Mini-dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, 2011. / Introduction This descriptive, quantitative perception survey aimed to determine the opinions and treatment regimes of registered South African homoeopaths, regarding childhood vaccinations. Purpose / Aim The purpose of this survey was to determine if there is a coherent treatment protocol amongst homoeopaths when dealing with childhood vaccinations. Methodology The researcher used a questionnaire (Appendix B), aimed at homoeopaths registered with the Allied Health Professions Council of South Africa (AHPCSA), as primary health care practitioners, to view their patient management techniques regarding vaccinations. This study aimed to document the intervention protocols offered concurrently or as an alternative to orthodox vaccinations. A participant information letter (Appendix A) and a questionnaire (Appendix B) were faxed or e-mailed to all homoeopaths. After a two week time lapse, an independent third party contacted the participants who had not returned the questionnaires to ensure they had received the questionnaire. A further 2 weeks were allowed to lapse for the return of the outstanding questionnaires, after which time the non-complying candidates were excluded from the study. v Anonymity was maintained as the 93 completed questionnaires were returned to the third party. All personal details were removed before the researcher was allowed access to the questionnaires. The data accumulated was evaluated and statistically analyzed using Pearson’s chi-square tests, frequency tables, bar charts, analysis of variance (ANOVA) and Bonferroni post hoc multiple comparison tests. A p-value <0.05 was considered as statistically significant. Results Polio was the only disease that participants felt should be vaccinated against (40%) and only 10.1% of participants rated vaccinations as very important. Half (55.3%) of the participants thought there was not enough scientific proof that vaccinations prevent infectious disease. The participants rated improved sanitization (82.9%); nutrition (72%); access to healthcare (65%); healthcare (64.6%) and education (64.2%) as the most important interventions contributing to the decline of infectious diseases. Conclusions The assumption that most homoeopaths disagree with vaccinations held true as 72% of the participants were not in favor of vaccinations. However, 44.4% felt that the risks of vaccinations did not outweigh the benefits. Results indicate that the majority of participants did not support the use of vaccinations although their treatment protocols and general opinions regarding vaccinations varied tremendously. vi In conclusion, the homoeopathic profession can use this information to decide what steps should be taken to rectify any misconceptions, improve general knowledge and attitudes regarding homoeopaths’ opinions and intervention protocols with regards to childhood vaccinations.

published_or_final_version / Community Medicine / Master / Master of Public Health

The purpose of this study was two-fold. First, it was designed to determine what factors physicians consider most important when choosing a hospital to use for patient referrals. The second portion of the study sought to determine what means of communication were most effective in reaching physicians. A review of the available literature showed that some studies had been conducted on the physician-tophysician referral process. However, nothing had been done on the physician-to-hospital relationship. No communication studies were found regarding what form(s) of communication is/are the most effective in reaching the physicians.A survey was sent to all members of the medical communities in Madision County/Anderson, Indiana, and Allen County/Fort Wayne, Indiana. All results of the survey were tested by statistics with all results found to be non-significant. Only percentages were reported in the study.The study showed that physicians were mostly concerned with care-related factors when referring patients to a hospital. These factors include quality of patient management, patient results, availability of specialists and reputation of specialists. Of least importance to the physicians were patient-related factors such as cost, convenience, and preference of hospital.The survey also showed that the physicians' age and area of specialty made no difference in how receptive they were to communications. When asked about mass media, the physicians said they noticed newspapers the most, followed by television and radio. When asked how they preferred to receive information from or about a hospital, doctors listed, from most preferred to least preferred, direct mail, medical staff newsletters, medical society publications, hospital publications, and educational meetings.The researcher feels that an in-depth interview approach with the physicians would better determine the more complex reasons for referral decisions. A readability study would also determine to what extent the physicians read, heard, or saw the messages sent to them, and how design, layout and writing style would assist the hospitals and other health professions in reaching the physicians more effectively.

