Rehabilitation of the handicapped as a result of tuberculosis is a most involved and complex process. In Canada today, the organization of rehabilitation services for tuberculous persons varies from province to province. In some provinces the rehabilitation services are handled exclusively by the provincial health departments; in other provinces the programmes are the responsibility of the provincial tuberculosis associations; in still other provinces, rehabilitation of the tuberculous is to a considerable extent a joint effort by voluntary and governmental agencies. This thesis examines the programmes for the tuberculous which are offered under public auspices in the province of British Columbia by the Division of Tuberculosis Control, and under private auspices in the province of Alberta by the Alberta Tuberculosis Association. The purpose of the study is to review the concept of rehabilitation, and to determine if differences of significance exist between the two programmes. The necessary material was compiled by a series of selected interviews with personnel involved in the operation of tuberculosis rehabilitation services in Alberta and British Columbia; analysis of annual reports of agencies in both provinces directly concerned in providing these services; and, by drawing upon the writer's own staff experience in one of these programmes. The scheme of analysis utilizes the following headings: (a) sponsorship and administration (b) facilities and personnel (c) rehabilitation services, and (d) co-ordination. The study reveals measurable differences in the two programmes selected, and these are reviewed. The major difference between the programmes is in terms of organizational structure. In British Columbia, a composite programme consisting of two specialized departments is in operation; one offering vocational rehabilitation services and the other welfare services. The Alberta programme in contrast, integrates vocational rehabilitation and social services, but has a smaller professional staff. The extent to which differences can be directly attributed to different auspices is doubtful; and there is room for further research. There is evidence, however, of need for more professionally trained social workers in comprehensive rehabilitation programmes. / Arts, Faculty of / Social Work, School of / Graduate

Approximately 18 months ago, an Arthritis Men's Group was started by the Social Work Department at the Vancouver Arthritis Centre. Having identified the need for such a group, interim objectives were proposed for the group which was still in the pilot stage of its development. The purpose of the study was to conduct a formative evaluation of the Men's Group to take a closer look at what was happening in the sessions, to examine the feasibility of the objectives and whether these objectives were being achieved. This information would be used by the planners to improve and/or modify the program. The underlying conceptual approach to the study was 'naturalistic'. In the context of this framework, several data collection methods were used including: interviews, quantitative measures, monitoring and narrative descriptions of group sessions. The findings suggested that interim objectives were being met in the sessions which focussed specifically on psycho-social issues. In addition, other sessions were serving an important 'informational' function which was recognized and valued by group members. Interviews with core-group members did indicate the perceived acceptance and usefulness of open discussions on psycho-social issues. However, over the short duration of the monitoring period no significant changes were found on the measures pre to post so that the positive or negative effects of the achievement of higher levels of emotional openness is not known. The study did provide a good preliminary data base on the nature of the group process and the heterogeneity of the membership. Useful information was gathered both on the kind of group process which may facilitate the achievement of the specific program objectives as well as the informational function of the group. Overall, group members seemed satisfied with group process and content and wanted to see the group continue. / Arts, Faculty of / Social Work, School of / Graduate

