Assuring quality of care for patients who face the end of life has been a major concern for those in hospice settings. Limited research is available that has a focus on understanding what quality of care in a hospice setting looks like. This research is important to provide insight into hospice health care providers' perceptions of the quality of care in the hospice setting and on the indicators that influence care quality. A qualitative phenomenological approach was used to answer the research questions on the perspectives of the health care providers in the hospice care setting regarding the quality of care and the factors that health care providers perceive as important to the quality of care in the hospice setting. Kolcaba's comfort theory served as the theoretical framework that guided the preparation of the questions used for the interviews and for interpreting the findings. Data collection was conducted through structured interviews with a sample of 15 hospice health care providers. Interviews were held in a private office of the hospice setting. After Walden Institutional Review Board approval, participants consented and interviews commenced. Data were transcribed and Nvivo software was used to assist with identifying major themes. Recommendations from the study reflect Kolcaba's comfort theory providing patient-centered care and enhanced quality of care for patients in a hospice setting. The research findings and recommendations will help promote a positive social change by raising awareness for effective provider communication, staffing, education and adequacy of resources in the hospice setting.

Because of their relative inexperience in performing procedures and handling sharps devices, medical students and resident physicians are considered to be at high risk for sharps injuries. A higher rate of sharps injuries for medical trainees implies a higher risk for occupationally-acquired infection with bloodborne pathogens and may have financial and legal implications for training institutions. This study examines the prevalence of sharps injuries among US medical students and resident physicians. A systematic review of the literature yielded 10 studies that gave data on sharps injuries for US medical students or residents, and those data were combined with data from our institution to produce pooled prevalences. Results from our institution showed that residents had a significantly higher risk of sharps injuries than medical students. While sharps injuries increased with students' years of training, residents' rates decreased with increasing level of training. Resident rates were highest in the department of Surgery and lowest for Pediatrics. Comparing pooled prevalences of US trainees revealed that residents were 6 times more likely than medical students to have a sharps injury. This information can be used by training programs to inform changes in residency training curricula and infection control policies, as well as to forecast Worker's Compensation and long-term disability insurance coverage requirements. Medical training institutions must continue to provide opportunities for students and residents to perfect their procedural skills, but at the same time, trainees must be protected from the risk of sharps injuries and exposure to bloodborne pathogens.

Background: Elderly today have an increased life expectancy and retaining their teeth longer than before, it is important that healthcare-professionals have knowledge about oral health and how to prevent oral diseases. Objective: To study knowledge and attitude of oral health among caregivers at nursing homes in Ga-Rankuwa, Pretoria, South Africa. Method: The study was a quantitative cross-sectional study. Data was collected by a questionnaire representing four dimensions; Internal Locus of Control, External Locus of Control, Self-Efficacy and Oral Health Care Beliefs (OHCB), consisting questions about oral health and oral hygiene. The population consisted of 130 caregivers. Result: A total of 50 out of 61 caregivers participated in the study, out of which 43 were females and 7 were males. The age-interval was between 20-75 years. Generally, no statistical significant differences in knowledge and attitudes between the two nursing homes and between the caregivers´ professional statuses was noticed. T-test showed a statistical significant difference (P=0.011) between the caregivers for OHCB-dimension, and (P=0.044) between nursing home “A” and “B” for OHCB dimension. Conclusion: The general level of knowledge and attitude among the caregivers was satisfactory but low. Monitored health intervention studies should be given to promote oral health care knowledge and beliefs. / Bakgrund: Äldre har idag en ökad livslängd och allt fler behåller sina tänder längre än tidigare. För att vårdpersonalen ska kunna förebygga orala sjukdomar hos dessa individer är det viktigt att dem har kunskap om oral hälsa samt hur man förebygger orala sjukdomar. Syfte: Att studera kunskap och attityder om oral hälsa bland personal på äldreboenden i Ga-Rankuwa, Pretoria, Sydafrika. Metod: Studien var en kvantitativ tvärsnittsstudie där datainsamlingen skedde genom ett frågeformulär som innehöll frågor om oral hälsa och munhygien. Populationen bestod av 130 vårdgivare. Resultat: Totalt deltog 50 av 61 vårdgivare i studien, varav 43 var kvinnor och 7 män. Åldersintervallen var 20–75 år. Generellt fanns det inga statistiskt signifikanta skillnader avseende kunskaper och attityder mellan dem två äldreboenden och mellan vårdpersonalens yrke. En tillfredsställande men låg kunskapsnivå och attityd uppmärksammades mellan äldreboenden och vårdgivarnas yrkesstatus. T-testen visade en statistisk signifikant skillnad (P = 0,011) mellan vårdpersonalen för OHCB-dimensionen och (P = 0,044) mellan äldreboenden "A" och "B" för OHCB-dimensionen. Slutsats: Generellt var deltagarnas attityd och kunskapsnivån tillfredställande men låg. Interventionsstudier med uppföljning bör göras för att bättra kunskap och attityd om oral hälsa.