This research addresses the need for a pacemaker/defibrillator that could perform an automatic system self-diagnostics check to assure operational functionality and give doctors a chance to assess a patient's status in the event they are experiencing complications, as pointed out in an article in the journal Health Scout, which stated that 'St. Jude Medical Inc., the nation's second-largest pacemaker manufacturer, has warned doctors that at least 90 of its pacemakers being used by heart patients could stop emitting the electrical signal that regulates heartbeat'. The proposed functionality would also serve the military in determining the whereabouts or state of being of an individual on the battlefield. This thesis investigates the use of Unified Modeling Language (UML) Diagrams, Object-Oriented Analysis and Design, and Structured Query Language (SQL) to develop the high level architecture of a system to store and retrieve digital/wireless communication information from a pacemaker/defibrillator, or other device, and to alert medical personnel when a person is experiencing problems with their health. It presents the requirements and architectural design of the Self-Diagnostics Digitally Controlled Pacemaker/Defibrillator Device. Applications of the SDDCPDD design concept for military missions are explored.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Family Medicine. Johannesburg 2003 / Residents of a Retirement Village (Rosehaven), in both the frail and the non-frail sections, were the subjects for this study. They were interviewed to determine demographic characteristics and attitude towards sleep and sleep problems. Subjects living in the frail care facility were compared to those living independently. In addition, the chronic use of benzodiazepines, and the perceptions of both the subjects, and the medical and nursing personnel caring for them, was studied. The physical and mental status of subjects currently taking benzodiazepines was compared with those who were not. No significant differences in demographic features, was found between the frail and the non-frail subjects. However, when subjects taking benzodiazepines were compared with those who were not, several interesting differences were determined. Frail subjects were more likely to be taking benzodiazepines. Sleep difficulties, and perception of poor sleep quality was more likely in the benzodiazepine group. Subjects taking benzodiazepines were more likely to be anxious, and to have suffered falls and resulting injuries. The daily functioning of subjects was rated using three well-validated scales: Instrumental Activities of Daily Living, Mini Mental State Examination, and the Geriatric Depression scale. Those subjects taking benzodiazepines scored significantly worse on all of these scales, independent of frail status (i.e. within both frail and nonfrail groups, subjects taking benzodiazepines scored significantly worse). In spite of the above findings, subjects’ perception of benzodiazepines was positive, and they believed them to be helpful. Nursing staff also perceived benzodiazepines to be beneficial medications. Most of the general practitioners questioned had doubts as to the safety of benzodiazepine use in elderly patients, however they were also generally happy to continue to prescribe them. / IT2018

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This research was designed to see whether the clinical method espoused by Moira Stewart et al in the book "Patient-Centered: Transforming The Clinical Method" is appropriate for Pakeha general practitioners to use in clinical consultations with Maori patients. This thesis uses qualitative methodology. One of my supervisors and I selected from the kuia (old women) and kaumatua (old men) of Hauraki those whom I would approach to be involved. Nearly all responded in the affirmative. The kuia and kaumatua talked about their tikanga, about the basis of tikanga, about the spirituality of their Maori worldview. They talked about the need to maintain their tikanga, about qualities that they respect. They described different roles within Maoridom, especially those of the kuia, whaea (mothers) and Tohunga (experts). They refer to a GP as a Tohunga because of the GP�s special expertise. The GP is able to use his or her special expertise to heal Maori patients, but needs to be able to get through barriers to do so. They are also clear that Maori and Pakeha live in two different worlds which can merge in some circumstances. I came to two conclusions. The first is that the elements of Patient-Centered Medicine are relevant to the consultation of a Pakeha GP and Maori patient, and provides a framework that is productive. The second conclusion is that there is a better framework for working with Maori patients, within which Patient-Centered Medicine can be practiced more effectively. Maori already have a framework (tikanga) in which they function, and if in their settings, especially the marae, he or she is welcomed and has a place in their world; tikanga accommodates the GP as a Tohunga and Maori respond to him or her as such. In summary, a Pakeha GP who has some knowledge of tikanga or Maori culture and who has a basic knowledge of the Maori language of tikanga of Maori culture and who has a basic knowledge of the Maori language can work very well for his or her Maori patients by working within the framework of Tikanga Maori and by being patient-centered in consultation.

The objective of this study was to assess Primary Care Physicians’ attitudes towards adoption of the Diagnostic Assessment Program-Electronic Pathway Solution (DAP-EPS), an electronic tool for improving cancer diagnostic processes. The implementation of DAP-EPS is a provincial activity supported by Cancer Care Ontario in collaboration with the Canadian Cancer Society. We conducted an online survey of Ontario PCPs. To guide our study, we used an integrated theoretical framework combining the Technology Acceptance Model and Diffusion of Innovation. Study results suggested a strong influence of perceived usefulness of the DAP-EPS tool on physicians’ attitudes towards adoption of the tool. The results also found that perceived usefulness was more important than perceived ease-of-use within the PCP context. The study revealed that perceived usefulness is the main predictor of physicians’ attitudes. The findings also suggested that the management and implementation team should emphasize the usefulness of the DAP-EPS to increase adoption among PCPs.

The objective of this study was to assess Primary Care Physicians’ attitudes towards adoption of the Diagnostic Assessment Program-Electronic Pathway Solution (DAP-EPS), an electronic tool for improving cancer diagnostic processes. The implementation of DAP-EPS is a provincial activity supported by Cancer Care Ontario in collaboration with the Canadian Cancer Society. We conducted an online survey of Ontario PCPs. To guide our study, we used an integrated theoretical framework combining the Technology Acceptance Model and Diffusion of Innovation. Study results suggested a strong influence of perceived usefulness of the DAP-EPS tool on physicians’ attitudes towards adoption of the tool. The results also found that perceived usefulness was more important than perceived ease-of-use within the PCP context. The study revealed that perceived usefulness is the main predictor of physicians’ attitudes. The findings also suggested that the management and implementation team should emphasize the usefulness of the DAP-EPS to increase adoption among PCPs.

The current maxim concerning diagnosis and treatment of mood and anxiety disorders is that family physicians fail to appropriately respond to patients with anxiety and depression. This estimate is based upon a collection of studies that have found that accurate recognition in general practice occurred in 9% to 75% of patients with depression, and 34% to 50% of patients with anxiety. However, most studies have found that more than half of physicians accurately detected depression and anxiety in their patients.<p> This dissertation examined physicians responses (detection, treatment, and follow-up) to clinical scenarios of patients presenting with symptoms of either depression or anxiety. Furthermore, this study evaluated the associations between physicians responses and physician attributes (personal and professional), organizational setting, information/resource use, and barriers to care.<p> A cross-sectional study of Saskatchewan family physicians yielded a response rate of 49.7% (N=331/666). The results of this study revealed that most physicians provided appropriate depression and anxiety care with respect to recognition of disorders and follow-up care. Specifically, 85.4% of physicians provided an accurate tentative diagnosis of depression, and 86.3% provided an accurate tentative diagnosis of anxiety; 82.5% of physicians suggested adequate follow-up depression care while 79.4% offered adequate follow-up anxiety care. However, a notable proportion of physicians did not provide effective treatment; 65.6% of physicians recommended effective (immediate) anxiety treatment, and 55.6% recommended effective (immediate) depression treatment.<p> This study found that physicians provision of care to patients with anxiety and depression was more likely to be associated with their personal attributes, organizational setting, and information/resource use than with their professional attributes. First, neither tentative diagnosis of depression nor tentative diagnosis of anxiety was significiantly associated with any of the tested measures. Second, ineffective treatment of depression was significantly more likely among physicians who were female, educated at the undergraduate level in Canada (versus elsewhere), scored lower on anxiety attitude factor 1 (social context view of anxiety amenable to intervention), had a low patient load (< 100 patients/week), and used medical textbooks to make specific clinical decisions; ineffective treatment of anxiety was significantly more likely among physicians who had completed their undergraduate and postgraduate medical training in Canada (versus elsewhere), had a low patient load ( <100 patients/week), did not practice in a private office/clinic, and used colleagues within as well as outside their main patient care setting to update their general medical knowledge. Third, physicians were significantly more likely to provide inadequate follow-up care to the depressed patient if they were in solo practice and used drug manuals to update their general medical knowledge, and significantly more likely to provide inadequate follow-up care to the anxious patient if they (the physician) were female and did not use mental health professionals to update their general medical knowledge.<p> Results indicated that after controlling for the effects of other factors, physicians with low patient loads were three times more likely to provide ineffective treatment of depression than physicians with high patient loads. Furthermore, when holding the effects of all other factors constant, physicians who had completed postgraduate training in Canada were approximately five times more likely to provide ineffective treatment of the anxious patient than physicians who had completed their postgraduate training outside of Canada.