Made available in DSpace on 2015-07-22T20:49:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-01-01. Added 1 bitstream(s) on 2015-08-11T03:26:21Z : No. of bitstreams: 1 Publico-200600001.pdf: 310057 bytes, checksum: a2ab830c065d3c7af052f70e82e1bbcc (MD5) / Objetivo: avaliar a adequação do método científico empregado nas teses de mestrado e doutorado dos docentes da Faculdade de Medicina de Marília, no período de 1997 a 2004. Local: Faculdade de Medicina de Marília - Famema, Disciplina de Endocrinologia e Metabologia ; Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina, Programa de Pós-graduação em Medicina Interna e Terapêutica, Centro Cochrane do Brasil. Método: estudo analítico transversal, avaliando todas as teses de mestrado e doutorado dos docentes da Faculdade de Medicina de Marília entre 1997 a 2004. O principal desfecho quantificado foi a adequação do método. Essa avaliação foi realizada por dois pesquisadores independentes e a concordância avaliada pelo teste de Kappa. Foi construído roteiro específico para avaliação de estudo quantitativo primário, secundário e qualitativo. O método do estudo foi considerado adequado (A) quando os escores atribuídos pelos pesquisadores eram maiores que 75%, parcialmente adequado (PA) se o escore estivesse entre 50% e 74%, e inadequado (I) se o escore fosse menor que 49%. Esses limites foram escolhidos arbitrariamente. Perspectivas / Viabilidade: Como os docentes da Faculdade de Medicina realizaram as suas pós-graduações nas principais universidades públicas do Estado de São Paulo, a amostra é aleatória e representativa de diferentes cursos. Se a hipótese do estudo for confirmada, os resultados deste trabalho poderão contribuir para avaliar a qualidade dos cursos de pós-graduação e contribuir para a melhora do planejamento do projeto de pesquisa. Quanto à viabilidade, é uma pesquisa de fácil execução e de baixo custo, pois, do ponto de vista humano, depende de dois pesquisadores e tecnicamente, de um computador e material de consumo. / TEDE / BV UNIFESP: Teses e dissertações

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: The World Spine Care (WSC) is a non-governmental organization that provides evidence-based spinal care to underserved communities around the world. The WSC opened a clinic in the Mahalapye District Hospital (MDH) in 2011 (Haldeman et al., 2015:2304). The WSC aims for long term presence in Botswana. They will require ‘buy in’ from the local community including the health care professionals of the region. Little is known about how WSC has been received by other health care professionals in the settings where they are present. Hence, this study aimed to determine the knowledge, attitudes and perceptions of health care professionals working at the MDH about the WSC. Method: A qualitative exploratory descriptive study was conducted using semi-structured interviews. Twenty health care professionals were interviewed at the Mahalapye District Hospital to ascertain their levels of knowledge, attitudes and perceptions. The interviews were semi- structured and conducted in English and later transcribed verbatim. The transcripts were then analyzed using the thematic analysis described by Graneheim and Lundman (2003:105). Thereafter codes, categories and themes were formed. Results: A variety of health care professionals from different departments were interviewed. Three overarching themes emerged from the data: knowledge of WSC and the management of spinal related disorders at the MDH, the perceived role of WSC, challenges to integration and possible solutions. The HCPs had varying levels of knowledge of the WSC depending on the amount of interaction they had with WSC. Some HCPs who had greater inter-professional interaction with WSC displayed more positive attitudes towards WSC. Many of the HCPs had a positive perception of the WSC though they were not confident in their knowledge of the WSC scope of practice which has limited referral by HCPs WSC. This is mainly due to an unclear referral pathway within the hospital and limited knowledge of WSC’s scope of practice. Increased awareness and an improved system of referral was a strong recommendation made. Many mentioned an unclear referral pathway for their patients. Those who had interacted with WSC generally had pleasant personal interactions with the WSC. Several of the HCPs had themselves been patients of the WSC. Most HCPs felt that WSC was beneficial to patients and made suggestions for WSC to expand to other centres across Botswana. Conclusion: Overall there was a positive perception of WSC however more effort to increase knowledge of what WSC offers and how it can be integrated into the hospital is necessary. Future studies should assess the perceptions of patients as well as knowledge and attitudes of HCPs towards WSC at other sites. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background ABSTRACT In the chiropractic profession, it has been an established goal to utilise evidence-based practice (EBP) in clinical practice in order to empower chiropractors to develop effective treatment protocols. However, the extent to which chiropractors are utilising EBP, and the factors associated with its implementation in practice is unknown. The lack of research in this regard suggests that further studies need to be undertaken within the chiropractic profession in South Africa in order to fully understand the relationship of factors which contribute to the adoption and application of EBP by chiropractors in clinical practice. Therefore, the aim of this study was to investigate the knowledge of, attitudes towards, perceptions of and perceived barriers towards EBP by chiropractors within the eThekwini municipality. Method A pre-validated cross sectional descriptive survey was administered to chiropractors practicing within the eThekwini municipality (n = 101) by hand delivery. The questionnaire was validated by means of a focus group and pilot testing. Participants gave informed consent prior to participation. Data were analysed using using SPSS Statistics 24.0 and Statgraphics Centurion 15.1 (2006) to determine the descriptive and inferential statistics while the open- ended questions were analysed qualitatively using manifest coding. Results A response rate of 51% (n=51) was obtained. The majority of respondents were male (51%), mean age of 37.8 years, practicing for less than 19 years, working in full time practice (76.5%) between 40 and 49 hours per week (45.1%). The majority of the respondents had a positive attitude and perception towards EBP with respondents showing a willingness to improve skills (72.6%) and utilisation (52.9%) of EBP. Respondent 15 explained that “it is very important to have the skills in order to utilise EBP. Once you have the skills, utilising EBP becomes easy”. Responses highlighted that respondents are engaging with scientific literature when necessary and possess the skills necessary to utilise EBP. The majority of respondents believe that they had a strong academic foundation in their knowledge and skills related to accessing and interpreting information, yet 47.1% reported not having received formal training in search strategies to access literature. However, most felt confident about their knowledge and skills to utilise EBP. Insufficient time (66.7%), lack of generalisability of the literature findings to their patient population (49.0%) and the inability to apply research findings to individual patients with unique characteristics (45.1%) were the three top barriers identified. Respondent 12 described: “most articles are vague or time consuming and searching for relevant, up to date and reliable articles is a difficult process that can take a lot of time” as a possible barrier to utilising EBP. Conclusion The respondents in this study had a favourable attitude towards, and perception of, EBP and its usefulness to chiropractic practice. However, like other healthcare professionals they felt that they had insufficient time to utilise EBP. This study also highlighted the importance of academic institutions providing the necessary skills required to utilise EBP. It is recommended that workshops focusing on EBP principles and training are arranged to assist practitioners in integrating EBP into practice / M

Na busca da qualidade de assistência nos serviços de saúde enfatiza-se a necessidade de conhecimento científico dos profissionais de enfermagem relacionado à prevenção da úlcera por pressão (UP), visto que frequentemente a prática não é baseada em evidências, e sim em mitos, tradições e experiências. Em âmbito internacional, existem várias diretrizes para a prática clínica que apresentam recomendações. Os objetivos deste estudo foram investigar o conhecimento dos membros da equipe de enfermagem que atuam diretamente na assistência a pacientes adultos e idosos em um hospital universitário sobre a prevenção da úlcera por pressão, e explorar a relação dos escores do teste de conhecimento com variáveis sócio-demográficas e estratégias de busca de informações científicas. Trata-se de pesquisa descritiva-exploratória, com métodos quantitativos. O projeto de pesquisa foi aprovado pelo comitê de ética da instituição e os dados foram coletados por meio de um instrumento estruturado e validado. Dos 386 participantes, 64,8% eram auxiliares/técnicos de enfermagem e 35,2% enfermeiros. A porcentagem média de acertos no teste de conhecimento foi 79,4% (DP 8,3) para os enfermeiros e 73,6% (DP 9,8) para os auxiliares/técnicos de enfermagem. Dos participantes, 92 (23,9%) acertaram menos de 70% no teste. Em relação à avaliação e classificação da UP, os itens com acertos menores do que 60% foram referentes à classificação da UP em estágio II (29,5%) e III (37%) e a presença da dor na UP em estágio II (56,5%). Os itens sobre prevenção com acertos menores do que 50% foram referentes ao uso da massagem (39,6%), rodas dágua ou de ar (35,2%), luvas dágua ou ar (47,9%), ao posicionamento do paciente quanto elevação da cabeceira do leito (27,7%), e ao período de tempo para reposicionamento quando sentado na cadeira (28%) e em decúbito lateral (37,3%). A porcentagem de acertos dos auxiliares/técnicos de enfermagem diminuiu com o tempo de formação profissional assim como com o tempo de serviço (p<0.05). A porcentagem de acertos dos enfermeiros com Especialização foi maior (80,6%) do que os sem Especialização (77,6%) e dos enfermeiros com Mestrado foi maior (83,1%) do que os sem Mestrado (79,1%). Os enfermeiros que participaram em pesquisa durante a graduação obtiveram porcentagem de acertos maiores do que aqueles que não participaram (p<0.05). As porcentagens de acertos dos que participaram em eventos científicos, comissões ou grupos de estudos e em atividades educacionais da instituição foram maiores dos que não participaram, (p<0.05). Os enfermeiros que faziam assinatura de revistas científicas e leitura de publicações científicas obtiveram maior porcentagem de acertos (p<0.05). Também os participantes que faziam o uso da biblioteca e da internet para a busca de informações científicas obtiveram melhor escore (p<0.05). Em relação às estratégias de busca de informações científicas com outros profissionais, a porcentagem de acertos obtida pelos participantes foi maior naqueles que afirmaram utilizar qualquer uma das formas. Os resultados obtidos podem auxiliar a identificar fatores antecedentes que interferem no conhecimento dos membros da equipe de enfermagem e nortear no contexto estudado, o planejamento de estratégias para disseminação e adoção de medidas preventivas tidas como inovações. / In the search for health service care quality, nursing professionals need for scientific knowledge on pressure ulcer (PU) prevention is emphasized, as practice frequently is not based on evidence, but on myths, traditions and experiences. In the international context, various guidelines for clinical practice present recommendations. This study aimed to examine the knowledge of nursing team members who deliver direct care to adult and elderly patients at a university hospital about pressure ulcer prevention, and to explore the relation between knowledge test scores, sociodemographic variables and scientific information search strategies.This descriptive-exploratory research used quantitative methods. The research project was approved by the ethics committee at the institution and data were collected through a structured and validated instrument. In total, there were 386 participants, 64.8% of whom were nursing auxiliaries/technicians and 35.2% nurses. The mean percentage of correct answers on the knowledge test was 79.4% (SD 8.3) for nurses and 73.6% (SD 9.8) for nursing auxiliaries/technicians. Among the participants, 92 (23.9%) gave less than 70% of correct answers on the test. As to PU assessment and classification, items answered correctly by less than 60% were related to PU classification in stage II (29.5%) and III (37%) and the presence of pain in stage II PU (56.5%). Items on prevention with less than 50% of correct answers referred to the use of massage (39.6%), water or air-filled cushions (35.2%), water or air-filled gloves (47,9%), patients positioning in terms of bed head elevation (27.7%), and to the period of time for repositioning when seated in a chair (28%) and in lateral decubitus (37.3%). The percentage of correct answers among nursing auxiliaries/technicians decreased with time since graduation and service time (p<0.05). Nurses with a Specialty degree gave more correct answers (80.6%) than nurses without this degree (77.6%), and nurses with a Masters degree scored higher (83.1%) than nurses without this degree (79.1%). Nurses who participated in research during their undergraduate program scored higher than those who did not participate (p<0.05). Correct answer percentages for participants who took part in scientific events, committee or study groups and in educational activities at the institution were higher than for those who did not (p<0.05). Nurses who subscribed to scientific journals and read scientific publications scored higher (p<0.05). The same was true for participants who used the library and internet to seek scientific information (p<0.05). As to strategies to seek scientific information from other professionals, participants who affirmed using any possible form scored higher. The obtained results can help to identify preceding factors interfering in nursing team members knowledge and guide the planning of dissemination strategies and the adoption of prevention measures considered innovative in the study context.

