Implementation strategies for the use of clinical practice guidelines are an integral component in bridging the gap between the best research evidence and clinical practice. However, despite some remarkable investments in health research regarding clinical practice guidelines implementation strategies, it is not yet known which of these are the most effective for intensive care units. The purpose of this research study was to systematically identify and /or search, appraise, extract and synthesize the best available evidence for clinical practice guidelines implementation strategies in intensive care units, in order to develop a draft guideline for clinical practice guidelines implementation strategies in the intensive care units. A systematic review design was used to systematically identify and /or search, appraise, extract and synthesize the best available evidence from the eligible included Level 2 studies (randomized controlled trials and quasi-experimental studies). Level 2 studies were applicable because they present robust evidence in the research results regarding effectiveness of clinical practice guideline implementation strategies. Furthermore, although other systematic reviews conducted in this area before, they included studies of In addition, no systematic review was identified that reviewed Level 2 studies and developed a guideline for clinical practice guideline implementation strategies in the intensive care units. Hence, including only Level 2 studies was distinctive to this research study. Databases searched included: CINAHL with full text, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials Issue 8 of 12, August 2013, and MEDLINE via PUBMED. Hand search in bound journals was also done. The search strategy identified 315 potentially relevant studies. After the process of critical appraisal, thirteen Level 2 studies were identified as relevant for the review. Of the 13 relevant studies, 10 were randomized controlled trials and three were quasi experimental studies. After the critical appraisal ten RCTs were included in the systematic review. Three studies (quasi-experimental) were excluded on the basis of methodological quality after the critical appraisal and agreement by the two independent reviewers. The Joanna Briggs Institute Critical Appraisal MASTARI Instrument for Randomized Controlled trials/ Experimental studies, and The Joanna Briggs Institute data extraction tools were used to critically appraise, and extract data from the ten included randomized controlled trials. The two reviewers who performed the critical appraisal were qualified critical care professional nurses and experts in research methodology. These reviewers conducted the critical appraisal independently to ensure the objectivity of the process. Appropriate ethical considerations were maintained throughout the process of the research study. The results indicated that 80 percent of the included studies were conducted in adult intensive care units while 20 percent were conducted in the neonatal intensive care units. Furthermore, 60 percent of the studies were conducted in the United States of America, 10 percent in France, a further 10 percent in Taiwan, another 10 percent in England and yet another 10 percfent was conducted in Australia and Newzealand. The included studies utilized more than one (multifaceted) implementation strategies to implement clinical practice guidelines in the intensive care units. The first most utilized were: printed educational materials; Information/ educational sessions/meetings; audit and feedback and champion/local opinion leaders; seconded by educational outreach visits; and computer or internet usage. Third most used were active/passive reminders; systems support; academic detailing/ one-on-one sessions teleconferences/videoconferences and workshops/in services. Fourth most used were ollaboration/interdisciplinary teams; slide shows, teleconferences/videoconferences and discussions. Fifth most used were practical training; monitoring visits and grand rounds. However all the strategies were of equal importance. Conclusively, the included studies utilized multifaceted implementation strategies. However, no study indicated the use of a guideline for the implementation strategies in the process of clinical practice guidelines implementation. The systematic review developed a draft guideline for clinical practice guideline implementation strategies in the intensive care units. The guideline will enhance effective implementation of clinical practice guidelines in such a complex environment.

