Health outcomes fulfill a number of roles in the health sector. Economists, clinicians, researchers and managers use health outcomes in a range of different contexts for distinct purposes. New management approaches that use contracts as the basis for health service accountability have attempted to take health outcomes from their clinical role into a management setting. In particular, the purchasers and managers of some health services expect that service providers should demonstrate that they improve the health outcomes of their patients to justify their on-going funding. However, a number of organisations have experienced barriers to the application of the outcomes approach to health service management and there has been no systematic evaluation of the approach. Nor has there been an investigation into why purchasing organisations have difficulty introducing health outcomes into purchasing contracts. The result is that managers and purchasers continue to assign resources to the pursuit of health outcomes as an accountability tool. This thesis addresses two research questions around the use of health outcomes in community and allied health service accountability. The first is the barriers to the application of health outcomes to health services accountability. The second question examines the conditions that must be met before health outcomes can be used as an accountability tool in purchasing contracts for allied health. The research questions are addressed through the analysis of case studies that explore systematically the approach taken by two organisations, the Department of Veterans� Affairs and ACT Community Care, in their attempts to identify health outcomes that could be used in purchasing contracts for community and allied health services. The case study analysis uses a health services research approach that draws on multidisciplinary techniques including epidemiology, health services management and anthropology. The thesis describes the accountability interactions within the purchaser-provider model. Accountability is not a uniform construct. It consists of many domains, levels and interactions. In health service delivery, there are a number of different actors and a wide range of interactions for which they are accountable. Two important interactions are identified: professional accountability, which describes the accountability of the health service professional to their patient; and contractual accountability, which is the obligation of the health service provider (or providing organisation) to the purchaser through their contractual agreement. I conclude that health outcomes are not an appropriate domain of contractual accountability but they are an important component of professional accountability and I discuss the implications of these finding for theory and practice.

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This study was conducted to determine if specialty areas are emerging in the magnetic resonance imaging (MRI) profession due to advancements made in the medical sciences, imaging technology, and clinical applications used in MRI that would require new developments in education/training programs and national registry examinations. In this exploratory study, statistical analysis incorporated the use of factor analysis and chi square. Factor analysis was used to group tasks performed by MRI technologists into factors to better identify emerging specialty areas within the MRI profession. Chi square was used to analyze the association between the tasks performed in (a) the employment setting, and (b) hospital size. Factor analysis identified four meaningful factors. The four named factors were: (a) Routine Imaging non-Central Nervous System Imaging; (b) Advanced Imaging; (c) Routine Imaging with Central Nervous System Imaging; and (d) Musculoskeletal and Spine Imaging. From the four named factors, three emerging specialty areas were identified: (a) central nervous system imaging; (b) vascular/cardiovascular imaging; and (c) musculoskeletal imaging. Chi square analysis identified 47 of the 78 tasks as being significant when finding an association between the employment setting and the frequency of tasks performed. Cramer's V was used to measure the strength of their association. The more complicated the procedure the more likely this procedure is performed in either a university or private hospital. Further, chi square analysis identified 42 of the 78 tasks as being significant when finding the association between the hospital size and the frequency of tasks performed. Gamma was used to measure the strength of their association. This means the larger the hospital, the more frequent the tasks were performed.

Background. A constantly changing reform agenda has frequently changed NHS management arrangements. Impacts are documented for medicine and nursing but much less so for the third largest profession, physiotherapy. Aims. To evaluate the impact of NHS reforms on physiotherapy analysing whether the resulting management structures impacted on staff and patient care; comparing English and Welsh arrangements with previous periods. Method. Observational mixed methods including a narrative literature review; questionnaire census; semi-structured interviews; physiotherapy narrative history; and a normative evaluation of physiotherapy management structures. Results. NHS reforms had impacted on the structure of physiotherapy management and organisation. Of the eight management structures described in Øvretveit’s (1992) schema: Three were not observed; two were observed but needed modification; three were observed and empirically applicable with small modifications; social enterprises had evolved with management structures similar to those in the NHS. The main changes to physiotherapy managers’ roles between1989-2014 were substantial reorganisations affecting the employing organisation and role of the managers with a reduction in Community Trusts and the introduction of competing providers into English NHS physiotherapy. Clinical autonomy had been extended with advanced practice roles in some areas. The role of the professional body and TU (the CSP) was generally well-regarded by managers. The differences between England and Wales related more to management structures than national policy differences. Conclusions. Most physiotherapists were managed within cross-AHP structures. Devolved structures were increasingly emerging but physiotherapy managers preferred professionally-led structures. Physiotherapy managers ranked the AHP Directorate the highest and the Fragmented structure the lowest. The AHP professions will need to consider merging to conserve their power as professions and to maximise their combined contribution to patient care and organise to meet fiscal challenges in both countries.