M.A. / Die doel van die verhandeling is om bydaende faktore wat aanleiding gee tot psigiatriese terugval vas te stel om sodoende aanbevelings te maak wat op die bevindinge gegrond is om diegene wie met psigiatriese pasiente werk te help . Deur middel van hierdie verhandeling is ‘ n poging aangewend om antwoorde tot die volgende vrae te verkry : • Wat is die persepsies van gesinne teenoor ‘n terugval van hul naasbestaandes ? • Wat word deur gesinne as ‘n vernamme bydraende faktor tot terugval beskou? • Wat is die gevolge van her-toelating op die gesin? • Wat is die algemene gevolge van institusionalisering op die pasient? Nie-waarskynlike steekproeftrekking vir die projek is gebruik. ‘m Onderhoudskedule is gebruik om data in te samel. Onderhoude is met twaalf respondente gevoer en hul antwoorde is aangebied en ontleed. Deur middel van hierdie ondersoek is vasgestel dat die oorgroter meerderheid pasiente pas nie so goed aan by die huis as in die gestig nie. In alle waarskynlikheid ‘n rede vir hierdie toedrag van sake is dat hulle hul voorskrif vir medikasie nakom nie. Hierdie nie-gehoorsaamheid deur pasiente lei daartoe tot die siening deur ‘n toenemende aantal gesinne dat hospitalisasie die geskikste plek is vir pasiente, met ontslag as nie-wenslik beskou. Tydens hierdie navorsingsprojek is vasgestel dat alle respondente nie voorberei is om te werk met geestessiektes nie. Hierdie probleem het daartoe aanleiding gegee tot ‘n mislukte integrasie proses aangesien pasiente nie terug na hulle gesinne en gemeenskappe teruggeplaas kon wees nie. Hierdie probleem het ‘n negatiewe aanslag op staatsbeleid om weg te doen met die institusionalisering van pasiente. / Prof. Mitchell

This exploratory study was designed to gather information about the needs and concerns of significant others of patients with recent spinal cord injuries. The respondents were asked about the impact of the patients' injuries on their own lives and about their feelings in relation to the treatment they and their patients were receiving from health care personnel. The study was conducted with a convenience sample of seven respondents, five women and two men, designated as significant others by seven patients with recent spinal cord injuries. Using a semi-structured interview guide each significant other was interviewed in depth from one to three times over a period of three to six weeks following their patient's injury. The interview guide covered eight selected themes relating to the significant other's': - need to feel that he or she is getting adequate information - need to feel that he or she is being helpful to the patient - need to feel able to cope with home and family responsibilities - need to have someone from whom he or she can obtain emotional support - need to express feelings, both positive and negative - need to feel that his or her patient is getting good care - past experiences and methods of coping with crisis situations - needs and concerns that may arise because of the likely major effects the patient's injury will have on the significant other's life in the future. All respondents reported needing initial access to physicians who would give a true report of their patients' medical conditions and progresses. Thereafter five respondents reported receiving adequate information from their patients or the nurses. The six respondents who were given a negative prognosis for their patients' recovery of function expressed less apparent emotional conflict than the one who was told there was some possibility of recovery. After the first interview three respondents stressed the need for practical information about how to help with their patients' physical care, although during the first interview all respondents expressed fear that any physical assistance they attempted might harm their patients. All respondents felt their greatest value to their patients was as a source of emotional support. Two respondents reported being able to defer all home and family responsibilities; the other five stated their home and family responsibilities were not directly increased by their patients' injuries. However these five reported stress caused by the necessity of coping with the patients' needs as well as home and family responsibilities. All seven significant others reported using some sources of external support, the most common being family members and close friends. All respondents voiced positive feelings about their patients and the health care they were receiving. Only three respondents expressed strong negative feelings which were directed at the cause of their patients' injuries or what they perceived as incorrect or inappropriate information given to them by health care personnel. All respondents stressed their need to know their patients were receiving good care. All significant others reported their patients' injuries were the severest crises they or their patients had ever undergone, but all also stated they believed they would be able to cope with the crisis. The respondents reported their patients' gravest concerns for the future related to finances, work and sexual functioning. The respondents themselves voiced less concern about finances and sexual functioning. Other concerns for the future expressed by the respondents related to housing, transportation, family activities, social relationships and coping with the inevitable "ups and downs" of the patients. There were some differences in concerns expressed by male and female respondents. The findings of the study demonstrated the presence of selected needs and concerns in a small convenience sample of significant others of spinal cord injured patients. Further research would be necessary to determine whether the findings are representative and whether there is a relationship between expressed needs and concerns and the sex of patients and/or significant others. The study offers suggestions to practicing nurses who wish to improve their care of spinal cord injured patients and their significant others. / Applied Science, Faculty of / Nursing, School of / Graduate

