Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

Thesis (M.Tech.: Emergency Medical Care)- Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xvii, 198 leaves. / The purpose of the study was to assess ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal, by determining the prevalence of bacteria and fungi in ambulances, including those that are potentially pathogenic, and evaluating the knowledge and practices of staff in infection control.

Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

Problem investigated: The activation and implementation of the Medical Emergency Team (MET) system. Procedures followed: The ability of the objective activation criteria to accurately identify patients at risk of three serious adverse events (cardiac arrest, unexpected death and unplanned intensive care admission) was assessed using a nested, matched case-control study. Sensitivity, specificity and Receiver Operating Characteristic curve (ROC) analyses were performed. The MET implementation process was studied using two convenience sample surveys of the nursing staff from the general wards of twelve intervention hospitals. These surveys measured the awareness and understanding of the MET system, level of attendance at MET education sessions, knowledge of the activation criteria, level of intention to call the MET and overall attitude to the MET system, and the hospital level of support for change, hospital capability and hospital culture. The association of these measures with the intention to call the MET and the level of MET utilisation was assessed using nonparametric correlation. Results obtained: The respiratory rate was missing in 20% of subjects. Using listwise deletion, the set of objective activation criteria investigated predicted an adverse event within 24 hours with a sensitivity of 55.4% (50.6-60.0%) and specificity of 93.7% (91.2-95.6%). An analysis approach that assumed the missing values would not have resulted in MET activation provided a sensitivity of 50.4% (45.7- 55.2%) and specificity of 93.3% (90.8-95.3%). Alternative models with modified cut-off values provided different results. The MET system was implemented with variable success during the MERIT study. Knowledge and understanding of the system, hospital readiness, and a positive attitude were all significantly positively associated with MET system utilisation, while defensive hospital cultures were negatively associated with the level of MET system utilisation. Major conclusions: The objective activation criteria studied have acceptable accuracy, but modification of the criteria may be considered. A satisfactory trade-off between the identification of patients at risk and workload requirements may be difficult to achieve. Measures of effectiveness of the implementation process may be associated with the level of MET system utilisation. Trials of the MET system should ensure good knowledge and understanding of the system, particularly amongst nursing staff.

Thesis (Ed. D.)--University of Toronto, 2007. / Source: Dissertation Abstracts International, Volume: 68-06, Section: A, page: 2350. Includes bibliographical references (leaves 140-151).

Thesis (M.Psych.Org.) - University of Queensland, 2005. / Includes bibliography.

Thesis (M.Psych.Org.) - University of Queensland, / Includes bibliography.

Thesis (M.Tech.: Emergency Medical Care)- Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xvii, 198 leaves. / The purpose of the study was to assess ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal, by determining the prevalence of bacteria and fungi in ambulances, including those that are potentially pathogenic, and evaluating the knowledge and practices of staff in infection control.

This critical realist thesis seeks to understand how student, graduate and professional identities emerge in Emergency Medical Science (EMS) students at a South African University of Technology (UoT) as well as in professional paramedics in the Emergency Medical Care Services (EMCS). It further considers the construct of graduate attributes (GAs) and its relationship to emergence of identity and influence on curriculum design. The research design is that of a case study. The theoretical framework is critical realism whose depth ontology posits three domains of reality. Causal powers and generative mechanisms exist in the Real domain which cause events or phenomena to emerge in the Actual domain that are experienced in the Empirical domain. Using retroduction one may come to explore some of the causes for the event. Using Bhaskar’s concepts of identity, the self, absence and emergence, ontology and four-planar social being, a Bhaskarian explanatory framework of identity to explore the emergence of identity has been created. In exploring graduate attributes, a critical realist question is posed: “What must the world be like for GAs to exist” to explore the possibilities of the existence of GAs. It was found that student identity emerges diachronically in three moments, while professional paramedic identity starts to emerge during the third year of study mainly through the structure, culture and agency of workplace-based learning. In answer to the critical realist question it was found that GAs emerge from the neoliberalist commodification of universities. In seeking an alternative to GAs, traits and attitudes were explored. It was found that these emerge from curriculum, interplay of departmental structure, culture and agency of and from students’ being which makes them ontologically radically different from GAs. This study concludes that student, graduate and professional identities emerge from a person’s core constellational identity diachronically within four-planar social being and the interplay of structure, culture and agency. GAs cannot be related to the emergence of identity and curriculum design because of their ontology; however, if traits and attitudes are substituted for GAs, a close relationship does exist between emergence of identity, traits and attitudes and curriculum design.

The sequence of events leading to the implementation of a change in emergency physicians' practice and the learning activities and processes undertaken are examined and described in this study. A qualitative case study design was utilized and semi-structured interviews were employed as the primary means of data collection. Thirty emergency physicians were interviewed in face-to-face or telephone interviews. One change that required learning was selected per physician for an in-depth interview. The following factors were examined: motivation to change a practice behavior, time to implementation of changes, source of awareness, barriers to change, use of learning resources, stages in the change process, and method of learning.