Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2002. / Abstract. Includes bibliographical references (leaves 86-89).

Thesis (Ph. D.)--Indiana University, 2004. / Includes bibliographical references (leaves 131-139).

Thesis (M.Sc.(Pharmacy)) - Rhodes University, 2007.

Thesis (M. A.)--University of British Columbia, 2006. / Includes bibliographical references.

This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

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Made available in DSpace on 2015-05-08T14:47:54Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1044835 bytes, checksum: fc5e0d184d277f66aa097fe27d7da8e0 (MD5) Previous issue date: 2010-12-13 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The current mental health care network, represented by substitutes services for psychiatric hospital, is a strategy for changing the hospital centered model for the community. These services operate from the perspective of promoting the rehabilitation of people suffering mental work, in education, recreation, society, among other sectors, encouraging the rehabilitation or construction of citizenship. This study investigated the practices of social inclusion developed by mental health care network professionals for people suffering psychological distress in view of the progress made with implementation of psychiatric reform in Campina Grande PB. This is a descriptive research qualitative interpretive approach, conducted with 19 professionals who work in the care of mental health. The empirical data were obtained through semi structured interview, during June July 2010. The data analysis was based on the technique of content analysis categorical theme proposed by Bardin, which resulted in three thematic units: design professionals on social inclusion, social inclusion practices: encouraging intersectoral and comprehensive care in mental health and, strategies managerial policies that facilitate and hinder the promotion of inclusive practices in the mental health care network. This study suggests a reflection on the different practices that have been conducted in the municipality and make visible advances occurring toward the consolidation of the psychiatric reform. The practices identified favored the linkage between mental health and other sectors of society, is education, culture, economy, creating social networks. Were identified as weaknesses to overcome the shortage of financial and material resources and social, institutional and professional prejudice for the mentally ill. The facilitating factors for the advancement of reform were highlighted: the interdisciplinary work, intersectoral collaboration and support of municipal mangers to train teams who work in psychosocial care, in primary care and other sectors of the care network. It is concluded that the council has made progress in psychiatric reform and has been consolidating the community mental health model, despite the obstacles which still persist, but can be overcome. / A atual rede de atenção á saúde mental, representada pelos serviços substitutivos ao hospital psiquiátrico, é uma estratégia para a mudança do modelo hospitalocêntrico para o comunitário. Tais serviços atuam na perspectiva de promover a reabilitação psicossocial e a inclusão das pessoas em sofrimentos psíquicos no trabalho, na educação, no lazer, na sociedade, dentre outros setores, favorecendo a recuperação ou construção da cidadania. Este estudo objetivou conhecer as práticas de inclusão social desenvolvidas por profissionais da rede de cuidado em saúde mental extra-hospitalar para pessoas em situação de sofrimento psíquico, tendo em vista os avanços ocorridos com a implementação da reforma psiquiátrica no município de Campina Grande PB. Trata-se de uma pesquisa descritiva - interpretativa de abordagem qualitativa, realizada com 19 profissionais que atuam na rede de cuidado da saúde mental. O material empírico foi produzido por meio de entrevista semiestruturada, no período de junho a julho de 2010. A análise do material fundamentou-se na técnica de análise de conteúdo tipo categorial temática proposta por Bardin, que resultou em três unidades temáticas: concepção dos profissionais sobre inclusão social; práticas de inclusão social: favorecendo a intersetorialidade e a integralidade do cuidado em saúde mental e estratégias políticas gerenciais que facilitam e dificultam a promoção de práticas inclusivas na rede de atenção à saúde mental. Este estudo possibilitou uma reflexão sobre as diferentes práticas que vêm sendo realizadas no município e tornam visível avanços que ocorreram em direção a consolidação da reforma psiquiátrica. As práticas identificadas favoreceram a articulação da saúde mental com outros setores da sociedade, seja educação, cultura, a economia, criando redes sociais. Foram apontadas como fragilidades a serem vencidas, a escassez de recursos financeiros e materiais e o preconceito da sociedade, de profissionais e instituições em relação ao doente mental. Como fatores facilitadores para o avanço da reforma, foram evidenciados: o trabalho interdisciplinar, a colaboração intersetorial, o apoio dos gestores municipais para a capacitação das equipes que atuam na atenção psicossocial, na atenção básica e em outros setores da rede de cuidado. Conclui-se que o município avançou na reforma psiquiátrica e vem consolidando o modelo de saúde mental comunitária, apesar de obstáculos os quais ainda persistem, mas podem ser vencidos.

