Thesis (M.H.A.)--University of Michigan, 1959.

Thesis (Ph. D.)--Lehigh University, 2005. / Includes vita. Includes bibliographical references (leaves 85-98).

Thesis (doctoral)--University of Tartu, 2006. / This dissertation is based on 5 papers.

Abstract General hospital psychiatry operates between the somatic and psychiatric approaches concerning the treatment of patients, combining knowledge from both somatic and psychiatric medicine. To establish its position, the general hospital psychiatry has to specify its role and means when rendering services. This study revealed how consultation had been arranged in six Finnish polyclinics of general hospitals. The goal was to find out which types of patients were referred to the consultation of the general hospital psychiatry and the extent of collaboration of the consulting psychiatrist with colleagues from other medical disciplines. Moreover, the focus of attention was on whether there were operational differences between the polyclinics of the University Hospital of Oulu and other hospitals. The work was also addressed to probing operational differences, if any, pertaining to people under or over 65. Additionally, one aspect to be clarified was how requests for psychogeriatric consultations and the responses of the consulting psychiatrists had developed during the five years period of the study. This study was part of a broad European Consultation Liaison Working Group effort aimed at clarifying the organization of general hospital psychiatry in 56 units in 11 European countries. The Finnish material consisted of 1255 patients, of whom 202 were over 65. The research methods applied here were psychiatric interviewing of clinical patients, and filling in of data collection forms following the instructions of the ECLW Group. The current work revealed that the number of psychiatric consultations was less than expected considering the incidence of psychiatric symptoms among somatically ill patients. Of the general hospital patients, elderly people were especially underrepresented. More than 90% of the patients who had a psychiatric consultation were diagnosed with a psychiatric problem. Thus the general hospital made available psychiatric treatment via psychiatric consultation, with a recommendation for future psychiatric care for more than half of the patients. However, one third of the patients under 65 and quarter of those above that age had already had on going psychiatric treatment. In view of this type of situation the position of the general hospital appears problematic. The object of consultation was in 90% of the cases the patients themselves, but in Oulu, almost half of the consultations were due to the personnel of the somatic disciplines in charge of the of the patients. The action mode in separate general hospitals was connected to established traditions, although the history of general hospital psychiatry is short and faces constraints put forward by the somatic hospitals. Collaboration between psychiatric and somatic disciplines was facing increasing difficulties during the five years observation period, probably due to economic recession.

M.Cur. / In the out-patient section of the Adolescent Unit at Tara, The H Moross Centre, certain problem areas were identified. In this section, adolescents with mostly behaviour problems are evaluated and where necessary, family therapy service is rendered or the patient may be admitted depending on the type and severity of the problem. The problems experienced in this section became very pressing due to the uneven ratio between the demand for the service and the availability of staff. At the centre of these problems lies the issue of resistance in the family towards change, resulting in broken appointments and premature termination of therapy. A lot of time is also wasted by faulty referrals and data gathering 1s in itself, very time-consuming. A new nursing need emerged out of these problems. Firstly, the emotional preparation of the family and, secondly, as part of her role as member of the therapeutic team, to gather relevant data which will aid the development of an adequate diagnosis of the family. A post was created on an experimental basis for the nurse to conduct an initial interview with families at home. At the same time it was decided to evaluate the effectiveness of this home visit through an empirical study to justify this service.

Transport projects are complex; the interface with different policy areas can often lead to significant challenges to ensuring that long-term value outcomes are achieved. This thesis seeks to explore the challenges associated with the effective provision of transport services from a social exclusion perspective. It uncovers a number of key factors that can affect the successful delivery and provision of such schemes by examining the consequence of the decisions and actions taken by service providers and commissioners. Using a case study approach conducted on three local authority projects across the United Kingdom, the study is exploratory in nature through an in-depth qualitative data analysis. In order to address the aim of the thesis, six key objectives are defined: to understand how transport projects may act as a vehicle for delivering policy aimed at addressing social exclusion in the United Kingdom; to understand and investigate the impact of deregulation of the bus industry on the provision of transport services, particularly for the socially excluded; to critically examine the process underpinning decisions that guide the provision of transport schemes to address social exclusion; to examine the propensity for service users to be actively involved in the decision making process; to conduct a case study research in order to explore the challenges to the successful provision and delivery of the transport services to the socially excluded as a consequence of the decisions and actions taken by the service providers in the case study areas; and to characterise the factors that should be considered in the provision and delivery of transport services, particularly for the socially excluded.Semi structured interviews were carried out with the service providers in three locations– West Midlands, Sheffield, and Manchester. These interviews seek to determine the challenges to the effective provision and delivery of transport services as a consequence of the decisions and actions of the service providers. Overall, some challenges that could inhibit the provision and delivery of transport services were identified. These include constraint on the provision and delivery of transport services for the socially excluded due to the Competition Act, lack of accessible information, lack of close working relationship between service providers, lack of trust and mutual respect between service providers, too much focus in reducing the number of benefits claimant, service accessibility – inflexible access criteria, lack of support for bus drivers, lack of cultural diversity in the workforce and marketing of services, resource constraints on scheme performance, tendency on the service providers to focus getting output rather than outcomes, partnership issues - lack of commitment, poor communication, lack of common understanding of social exclusion, tendency on the service providers to focus on economic aspect, and lack of willingness to fully engage with citizens in the delivery and provision of transport services.These challenges identified were then further analysed in order to examine the underlying reasons why those challenges existed. Having identified and examined the challenges that could hinder the provision and delivery of the transport services, particularly for the socially excluded, some recommendations were made based on the identified issues that should be considered in the provision and delivery of transport services, particularly for the socially excluded.The findings that emerged contribute toward the social exclusion and transport provision domain in four areas:• Highlighted and provided an understanding of the difficulties surrounding the role of bus drivers and how it affects transport provision for the socially excluded;• The importance and the need to have the local knowledge in delivering transport service;• Understanding service provider’s attitude towards engaging with the community in the provision of transport services; and, • Inadequate funding and the impacts on transport provision for the socially excluded.