Purpose: Internet of Things (IoT) is an emerging technology and is a technological paradigm that is revolutionizing the healthcare industry all over the world. The purpose of our thesis is to investigate the phenomenon of IoT adoption in the healthcare industry in the context of a developing country to find out the barriers and how the industry is trying to overcome them. As the second highest population with a landmark of topping the table of developing country list, India has significant potential to bring interest in the IoT adoption in healthcare. Our unit of analysis is a hospital in India. Method: To reach our research, we have chosen a qualitative research approach and systematic combining method as our research strategy, which will facilitate us to narrow down the findings of the phenomenon by using a back and forth process. Semi-structured interviews have been conducted with participants of the case hospital as part of the data collection process. Finding and Analysis: The first part of the empirical finding is analyzed by the thematic analysis tool, which we have used for the data analysis. This enabled us to interpret the themes in our own way going back to data collected and previous literature references. The study helped us identify some of the main factors affecting IoT adoption in the hospital, categorized under three different sections: technological, organizational, and environmental. The findings indicate that IoT adoption barriers in hospital are categorized as per our tentative framework with theoretical frame reference in the literature review part. Adoption challenges were found mainly centred on technological acceptance, complexity, organizational behaviour, lack of expertise and infrastructure, lack of stringent regulations and standard and finally, the security and privacy concerns. They have initiated a well organizational structure with experts, providing rigorous training for key staff and visionary leadership to facilitate the adoption process.

Background: During a woman's pregnant state, a diet that is adequate in nutrition is critical to the developing fetus, especially in the lower socioeconomic status population. The healthcare provider is charged with the acute fundamental awareness of this additional factor that can grossly impact pregnancy. Nutritional advice from the health care provider is one of many key points that contribute to the successful outcome of the pregnancy. Purpose: The purpose of this quality improvement project was to develop a standardized, evidence-based practice (EBP) protocol for the management of maternal nutrition, gestational weight gain, and physical activity for provider use at an LSE community clinic. Theoretical Framework: Theory of Planned Behavior Methods: After receiving institutional support for the implementation of the protocol presentation and instruction of the Maternal Nutrition Guideline, pre- and post-surveys were administered to eligible participants. A quantitative descriptive design was used for the project. Results: There were twenty-six respondents for both the pre-and post-survey. The data analysis revealed that two questions revealed the most significant increase between the pre-and post-survey occasions utilizing the Mann-Whitney test and related to physical activity during pregnancy and dietary intake. An independent sample t-test was performed to compare the two occasions. There was a tendency for an increase in the the total score between the pre-and post-surveys, but the difference did not reach statistical significance, which may be related to sample size (t24df = 1.782, p =0.087). Conclusion: A standardized, evidence-based nutritional guideline is a necessary tool to serve as a consistent resource and empower all health care providers to bring awareness and understanding to facilitate positive outcomes to the obstetric patient population for which they care.

Introduktion: Kvinnor utsatta för våld i nära relationer [VNR]söker ofta sjukvård, detta ger vårdpersonal en unik möjlighet och ett stort ansvar att fånga upp och hjälpa dem. Därför är det väsentligt att beskriva kvinnors upplevelser av vården och identifiera önskat bemötande. Syftet med studien var att beskriva hur kvinnor utsatta för våld i nära relationer upplever bemötandet av vårdpersonal, samt hur de önskar att bli bemötta angående sin situation. Metod: Detta är en deskriptiv litteraturstudie som granskat kvalitativa originalartiklar. Efter kvalitetsgranskning valdes tio studier som svarade mot studiens syfte. Efter noggrann genomläsning och diskussion utformades ett resultat med två teman och flera kategorier. Resultat: Kvinnorna beskrev främst barriärer de upplevt i mötet med vårdpersonal. Dessa barriärer började redan innan mötet med rädsla för vad som kunde hända om de sökte hjälp. Stress, tidsbrist och bristande kontinuitet i mötet med vården förhindrade uppbyggnad av den förtroendeingivande relation som beskrevs som essentiell för att kvinnan skulle känna trygghet. Kvinnorna upplevde även olika faser i hur redo de var att berätta och hantera våldsutsattheten. Skam, skuld och informationsbrist var andra barriärer. Rätt information vid rätt tidpunkt begränsade informationsbristen. Planscher och broschyrer på toaletter, i väntrum och i mottagningsrum upplevdes väldigt uppskattat. Direkta frågor och en motivering till varför frågan ställdes uppskattades av majoriteten av de studerade kvinnorna. Slutsats: I bemötandet av vården upplevde kvinnorna en mängd barriärer. Dessa kan överkommas med rätt information, en trygg miljö och en icke dömande och kontinuerlig personal-patientrelation, där kvinnans autonomi respekteras. / Introduction: Women exposed to Intimate Partner Violence [IPV] often seek medical care, which gives healthcare providers [HCP] a unique opportunity and a great responsibility to help. The aim of this study was to describe how women exposed to IPV experience encounters with HCP and how they want these encounters to be. Method: This is a descriptive study that examines qualitative original articles. After quality reviewing, ten articles that met the study criteria were chosen. The articles were independently read and then discussed to form a result, consisting of two themes and several categories. Result: The women primarily described experiences of different obstacles they faced in the encounter with HCP. These obstacles started with fear for what could happen if they disclosed the violence. Shame, guilt and lack of information were other barriers. Stress, lack of continuity and of time hindered the essential patient-provider relationship from growing. The women also experienced different stages of readiness in dealing with the IPV. Adequate information at the right time and in the right way could reduce the lack of information. Posters and brochures in waitingrooms, bathrooms and meeting rooms were appreciated. A majority of the studied women appreciated direct questions as well as a motivation why they were asked. Conclusion: The women experienced obstacles when meeting HCP. These obstacles could be overcome through correct information, a safe environment, and a safe, non-judgemental patient-provider relationship, where the women’s autonomy is respected.

