Thesis (M.Soc.Sc.)--University of Hong Kong, 1989. / Also available in print.

Background. Diabetes mellitus (DM) is a common condition. The high burden of undiagnosed DM and lack of large population studies make accurate prevalence estimations difficult, especially in the surgical environment. Furthermore, poorly controlled DM is associated with an increased risk of perioperative complications and mortality. Objectives. The primary objective was to establish the prevalence of DM in elective adult non-cardiac, non-obstetric surgical patients in Western Cape hospitals. The secondary objectives were to assess the glycaemic control and compliance with treatment of known diabetics. Methods. This was a five-day, multicentre, prospective observational study performed at six government-funded hospitals in the Western Cape. Screening for DM was done using fingerprick capillary blood glucose (CBG) testing. Patients found to have a CBG of ≥ 6.5 mmol/L had an HbA1c level done. DM was diagnosed based on the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) diagnostic criteria. Patients known with DM had an HbA1c performed and Morisky Medication Adherence Scale (MMAS-4) questionnaires completed, to assess glycaemic control and compliance with treatment. Results. Of the 379 participants, 61 were known diabetics (16.15%; 95% CI 12.4-19.8%). After exclusion of eight patients with incomplete results, a new diagnosis of DM was made in five out of 310 patients (1.6%; 95% CI 0.2-3.0%). Overall prevalence of DM was 17.8% (66/371; 95% CI 13.9-21.7%). HbA1c results were available in 57 (93.4%) of the 61 known diabetics. Of these 27 (47.4%; 95% CI 34.4-60.3%) had an HbA1c level≥8.5% and 14 (24.6%; 95% CI 13.4 - 35.8%) had an HbA1c ≤7%. Based on positive responses to two or more questions on their MMAS-4 questionnaires, 12 out of 60 participants (20%) were deemed non-compliant. Conclusion. There is a low rate of undiagnosed DM in our elective surgical population; however there is a large proportion of poorly controlled DM. Since poorly controlled DM is known to increase postoperative complications, this likely increases the burden of perioperative care. Resources should be focused on improvement of long-term glycaemic control in patients presenting for elective surgery.

In recent years, there has been an increasing demand to study the information needs and information-seeking behaviour of doctors as an essential element in developing successful clinical information systems and improving the quality of healthcare services. This doctoral thesis focuses on exploring the information needs and information seeking behaviour of doctors in Kuwait government hospitals (KGH). The aims are to investigate the internal and external information sources used by doctors in Kuwait government hospitals and to analyse whether the existing clinical information sources meet their needs. A strategy of sequential, mixed-method procedures was followed to gather the research data using focus groups, a paper-based questionnaire and semi-structured telephone interviews. The participants of the research included all categories of doctors (consultants, senior specialists, specialists, senior registrar, registrar, assistant registrar and trainees), working in four government hospitals: Mubarak AI Kabeer, AI Sabaha, AI Farwania and AI Amiri in Kuwait. The findings of the study show that the most frequently mentioned need for information was to keep up-to-date to maintain good practice. It was found that interpersonal communication and a doctor's personal collection, consisting primarily of electronic resources, were the sources most frequently reported as used by the doctors. However, the degree of use of clinical information sources showed that doctors' information seeking varied depending on the clinical scenario. Doctors' knowledge and patient data were the doctors' most frequently used sources of information in the three clinical scenarios: outpatients, wards and the emergency department. There was a low use of knowledge-support resources such as the Internet and library resources in the outpatient and emergency rooms. However, use of the knowledge-support resources was highest in the wards. The results showed some contextual factors either supported or hindered doctors in seeking the information they need. The factors were categorised in the following contexts: a) Organisation context, b) Socio-cultural context; c) Information sources context and d) Scenarios context. Doctors made a number of suggestions for effective information communication and improving the information provision system in KGH. Two conceptual models result from the study findings: a clinical decision-making model scenario· and the overall conceptual model of information seeking by doctors in Kuwait government hospitals. The thesis concludes with recommendations and practical implications to enhance the information provision in KGH. Suggestions for further research are also given.