No description available.

As educators are held accountable for student outcomes more frequently, more stringently, and more fully throughout the school organization, service delivery systems have become a focus. Not only are teachers being held accountable for students' learning, but also principals and other administrators are beginning to feel the pressure from public concerns regarding the education of children in the United States. The quality of student instruction can be addressed through practical service delivery models, while administrators' support of the model chosen for their schools is a pivotal variable for effectiveness and efficiency. Students with identified disabilities are being served more frequently in general education classrooms for all or most of their school day. The percentage of students with disabilities served in heterogeneous classes has increased from 32.8% in 1990-1991 to 44.5% in 1994-1995 (U. S. Department of Education, 1997). The more service delivery options available, the more likely an appropriate education will be delivered to these students with disabilities who are placed in heterogeneous classrooms. Cooperative services between general and special educators such as consultation and co-teaching, which include both direct services to students and indirect services through the classroom teacher, offer unique and malleable options for service delivery. To fully understand the process of administrative support for this innovative model, it is imperative to study the interactions between the innovation, the context in which it is being implemented, and the individuals involved with the innovation (Corbett, Dawson, & Firestone, 1984). The study of a process is difficult because it involves investigating the factors that affect the likelihood that there will be change in the individuals who are involved. It necessitates the need to identify what they do, think, and believe in relation to the demands outlined by an innovation (Fullan, 1982). Researchers suggest the necessity of on-site case studies to gain insight and to investigate processes (Fullan; Hall & Hord, 1987; Huberman & Miles, 1984; Patton, 1990). The intent of this qualitative study is to explore how principals view their ability to support the cooperation between general and special educators for the benefit of students with disabilities. Specifically, the goal is to gain a deeper understanding of the facilitators and inhibitors that principals face when attempting to support this cooperation and to describe methods that principals have used, successfully and unsuccessfully, to avoid barriers to cooperation. Interviews will be conducted with principals who have previously been the special or general educator in a collaborative consultation process, as well as with both general and special educators currently working with this principal. This unusual perspective is designed to give rich descriptive information to educators who choose to use this promising practice of service delivery for at-risk students and students with disabilities at the K-12 level. / Ph. D.

Background This study assessed the impact of infectious diseases consultation (IDC) on 30-day readmission rates in patients with Staphylococcus aureus bacteremia (SAB). Furthermore, this study also evaluated the effect of IDC on adherence to guideline-directed therapy. Methods This retrospective cohort study enrolled 149 adult patients with SAB. Cohort 1 included 28 patients without IDC. Cohort 2 included 121 patients with IDC. Primary end point was all-cause 30-day readmission rates. Secondary outcomes included adherence to guideline-directed therapy and hospital length of stay (LOS). Guideline-directed therapy included repeat blood cultures until blood sterility, assessment for an echocardiogram, and appropriateness of antimicrobial therapy (including antibiotic, dose, and duration). Results Readmission rates were 46.4% (13/28) without IDC and 19% (23/121) with IDC (P = 0.006). Guideline-directed therapy occurred in 21.4% (6/28) without IDC versus 96.7% (117/121) with IDC (P = 0.0001). The average LOS was shorter without IDC than with IDC (5.6 vs 7.8 days, respectively; P = 0.01). The most common reasons for lack of guideline adherence in the control group were lack of echocardiogram (72.4%) and lack of repeat blood cultures (51.7%). Multivariate analysis demonstrated that only lack of IDC significantly affected readmission rates (odds ratio, 3.51; 95% confidence interval, 1.48-8.52; P = 0.0048). Conclusions Consultation with infectious diseases reduces 30-day readmission rates in patients with SAB and increases adherence to guideline-directed therapy; however, LOS was increased. Infectious diseases consultation should be considered for all patients with SAB.

No description available.