With the rapid development of terminal hardware, mobile users and network environments, the scale of the mobile Internet appears to be catching up with the desktop Internet. Positioning System, phone sensors and applications which are able to be used anywhere have caused the arrival and increase in usage of the smart phone, and the world has become mobile-first. Within medical fields, the smart phone is also regarded as an acceptableassistant for nurses and patients as based on the advantages of mobile Internet. It is possible for healthcare personnel to assign tasks for the patients from a different place if there is a computer connected to the Internet. In addition,the smart phones is able to act as a nurse and remind the patients to complete their tasks. Accordingly, it has become a necessity to achieve this electronic healthcare system for hospitals. The objective of this research project is to summarize the procedures of this development, and release the relevant software based on an Android platform. Additionally, a corresponding website is to be designed so that healthcare personnel are able to sign in in order to deal with the tasks. The entire system has been tested in real scenarios, at this point only by the authorbut has still not been used by other organizations. The final part of the report involves the conclusions drawn and provides suggestions for further work about the whole project.

Class of 2013 Abstract / Specific Aims: To assess associations between clinical and economic outcomes of metastatic thyroid cancer within inpatient settings in the United States from 2001-2010. To determine the direct inpatient burden of and describe the characteristics of patients and hospitals associated with metastatic thyroid cancer. Methods: A multivariate retrospective cohort study was performed on the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database, for the years 2001-2010, focusing on three main outcomes: inpatient mortality, inpatient charges, and inpatient length of stay. Regression analyses controlled for patient demographics, hospital characteristics, payer, clinical comorbidities, and site of metastases. Inclusion criteria included: age ≥ 18 years, any listed diagnosis of thyroid cancer, and any listed secondary malignancy. Main Results: Overall, 84,191 inpatient cases were observed for metastatic thyroid cancer with 3,032 resulting in mortality (3.6%). The total charges were $3.1 billion (USD 2012) for overall inpatient hospitalizations with average inpatient charges at $38,292 (SD±56,135) for each overall case and $80,948 (SD±117,645) for each mortality-only case. Higher inpatient mortality, charges, and length of stay were significantly associated with central nervous system and lung metastatic cancer sites (p < 0.01) and deficiency anemias, coagulopathy, fluid and electrolyte disorders, pulmonary circulation disorders, and weight loss comorbidities (p < 0.01). Conclusion: There is a considerable national inpatient burden of metastatic thyroid cancer. The analyses in this study quantify the associations and outcomes, and as such can be used to assist in the prediction of those outcomes and clinical decision-making.

Health and care services need to be optimised to meet the future demand that will be placed on them. This will require a closer coupling of service and research, whereby innovations in services can be rapidly tested and evaluated, and feed back into a continual process of service optimisation. The timely delivery of information from services into research is critical to this cycle. However, there are serious problems with the evidence on which healthcare and public health practice is based: it is expensive to produce; it takes a long time to produce; it takes a long time to influence professional practice; it is crude, relating to the average participant and simple treatment definitions under ideal conditions. In other words, it gives a low-resolution picture of how a patient might respond to treatment or a how a sub-group of the community might respond to a public health intervention. This work is an exploration of informatics solutions to these problems with an aim to re-engineer health care systems to make best use of the evidence available.

There are a number of processes at play within the child welfare and healthcare systems that have the potential to be othering and stigmatizing for people (Pollack, 2010; Snowden, 2003; van Ryn, 2003). These stigmatizing practices are compounded and made all the more complex when the child welfare and healthcare systems operate simultaneously in people’s lives. Despite this, there appears to be limited research about the interplay between the child welfare and healthcare systems in producing stigma, in spite of how closely and recurrently these structures interact and work with one another. This study investigates the interaction of stigmatizing processes and practices at play between Brant Family and Children’s Services and the Brantford General Hospital. Specifically, it explores, from the viewpoint of child welfare staff, the experiences of new mothers receiving perinatal care at this hospital, who are also clients of Brant Family and Children’s Services. This study employs a critical social work framework, coupled with elements of intersectionality and a social justice lens. An eclectic methodological approach was used, integrating tenets of critical and interpretive social science research, and a narrative approach. Four semi-structured, face-to-face interviews were conducted with child protection staff employed at Brant Family and Children’s Services, with six major themes identified, including: the exclusion of mothers within the hospital setting, issues with Brant FACS’ birth alert documentation, and the paradoxical ways in which stigma can operate in the lives of new mothers receiving care at this hospital. These themes are explored and future directions and recommendations are discussed. Suggestions are also made in terms of how these organizations can begin to address the practices at play between both systems that unfortunately, appear to harmfully impact on mothers who are involved with Brant Family and Children’s Services, and receiving perinatal care at the Brantford General Hospital. / Thesis / Master of Social Work (MSW)

