This thesis considers the current requirements for security in European healthcare establishments. Information Technology is being used increasingly by all areas of healthcare, from administration to clinical treatment and this has resulted in increased dependence upon computer systems by healthcare staff. The thesis looks at healthcare security requirements from the European perspective. An aim of the research was to develop security guidelines that could be used by healthcare establishments to implement a common baseline standard for security. These guidelines represent work submitted to the Commission of European Communities SEISMED (Secure Environment for Information Systems in Medicine) project, with which the research programme was closely linked. The guidelines were validated by implementing them with the Plymouth and Torbay Health Trust. The thesis also describes the development of a new management methodology and this was developed to allow the smooth implementation of security within healthcare establishments. The methodology was validated by actually using it within the Plymouth and Torbay Health Authority to implement security countermeasures. A major area of the research was looking at the use of risk analysis and reviewing all the known risk analysis methodologies. The use of risk analysis within healthcare was also considered and the main risk analysis methods used by UK healthcare establishments were reviewed. The thesis explains why there is a need for a risk analysis method specially developed for healthcare. As part of the research a new risk analysis method was developed, this allows healthcare establishments to determine their own security requirements. The method was also combined with the new management methodology that would determine any implementional problems. The risk analysis methodology was developed into a computerised prototype, which demonstrated the different stages of the methodology.

Hand-washing compliance was examined by thematic analysis of focus group discussions in nurses, mothers and children. Perceptions in these groups were identical, with the purpose of hand-cleansing seen as self-protection from infection. This assessment is not grounded in microbiology, but is strongly driven by emotion. Two types of hand-cleansing (???hand-hygiene???) behaviour were identified: (a) ???inherent??? hand-washing. This behaviour is taught by mothers to their children early in life. The behaviour occurs when hands have been visibly or ???emotionally??? soiled or feel sticky, and drives most hand-hygiene undertaken in the community; and (b) ???elective??? hand-hygiene, which occurs in the absence of perceived threat. As patient contact by healthcare workers is frequently assessed by healthcare workers as not posing risk, healthcare workers omit much elective hand-hygiene, leading to potential cross-infection. Modelling responses of 754 nurses on the Theory of Planned Behaviour for these two hand-hygiene behaviours in the healthcare setting explained 64% of elective hand-hygiene and 76% of inherent hand-washing intention. Translation of hand-washing behaviour patterns of the community into the healthcare setting is the predominant driver of all hand-hygiene in healthcare workers. In-hospital elective hand-hygiene behaviour is further significantly predicted by belief in the benefit from the activity, peer pressure and role modelling of senior physicians and administrators. For inherent hand-washing intent, only attitudes and peer behaviour are predictive. Time constraints, commonly implicated to explain poor compliance, are important mostly to elective hand-hygiene. Reduction in necessary effort by introducing an alcohol-based hand rub without a concomitant behavioural modification program will therefore have only minimal impact. Further components essential to hand-hygiene programs have been identified. These accord with the outcomes of the modelling and include the need for institutional recognition of hand-hygiene as a priority, overt clinician leadership support, and reinforcement of purpose by both education and performance feedback. In the long-term, society would be best served by altering the entire paradigm of hand-hygiene behaviour with nationwide campaigns based on principles of social marketing. Ideally, hand-hygiene should be taught by mothers and reinforced in early education programs as behaviour that is self-protective but with the defining theme: ???clean your hands, and protect others, not just yourself.???

Introduction: The use of e-learning in healthcare education is being increasingly advocated and used, but can prove challenging. The need to explore educator’s experience and student perspectives in relation to this area of pedagogy was identified as a relevant area of study Study Aim: To explore and critically analyse the perspectives and experiences of healthcare educators and students regarding e-learning. Design: A mixed methods exploratory case study of one HEI’s use of e-learning. Methods: Quantitative descriptive data was collected through educator and student questionnaires from 34 academics and 127 students across four university departments delivering undergraduate healthcare related programmes. A sample of 12 module web spaces and associated documentation was reviewed. The data sets were considered in relation to the thematic analysis of 16 semi-structured educator interviews and 6 healthcare student focus groups. Results: Educator and student needs are interwoven during undergraduate healthcare provision. Differing educational philosophies, practices and culture across the cases created opportunities and challenges with e-learning. Two differing, yet potentially complimentary definitions of e-learning existed within and across the four departments which produced either congruence or conflict toward the varied e-learning approaches. Student respondents selectively engaged in what was primarily educator controlled e-learning. Conclusions: The findings highlighted the need for agreement and understanding of philosophical and pedagogical underpinnings which define and shape e-learning by educators and students, along with an awareness of differing professional cultures across which e-learning is required to operate. Originality / Value: The findings of this study offer a deeper understanding of the effect on educator and student engagement in e-learning of differing higher education and professional practice education cultures. A model is offered as a response to particular issues faced by the study respondents; whilst non-generalisable the model may serve as an enlightening guide for educators who are introducing or applying constructivist e-learning practices within undergraduate healthcare provision and benefit the student experience.

This study focuses on the possible ways to improve healthcare services around the world, which increase the life expectancy for aging people. Utilizing a cost-effective analysis, the relationship between various healthcare expenditures and conditional life expectancy for people aged 60 and above was examined. A linear regression model was used to analyze data from 122 WHO (World Health Organization) countries obtained from the year 2000. The model included additional health-adjusted life years (HALE) at age 60 as the dependent variable and healthcare cost indicators as the independent variables. Regression results revealed that cost of healthcare was overall significant in contributing to HALE at age 60. The independent cost variables that were individually significant in the model consisted of government expenditure, private healthcare expenditure, out-of-pocket expenditure, and social security funding. While public healthcare costs such as government expenditure and social security funding positively impacted HALE, private healthcare expenditure negatively impacted HALE years at age 60. This finding suggests that countries with higher private healthcare expenditure than public healthcare expenditure decreased their chances of improving life expectancy for senior citizens. Through a cost-effective lens, in order to increase the quality and quantity of healthy life years for the elderly, countries should focus on instating policies that fund more public healthcare services.