M.A. (Business Management) / With the raise of competition in the Gabonese health industry and increased costs, most health service providers in Gabon have become under pressure to deliver good service quality. This also relates to the military hospital in Libreville in Gabon striving to provide adequate health services to its patients. The cost for hospitals to attract patients through several means such as providing good service quality has become crucial. Patient loyalty and retention can have an important financial advantage for a hospital, thus it has become essential for hospitals to create a sustaining relationship with their patients. The question of assessing service quality presents itself. This study investigated service quality at a military hospital in Libreville in Gabon. It was the objective of this study to establish if there is a difference in how patients rate doctors and nurses on the service quality dimensions. This research was quantitative and descriptive in nature. Theory relating to service quality and patient satisfaction was provided. The population for the study consisted of patients who were at least 18 years old, males and females, who have experienced medical services and stayed over at the military hospital for at least one night. A self administered questionnaire was designed based on the theoretical literature illustrated in the study. The questionnaire assessed various elements that were identified through the literature review. The questionnaire was based on a set of statements linked to the literature theory, and a 7-point Likert scale which enabled respondents to choose from seven different alternatives ranging from strongly disagree to strongly agree. A number of statistical analysis techniques were undertaken to achieve the objectives of the study, such as factor analysis. The conclusion and findings of the research assisted in explaining the objectives of the study and the results of the statistical analysis were found to reject the hypotheses that there is no significant difference in how patients rate the reliability, responsiveness, assurance and empathy of doctors and nurses and to reject the hypothesis that patients do not have a positive perception of the tangible aspects of a military hospital in Libreville, Gabon. In terms of the doctors’ services, patients felt a need for more privacy in terms of the confidentiality of their treatment, a need for more individual attention, a need to be heard, and to trust doctors. Therefore such needs could be addressed through improved compassion, communication and understanding of doctors during the diagnosis of the problem. The feeling expressed was that doctors should pay more attention to patients’ problems and share with them their experience. Doctors at the military hospital should develop more work ethic where patients’ records and cases should never be discussed with anyone without patients’ permission. The military hospital should employ highly trained and qualified doctors to address the trust issue with patients. Lastly, consultation time may need to be reviewed to add some extra time to better address patients’ needs during their consultation with doctors. In terms of the services delivered by nurses towards patients, the latter were of the opinion that there was a need for more individual attention from nurses. Such individual attention could include greater information sharing when a patient is treated, friendlier communication to install greater trust and respect. Such needs could be addressed through improved patience, compassion and understanding by nurses during their dealings with patients. Nurses should also develop more work ethic regarding patients’ records, and cases should never be discussed with anyone without their permission. Officials in the hospital should hire highly trained and qualified nurses to address the issue of trust in patients and consultation time may need to be reviewed to add some extra time to better address patients’ needs during their dealings with nurses.