As doenças cardiovasculares (DCV) de origem aterosclerótica estão entre as principais causas de morbimortalidade cardiovascular. A periodontite, por meio de bacteremia e endotoxemia, tem sido apontada como possível fator de risco para início e progressão da aterosclerose. A proposta desta revisão foi buscar, reunir e analisar evidências científicas atuais de nível I e II sobre a associação entre periodontite e aterosclerose em seres humanos. As bases de dados consultadas foram: Medline (Medical Literature Analysis and Retrieval System), registro Cochrane de ensaios controlados (Cochrane Central Register of Controlled Trials - Central) e registro Cochrane de revisões sistemáticas (Cochrane Databasis of Systematic Reviews - CDSR). Foram identificados 532 estudos, sendo 22 elegíveis, dos quais nove atenderam aos critérios de inclusão. A amostra foi composta por 100% de ensaios clínicos randomizados controlados (ECRC). Oito estudos (89%) avaliaram o efeito do tratamento periodontal quanto aos parâmetros clínicos periodontais e marcadores relacionados à fisiopatologia da aterosclerose, em três destes (37,5%) o efeito do tratamento periodontal foi testado com antibioticoterapia e um (11%) avaliou o efeito somente da antibioticoterapia. Sete (78%) avaliaram níveis séricos de proteína C-reativa (PCR) antes e após o tratamento periodontal, em quatro (57%) houve redução deste marcador nas avaliações posteriores a seis semanas. Cinco (55,5%) avaliaram níveis séricos de interleucina-6 (IL-6), dos quais três (60%) relataram redução após mais de um mês do tratamento periodontal. Fatores lipídicos foram avaliados em três estudos (33%) e todos relataram melhoria significativa após tratamento periodontal. Evidências científicas de nível II apontam que a periodontite parece provocar alterações nos marcadores sistêmicos relacionados à fisiopatologia da aterosclerose podendo o tratamento periodontal ser benéfico para controlar marcadores séricos de risco para aterosclerose, com resultados significativos em casos mais severos de periodontite e para os marcadores lipídicos. / Cardiovascular diseases (CVD) caused by atherosclerosis are among the leading causes of cardiovascular morbity and mortality. Periodontitis through bacteremia and endotoxemia has been identified as a possible risk factor for initiation and progression of atherosclerosis. The purpose of this review was to seek, gather and analyze evidence of level I and II available in the literature on the association between periodontitis and atherosclerosis in the last ten years. The databases were consulted: Medline (Medical Literature Analysis and Retrieval System), Cochrane register of controlled trials (Cochrane Central Register of Controlled Trials - Central) and record Cochrane systematic reviews (Cochrane Database of Systematic Reviews - CDSR). We identified 532 studies, of which 22 eligible, of which 9 met the inclusion criteria. The sample consisted of 100% of randomized controlled trials (ECRC). Eight studies (89%) evaluated the effect of periodontal treatment on the clinical periodontal parameters and markers related to the pathophysiology of atherosclerosis in these three (37.5%) the effect of periodontal treatment has been tested with antibiotics and one (11%) evaluated only the effect of antibiotic therapy. Seven (78%) evaluated serum levels of C-reactive protein (CRP) before and after periodontal treatment in four (57%) decreased this marker in subsequent evaluations to six weeks. Five (55.5%) evaluated serum levels of interleukin-6 (IL-6), of which three (60%) reported a decrease after more than a month of periodontal treatment. Lipid factors were evaluated in three studies (33%) and all reported significant improvement after periodontal treatment. Strong scientific evidence (Level II) indicate that periodontitis seems to cause changes in systemic markers related to the pathophysiology of atherosclerosis, periodontal treatment may be beneficial to control serum markers for atherosclerosis, with significant results in more severe cases of periodontitis and the lipid markers.

Orientador: Maria das Graças Conde Caldas / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Estudos da Linguagem / Made available in DSpace on 2018-08-22T12:33:10Z (GMT). No. of bitstreams: 1 Clark_LucianaGontijodeOliveira_M.pdf: 246185391 bytes, checksum: 073d591a8cadea15381c8e287b28e420 (MD5) Previous issue date: 2013 / Resumo: Esta pesquisa se propôs a discutir a relação entre Comunicação e Saúde, por meio da análise das reportagens de capa sobre o câncer publicadas pela revista Veja nos últimos 40 anos. O corpus da pesquisa incluiu 26 matérias das quais 17 foram assunto principal da capa e 9 foram chamadas secundárias. Este estudo buscou avaliar vários aspectos sobre a divulgação do câncer na mídia para melhor compreender seu impacto na construção do imaginário social sobre a doença, mitos e realidade. Alguns dos aspectos examinados foram: a evolução histórica das reportagens publicadas, a frequência de publicação dos temas de saúde e mais especificamente do câncer nas capas de Veja, a mensagem transmitida pelas chamadas de capa; as abordagens das matérias internas e o seu potencial de gerar expectativas no paciente/leitor. Esta pesquisa utilizou as metodologias de estudo de caso e de análise de conteúdo, sendo que a abordagem dos textos foi de natureza qualitativa, embora recorresse ao quantitativo, de forma complementar. Os resultados demonstraram