Background: Since 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement. This study assessed whether changes in healthcare expenditure (HCE) explain this reversal in trends in LE. As an alternative explanation, the impact of changes in smoking behavior was also evaluated. Methods: To quantify the contribution of changes in HCE to changes in LE, we estimated a health-production function using a dynamic panel regression approach with data on 19 OECD countries (1980-2009), accounting for temporal and spatial correlation. Smoking-attributable mortality was estimated using the indirect Peto-Lopez method. Results: As compared to 1990-1999, during 2000-2009 LE in the Netherlands increased by 1.8 years in females and by 1.5 years in males. Whereas changes in the impact of smoking between the two periods made almost no contribution to the acceleration of the increase in LE, changes in the trend of HCE added 0.9 years to the LE increase between 2000 and 2009. The exceptional reversal in the trend of LE and HCE was not found among the other OECD countries. Conclusion: This study suggests that changes in Dutch HCE, and not in smoking, made an important contribution to the reversal of the trend in LE; these findings support the view that investments in healthcare are increasingly important for further progress in life expectancy.

Class of 2015 Abstract / Objectives: The purpose of this study was to measure and compare basic nutritional knowledge in first year health professional students. Authors hypothesized that nursing students would have more nutritional knowledge since a nutrition prerequisite was required. Methods: In fall 2013 authors’ surveyed 244 subjects at a University, comprising of first-year medicine, pharmacy, and nursing students. A descriptive, cross-sectional study was performed utilizing a print-based questionnaire containing 3 descriptive and 14 multiple-choice questions (21 total points). Each college’s average score was compared using chi-square analysis. The a priori alpha was 0.05 (Bonferroni correction = 0.016). Results: The overall response rate was 93%; 91%, 97%, and 92% for Medicine, Pharmacy, and Nursing, respectively. Average scores per college were: 6.50±1.76, 5.88±2.00, and 5.72±2.08, respectively. Analyses showed no significant difference between groups (p>0.016). Conclusions: Although no difference in nutritional knowledge was identified between groups, the low scores reflect insufficient knowledge and suggest the need to re-evaluate curricula.

Objectives: Technological innovation in medicine is a significant driver of healthcare spending growth in the United States. Factors driving adoption and utilization of new technology is poorly understood, however market forces may play a significant role. Vascular surgery has experienced a surge in development of new devices and serves as an ideal case study. Specifically, the share of total abdominal aortic aneurysm (AAA) repairs performed by endovascular aneurysm repair (EVAR) increased rapidly from 32% in 2001 to 65% in 2006 with considerable variation between states. This paper hypothesizes that that hospitals in competitive markets were early EVAR adopters and had improved AAA repair outcomes. Methods: The Nationwide Inpatient Sample (NIS) and linked Hospital Market Structure (HMS) data was queried for patients who underwent repair for non-ruptured AAA in 2003. In HMS the Herfindahl Hirschman Index (HHI, range 0-1) is a validated and widely accepted economic measure of competition. Hospital markets were defined using a variable geographic radius that encompassed 90% of discharged patients. Bivariable and multivariable linear and logistic regression analyses were performed for the dependent variable of EVAR use. A propensity score-adjusted multivariate logistic regression model was used to control for treatment bias in the assessment of competition on AAA-repair outcomes. Results: A weighted total of 21,600 patients was included in the analyses. Patients at more competitive hospitals (lower HHI) were at increased odds of undergoing EVAR vs. open repair (Odds Ratio 1.127 per 0.1 decrease in HHI, P<0.0127) after adjusting for patient demographics, co-morbidities and hospital level factors (bed size, teaching status, AAA repair volume and ownership). Competition was not associated with differences in in-hospital mortality or vascular, neurologic or other minor post-operative complications. Conclusion: Greater hospital competition is significantly associated with increased EVAR adoption at a time when diffusion of this technology passed its tipping point. Hospital competition does not influence post-AAA repair outcomes. These results suggest that adoption of novel technology is not solely driven by clinical indications, but may also be influenced by market forces.

Advantages of applying information and communication technologies to support complex team practices in healthcare domain have often been supported in the extant literature. The primary assumption is that before putting any technologies in place to support team functions, the team-based environment should be completely modeled. To date, many frameworks have been proposed for modeling healthcare teams; however, most of the frameworks only focus on single or a few aspects of teamwork and the outcomes usually present overlaps, limitations and inconsistencies. As a result, there is an increasing demand for offering an overarching framework that integrates the multiple dimensions of healthcare teamwork into a synthetic whole and clearly conceptualizes the potentially important relationships and dependencies that exist over those dimensions. In order to properly address the aforementioned challenge, this thesis applies ontological engineering to develop an overarching framework for integrating the multiple dimensions of teamwork concept in healthcare domain. For this purpose, we first illustrate a set of four stage methodological approach to provide explicit details on how to incorporate a theatrical foundation into the ontology. Then, the proposed approach is used to develop a derived ontological framework. Finally, accuracy and completeness of the proposed ontology based framework is validated to show that it is able to accurately represent the domain is it being employed for. The values and capabilities of ontology have already been studied and approved, and this technology is known as the best sources to represent a knowledge domain by means of concepts and accurately define the relationships among them. Our aim in this thesis is to further research how to develop and evaluate a standard ontology based framework to facilitate the healthcare team modeling.

Magister Theologiae - MTh

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