of a person’s well-being, with a theoretical grounding in the capability approach, designed for use in health and social care research. This thesis reports qualitative and quantitative investigations into the validity and responsiveness of the ICECAP measures. A methodological review of existing validation studies was completed. Seventeen semi-structured interviews with health research professionals were carried out and an iterative, constant comparative, thematic analysis was completed to assess the content validity of the ICECAP-A. The construct validity and responsiveness of the measures were assessed using two randomised controlled trials: the BEEP trial (ISRCTN 93634563) and the Past BP trial (ISRCTN 29062286). Qualitative and quantitative results provide positive indications of validity. The qualitative work showed that research professionals viewed the ICECAP-A as a relevant and feasible measure for use in health research. The quantitative results confirmed the majority of a priori hypotheses in the validity analyses, while longitudinal data provided evidence that the measures are responsive to self-reported changes in health status. In conclusion, this thesis reports the first assessment of validity in a randomised controlled trial setting and the first analysis of responsiveness. While further testing of the ICECAP measures is required, results indicate that the measures are appropriate for use in health research.

Tuberculosis has been a deadly human pathogen for thousands of years and is as prevalent and lethal now as it was in the pre-antimicrobials era. With new challenges continually being presented in the form of multidrug resistant strains evolving and the implications of the HIV epidemic, it is imperative that every effort is made to understand the causative agent, Mycobacterium tuberculosis, and develop new effective and affordable drugs to treat the disease. With this in mind, the first part of this project tests novel drugs that have been identified using different approaches. The desired targets for all the compounds were the fatty acid and mycolic acid biosynthesis systems in M. tuberculosis, Mycobacterium bovis BCG and Mycobacterium smegmatis. Some promising compounds were identified, which inhibited enzymes of the prokaryotic FAS-II system, whilst not affecting the mammalian FAS-I system. As well as identifying new drugs, it is equally important to recognise the essential genes of M. tuberculosis, which could be novel drug targets. Whilst the fatty acid biosynthesis pathway has been well studied, a lot less is known about fatty acid degradation. M. tuberculosis has an abundance of fad genes, yet it is only recently that they have started to be explored. Here, the functions and roles of the fadB genes in M. tuberculosis, M. bovis BCG and M. smegmatis have been explored. By producing purified recombinant protein and generating gene deletion mutants, it has been possible to fully characterise Mt-FadB2 and provide preliminary information regarding fadB3, fadB4 and fadB5.

The following work has been completed as part of the Birmingham University Clinical Psychology Doctorate. Volume One contains three research papers: a literature review on work exploring care-giving approaches in family carers of people with dementia; an empirical paper exploring the link between perceptions of continuity in spouses caring for someone with dementia and person-centred care; and an executive summary of the empirical paper. Volume Two contains the following clinical practice reports (CPR) completed whilst on placements within the NHS. The models CPR describes the assessment, Cognitive-Behavioural and Psychodynamic formulation of a twenty-year old young man with a diagnosis of Somatoform Disorder. The service evaluation CPR is a qualitative exploration of staff experiences and needs in the use of Cognitive Behavioural Approaches in Community Mental Health Teams. The Single Case CPR describes and evaluates an intervention for visual neglect conducted with a 55 year-old man. The Case study CPR presents cognitive-behavioural therapy work conducted with a teenage girl with appearance-related social anxiety. The abstract for the Clinical Presentation CPR is included and this described work with a 79 year old man in a general hospital, referred for low mood.

This research investigates the interplay between strategy, innovation, oral health inequalities, and the Primary Care Organisation (PCO). There has been little previous consideration of the interplay between these four factors, which this research addresses through a mixed-methods approach combining interviews, secondary-data analysis, and an investigation into the availability of oral health strategies. Analysis was supported by dialectic and functionalist approaches and suggested that structural and process difficulties affected the ability of PCOs to address inequalities in oral health through strategy and innovation. The role of PCOs and consultants in dental public health in relation to strategy and innovation was characterized by contradictions and inconsistencies, some of which appeared to be dysfunctional. The findings raise a number of considerations regarding the role PCOs adopted with regard to oral health inequalities. In particular, this thesis demonstrates that local and macro-level structures and processes may be inadequate to ensure reductions in oral health inequality through strategy and innovation. Integration of strategy and innovation in this thesis leads to a suggested innovation-strategy complex.

The numbers of acutely ill patients (AIP) are admitted in general hospital wards increased. The failing to identify, manage and deliver timely and optimal care to AIPs may lead to catastrophic outcomes. A qualitative study aimed to define the current state of AIPs in Iranian hospitals showed the flaws and shortcomings in the current services for identifying and managing AIPs. An evaluation study was designed to explore the potential impact of Critical Care Service (CCS) in an Iranian University Hospital. The study design was a Stepped-Wedge Cluster Randomized Controlled Trial. The study included, for each ward, an unexposed to the intervention, training, and an exposed to the intervention phase. The data was analyzed using three methods: all patients, matched randomized and before-after. The null-hypothesis was tested using the mixed effect logistic regression, linear mixed and the mixed effects models. The results showed that there are no significant differences in mortality, CPR, ICU admission and length of stay. A second qualitative to find the views of staffs toward the CCS indicated that the CCS had several favorable effects, however; overcoming contextual problems in the hospital, prior to implementation of CCS, may facilitate its implementation.