The present study explored how authenticity is constructed by clinical psychologists and asked what might be the implications of these discourses. The study is concerned with offering a focus on the making of authenticity in discourse as well as providing an understanding of the complexity of authenticity within clinical psychology. The study used a discourse analytic approach known as critical discursive psychology to examine clinical psychologists’ talk of authenticity. Participants included twelve qualified clinical psychologists working in adult mental health services who took part in semi-structured interviews. Following a detailed critical discursive analysis of the texts, four discourses were identified with regard to the construction of authenticity. These discourses were commonly used to construct authenticity in extremely positive terms, however, some participants did draw attention to an ideological dilemma of authenticity versus professionalism. Participants used authenticity to establish their identity and manage their relationships with service users, colleagues and institutions. Drawing upon psychotherapeutic and professional discourses positioned participants as having power and being more authentic than others. Authenticity was problematised in relation to the participants need for professional boundaries. It is suggested that psychologists internalise dominant discourses of authenticity from the profession of clinical psychology, which is itself influenced by wider societal discourses around what it means to be authentic or inauthentic. Extra-discursive factors including institutions and embodiment were found to influence and constrain available discourses. The limitations of this study’s research findings are discussed as well as implications for future research and clinical psychology practice.

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Introduction: The purpose of this study was to identify mentoring practices of new faculty members in Commission on Accreditation for Respiratory Care (CoARC) accredited respiratory care programs in the U.S. and to identify the perceptions of program directors regarding the observed impact of program mentoring practices. Methods: The method for the study was quantitative non-experimental survey research. The survey instrument was an electronic questionnaire titled Respiratory Care Faculty (RCF) Mentoring Survey. The 25-item survey was divided into three dimensions: mentoring practices, mentor/mentee relationship, and perceptions of the impact of new faculty mentoring. Of the 410 possible program director participants, 126 (30%) responded to the survey. Data from the survey were used to analyze three primary research questions on four independent variables (12 total research questions). Results: Testing of the null hypotheses associated with the 12 research questions resulted in three significant findings and 9 findings that were not significant. Significant findings included female program directors reported greater opportunities for mentoring within their programs and greater levels of expectation concerning mentoring as compared to male program directors. Program directors from associate degree programs also reported a higher level of expectation concerning mentoring than program directors in bachelor’s degree programs. There was overwhelming agreement regarding the potential impact and benefit of mentoring new faculty to improve job performance, reduce turnover, improve job satisfaction, and organizational commitment. Conclusion: The results of this study may benefit administrators and educators in respiratory care in efforts to support new faculty who possibly feel underprepared or overwhelmed in the new role. Because other allied health fields of study are similar in nature to respiratory care, the findings of the study could have potential implications across a range of health-related professions.

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Ethanol and n-hexane extracts obtained from the leaves and inflorescences of Gnaphalium gracile, were tested at different concentrations to evaluate their antineoplastic activities on pancreatic, colon, and prostate cancer cell lines by examining mitochondrial function. The polar extracts of both, leaves and inflorescences which contain gnaphalin, quercetin, and 3-methoxy quercetin, exhibited cytotoxicity against every cell line tested with EC50 values ranging between 20.23±1.185 µg/mL and 70.71±1.1419 µg/mL. The most remarkable values were observed in pancreatic cancer Panc 28 and androgen-dependent prostate LnCaP cells, with EC50 values of 20.23±1.185 and ˂25µg/mL, and androgen-independent prostate cancer PC-3, colon HCT-116 and pancreatic MIA PaCa cells with values ranging between 28.84±1.1766 and 34.41±1.057 µg/mL. The non-polar extract derived from leaves demonstrated significant cytotoxicity towards colon cancer HCT-116 cells, with an EC50 of 39.46±1.0617 µg/mL. However, the non-polar extract from the inflorescences did not have an appreciable effect on cell proliferation of any of the cell lines tested except for androgen-independent prostate cancer PC-3 cells with an EC50 of 62.05±1.237 µg/mL. The data obtained support the traditional use of G. gracile and suggest the polar extracts from aerial parts, as an interesting source for the development of novel antineoplastic agents.

The adequate intake of micronutrients is important to maintain optimal health and prevent nutritional disorders and chronic disease. Studies have shown that medical students often reduce self-care behaviors and lack adequate dietary intake, leading to nutritional deficiencies. In this quantitative cross-sectional study, measurements of micronutrient levels in a sample of allied health and nursing students were compared to Recommended Daily Allowance (RDA) values. NutritionQuest Data-on-Demand System was used to analyze nutrients and food group intake. The postpositivist paradigm was used to examine how the independent and dependent variables relate to each other. Using a one-sample t test, a comparison of average micronutrient intake among study participants with RDA values for those micronutrients showed that average micronutrient intake in the study population was higher than recommended values. Two sample t-test results showed no significant difference in average intake of micronutrients among participants with high and low income levels, or with high and low stress levels. As the normality assumption was not satisfied by the outcome variables, nonparametric tests were used to evaluate hypotheses. While this finding does not support the original hypothesis, it could have implications for the role of allied health and nursing practitioners in the care of both their patients and members of their medical team. Conversely, an assumption of this study was that a high level of similarity between the traditional medical student population and the allied health and nursing population in terms of nutritional habits may have led to a flaw in the overall research hypothesis. The detection of micronutrient deficiencies in students can bring awareness to improve nutritional intake and initiate a change in how public health officials advocate healthy and balanced diets.