La téléréadaptation, une application de la télésanté, qui se définit par le suivi thérapeutique d'un patient par un clinicien via un lien Internet, est en pleine émergence au Québec et au Canada. Que ce soit pour procéder à une consultation ou pour prodiguer des traitements, il est inévitable pour le clinicien d'effectuer éventuellement une évaluation de la condition de l'usager. Actuellement, aucune étude ne s'est intéressée à l'évaluation physique d'une condition orthopédique d'un centre de services vers le domicile du patient. Le but de cette étude est de: Objectif 1. Démontrer la faisabilité d'une évaluation en téléréadaptation à l'aide de tests cliniques auprès de personnes présentant des conditions orthopédiques au membre inférieur pour les variables suivantes: état de la cicatrice, présence de signes inflammatoires (gonflement articulaire) et circulatoires, les amplitudes articulaires de la hanche et du genou (flexion et extension), la force globale aux membres inférieurs, la capacité de se mouvoir, la description de la marche ainsi que l'équilibre. Objectif 2. Comparer les données d'évaluation d'une condition orthopédique au membre inférieur prises par le physiothérapeute en téléréadaptation à celles recueillies par le physiothérapeute en observation face-à-face (mesure étalon). Matériel et méthodes. Il s'agit d'un devis de validité de critère où l'évaluation du physiothérapeute, réalisée au domicile du patient (mesure étalon), a été comparée à l'évaluation, des mêmes variables, effectuée en téléréadaptation à l'aide d'un système de visioconférence. L'étude a été effectuée auprès d'hommes et de femmes (n=17) en phase de réadaptation ayant une atteinte physique de type orthopédique affectant la fonction des membres inférieurs. Deux conditions expérimentales ont été exploitées. Un sous-groupe de notre échantillon (n=7) a été évalué dans un environnement contrôlé, soit sans la présence d'obstacles et avec une luminosité appropriée pour les systèmes de visioconférence. Concernant l'autre sous-groupe (n=1D), l'évaluation en téléréadaptation a été réalisée au domicile du patient dans des conditions réelles. L'intérêt de procéder aux évaluations dans deux environnements différents est pour mieux comprendre l'influence potentielle des environnements domiciliaires sur la faisabilité et la validité des tests inclus dans le protocole. Les tests physiques s'intéressaient à dix variables quantifiés à l'aide de sept outils de mesure soit: la cicatrice (New quantitative scale for clinical scar assessment), la mesure du gonflement au genou (bilan circonférentiel), l'amplitude articulaire à la hanche (flexion/extension) et au genou (flexion/extension) à l'aide du goniomètre universel, la force globale aux membres inférieurs (30-sec chair-stand test), la capacité de se mouvoir (Timed up and Go) et la description de la marche (test de Tinetti) ainsi que l'équilibre (test de Berg). Résultats. La comparaison entre les mesures en téléréadaptation et les valeurs étalons a montré d'excellents résultats (Rhô de Spearman) pour le gonflement articulaire (r s =.94), les amplitudes articulaires de la flexion de la hanche (r s =.93) et de la flexion du genou (r s =.82), la la capacité de se mouvoir (r s =.91), la description de la marche (r s =.88) et la force musculaire aux membres inférieurs (r s =.92). Par contre, l'évaluation de la cicatrice (r s =.56) et l'amplitude articulaire de l'extension de la hanche (r s =.19) et du genou (r s =.67) ont démontré des coefficients inférieurs. Un dernier test a présenté des résultats mitigés, soit celui de l'épreuve d'équilibre de Berg (r s =.79). Conclusion. Notre étude a permis de démontrer qu'avec une certaine adaptation, il est possible d'évaluer plusieurs variables cliniques importantes en téléréadaptation au même titre que si nous avions réalisé l'évaluation dans un mode conventionnel en face-à-face. Les coefficients de corrélation ne différaient pas même si le patient était évalué à son domicile ou dans un environnement propice à ce type d'évaluation. En effet, les coefficients de corrélation sont élevés (r s >.79) pour l'ensemble des variables cliniques à l'étude. Seulement l'évaluation de la cicatrice et la mesure de l'extension de la hanche ont obtenu des coefficients de validité sous le seuil clinique acceptable.