This research addresses the fluctuating demand and high variability in healthcare systems. These system’s variations need to be considered whilst at the same time making efficient use of the systems’ resources. Patient dependency fluctuation, which makes determining the level of adequate staffing highly complex, is among the variations addressed. Dealing with variability is found to be a key feature in the design, planning and evaluation of healthcare systems. Healthcare providers are facing increasing challenges resulting from an aging population, higher patient expectancies, a shortage of healthcare professionals, as well as increasing costs and reduced funding. Despite the accentuated need for effective healthcare systems and efficient use of resources, many healthcare organisations are inadequately designed and, moreover, poorly managed. Hospital systems consist of complex interrelations between relatively small units, each of which is sensitive to stochastic variations in demand. In addition to this aspect of the system view, a critical resource for the patients’ wellbeing and survival is the staffing level of nurses. This puts the planning and scheduling of human resources as one of the system’s foremost aims. Current tools for staffing and personnel planning in healthcare organisations do not take into consideration the workload variations that result from the variable nature of patient dependency levels. The work presents the empirical findings of a number of case studies conducted at a regional hospital in Sweden. Principles and practical suggestions for the robust system design of inpatient wards using Discrete Event Simulation (DES) have been identified. Although DES techniques have, in principle, all the features for modelling the variation and stochastic nature of systems, DES has not been previously used for workload studies of inpatient wards. The main contribution of this work is therefore how a combination of DES and the data of Patient Classification Systems (PCSs) can be used to model workload variations and, subsequently, plan the nurse staffing requirements in systems with high variability. The work presented gives step by step guidance in how the analysis and subsequent modelling of an inpatient ward should be carried out. It defines a novel modelling methodology for patient dependency variations and length of stay modelling of a patient’s dependency progression, including an adaptation to the ward’s discharge figures. The modelling approach opens a novel way of analysing and evaluating the system design of inpatient wards.

During the transition from a planned economy to a decentralized, market socialist economy, the Chinese healthcare system has evolved from a centralized, egalitarian public system (1949-1979) to one which is largely self-governed and can be characterized as �public identity, private behavior� healthcare system (1980-1999). With blurring of the distinction between public and private governing systems, and a shift in norms towards profit orientation, major concern has arisen about the extent of high cost, high volume services being offered through excessive entrepreneurial practices. This thesis is concerned with the regulatory strategies and options to reach 2010 health reform objectives of equity and efficiency under a mixed public/private market. While possible lessons can be drawn from established economies and transitional economies, China faces some unique challenges, given the diverse market structures and fragmented healthcare system across the country, and the underdeveloped framework for the rule of law. The thesis reviews policy documents from 1949 to 2004 and draws from interviews with senior health policy-makers and hospital directors in three different locations, in order to explore the role of the state in market regulation, the effectiveness of technical and social regulations, and how policy implementation and regulatory compliance occur. The research has found that the dynamics of the healthcare system are shaped by the financing arrangements for healthcare and the absence of arms-length governance of hospitals by health departments. Without an effective state health financing tool, nor mature market institutions, China is not able to use neither performance-based regulation nor technology-based regulation. China has adopted a management-based regulatory strategy but the absence of effective governance structure hinders effective regulation. If the reform objectives of improving healthcare quality while costs are to be attained, China will need to develop purchasing tools to alter the current perverse incentives for provider behavior. Government will also need to work with civil society organizations to develop tools for clinical governance, such as clinical audit for risk management and hospital accreditation programs. To do so requires establishing arms-length governance mechanisms between health departments and hospitals, and appropriate corporate governance structures within hospitals. Specifically, MOH needs to establish a technical policy think tank to investigate all the policy issues arising from the announcement of the 1997 health reform, including coordination with other line ministries and provincial authorities, and formulation and implementation of a policy research agenda, in order to attain a market-based governance system for health by 2010.