This study is a part of a three stage pursuit to examine and to comprehend the relationship between the resources available, the apparent utilization patterns of those resources by the population being served, and the selected characteristics of the populations utilizing and not utilizing the prevailing medical care system. The first stage of the research involves the examination of the existing patterns of medical care utilization by socioeconomic status groups. Cross-national Comparison of Physician Utilization by the Socioeconomic Status Groups is the pilot research for the first stage and both modifies and develops the methodology for this type of research and also examines the physician utilization patterns of a population in well defined basic measurements — in this case the socioeconomic status index, the diagnosed disease, and the number of physician contacts. The comparison of the physician utilization patterns of socioeconomic status groups in respect to the prevailing medical care delivery system necessarily involves cross-area studies at least at regional level, but most likely cross-national comparisons as well. This study used already collected data, nevertheless, primary data, which had been collected and partly analysed in the World Health Organization/International Collaborative Study of Medical Care Utilization. The data came from twelve geographical areas, altogether from seven countries, and provided documented research material on the surveyed respondents' social characteristics, standard diagnostic procedures, and standard definitions of the interactions between the users and the prevailing medical care delivery systems. The social characteristics were used separately, but in a standardized way, in order to derive socioeconomic status groups in each area; the diseases distributions were examined in relationship to the socioeconomic status groups, and the physician utilization patterns were related to the socioeconomic status groups while controlling for the distributions of selected diseases, after which the study areas were compared to each other in terms of the exhibited relationships between the physician utilization and the socioeconomic status groups. The physician utilization patterns were found to vary only little from one area to another, however, consistently, to warrant the use of derived information for the second stage of the research. Physician utilizations were very weakly correlated to the socioeconomic status and these correlations were not substantially effected by the selection of the controlling disease, i.e., they were consistent. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Significance. International Medical Graduates (IMGs) comprise 26% of the physician workforce in the United States and 18% of the physician workforce in Iowa. IMGs fill gaps in health professional shortage areas (HPSAs) in the United States and are significant contributors to the medical community. The State Conrad 30 Program allows states to recruit IMGs to HPSAs. Physicians supported under the Conrad 30 Program are obligated to work in HPSAs for three years. Although an important subset of the physician population, little is known about the experiences of Conrad 30 Program participants, or the factors associated with recruiting and retaining this sector of the physician workforce. Purpose. This dissertation described the characteristics and experiences of IMGs practicing in the Iowa Conrad 30 Program, examined retention intention and actual retention of these physicians, and analyzed factors associated with retention of four or more years. Methods. This dissertation utilized a mixed methods approach. Study 1 examined the characteristics of 410 IMGs participating in the Iowa State Conrad 30 Program between 1996 and 2012, using existing data. Logistical regression was used to compare the characteristics of physicians who were retained for four or more years with those who were retained less than four years, controlling for covariates. Study 2 explored the experiences of nine physicians using in-depth qualitative interviews. Inductive content analysis was used to identify themes related to site selection and retention. Study 3 used a physician survey to analyze physician attitudes and subjective norms on 33 practice factors. ANOVA and linear regression was used to analyze the difference in attitudes and subjective norms by physicians’ intent to remain practicing in Iowa long term and actual retention. Results. Study 1: Of 410 physicians, 378 (92%) met the 3-year program obligation to practice at the original practice site and 280 physicians (68%) were retained four or more years. The average length of retention was 6 years and 4 months (SD = 4 years, 1 month). Male physicians had 2.7 greater odds of being retained four or more years than female physicians (95% CI = 1.39, 5.19). Physicians with a region of origin of the Americas had 0.25 lower odds of being retained four or more years compared to physicians with other regions of origin (95% CI = 0.06, 0.98). Marital status, having children at the time of hire, training in the Midwest, practice specialty, and salary were not significantly associated with odds of being retained four or more years. Study 2: Nine physicians completed semi-structured interviews. Themes from the interviews included: Physicians’ visa obligation requirements drove the initial site selection. Physicians had minimal knowledge about the state prior to selecting a practice site and had little intent to remain practicing in Iowa long term when making the initial practice site selection. Visa-related issues and the physician’s perception of mistreatment due to the visa status influenced the retention decision. The practice setting and personal motivators influenced the retention decision through the practice model, community attributes, influence of salient others, career motivators, and a sense of place. Study 3: Fifty-one physicians completed a survey regarding their retention intention when initially selecting the practice site, and their attitudes and subjective norms towards the practice and community. The perception of the beliefs of residency/fellowship faculty (subjective norms) were significant (p = 0.01) for those physicians intending to remain at the practice site for their careers. Attitudes towards the community were significantly more positive (p = 0.03) for physicians intending to remain at the practice site for their careers. Positive subjective norms of significant others (p = 0.02) and residency/fellowship faculty (p = 0.04) were significantly associated with actual retention of four or more years. Positive attitudes towards the practice site and employment factors were significantly associated with longer retention in months (p = 0.02, p = 0.03, respectively). The positive subjective norms of significant others and residency/fellowship faculty were significantly related to longer retention in months (p = 0.0002, p = 0.02). Conclusions: The findings of this study provide important empirical data on the factors influencing site selection and retention of IMGs that participated in the Iowa Conrad 30 Program. The findings suggest a modification may be needed for the existing theoretical model, which was based upon the Theory of Reasoned Action. Improving retention of physicians could help improve quality of care and reduce overall costs for physician practices. Understanding why Conrad 30 Program participants may elect to practice in rural and underserved areas, and the factors influencing retention of physicians in these areas can assist employers, program administrators, and policymakers to aid in improving the retention of International Medical Graduates.

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Criminal liability of a physician and its evidence This master's thesis focuses on the concept of criminal liability regarding the performance of medical activities and its evidence. The aim of the thesis is to introduce the reader to the current issues of medical law from the perspective of criminal liability and to provide insight into other key aspects of its determination. The thesis offers answers to the questions of who and on what basis assess whether the doctor's actions were (non) lege artis, what consequences from such actions for the doctors may arise and under which circumstances the doctor will not be criminally liable. The thesis itself is divided into six chapters, which are then divided into other subchapters. The first chapter introduces medical law within the system of law of the Czech Republic and provides the basic framework of the sources of this area of law, which is regulated by both international conventions as well as national laws. The second chapter is devoted to the concept of (non) lege artis, this concept is a key criterion in deciding on the application of legal liability. The third chapter provides definitions of the conditions of criminal liability of (not only) doctors and its manifestation in the provision of health care. An important precondition for criminal...