Background Due to the COVID-19 pandemic, there was a significant reduction in in-person healthcare visits as a precautionary measure to minimize the risk of infection for both patients and healthcare provides. Consequently, there was a remarkable surge in the adoption of telehealth services, although mental healthcare services were already using it more frequently than primary and specialty care services before the pandemic. Despite the continued increase in telehealth services, there are differing views among healthcare providers on the efficacy of providing healthcare services remotely, leading to an opportunity to investigate this matter further. Objective The primary goal of this study was to evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences between mental health providers and non-mental health providers. Methods The proposed study collected primary data through surveying providers across the United States from November 2022-March 2023. The surveys were conducted through REDCap, and disseminated through research staff outreach and recruitment. Providers were asked to complete a 33-item survey, which took them about 30 minutes to finish and queried them about their satisfaction, utilization, and experiences with telehealth. The provider survey was disseminated to both mental health providers and non-mental health providers who use telehealth technology. Descriptive analysis was conducted to determine the characteristics of the population surveyed. Data was then dichotomized by mental health providers vs. non-mental health providers. Differences in mean responses for all variables between mental health and non-mental health providers was assessed using Mann-Whitney U (MW) tests. Results A Mann-Whitney Wilcoxon test indicated that the satisfaction with the telemedicine platform was greater for non-mental healthcare providers than mental healthcare providers (p < .05). A Mann-Whitney Wilcoxon test indicated that the reliability of the telemedicine app for facilitating health care services, that the ability to trust the telemedicine application to work, the lack of physical contact during a video visit being a problem, the video visits being a convenient form of healthcare delivery, the visits on the telehealth system are the same as in-person visits, and that continued use of telehealth services in the future was greater for mental healthcare providers than non-mental healthcare providers (p < .05). Conclusions Looking forward, we expect to see more extensive studies involving providers from various regions and the implementation of additional approaches to enhance their experiences.

Introduction : Les personnes âgées vivant à domicile font des chutes qui peuvent entraîner des conséquences graves. La possibilité de les détecter et d’intervenir rapidement grâce à la vidéosurveillance intelligente constitue une avenue prometteuse. Objectif : L’étude vise à explorer la perception et la récep-tivité des acteurs du système de santé face à l’utilisation de cette technologie sous trois aspects : la transmission des images, l’accessibilité de leur clientèle à cette technologie et son introduction dans leur pratique. Méthodologie : Sept groupes de discussion focalisée ont permis de recueillir le point de vue de 31 participants. Une analyse de contenu avec le logiciel N’Vivo a été réalisée. Résultats : Les participants estiment que les images de chute pourraient parve-nir au CLSC, au proche aidant, au 911 ou à une centrale de surveillance. Ils considèrent que des critères d’admissibilité seraient nécessaires pour favoriser l’accessibilité à la vidéosurveillance intelligente qui, croient-ils, pourrait améliorer les interventions en termes de gestion des urgences lors de chutes et de déter-mination de leurs causes. Conclusion : Les participants sont favorables à la technologie proposée, mais ils requerraient une période d’adaptation afin d’ajuster leur pratique. Ils suggèrent la réalisation d’un projet pilote qui validerait cette technologie. / Introduction: Elderly living at home fall and this may result in severe consequences. However, rapid detection and effective intervention using an intel-ligent videomonitoring system is very promising. Objective: The study aims at exploring the perception and receptiveness of healthcare providers regarding this technology from three angles: image transmission, the accessibility of their cli-ents to such a system, and its introduction in their practice. Methodology: Seven focus groups allowed 31 healthcare providers to express their points of view. A content analysis was performed with N’Vivo software. Findings: Participants reckon that CLSC, caregivers, the 911 or a central call center might receive im-ages of falls. They believe that admission criteria might have to be developed in order to ensure accessibility to the videomonitoring system which, they think, could improve their interventions in terms of emergency management when falls occur as well as of cause seeking. Conclusion: The participants are in favour of using the intelligent videomonitoring system, but they might require an adaptation period in order to adjust their practices. They have recommended that a pilot study be carried out to confirm its feasibility in a real-life setting.