The dispensation of hearing aids in the public sector of South Africa is burdened with problems such as lack of provision of batteries for hearing aids, poor repair services and inadequate follow-up. This affects the maximum benefit derived from the hearing aid. Hearing loss which affects communication also negatively impacts on speech and language development, cognitive development, pragmatic skills, and employment opportunities i.e. all aspects of daily living. A hearing aid is an example of an assistive listening device that attempts to minimise the consequences of hearing loss. It is a restorative mechanism that amplifies sound to compensate for hearing loss. For the greater part of the population with hearing loss it is the most cost-effective solution. Therefore, the hearing aid must be correctly fitted and used. It is vital that the client knows how the instrument operates, how to handle it, how to care for it, and, most importantly, how to use it. This involves a great deal of information giving, practice, and counselling by the speech-language pathologist and audiologist. An effective orientation and rehabilitation programme should constitute of the following: a discussion of the types of hearing loss, the facilitation of understanding of the audiogram; information on troubleshooting and using hearing aids effectively; as well as information on the expectations of the hearing aid/s. Speech-reading techniques, coping and communication repair strategies are also important. It is hypothesized that many individuals who are fitted with government hearing aids cannot adequately utilise and maintain their devices. Furthermore, this problem could be related to the initial hearing aid orientation and lack of follow-up rehabilitation as this when information regarding utilisation and maintenance is usually disseminated to clients. This study therefore aimed to examine the maintenance and utilisation of hearing aids given to clients attending provincial hospitals in Tshwane and to probe factors that impacted on the aural rehabilitation and the hearing aid fitting process, in order to contribute to the formation of service delivery guidelines. Both a qualitative and quantitative research approach was utilised. The type of research was cross-sectional and analytical. The nature of the investigation was a descriptive survey utilising face-to-face interviews. A method of non-probability purposive sampling was employed. Fifty seven adult hearing aid users were interviewed with a structured interview schedule. Quantitative results were analysed using statistics and qualitative data was categorised into main themes and ideas. Results showed that there was a general consensus about the self-image and wearing of hearing aids, as most participants were embarrassed to wear their devices. This could be due to inadequate and lack of counselling and public awareness. Furthermore, it was found that most government fitted hearing aids and accessories were poorly cared for and maintained. There were several factors which negatively influenced the utilisation and maintenance of hearing aids. One of these factors was finance i.e. the cost of travelling to and from hospitals, the cost of batteries as well as the cost of repairs to hearing aids played a significant role in how the hearing aid was utilised and cared for. Distance from hospitals also impacted on the maintenance as all hearing aid services were only available at tertiary institutions and not at community level. Furthermore, the issue of multilingualism presented an obstacle in terms of utilising hearing aids correctly and to their full benefit, as most participants were not instructed on hearing aid care and use in their first language. The results from this study were utilised in the development of service delivery guidelines for the dispensation of government hearing aids. / Dissertation (MCommunication Pathology)--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / Unrestricted

Republic Act No. 9173, or the Philippine Nursing Act of 2002 enunciates a bevy of incentives under its Health Human Resource Production, Utilization and Development provisions, intended to stem the rising tide of Filipino nurses leaving the country to work overseas. Under Sections 30 to 34 of the Nursing Act, these incentives include the following: (1) upgrading the minimum base salary of nurses from salary grade 10 to 15; (2) establishing a nurse specialty program in government hospitals to upgrade the nurses’ skills whereby recipients of the program are required to work in government hospitals for two years; and (3) the provision of other benefits such as scholarship grants, free medical care, etc. These provisions are the government’s policy response to mitigate the impact of nurses’ migration and retain an adequate supply of skilled Filipino nurses in the country: This research is a qualitative study that seeks to assess the health human resource development provisions and their implementation and aims to help improve them. This study examines the responsiveness of the provisions to the needs of nurses, and identifies the deficiencies of the provisions by looking into the working conditions of nurses in two Philippine government hospitals. It also examines the processes and the factors affecting the implementation of the provisions. This study