que ao longo dos anos houve um aumento sustentado do número de reportagens sobre saúde nas capas de Veja, com destaque para o câncer como o terceiro tema mais presente. A análise das matérias detectou um uso persistente das metáforas bélicas para explicar os vários aspectos da doença e das terapias, o uso de analogias simplistas na descrição dos tratamentos com uma tendência a minimizar seus efeitos adversos e uma concentração cada vez mais acentuada das informações em infográficos nos últimos dez anos. O uso de resultados de estudos científicos de boa qualidade para embasar as informações passadas nos textos ainda é muito limitado. Apenas uma vez, nas 17 edições analisadas, uma revisão sistemática da literatura foi citada para embasar as informações de uma reportagem de capa sobre o câncer em Veja. A maioria das reportagens deu maior destaque para estudos de fase II, considerados potenciais novidades, ainda que seus resultados fossem experimentais e a despeito de existirem estudos de boa qualidade, com metodologias adequadas e altos níveis de evidência sobre os mesmos temas abordados / Abstract: This study discusses the relationship between Health and Communications, through the analysis of all the cancer reports on the covers of Veja, the weekly magazine with the largest circulation numbers in Brazil. All 26 reports detected over the above-mentioned period were included for a global evaluation. Of those, nine were secondary news about cancer on the cover (not the main theme of that edition) and 17 were the main cover news. The latter were subsequently analyzed in depth. Several aspects about scientific divulgation of cancer on the mass media were studied to better understand the construction of this disease's image on the social collective imaginary, its myths and realities. Some of the topics included were: the evolution of the reports in a historic context; the frequency of health related themes, specially cancer, on the covers; the message passed to the readers by the texts and their potential for generating high expectations on them. This research is a case study in which content analysis, as described by Bardin, was employed. The methodology used to approach the texts was both qualitative and quantitative. The results showed that there was a steady increase in the numbers of reports about health themes on the covers of Veja, with cancer being the third most common topic in the area. The analysis of the texts demonstrated that warfare metaphors are persistently present to describe both the disease and its treatments, with simplistic analogies being applied to explain the therapies, although with a marked lack of stress on their frequent side effects. The last decade showed an increase in the use of infographics instead of text to pass information to the readers. The use of high quality studies to support the healthcare information on the reports is still very limited. Only once in the 17 texts analyzed a systematic review of the literature was cited on a text about cancer on the covers of Veja. Most reports give undue highlights to experimental phase II studies, considered sources of potential novelties, even if their results are flimsy at best and other studies, with better quality, more robust methodologies and higher levels of evidence on the very same topics are readily available on the medical literature / Mestrado / Divulgação Científica e Cultural / Mestra em Divulgação Científica e Cultural

La thèse se positionne dans un ensemble de travaux portant sur les rationalisations contemporaines des organisations de santé, et se focalise sur les pratiques des médecins hospitaliers au sein de réunions de concertation pluridisciplinaire en cancérologie. Nous développons une hypothése selon laquelle la dimen- sion prudentielle, conjecturale de l'activité médicale est en tension avec les dynamiques de rationalisation qui traversent l'organisation. En étudiant les techniques qui structurent les savoirs médicaux et qui équipent les pratiques délibératives et interprétatives des médecins, nous analysons une tension spécifique qui se produit au cœur des pratiques conjecturales ethnographiées. La thése expose les différentes conceptions de l'incerti- tude qui sont formalisées dans les dispositifs techniques qui équipent les savoirs et les pratiques médicales, où les prises de position objectiviste et épistémique divergent et doivent être articulées au sein de processus communicationnels, délibératifs et interprétatifs. / This thesis belongs to the field of rationalization studies in healthcare organizations. Its focus is on medical practices observed in multi-disciplinary meetings in the oncology ward of a hospital in South West France. We hypothesize that tension exists between the prudential and conjectural dimension of medical activity and the rationalization dynamics present across the organization. Technologies exist that structure medical knowledge and practices. They equip deliberative and interpretative medical practices. By studying these technologies, we can analyze a specific tension that exists in the depths of the observed conjectural practices. The thesis shows the different conceptions of uncertainty that are formalized in the technological dispositifs equiping medical knowledge and practice. It highlights those areas where objective and epistemic positions differ, and which therefore require articulation inside communicational, deliberative and interpretative processes.