This dissertation will examine the legality of assisted dying procedures performed in the Republic of South Africa. This is due to the rising awareness about terminal patients’ dignity and autonomy at the end of their life. The physician’s liability, who assists such a patient to end their life, will be examined and whether there is any legal recourse available will be explored. Comparisons will also be made between other legal systems, including Canada, the Netherlands, Oregon of the United States of America and England and Wales. These jurisdictions have been chosen to provide a wide variety of perspectives and possible alternatives that South Africa should take into consideration should parliament or the courts decide to argue the matter. Other sources are also considered, such as the influence of the history and development of the common law crime of murder, as well as the role the Health Professions Council of South Africa will play. Possibly most importantly, the material criminal law of South Africa is thoroughly studied with all forms of assisted dying in mind. This is to establish what kind of liability, criminal or otherwise, a physician might incur should they decide to assist a patient in these circumstances. Lastly, recommendations are made based on the research done throughout this dissertation, which would ideally assist in any future arguments made on the topic. / Dissertation (LLM)--University of Pretoria, 2017. / Public Law / LLM / Unrestricted

Walden University College of Health Sciences This is to certify that the doctoral dissertation by Veronica Laviece Givan has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Diana Naser, Committee Chairperson, Health Services Faculty Dr. Nicoletta Alexander, Committee Member, Health Services Faculty Dr. Michael Brunet, University Reviewer, Health Services Faculty The Office of the Provost Walden University 2019 Parent/patient satisfaction surveys are important tools used to measure quality of health care provided by physicians, nurses, and hospitals. Research has been conducted on patient satisfaction in adult settings; however, a gap exists in the research about pediatric patient satisfaction in relationship to nurse interactions and interactions with physicians in various clinical settings. The purpose of this descriptive quantitative study was to determine whether a significant difference exists in overall parent/patient satisfaction scores and interaction of patients with nurses, and physicians, as well as interaction with anesthesiologists in terms of pain management in the pediatric surgical service in comparison to the medical inpatient unit and intensive care unit. Watson's caring science theory served as the framework for this study. Research questions evaluated parent/patient satisfaction scores and tested interactions between the parent/patient and the physicians, nurses, and anesthesiologists in a children's hospital. A total of 675 parent/patient satisfaction surveys from a children's hospital were analyzed using an independent samples t test, Levene's test, and regression analysis. The data analysis revealed a significant difference between overall parent/patient satisfaction scores (p = .021) in the pediatric surgical service as compared with the medical unit and for the parent/patient satisfaction survey responses (p = .004) for the interaction with nurses and physicians in the pediatric surgical service as compared with intensive care units. The potential social change that could result from this study is that health care organizations should record patient experiences to facilitate and improve the quality of care, interactions with physicians and nurses, and clinical outcomes

Academic dishonesty and cheating abound in universities across the globe, with increased instances of academic dishonesty in many disciplines including medical professional education programs that have high expectations for integrity and ethical conduct. The purpose of this study was to determine how faculty in physician assistant (PA) programs described their experiences, specifically their roles and responsibilities, in addressing incidents of academic dishonesty. The conceptual framework by Nitsch and colleagues, which focused on faculty failure to report conduct violations in dishonesty cases, informed interviews with 10 PA faculty members concerning the role of faculty members in academic dishonesty violations. Interview transcripts were analyzed to identify common themes through a manual coding process. Interviews were followed by a modified Delphi process with 5 of the participants to confirm consensus of the responses obtained in the interviews. Themes from the findings focused on faculty members' high expectations of academic honesty from students in PA programs, the role of university involvement in reporting and managing cases of academic dishonesty, including deterrents to faculty reporting, and program strategies to deter academic dishonesty. Based on findings, a PA faculty development workshop was developed for creating cultures of academic integrity in PA programs and program campuses. Positive social change may result through better management of cases of academic dishonesty in PA programs and on campus, as well as the use of faculty as change agents in promoting a culture of campus integrity.

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