During the transition from a planned economy to a decentralized, market socialist economy, the Chinese healthcare system has evolved from a centralized, egalitarian public system (1949-1979) to one which is largely self-governed and can be characterized as �public identity, private behavior� healthcare system (1980-1999). With blurring of the distinction between public and private governing systems, and a shift in norms towards profit orientation, major concern has arisen about the extent of high cost, high volume services being offered through excessive entrepreneurial practices. This thesis is concerned with the regulatory strategies and options to reach 2010 health reform objectives of equity and efficiency under a mixed public/private market. While possible lessons can be drawn from established economies and transitional economies, China faces some unique challenges, given the diverse market structures and fragmented healthcare system across the country, and the underdeveloped framework for the rule of law. The thesis reviews policy documents from 1949 to 2004 and draws from interviews with senior health policy-makers and hospital directors in three different locations, in order to explore the role of the state in market regulation, the effectiveness of technical and social regulations, and how policy implementation and regulatory compliance occur. The research has found that the dynamics of the healthcare system are shaped by the financing arrangements for healthcare and the absence of arms-length governance of hospitals by health departments. Without an effective state health financing tool, nor mature market institutions, China is not able to use neither performance-based regulation nor technology-based regulation. China has adopted a management-based regulatory strategy but the absence of effective governance structure hinders effective regulation. If the reform objectives of improving healthcare quality while costs are to be attained, China will need to develop purchasing tools to alter the current perverse incentives for provider behavior. Government will also need to work with civil society organizations to develop tools for clinical governance, such as clinical audit for risk management and hospital accreditation programs. To do so requires establishing arms-length governance mechanisms between health departments and hospitals, and appropriate corporate governance structures within hospitals. Specifically, MOH needs to establish a technical policy think tank to investigate all the policy issues arising from the announcement of the 1997 health reform, including coordination with other line ministries and provincial authorities, and formulation and implementation of a policy research agenda, in order to attain a market-based governance system for health by 2010.

The theme of thesis is to define the living costs of person with the spinal cord injury in the cervical spine - tetraplegics. Tetraplegics are specific group of people with injury. Partial goal is to find out, whether state contributes and compensates health handicap of citizens enough. Thesis describes spends needed on one side and possibilities of state contributions on the other side. First part of theoretical part clarifies handicap of spinal cord injury and associated complications. It describes necessary compensational and medical equipment including process of its aquirement. Second part of theoretical part is based on Czech legislation and analyzes savings, advantages and contributions provided by social system of Czech Republic for disabled people. Practical part evaluates survey as a background for final conclusion of economic situation of tetraplegics. Key words tetraplegia, healthcare system, Czech Republic

Objective: To explore and describe the current transition environment for young people with chronic pain in Canada. Quantitative study: An online survey of nurses working in the pediatric and adult chronic pain setting was conducted to describe the current clinical practices used in both settings to support transition of young people with chronic pain in Canada. Qualitative study: Semi-structured interviews were conducted with young people with chronic pain who had recently transitioned from the pediatric setting to the adult healthcare setting to explore their transition experiences. Conclusions: The findings from these studies suggest that young people with chronic pain have similar transition related needs to other young people with chronic conditions as well as unique challenges. Nurses can have a positive impact on transition outcomes by developing processes and forming networks of clinicians who work with young people with chronic pain in order to improve transition related outcomes.

Magister Artium (Child and Family Studies) - MA(CFS) / One of the sustainable development goals the World Health Organization (WHO) has set for member countries is the implementation of universal health coverage (UHC) in order to ensure all citizens have the right to access healthcare. In recognising that the global demand for traditional and complementary medicine (T&CM) continues to grow, the WHO has encouraged the inclusion of T&CM into the national health systems of member countries as a way of ensuring that UHC can be achieved.