employed a combination of four data collection methods: (1) focus group interviews of nurses working in two Philippine government hospitals, (2) key informant interviews of officials of government agencies and private organizations tasked to implement the health human resource development provisions, (3) document analyses, and (4) researcher’s field notes/journal. The researcher conducted five focus group interviews with a total of 15 nurse participants and 12 key informant interviews. The nurses are working under conditions of low salaries and heavy workload, that is characterized by low nurse-to-patient ratios in the National and LGU Hospitals. The problems of inadequate nurse staffing, large number iii of patients and inadequate supplies in the two government hospitals are identified as causes for the heavy workload of nurses. The nurses want a salary increase that is commensurate to their heavy workload, their professional qualifications and long years of service. For the nurses, a salary increase signifies the government’s recognition of their dedication, hard work, and commitment to provide health care to Filipinos despite working under dire circumstances. The nurse specialty training program in areas such as oncology, nephrology, critical care, etc. has not been implemented because of the limited capacities of government hospitals to provide this kind of training and the lack of regulatory framework for the practice of nurse specialists in the Philippines. The other benefits have not been implemented as well. The provisions of the Nursing Act are deficient because they do not address the causes of the heavy workload of nurses. To improve the work conditions of nurses, the Philippine government needs to prioritize to the long neglected health sector by increasing the budgetary allocation in order to create more nurse positions in government hospitals, to provide adequate supplies and equipment for government hospitals and to improve the facilities for nurses.

Republic Act No. 9173, or the Philippine Nursing Act of 2002 enunciates a bevy of incentives under its Health Human Resource Production, Utilization and Development provisions, intended to stem the rising tide of Filipino nurses leaving the country to work overseas. Under Sections 30 to 34 of the Nursing Act, these incentives include the following: (1) upgrading the minimum base salary of nurses from salary grade 10 to 15; (2) establishing a nurse specialty program in government hospitals to upgrade the nurses’ skills whereby recipients of the program are required to work in government hospitals for two years; and (3) the provision of other benefits such as scholarship grants, free medical care, etc. These provisions are the government’s policy response to mitigate the impact of nurses’ migration and retain an adequate supply of skilled Filipino nurses in the country: This research is a qualitative study that seeks to assess the health human resource development provisions and their implementation and aims to help improve them. This study examines the responsiveness of the provisions to the needs of nurses, and identifies the deficiencies of the provisions by looking into the working conditions of nurses in two Philippine government hospitals. It also examines the processes and the factors affecting the implementation of the provisions. This study employed a combination of four data collection methods: (1) focus group interviews of nurses working in two Philippine government hospitals, (2) key informant interviews of officials of government agencies and private organizations tasked to implement the health human resource development provisions, (3) document analyses, and (4) researcher’s field notes/journal. The researcher conducted five focus group interviews with a total of 15 nurse participants and 12 key informant interviews. The nurses are working under conditions of low salaries and heavy workload, that is characterized by low nurse-to-patient ratios in the National and LGU Hospitals. The problems of inadequate nurse staffing, large number iii of patients and inadequate supplies in the two government hospitals are identified as causes for the heavy workload of nurses. The nurses want a salary increase that is commensurate to their heavy workload, their professional qualifications and long years of service. For the nurses, a salary increase signifies the government’s recognition of their dedication, hard work, and commitment to provide health care to Filipinos despite working under dire circumstances. The nurse specialty training program in areas such as oncology, nephrology, critical care, etc. has not been implemented because of the limited capacities of government hospitals to provide this kind of training and the lack of regulatory framework for the practice of nurse specialists in the Philippines. The other benefits have not been implemented as well. The provisions of the Nursing Act are deficient because they do not address the causes of the heavy workload of nurses. To improve the work conditions of nurses, the Philippine government needs to prioritize to the long neglected health sector by increasing the budgetary allocation in order to create more nurse positions in government hospitals, to provide adequate supplies and equipment for government hospitals and to improve the facilities for nurses.

Republic Act No. 9173, or the Philippine Nursing Act of 2002 enunciates a bevy of incentives under its Health Human Resource Production, Utilization and Development provisions, intended to stem the rising tide of Filipino nurses leaving the country to work overseas. Under Sections 30 to 34 of the Nursing Act, these incentives include the following: (1) upgrading the minimum base salary of nurses from salary grade 10 to 15; (2) establishing a nurse specialty program in government hospitals to upgrade the nurses’ skills whereby recipients of the program are required to work in government hospitals for two years; and (3) the provision of other benefits such as scholarship grants, free medical care, etc. These provisions are the government’s policy response to mitigate the impact of nurses’ migration and retain an adequate supply of skilled Filipino nurses in the country: This research is a qualitative study that seeks to assess the health human resource development provisions and their implementation and aims to help improve them. This study examines the responsiveness of the provisions to the needs of nurses, and identifies the deficiencies of the provisions by looking into the working conditions of nurses in two Philippine government hospitals. It also examines the processes and the factors affecting the implementation of the provisions. This study employed a combination of four data collection methods: (1) focus group interviews of nurses working in two Philippine government hospitals, (2) key informant interviews of officials of government agencies and private organizations tasked to implement the health human resource development provisions, (3) document analyses, and (4) researcher’s field notes/journal. The researcher conducted five focus group interviews with a total of 15 nurse participants and 12 key informant interviews. The nurses are working under conditions of low salaries and heavy workload, that is characterized by low nurse-to-patient ratios in the National and LGU Hospitals. The problems of inadequate nurse staffing, large number iii of patients and inadequate supplies in the two government hospitals are identified as causes for the heavy workload of nurses. The nurses want a salary increase that is commensurate to their heavy workload, their professional qualifications and long years of service. For the nurses, a salary increase signifies the government’s recognition of their dedication, hard work, and commitment to provide health care to Filipinos despite working under dire circumstances. The nurse specialty training program in areas such as oncology, nephrology, critical care, etc. has not been implemented because of the limited capacities of government hospitals to provide this kind of training and the lack of regulatory framework for the practice of nurse specialists in the Philippines. The other benefits have not been implemented as well. The provisions of the Nursing Act are deficient because they do not address the causes of the heavy workload of nurses. To improve the work conditions of nurses, the Philippine government needs to prioritize to the long neglected health sector by increasing the budgetary allocation in order to create more nurse positions in government hospitals, to provide adequate supplies and equipment for government hospitals and to improve the facilities for nurses.