En el Perú, la elaboración de guías de práctica clínica tiene exigencia normativa desde el año 2005 (NT N° 027-MINSA/DGSP-V.01); sin embargo, su desarrollo ha ténido poco énfasis en la calidad metodológica de las mismas, prefiriendo el tipo narrativo. Desde hace varios años se realizan esfuerzos dispersos para mejorar la calidad metodológica, principalmente que su elaboaración esté basada en evidencias científicas. Actualmente se cuenta con una nueva normativa (NT N° 302-2015/MINSA) que pone mayor enfasis en esta exigencia y algunas instituciones ya trabajan para adecuarse a estandares internacionales y poder generar impactos positivos en nuestro sistema de salud a través del adecuado desarrollo de guias de practica clínica en nuestro pais. / There has been a regulation for generating clinical practice guidelines in Peru since 2005 (NT N° 027-MINSA/DGSP-V.01), which was issued by the Ministry of Health. However, its use has had little emphasis in the methodological quality of such guidelines, and a narrative style was preferred. Some isolated efforts aiming to improve the quality of such guidelines have taken place, especially with respect to have such documents produced based on evidence. Now we have a new regulation (NT N° 302-2015/MINSA), which places more emphasis in this requirement; and some institutions are already working in such way, in order to comply with international standards and be able to generate a positive impact in our healthcare system through the adequate development of clinical practice guidelines in our country.

The shortage of healthcare workers and doctors in the developing world compared to the developed world is a problem, and will continue to be so, due to the continual migration of qualified professionals and the inability of the state to remedy these shortfalls. A shortage of healthcare workers and specialist doctors will seriously hamper the Government’s National Health Insurance (NHI) plan, as well as the sustainability of the private health care sector. In addition, the duration of medical training in South Africa is exceptionally long. The three major hospital groups and other private corporates have over the last number of years taken limited initiative to fund education projects in conjunction with the academic institutions. However, these projects have been poorly focused and have been managed in an unstructured and detached manner. There is a desire from the private sector to get involved in these projects on a much larger scale through more formalised structures. Given this background, the primary objective of this research is to develop a business model for medical subspecialty training to complement the current academic subspecialty training in South Africa. A trial model for training subspecialists in reproductive medicine was developed as a first attempt to address the threatening shortages and training duration. This trial programme is the basis of this research. A two-phased process was used in collecting data. In Phase 1 data was collected from stakeholder groups. The results of this survey assisted in generating variables to include in the measuring instrument for the survey in Phase 2. In Phase 2 the perceptions and expectations of sub-specialists (reproductive subspecialists and cardiologists) regarding sub-specialty training was collected. The results of the demographic variables confirm the aging profile of subspecialist and the need to ensure succession. The results further showed that cardiologists and reproductive subspecialist expectations of the training of subspecialists are very similar except for their expectations on the training duration. Reproductive subspecialist respondents agreed more than cardiology subspecialist respondents that the training duration is too long. The biggest gap between perceptions and expectations is also with the factor training. The results showed that the expectations of subspecialists are not met for training. From these results a business model for the training of medical subspecialists is proposed. This proposed business model can play a complementary role to the existing state controlled system and form the bases of Public Private Partnerships (PPP) in medical training. This proposed business model will fit a developing country were the focus is on primary healthcare, with financial and capacity constraints. The proposed model would require role players to bring about change to accommodate a larger scale Public Private Partnership (PPP) to ensure the implementation of the model. The proposed decentralised business model for training subspecialists would allow the trainee subspecialist to practise as a specialist thus maintaining an acceptable income, and enable an expedited completion and lead to a wider dissemination of medical expertise that can be delivered in a wider national foot print. It further will provide for a structured Public Private Partnership.

Clinical decision rules improve health care fidelity, benefit patients, physicians and healthcare systems, without reducing patient safety or satisfaction, while promoting cost-effective practice standards. It is critical to appropriately and consistently apply clinical decision rules to realize these benefits. The objective of this thesis was to understand how physicians use the Ottawa Ankle Rules to guide radiography decision-making. The study employed a clinical judgment survey targeting members of the Canadian Association of Emergency Physicians. Statistical analyses were informed by the Brunswik Lens Model and Social Judgment Analysis. Physicians’ overall agreement with the ankle rule was high, but can be improved. Physicians placed greatest value on rule-based cues, while considering non-rule-based cues as moderately important. There is room to improve physician agreement with the ankle rule and use of rule-based cues through knowledge translation interventions. Further development of this Lens Modeling technique could lend itself to a valuable cognitive behavioral intervention.