published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

There has recently been an increased pressure in all-healthcare disciplines to provide interventions that are scientific, safe, efficient and cost-effective. Evidence-based practice is said to be the current best approach to address these attributes. All healthcare professionals including physiotherapists need to adopt it. Numerous physiotherapy studies have been carried out to ascertain the attitudes towards, knowledge of, engagement in as well as the barriers of evidence-based practice. These studies were mostly carried out in the developed countries and almost none in the devloping African countries. By means of an exploratory cross-sectional study, deploying both quantitative and qualitative methods, this study investigated the Tanzanian physiotherapists attitudes towards the concept of evidence-absed practice. The study also examined the knowledge that they possess, that could enable them engage in evidence-based related activities. In addition, this study explored the barriers they experience while practicing evidence-based practice.

Doctor of Philosophy (PhD) / Introduction The aim of this study was to examine how the term “evidence” was conceived and used among academics and practitioners who teach medicine and public health. The rationale for the study was the widespread debate in the 1990s about evidence in health care. Methods Qualitative data were collected between 1996 to 1999. The core data came from unstructured interviews with researchers and practitioners linked to the Faculty of Medicine, University of Sydney. Other sources of data were: participant observation of group interactions in the Faculty of Medicine and at national and international conferences about evidence in health care; discourse in health care literature; and Internet posting to an international “evidence-based health” Email discussion list. The Grounded Theory method was adopted to analyse and interpret these data. The process involved systematic coding of the data to develop conceptual categories. These categories were employed to formulate propositions about the topic of evidence and how it was conceived and used by the study participants. Results Researchers and practitioners often discussed evidence from a “realist” view: that is they valued scientifically derived and rigorously substantiated knowledge about the natural world. Yet despite their widely shared epistemological perspectives, study participants presented several diverse concepts of evidence. Their ideas were also dynamic and evolving, and often influenced by the developing (local and international) debates and controversies about evidence-based medicine (EBM). Grounded Theory analysis leads to the selection of a core “social process”. This is a core conceptual category that draws together the ideas observed in the data, and that is adopted to present the study findings. In this study, “judgement” was identified as the core social process to underpin all examined reflections and discussions about evidence. Study participants defined the concept of evidence through a combination of description and appraisal. Evidence was described in three ways, i.e.: as a “measure of reality”, by its “functional role”, or as a “constructed product”. Evidence was also appraised on three “dimensions”, i.e.: “benchmarked”, “applied” and “social” dimensions of evidence. Participants invoked these concepts of evidence differently when forming their own judgements about medical or public health knowledge; when making decisions about clinical practice; and when using argument and persuasion to influence the judgements of others. Many researchers and practitioners also modified their judgements on evidence in the light of EBM. This was based on perceptions that EBM had become a dominant rhetoric within health care, which had the potential to channel the flow of resources. This led to an increasing consideration of the “social dimension” of evidence, and of the social construction and possible “misuse” of the term evidence. Conclusions The concept of evidence is presented in this study as a multi-dimensional construct. I have proposed that the three descriptions and three dimensions of evidence presented in this study, and recognition of the way these may be invoked when forming and influencing judgments, can be used as a basis for communicating about evidence in medicine and public health among colleagues and with students. There are significant gaps in knowledge (based on empirical research) about the social dimension of evidence. Particularly, in situations where researchers and practitioners wish to employ the concept of evidence to influence others’ medical and public health practice and wider social policy.

Thesis (Ph. D.)--University of Sydney, 2001. / Title from title screen (viewed 9 January 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Department of Public Health and Community Medicine, Faculty of Medicine. Includes bibliographical references. Also issued in print.

Thesis (M.Med.Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 47-55). Also available in print.

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references. Also available in print.

Thesis (M.S.)--Iowa State University, 2008. / Adviser: Annette M. O'Connor. Includes bibliographical references.

Magister Scientiae (Physiotherapy) - MSc(Physio) / There has recently been an increased pressure in all-healthcare disciplines to provide interventions that are scientific, safe, efficient and cost-effective. Evidence-based practice is said to be the current best approach to address these attributes. All healthcare professionals including physiotherapists need to adopt it. Numerous physiotherapy studies have been carried out to ascertain the attitudes towards, knowledge of, engagement in as well as the barriers of evidence-based practice. These studies were mostly carried out in the developed countries and almost none in the devloping African countries. By means of an exploratory cross-sectional study, deploying both quantitative and qualitative methods, this study investigated the Tanzanian physiotherapists attitudes towards the concept of evidence-absed practice. The study also examined the knowledge that they possess, that could enable them engage in evidence-based related activities. In addition, this study explored the barriers they experience while practicing evidence-based practice. / South Africa

A medical negligence case presented to the court is based on averments of neglected duty of care of the defending doctor, a duty owed in accordance with the law of delict, and alternatively and/or accumulatively averments that the contractual agreement between the complainant and the defending doctor was not honoured. In order to prove failure of duty of care and/or breach of agreement, the complainant bears the onus of proof to present to the court reliable medical evidence that would enable the court to reach a decision. The courts have ruled for and against many plaintiffs throughout the years, setting the standards and yardsticks for the requirements of medical negligence. The value or lack thereof of the medical evidence presented came under the magnifying glass in the case of Michael vs Linksfield Park Clinic (Pty) Ltd 2001 (3) SA 1188 SCA and the court indicated the necessity for a "collective mind" from the medical profession. Brilliant legal writers published on this topic and the search and need created this dissertation. The study sets as goal to scrutinize the quality of medical evidence in general, and more specific the Michael-case. From a wide perspective medical evidence was researched, and the term evidence-based medicine led the study to an existing "collective mind" of the medical profession. The study investigated the history and development of evidence-based medicine in order to evaluate whether it can be seen as the "collective mind" of the medical profession. Satisfied that the "collective mind" was found the study tested the available medical evidence, randomly searched, against specific medical issues in the Michael-case and the study compiled substantial medical evidence to work with. An independent expert was consulted and the medical evidence was scrutinized with commentary, explanation and the basis formulated for negligence. The Michael-case was deconstructed and subsequently reconstructed, and the outcome predictably different, based on sound medical evidence. The study explained and warned against exploitation of the statistical data and incorrect interpretation of results. The study concluded that the court as the ultimate trier of the facts should determine whether the medical evidence presented to the court forms part of the "collective mind", and whether it complied with logical principles and reasoning prior to reaching a decision. General notes: <ul> <lo>1. Wikipedia and e-medicine was used as first search and easy reference and not for court purposes or proper reference;</lo> <lo>2. Note that the dissertation has a legal component and medical component and the references in the Bibliography is split under legal and medical references;</lo> <lo>3. Note all the chapter regarding the Michael-case reference to: epinephrine=adrenaline; nor-epinephrine=nor-adrenaline; propranolol=propanolol (American spelling versus the English spelling, both accepted in South Africa);</lo> <lo>4. The spelling of nomenclature like anaesthetist versus anesthetist, gynaecologist versus gynecologist; paediatrist versus pediatrist etc are used inconsistently as it is once again the American spelling versus the British spelling, which are accepted in South Africa.</lo> </ul> / Dissertation (LLM)--University of Pretoria, 2011. / Public Law / unrestricted

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