Republic Act No. 9173, or the Philippine Nursing Act of 2002 enunciates a bevy of incentives under its Health Human Resource Production, Utilization and Development provisions, intended to stem the rising tide of Filipino nurses leaving the country to work overseas. Under Sections 30 to 34 of the Nursing Act, these incentives include the following: (1) upgrading the minimum base salary of nurses from salary grade 10 to 15; (2) establishing a nurse specialty program in government hospitals to upgrade the nurses’ skills whereby recipients of the program are required to work in government hospitals for two years; and (3) the provision of other benefits such as scholarship grants, free medical care, etc. These provisions are the government’s policy response to mitigate the impact of nurses’ migration and retain an adequate supply of skilled Filipino nurses in the country: This research is a qualitative study that seeks to assess the health human resource development provisions and their implementation and aims to help improve them. This study examines the responsiveness of the provisions to the needs of nurses, and identifies the deficiencies of the provisions by looking into the working conditions of nurses in two Philippine government hospitals. It also examines the processes and the factors affecting the implementation of the provisions. This study employed a combination of four data collection methods: (1) focus group interviews of nurses working in two Philippine government hospitals, (2) key informant interviews of officials of government agencies and private organizations tasked to implement the health human resource development provisions, (3) document analyses, and (4) researcher’s field notes/journal. The researcher conducted five focus group interviews with a total of 15 nurse participants and 12 key informant interviews. The nurses are working under conditions of low salaries and heavy workload, that is characterized by low nurse-to-patient ratios in the National and LGU Hospitals. The problems of inadequate nurse staffing, large number iii of patients and inadequate supplies in the two government hospitals are identified as causes for the heavy workload of nurses. The nurses want a salary increase that is commensurate to their heavy workload, their professional qualifications and long years of service. For the nurses, a salary increase signifies the government’s recognition of their dedication, hard work, and commitment to provide health care to Filipinos despite working under dire circumstances. The nurse specialty training program in areas such as oncology, nephrology, critical care, etc. has not been implemented because of the limited capacities of government hospitals to provide this kind of training and the lack of regulatory framework for the practice of nurse specialists in the Philippines. The other benefits have not been implemented as well. The provisions of the Nursing Act are deficient because they do not address the causes of the heavy workload of nurses. To improve the work conditions of nurses, the Philippine government needs to prioritize to the long neglected health sector by increasing the budgetary allocation in order to create more nurse positions in government hospitals, to provide adequate supplies and equipment for government hospitals and to improve the facilities for nurses.

Republic Act No. 9173, or the Philippine Nursing Act of 2002 enunciates a bevy of incentives under its Health Human Resource Production, Utilization and Development provisions, intended to stem the rising tide of Filipino nurses leaving the country to work overseas. Under Sections 30 to 34 of the Nursing Act, these incentives include the following: (1) upgrading the minimum base salary of nurses from salary grade 10 to 15; (2) establishing a nurse specialty program in government hospitals to upgrade the nurses’ skills whereby recipients of the program are required to work in government hospitals for two years; and (3) the provision of other benefits such as scholarship grants, free medical care, etc. These provisions are the government’s policy response to mitigate the impact of nurses’ migration and retain an adequate supply of skilled Filipino nurses in the country: This research is a qualitative study that seeks to assess the health human resource development provisions and their implementation and aims to help improve them. This study examines the responsiveness of the provisions to the needs of nurses, and identifies the deficiencies of the provisions by looking into the working conditions of nurses in two Philippine government hospitals. It also examines the processes and the factors affecting the implementation of the provisions. This study employed a combination of four data collection methods: (1) focus group interviews of nurses working in two Philippine government hospitals, (2) key informant interviews of officials of government agencies and private organizations tasked to implement the health human resource development provisions, (3) document analyses, and (4) researcher’s field notes/journal. The researcher conducted five focus group interviews with a total of 15 nurse participants and 12 key informant interviews. The nurses are working under conditions of low salaries and heavy workload, that is characterized by low nurse-to-patient ratios in the National and LGU Hospitals. The problems of inadequate nurse staffing, large number iii of patients and inadequate supplies in the two government hospitals are identified as causes for the heavy workload of nurses. The nurses want a salary increase that is commensurate to their heavy workload, their professional qualifications and long years of service. For the nurses, a salary increase signifies the government’s recognition of their dedication, hard work, and commitment to provide health care to Filipinos despite working under dire circumstances. The nurse specialty training program in areas such as oncology, nephrology, critical care, etc. has not been implemented because of the limited capacities of government hospitals to provide this kind of training and the lack of regulatory framework for the practice of nurse specialists in the Philippines. The other benefits have not been implemented as well. The provisions of the Nursing Act are deficient because they do not address the causes of the heavy workload of nurses. To improve the work conditions of nurses, the Philippine government needs to prioritize to the long neglected health sector by increasing the budgetary allocation in order to create more nurse positions in government hospitals, to provide adequate supplies and equipment for government hospitals and to improve the facilities for nurses.