Background: Red Cross Children's Hospital treats an average of 2 000 children per annum with thermal injuries. Five hundred of these are new injuries and 60 patients have a total body surface area burn (TBSAB) that exceeds 20%. There is substantial evidence in adult burn literature that suggests that early enteral feeding (EEF) compared to initial starvation has a profound impact on the hormonal response, metabolic rate and gastrointestinal maintenance post thermal injury. However, research addressing these issues in the burned child (birth to 13 years old), are limited. Aim: To compare EEF, to delayed or late enteral feeding (LEF), and to evaluate whether the practice is beneficial in paediatric burned patients. Criteria: The criteria for the patients were (a) a burn less than 24 hours old and a TBSAB more than or equal to 20%, (b) an age of less than 13 years and (c) admission to the Red Cross Children's Hospital Burns Unit. Objectives: The objectives were to compare the effect of EEF and LEF on (1) the concentrations of insulin, insulin-like growth factor-1 (IGF1), glucagon, cortisol and growth hormone (GH), (2) the estimated energy expenditure (EEE) and calculated energy expenditure, (3) the respiratory quotient (RQ), (4) the intestinal permeability and (5) the clinical outcome. Methods: The children were assigned to either the EEF or LEF group. Nine patients in each study group completed the study successfully, with similar median ages (4.5 yr.), body weights (14 kg) and TBSAB (30%). The EEF group was enterally fed via a nasojejunal feeding tube within a median time of 10.75 hours post burn, whereas the LEF group fasted for a median of 54 hours, after which enteral feeds were introduced. This study is unique in that enteral feeds were used as part of the resuscitation regime in the EEF group. The EEF group received their full resuscitation volumes from the enteral feed at a median time of 16 hours from initiation. Venous blood samples were taken daily between 7h00 and 8h00, before breakfast, for the hormone measurements. The REE and RQ were measured by indirect calorimetry and compared to the recommended dietary allowances (RDA), Galveston and Solomon's equations, which estimate energy requirements. Small bowel permeability was measured by the sugar-absorption-test (SAT), and expressed as lactulose:rhamnose ratios.

Bibliography: pages 119-139. / The purpose of this study was to identify the needs and problems that were experienced by rural cancer patients and to investigate the level of emotional stress that they reported. A further purpose was to interpret the main findings of the study according to the Biomatrix Theory. 496 Cancer patients who lived in rural areas of the Western Cape and 140 urban cancer patients were interviewed. The urban cancer patients formed a control group for comparison of the stress data. In order to consider the needs and problems of rural cancer patients from a widespread area, stratified random sampling of magisterial districts was applied and an attempt was made to interview all cancer patients who were living in each of the 21 magisterial districts sampled. Data on needs and problems were collected by use of a questionnaire, and the stress data was collected by administering a modified format of the Stress Evaluation Inventory (SEI). The findings of this study revealed that financial difficulties were the most frequently reported problem while transport difficulties and frustration of emotional support needs were also frequently reported. Patients who reported experiencing these problems also reported statistically significantly higher stress according to the SEI than those who did not.

Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Community Psychology in the Department of Psychology in the Faculty of Arts at the University of Zululand, 2006. / The present study investigated the role that is played by family members in helping psychiatric patients cope with their illnesses. Twenty-seven psychiatric patients participated in the study. Of these, eighteen had been admitted to the local hospital for various complaints, and had been referred to the psychologist for psychotherapy. Nine participants were seen during private consultation sessions with the author/researcher. A convenient sample was used in that the criterion for inclusion of participants in the sample was based on patients suffering from certain psychiatric illnesses for example mood disorders, psychotic disorders or anxiety disorders. A semi-structured questionnaire was used to collect data for the study. The questionnaire covered participants' biographical information, details about psychiatric patients' illness such as their initial reactions to the diagnosis, knowledge about the illness, the level of support they received from family members and the community and the perceived causes of the illness. The procedure for data collection involved directed conversations in which patients reflected on their experiences both in and out of the hospital, for example the level of support they received from the family and community members, and information about their psychiatric conditions after being discharged from hospital. In addition, family members were asked to express their feelings and perceptions about the patients' conditions including the challenges they encountered as a result of having a family member with a psychiatric illness. The results of the study were that many psychiatric patients reacted with shock, fear and confusion to their illness diagnosis. Many also appeared to have some knowledge of the illness, including the belief by some that they had been bewitched. Some of the patients were unemployed as a result of being mentally ill, and this led to financial strains in the family. The main finding of the study was that most psychiatric patients still continue to be discriminated against in the communities in which they live. Most family members, however, were found to be supportive to their mentally ill relative. Some of the challenges faced by family members included a lack of knowledge about the illnesses affecting their relatives. The results of the study are generally consistent with the findings by other investigators regarding the important role that is played by family members in helping their relatives cope with psychiatric illnesses. In addition the study highlighted an urgent need by the government to improve mental health services by, among other things, providing adequately qualified professionals who may facilitate the process of integrating mentally ill persons with their communities.

Truth telling forms part of the contemporary debate in clinical bioethics and centers around the right of the patient to know honest information concerning his or her medical condition / illness and the duty of the doctor to inform the patient of such. Anecdotal evidence seems to imply that patients have concerns with the practice of truthtelling. Many often complain that they are not being informed and sometimes simply being ignored in matters that primarily concerns their health. On the other hand, there may be patients who do not to want a truthful answer to their health problems-they would in fact rather not know. The aim of this study was to explore my intuition that patients who attend the Johannesburg General Hospital are not given full information about their condition(s) and / or treatment(s) although they would like to know. The study explored the preferences of patients regarding the practice of truth telling and their attitudes toward truth telling in four out patient clinics of the Johannesburg General Hospital. Four hundred and sixty five participants completed and retuned the questionnaire from four different out patient clinics, namely oncology, surgical (general surgery and orthopedics), medical (gastro, renal and general internal medicine) and the nuclear medicine unit that represented the mixed out patient clinic. The majority of participants stated that the doctor had disclosed information about their condition (92.90%). Almost all participants were of the opinion that patients have the right to know about their condition (98.28%) and also that the doctor has the duty to inform them of their condition (98.02%). If they were suffering from a serious condition, a higher percentage of participants (86.28%) would prefer to know about their condition while a small but significant percentage (13.72%) would prefer not to know. The vast majority of participants (96.64%) also preferred to know about information relating to their treatment in detail while a high percentage (87.83%) supported disclosure to relatives. Variables such as gender, age and level of education did not seem to impact on the participants’ opinions of the truth telling process with significance with the exception of iv gender in relation with knowledge of one’s condition (p=0.0176) and education with regard to opinions on the right of patients to disclosure (p=0.0430). From the above results it can then be concluded that: 1. Participants in our study supported the right of patients to disclosure and the vast majority also felt that doctors have the duty to inform patients of their condition. 2. A significant percentage of participants felt that the level of information given to them was not satisfactory even when they have requested for more. This should be looked at and means for improvement should be sought. 3. A small but significant group did not support disclosure and must be respected as autonomous beings. 4. Gender seems to influence opinions of patients concerning their condition and education impacts on opinions relating to right of patients to disclosure of information. 5. To our appeasement, we found that patients attending the Johannesburg hospital are in fact given information about their condition. It is rather the quality and the quantity of information given that should be subject to scrutiny if we would like to move towards full disclosure in the process of truth telling in our institution. 6. Future studies should be considered to assess the attitudes of doctors towards disclosing, as well as further assess conflicting opinions in small group of patients by means of direct interviews.

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