Magister Public Health - MPH (Public Health) / The prevalence of diabetes in Africa has been on the increase. A prevalence of 1%- 10% has been reported by different authors in different regions in Nigeria. The International Diabetes Federation estimates that 1.9% of Nigerians are diabetic and most of them have complications at the time of diagnosis. Laboratory measurement of Glycosylated hemoglobin (HbA1c) is the method of choice for monitoring glycaemic control but due to its cost and limited availability, most developing countries use fasting plasma glucose (FPG) measurement (which is less reliable) to assess glycaemic control. Most diabetic patients in Nigeria have poor glycaemic control and several factors have been implicated especially socio-economic, behavioral and treatment-related factors. Understanding the reasons for poor glycaemic control is essential in order to reduce the rate of diabetes complications.

Orientadores: Renato Passini Júnior, Maria José Martins Duarte Osis / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-27T11:33:12Z (GMT). No. of bitstreams: 1 Cacique_DenisBarbosa_M.pdf: 6021042 bytes, checksum: 3c34c17eea2198eff7a2db0a382f8d99 (MD5) Previous issue date: 2012 / Resumo: No Brasil, o observável crescimento no número de publicações de pesquisas, realizadas ao longo dos últimos anos, visando a conhecer as opiniões de profissionais da saúde sobre a moralidade do aborto não tem sido capaz de desvelar, ao mesmo tempo com abrangência e profundidade, não apenas as atitudes favoráveis ou contrárias ao direito ao aborto, mas também suas razões subjacentes. O objetivo desta pesquisa consistiu em se desenvolver e validar o conteúdo do Mosaico de Opiniões Sobre o Aborto Induzido (Mosai), um questionário pelo qual se pretende conhecer com abrangência e profundidade as opiniões de profissionais da saúde sobre a moralidade do aborto. Sua primeira versão foi desenvolvida lançando-se mão da técnica de análise temática de conteúdo de livros, artigos, filmes, sites e jornais relatando casos de abortamento, bem como argumentando sobre sua prática. Inspirado no formato do instrumento Defining Issues Test, o Mosai apresenta seis dilemas morais relacionados à interrupção voluntária da gravidez, cujos desfechos devem ser escolhidos pelos respondentes e podem ser justificados mediante a classificação de 15 padrões de argumentos sobre a moralidade do aborto. A fim de validar seu conteúdo, o questionário foi submetido ao crivo de um painel de 12 especialistas, incluindo médicos, juristas, bioeticistas, sociólogos, enfermeiros e estatísticos, que emitiram notas e comentaram os critérios de clareza da redação, pertinência, adequação à amostra e adequação aos domínios. Ao incorporar algumas das críticas e sugestões recebidas nesse processo, espera-se que o Mosai apresente maior validade de conteúdo, habilitando-se para novas etapas de aperfeiçoamento até que possa ser aplicado amplamente entre profissionais da saúde com formações diversas / Abstract: There has been an observable increase in the number of research publications in Brazil aiming to investigate health care professionals' point of view over abortion morality in the past few years. However, such publications have failed to uncover the subjects' pro-life and pro-choice attitudes, as well as the reasons behind them. The objective of this research is to develop and validate the contents of "Mosaico de Opiniões Sobre o Aborto Induzido" (Mosai), a questionnaire intended to investigate, with both breadth and depth, health care professionals point of view about abortion morality. Its first version has been developed based on the thematic content analysis of books, articles, movies, websites and newspapers reporting cases of abortion, as well as arguing about their practices. Inspired by the characteristics of the instrument "Defining Issues Test", Mosai presents six moral dilemmas related to the voluntary interruption of pregnancy. The questionnaire is intended to enable research subjects to define the outcomes of such dilemmas. The same subjects would then be able to justify such outcomes by means of the classification of 15argument patterns about abortion morality. In order to validate the questionnaire, Mosai has been submitted to a scrutiny panel composed by 12 experts, which included doctors, lawyers, ethicists, sociologists, nurses and statisticians, who evaluated the criteria of clarity of writing, relevance, appropriateness to the sample and suitability to the domains. By incorporating some of the criticisms and suggestions received during this process, Mosai is expected to achieve good content validity, which would enable it to further enhancement steps and widely application among health care professionals with diverse backgrounds / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde