A quantitative, descriptive, explorative design was applied to study the problems that hindered the Primary Health Care (PHC) nurses in rendering quality health care in the health facilities in Limpopo province South Africa. The sample consisted of 53 PHC nurses who completed a pre-tested questionnaire which covered various aspects related to the provision of quality PHC services. The data were analysed by computer using SPSS version 15 soft ware. The findings revealed that most of the problems could be attributed to financial constraints, poor budgeting, and shortage of staff to manage large number of patients, lack of enough support from other professional staff, unreliable referral systems and communication networks. PHC nurses work under difficult conditions and often have to improvise to care for patients, but unless more funds are allocated to rural health care facilities and these problems are addressed, more nurses will work under difficult circumstances. / Health Studies / M.A. (Health Studies)

Apart from isolated programs in private and public health care sectors, South Africa has no existing systematic public infant hearing screening program at community level. As a result, early identification of hearing loss is certainly not being attained for the majority of infants in South Africa with far-reaching effects for individuals, families and society at large. Screening programs at primary health care immunization clinics have been proposed as an alternative to hospital-based programs in South Africa. The objective of this study was to evaluate the first systematic community-based infant hearing screening program in a developing South African community in the Western Cape. A combined descriptive and exploratory research methodology was followed incorporating aspects of a program evaluation design. The study was of a quantitative nature and the required data were collected by means of a questionnaire and OAE testing conducted by clinic nurses on subjects. A community-based universal infant hearing screening program initiated at eight primary health care clinics in the Cape Metropolitan area was evaluated over a 19-month research period. During this time 6227 infants who were candidates for screening attended their 6, 10 or 14-week immunization visit at the relevant clinic. Clinic nurses were trained as screening personnel. A two-stage distortion product otoacoustic emissions screening protocol was utilized. The target disorder for this study was bilateral permanent congenital and early onset hearing loss and infants referring the first screen were scheduled for a 4-week follow-up visit at the clinic. Diagnostic audiological and medical evaluations were scheduled at referral hospitals when indicated. The study evaluated the efficacy of the program based on coverage, referral and follow-up rates and diagnostic outcomes according to guidelines specified by the Health Professions Council of South Africa 2007 Position Statement. Overall coverage rate across the eight clinics was 32.4% with 2018 infants (aged 0- 14 weeks) screened. The mean age of the sample at first stage screen was 3.9 weeks of age and 13.5 weeks of age for first hospital visit. Overall first stage screen referral rate was 9.5% with 62 subjects (3%) referred for diagnostic services at hospital level after a follow-up screen. The average follow-up rate for rescreens at clinic level was 85.1% and for initial diagnostic assessments at hospital level it was 91.8%. Although minimal hearing loss was not the primary focus of the screening program the outcomes did include those subjects with fluctuating conductive hearing loss and permanent unilateral hearing loss. Prevalence rates were 4.5/1000 with significant hearing loss, including sensorineural (1.5/1000) and conductive (3/1000) losses, and 12.9/1000 for subjects with middle ear effusion.<p-> The community-based infant hearing screening program was valuable in attaining high follow-up return rates but reaching sufficient coverage may require dedicated screening personnel as opposed to existing nursing personnel. Furthermore, consideration of an alternative community-based platform such as midwife obstetric units may improve coverage and referral rates and prevalence of permanent congenital and early onset hearing loss. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / Speech-Language Pathology and Audiology / Unrestricted

Dans cette thèse, nous nous intéressons aux problèmes de découverte, de sélection et de composition de services. L'objectif est de satisfaire une requête complexe d'un demandeur de services. Pour ce faire, nous proposons une approche multi-agents fondée sur la confiance et les réseaux sociaux. Nous définissions un modèle de confiance en tant que concept compositionnel formé de quatre composantes: une composante sociale, une composante d'expertise, une composante de recommandation et une composante de coopération. La composante sociale juge s'il est intéressant de suivre un fournisseur avant d'utiliser ses services. La composante d'expertise estime si un service se comporte bien et comme prévu. La composante de recommandation vérifie si un agent est pertinent ou pas et si l'on peut compter sur ses recommandations. La composante de coopération permet aux agents de décider avec qui interagir dans une composition de services. Nous proposons un algorithme distribué pour la découverte de services utilisant la confiance entre les agents ainsi que les systèmes de références dans les réseaux sociaux. Nous développons également une nouvelle méthode s'appuyant sur un modèle probabiliste pour inférer la confiance entre les agents non adjacents tout en tenant compte des rôles des agents intermédiaires. Finalement, nous présentons un processus original de formation de coalitions qui est incrémental, dynamique et recouvrant pour une composition de services dans les réseaux sociaux. Les résultats expérimentaux montrent que nos approches multi-agents sont efficaces, plus performants que les approches similaires existantes et peuvent offrir des résultats plus dignes de confiance à faible coût de communications. / This thesis deals with service discovery, selection and composition problems. The aim is to fulfill a complex requester query. To do that, we propose a multi-agent approach based on trust and social networks. We define a trust model as a compositional concept that includes social, expert, recommender and cooperation-based component. The social-based component judges whether or not the provider is worthwhile pursuing before using his services. The expert-based component estimates whether or not the service behaves well and as expected. The recommender-based component checks whether or not an agent is reliable and if we can rely on its recommendations. The cooperation-based component allows agents to decide with whom to interact in a service composition. We propose a distributed algorithm for service discovery using trust between agents and referral systems in social networks. We also develop a new method based on a probabilistic model to infer trust between non adjacent agents while taking into account roles of intermediate agents. Finally, we present an original coalition formation process which is incremental, dynamic and overlapping for service composition in social networks. %In particular, our coalition formation process engaging self-interested agents is incremental, dynamic and overlapping. Experimental results show that our multi-agents approaches are efficient, outperforms existing similar ones and can deliver more trustworthy results at low cost of communications.

The purpose of this project is to support health promotion of children entering foster care, ensure that children receive all health care services needed, prevent the trauma of duplication of immunizations, and reduce disruption of health care as children move through the foster care system.

Business processes that are maintained in, and through, digital information chains are a widespread phenomenon in society. In these chains, several actors are active both in the production and transfer of information, where each actor is dependent on another actor's effective transmission to be able to perform his job. To explore this phenomenon, this study investigates an electronic referral process of the regional Health Care system in Sweden, that allows for the transfer of rights, duties and obligations between health care providers. In this process, effective information transfer is necessary to achieve high levels of patient safety and to prevent delays in care delivery. This study intends to unveil the technological and communicative challenges of information transfer faced by doctors who are involved in that process. The study draws upon primary data collected from nine interviews conducted with secondary care doctors working at the Uppsala University Hospital. The results were analyzed primarily using communication theories of representation and through a constructionist perspective of knowledge. The results show that most challenges are communicative, most of which, as well as the technological challenges identified, relate to mediation and sharing of meaning. Challenges also tend to be more or less prominent depending on the actors involved, and the nature of what is being transferred. In order to deal with the challenges, the referral process is circumvented and the methods of circumventing prove to be as institutionalized as the referral process itself. / Verksamhetsprocesser som upprätthålls i och genom digitala informationskedjor är ett utbrett fenomen. I dessa kedjor är flertalet aktörer aktiva i både produktionen och överföringen av information, där varje aktör är beroende av en annan aktörs överföring för att kunna utföra sitt arbete. I avsikt att närma sig detta fenomen, är syftet med studien att förstå vilka utmaningar som kan uppstå i en sådan verksamhetsprocess genom att undersöka det digitala remissförfarandet inom sjukvården. Remissförfarandet är en central process genom vilken patientvård samordnas via remisser och remissvar. För att uppnå hög patientsäkerhet, är processen beroende av effektiv informationsöverföring. Frågeställningen som studien ämnar besvara, är “Vilka informationsteknologiska och kommunikativa utmaningar kring informationsöverföring i remissförfarandet upplevs inom specialistsjukvården?”. För att besvara denna fråga har nio intervjuer med specialistläkare på Akademiska sjukhuset i Uppsala utförts. Intervjudatan har i huvudsak analyserats utifrån ett kommunikationsvetenskapligt angreppssätt som kombinerar ett konstruktivistiskt kunskapsperspektiv och representationsteori. Resultaten visar på att majoriteten av utmaningar är kommunikativa, varav de flesta, liksom de informationsteknologiska utmaningar som identifierats, relaterar till förmedling och delande av mening. Utmaningar tenderar också bli mer eller mindre framträdande beroende på vilka aktörer som deltar i informationskedjan samt karaktären på det som överförs. För att hantera utmaningarna kringgås remissförfarandet, där sätten att kringgå visar sig vara lika institutionaliserat som remissförfarandet självt.

No description available.

Abstract Word-of-mouth (WOM) personal referrals are more efficient and influential than other forms of advertising; however, there is a lack of information regarding the value of referral programs. The purpose of this qualitative case study was to explore the perceptions of business owners, staff, and customers of alternative health care organizations in a Midwestern U.S. state about efficient referral strategies, measuring the effect of those strategies, and motivations of consumers to make referrals. Maslow's hierarchy of needs theory of motivation and customer decision-making theories provided the conceptual framework. The research questions addressed how industry leaders perceived and ranked referral strategies and addressed customers' perceptions and motivations to make personal referrals. Data collection consisted of semistructured interviews with 4 business owners, 2 staff members, and 10 client participants. Data were analyzed using constant comparative analysis methods, and member checking enhanced the accuracy of the findings. Results indicated that participants viewed WOM personal referrals as the most efficient nontraditional strategy to make or receive referrals, and they perceived referrals from impartial and trustworthy sources as the most valued information. This research has implications for positive social change. Findings may be used to enhance business owners' understanding of the value of personal referrals in their marketing mix, and of the motivation for customers to make referrals. WOM personal referrals may be used as a marketing strategy to increase sales and lower costs of formal advertising, which may contribute to the growth of the business.

Human trafficking has become an international issue of significant importance; it is the largest and most profitable organised crime after drugs and arms trafficking. Particular concern has recently been raised due to the Brexit potential ramifications on Human trafficking. There is a risk that the EU directive 2011/36 will be repealed as a result of Brexit. Accordingly, it has been questioned whether the UK national efforts and legislation concerning human trafficking are comprehensive and sufficient enough without the strengthening support of the EU and especially the EU directive 2011/36. Thus, this thesis aimed to determine the impact Brexit will have on human trafficking in the UK by investigating if there will be "gaps" in the UK national legislation on human trafficking.  A comparative content analysis was conducted to analyse the UK national legislation on human trafficking, The Modern Slavery Act 2015 (MSA 2015). The Modern Slavery Act was compared with the EU directive 2011/36 to determine how the legislation differed. The method and analysis were conducted on both a latent and manifest level which means it both described the definitions and analysed how the definitions could be interpreted, hence how it affects reality. Based on what has commonly been argued the main reasons behind human trafficking in Europe, the content analysis focused on the definitions of human trafficking, prostitution and protection of migrant victims. Prostitution and migrations are frequently claimed to be the main reasons behind human trafficking in Europe.  Due to the risk of the EU directive 2011/36 being repealed, the result of the thesis exhibits the need for the UK to update their national legislation. The MSA 2015 needs to become coherent with international agreements and strengthen the protection of victims of human trafficking. Due to the gendered nature of human trafficking, this research addressed human trafficking from a feminist perspective by applying the "dominance theory" and the "sameness theory". The feminist theories helped analyse and investigate the issue of human trafficking and the potential ramifications of Brexit. Applying the ideas illustrated the patriarchal structures surrounding human trafficking and within the MSA 2015.

Au Canada, approximativement 30 000 adultes sont hospitalisés chaque année des suites d’un accident vasculaire cérébral (AVC) et environ 20 000 des suites d’un traumatisme craniocérébral (TCC). Les survivants doivent composer avec de multiples incapacités incluant des difficultés sur les plans physique, cognitif, langagier, émotionnel et comportemental. Les besoins de réadaptation de ces patients sont considérables. Environ 55 % à 78 % des personnes hospitalisées des suites d’un AVC ou d’un TCC requerront des services de réadaptation suivant le congé hospitalier. Les professionnels œuvrant en soins aigus sont sollicités quotidiennement pour évaluer le potentiel de réadaptation de ces patients afin d’identifier ceux qui sont aptes à entreprendre une réadaptation posthospitalière. L’évaluation de ces professionnels constitue donc un élément déterminant de l’accès à des services posthospitaliers de réadaptation. Bien que les professionnels s’appuient couramment sur le concept de potentiel de réadaptation dans leurs prises de décision, il n’existe étonnamment aucune définition consensuelle de ce concept et très peu d’écrits scientifiques sur son évaluation et comment celle-ci guide les décisions d’orientation. Ce projet doctoral propose d’examiner le concept de potentiel de réadaptation chez les personnes ayant subi un AVC ou un TCC et d’explorer l’évaluation de ce concept dans le contexte de prise de décision concernant l’orientation vers des services posthospitaliers de réadaptation. Le projet s’articule autour de trois grandes questions de recherche : (1) Quels sont les facteurs influençant les décisions d’orientation vers des services posthospitaliers de réadaptation pour la clientèle AVC et TCC? (2) Comment le potentiel de réadaptation est-il défini et conceptualisé dans les écrits scientifiques? et (3) À quoi pensent et comment raisonnent les ergothérapeutes impliqués dans l’évaluation du potentiel de réadaptation et les décisions d’orientation? Un positionnement constructiviste a été privilégié pour guider les efforts de recherche de l’ensemble du projet doctoral. Deux synthèses de la littérature et deux études qualitatives auprès d’ergothérapeutes ont été réalisées. Les résultats révèlent que de nombreux facteurs influencent l’évaluation du potentiel de réadaptation et les décisions d’orientation qui s’ensuivent. Ces facteurs se regroupent en trois catégories, soient des facteurs liés au patient (par exemple, les capacités cognitives), des facteurs liés au contexte organisationnel (par exemple, la disponibilité des services posthospitaliers de réadaptation dans le continuum de soins) et des facteurs liés aux caractéristiques du professionnel lui-même (par exemple, son champ d’expertise). Les travaux de cette thèse proposent aussi un début de conceptualisation du potentiel de réadaptation, conceptualisation qui met l’accent sur la nature prédictive des interprétations faites par les professionnels, des facteurs liés au patient et des facteurs organisationnels. Les interprétations des professionnels, plus spécifiquement des ergothérapeutes, s’opèrent à trois niveaux, c’est-à-dire qu’ils tentent de prédire la récupération, d’estimer le potentiel de réadaptation et de déterminer l’éligibilité du patient pour la réadaptation posthospitalière. Un algorithme basé sur ces trois niveaux d’interprétation est présenté et schématise le raisonnement sous-jacent aux décisions d’orientation. Finalement, ce projet doctoral présente deux processus cognitifs de raisonnement clinique utilisés par les ergothérapeutes lors de l’évaluation du potentiel de réadaptation et lors des décisions d’orientation vers des services posthospitaliers de réadaptation pour la clientèle AVC et TCC. En explicitant le concept de potentiel de réadaptation et le raisonnement clinique sous-tendant son évaluation, ce projet doctoral pose les assises pour de futures recherches s’intéressant à la pratique d’évaluation en soins aigus et enrichit les connaissances pertinentes à l’enseignement des compétences nécessaires à cette pratique. / In Canada, approximately 30,000 adults are hospitalized each year as a result of a stroke and approximately 20,000 as a result of a traumatic brain injury. Survivors face a myriad of consequences including physical disability, cognitive impairments, communication difficulties as well as emotional and behavioral disturbances. The rehabilitation needs of these patients are considerable. About 55% to 78% of hospitalized stroke and TBI patients will require rehabilitation services following discharge. Acute care professionals are called upon daily to assess the