The management of physical healthcare assets is vital for efficient delivery of healthcare services along with improving quality and productivity, amidst significant structural and funding re-organisation within the NHS. Capital allocations are under pressure and advanced strategic planning of healthcare infrastructure is required to maintain services. In doing so, the complexity of multiple interacting systems and mixed stakeholder expectations and competencies need to be addressed. The relationship between stakeholder public consultation and estates strategy development in theory and practice is poorly understood and further theoretical development is required to advance our knowledge in Strategic Asset Management (SAM). This thesis adopts an interpretivist paradigm, and an abductive approach with a case study design methodology. Data were collected from six case studies comprising 91 participants (focus groups and workshops); 6 unstructured interviews; 907 questionnaires; and observations resulting in over 30 hours of transcribed data, along with web-based document analyse (desk studies) within 149 NHS Trusts. The data were further analysed using thematic analyses. Findings reveal how localised conditions within individual healthcare Trusts influence the ways in which national initiatives are interpreted and incorporated; these impact existing ways of developing an estates strategy and in some cases, have implications on the usability of associated healthcare infrastructure spaces. This had clear implications on existing SAM practice, which were diverse, driven by individual project team competencies and associated project management practice. In practice, more focus was given to technical competencies (knowledge of SAM datasets and tools) and behavioural competencies were downplayed. Thus, the integrative Strategic Asset Management (iSAM) framework developed in this research, established a unique baseline to develop SAM plans from a complex interaction of care, estates and transport, providing a valuable resource for healthcare planning teams. Stakeholder consultation should be selective (representative sample) and the content of consultation should be appropriate at various SAM stages. Trusts should clearly indicate how their plans have been influenced, given the feedback from stakeholder consultation. Thus, moving it from a tick box exercise, to one that adds value in the decision making process. Empirical findings revealed that although literature promoted tools and methods to facilitate SAM, in practice, these were hardly used and most teams within English healthcare Trusts were not aware of best practice tools and solutions. Structuration theory was further used as a heuristic device to theoretically triangulate the empirical findings and contribute to a nuanced understanding of SAM within healthcare Trusts. In doing so, a middle range theory for integrative SAM (iSAM) was developed. It revealed that a dynamic system of individual action and organisational structure both constrained and enabled SAM. It was evident that the process of SAM is an open, emergent process of sense making rather than a pre-determined and closed process following prescriptive rules. This thesis has advanced knowledge in SAM and has raised the importance of front end project management within English healthcare Trusts. The new integrative and interdisciplinary iSAM framework facilitates the development of estates strategy and stakeholder consultation decision-making within healthcare Trusts.

No description available.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Thesis advisor: Richard Jackson / Interest in the psychosocial wellbeing of the visually impaired has existed for years as a nebulous and undefined goal of educational programs for children. Yet there is a dearth of systematic inquiry into the influence of teachers on social and emotional development of children and families. The purpose of this study was therefore to develop a foundation of knowledge relating to the role of specialist teachers in addressing the affective adjustment needs of visually impaired children and their families. Drawing upon the theories and intervention practices commonly used in the human service professions, 59 family consultation competencies were identified and grouped into four major knowledge areas, namely affective adjustment to blindness, principles and processes of change, interpersonal communication skills, and specific intervention strategies. This research was exploratory and descriptive in nature, utilizing a semistructured interview format to produce data for both numerical and qualitative analysis. A 3-part questionnaire was administered orally to a sample of 20 certified and fulltime employed teachers of the visually impaired who were working in one of five major service delivery systems found in the Greater Northeast. Participating teachers reported a range of 13.5 to 38.6% of their professional time spent in consultative interactions with teachers, parents, administrators, and related service providers, as compared to a range of 15 to 50% of time given to direct student instruction and assessment. Furthermore, regardless of situational differences in educational and occupational backgrounds, teachers perceived the process skills of interpersonal communication and relationship-building as necessary competencies in their ability to meet vision-specific psychosocial needs of visually impaired children and their families. Variables which were considered by practitioners to influence their proficiency in providing consultative services included the nature and degree of professional preparation, trial and error experience, and interpersonal style or personality. In summary, 49 of the original family consultation competencies presented in this survey were confirmed by participating teachers to be necessary, relevant, and appropriate to their professional responsibilities as educators of the visually impaired. / Thesis (PhD) — Boston College, 1987. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Education.

'Being There' is about developing appropriate design processes which have the opportunity to give local communities a voice through the language of landscape. My Research aimed to learn from Australia's Indigenous conscience to attain more culturally, ecologically and socially accurate modes of engagement with the landscape throughout design practice. Stretching between Coober Pedy and Tweed Heads 'Being There' has become an exploration into the Landscape Architectural practice of engaging intimately with site and community through grounded techniques. In addition, the work aspires to engage with the idea of evolutionary design processes, which envisage landscape projects as points of open-ended interaction with site and place. 'Being there' is not only about spending time in one place, but also the techniques that these opportunities have given me such as documenting information gleaned through the eyes of local experts. As a practitioner, I can not do this without appropriately engaging in the richness and complexity of place defined and revealed through the challenge of communication. In this mode of design the processes of analysis and consultation act as lenses in curating the existing condition, defining its successes and failures in the cultural terms of people and place. Here, in contrast to my former practice, the intent is that design recovers landscape, rather than recreating it.

Thesis (M.A.)--Kent State University, 2008. / Title from PDF t.p. (viewed Nov. 10, 2009). Advisor: Timothy Gallagher. Keywords: sociology, gender, doctor-patient interactions, doing gender. Includes bibliographical references (p. 78-88).

Reproduction de : Thèse d'exercice : Médecine. Médecine générale : Nantes : 2008. / Bibliogr.

Reproduction de : Thèse d'exercice : Médecine. Médecine générale : Nantes : 2009. / Bibliogr.

Reproduction de : Thèse d'exercice : Médecine. Médecine générale : Nantes : 2009. / Bibliogr.