rehabilitation potential of these patients and to identify those who are most suitable for post-acute rehabilitation. These professionals’ assessments are therefore key to determining access to post-acute rehabilitation services. Although professionals commonly rely on the concept of rehabilitation potential in their decision-making, there is surprisingly no consensus regarding the definition of this concept as well as very little scientific literature on its assessment and how this concept guides referral decisions. This doctoral project examines the concept of rehabilitation potential in people with stroke and traumatic brain injury and explores its assessment in the context of decision-making regarding referral to post-acute rehabilitation. The doctoral project is organized around three main research questions: (1) What factors influence referral decisions to post-acute rehabilitation for stroke and traumatic brain injury patients? (2) How is rehabilitation potential defined and conceptualized in the scientific literature? and (3) What do occupational therapists think about when assessing stroke or traumatic brain injury patients’ rehabilitation potential and how do they reason? A constructivist stance was chosen to guide the research efforts of the entire doctoral project. Two literature reviews and two qualitative studies exploring occupational therapists’ perceptions were conducted. Results reveal that many factors influence the assessment of rehabilitation potential and subsequent referral decisions. These factors fall into three categories: patient-related factors (such as cognitive abilities), organizational factors (such as the availability of post-acute rehabilitation services in the continuum of care), and clinician-related factors (such as the 8 clinician’s expertise). The work in this dissertation also proposes a conceptualization of rehabilitation potential that emphasizes the predictive nature of clinicians' interpretations of patient-related factors and organizational factors. Professionals’ interpretations, specifically those of occupational therapists, operate at three levels, i.e., they attempt to predict recovery, estimate rehabilitation potential, and determine patient candidacy for post-acute rehabilitation. An algorithm based on these three levels of interpretation is presented and illustrates the reasoning underlying referral decisions. Finally, this doctoral project presents two cognitive processes used by occupational therapists when reasoning about patients’ rehabilitation potential and making referral decisions to post-acute rehabilitation for stroke and traumatic brain injury patients. By clarifying the concept of rehabilitation potential and the clinical reasoning underlying its assessment, this doctoral project lays the foundation for future research into assessment practices in acute care and adds to the knowledge base relevant to teaching the skills necessary for this practice.

Previous research has reported that inequalities exist in uptake of NHS sight tests in relation to socio-economic status, and that community optometric services have potential to improve system efficiency. The current research found inequalities in sight test outcome related to socio-economic status and the type of practice that a patient visits (multiple, or independent). Patients attending multiples were more likely to receive a ‘new or changed prescription’ relative to ‘no prescription’ compared to patients that attended independent opticians (36-71% more likely). Those living in the least deprived areas were also less likely to receive a new prescription (1-12%) and those aged <16 years were less likely to be referred (9%). The study examining the need for a Minor Eye Condition Service in Leeds and Bradford found it would produce theoretical cost savings, whilst maintaining high patient satisfaction. Subsequently, a MECS was commissioned in Bradford. The study attempting to collect data from MECS across all areas of England found that data is not routinely collected, or shared. The limited data available typically showed that 73-83% of patients were retained in optometric practice with 12-18% receiving a hospital referral. A prospective evaluation of a COVID urgent eye care service found that teleconsultations frequently did not resolve patients’ eye problems (27%). These telephone consultations failed to detect some serious conditions such as scleritis, wet macular degeneration, retinal detachment. The results from the thesis support the view that the current method of delivering eye care in England is contrary to the public health interest.