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O crescente e desordenado aumento da população mundial e seus avanços tecnológicos, muitas vezes conseguido com violentas agressões à natureza, têm trazido conseqüências amargas que levam a sociedade a refletir como um todo sobre que tipo de futuro esperamos legar às próximas gerações e até onde podemos progredir sem desrespeitar as leis imutáveis do meio ambiente. Uma das principais preocupações modernas relacionadas a este tema é o aumento progressivo da geração de resíduos resultantes da produção, prestação de serviços e consumismo descontrolado. Dentre estes resíduos, ocupam lugar de importância os resíduos de serviços de saúde (RSS), por caracterizarem um desequilíbrio de caráter epidemiológico, com potencial de infecção altamente conhecido, tornando-se um assunto de interesse mundial no impacto ambiental gradativamente acumulado. Atitudes estão sendo tomadas por autoridades governamentais, sanitárias e científicas, que procuram minimizar estes impactos e encontrar saídas para o gerenciamento seguro destes resíduos, que estão cada dia mais volumosos e trazendo preocupações sociais e ambientais. Esta tese de doutorado focou atenção no potencial de contaminação ambiental e humana, causada pelos resíduos de serviços de saúde gerados em estabelecimento hospitalar, estabelecendo o objetivo de contribuir com medidas que, em associação com o manejo adequado dos RSS, promovam a prevenção e minimização dos efeitos infectantes e agressivos destes resíduos em relação ao meio ambiente, à infecção hospitalar, e à saúde dos trabalhadores em ambiente hospitalar. As atividades de pesquisa de campo foram desenvolvidas em um hospital de grande porte, voltado ao tratamento do câncer, que apresentou um modelo de gerenciamento dos RSS, antes da promulgação das leis federais atualmente em vigor sobre o assunto – Anvisa 306/2004 e Conama 358/2005. Constatou-se, após uma metodologia investigativa e exploratória, que é possível gerenciar corretamente os RSS – conforme as regras atuais de manejo previstas em lei - e contribuir para um maior alcance de preservação da saúde ambiental e humana, através de medidas de prevenção e minimização frente ao potencial infectante dos RSS. Para tanto, esta tese foi construída no sentido de contribuir para a discussão técnico-científica da difícil tarefa de reorganizar e reverter o processo de contaminação de nosso “casa por excelência” - o nosso planeta / The developed and disordered increasing of the world population and your technologies progress, sometimes obtained with violent aggressions to the nature, it has brought severe consequence that take society thinking about what kind of future we hope to leave the next generation and how far we can progress without disrespect the immutable laws from the environment. One of the most moderns preoccupations related to this topic is the progress increase from the generation of residues resultant from the production, useful service, and consumption out of control. Inside these residues, take the important places the residues from the health services (RSS), for characterize one instability from the epidemiologic character, with the high potential infection well-known, being a subject of the world-wide concern of the environmental impact gradually accumulated. Attitudes are being taken by governmental authorities, sanitarians and scientifics, which they are searching to minimize these impacts and find out the ways to the secure management of these residues, which they are being more voluminous and brining out social and environmental concerned. It had searched, with this work, to realize bibliographies analysis and practices of the potential infection from the service residues of health to the men and environment, as well as the current model of management (determined in the federal rule) and its narrows relation with the active participation from the workers concerned at the handling from RSS, to come up with that by the environment of the work teams and administration of the hospital institutions, could reach the significant positive results from the combat of the hospital infection, human contamination and environmental from the infecting residues originated by the services attention of health. This project brings back the attentions for this important current topic and conducts its methodology in the direction to contribute for the scientific technical discussion from the hard work to reorganize and revert the pollution of our “house from excellence” – our planet

Screening to detect diseases early is attractive as it can improve the prognosis and decrease costs, but it is often a problematic concept and there are several pitfalls. Many healthy individuals have to be investigated to avoid a disease in a few, which results in a dilemma because to save a few, many are exposed to a procedure that could potentially harm them. Other examples of problems associated with screening are latent diseases and over-treating. The question of optimal design of a screening program is another source of uncertainty for decision-makers, as a screening program may potentially be implemented in very different ways. This highlights the need for structured analyses that weigh benefits against the harms and costs that occur as consequences of the screening. The aim of this thesis is, therefore, to explore, develop and implement methods for health economic evaluations of screening programs. This is done to identify problems and suggest solutions to improve future evaluations and in extension policy making. This aim was analysed using decision analytic cost-effectiveness analyses constructed as Markov models. These are well-suited for this task given the sequential management approach where all relevant data are unlikely to come from a single source of evidence. The input data were in this thesis obtained from the published literature and were complemented with data from Swedish registries and the included case studies. The case studies were two different types of screening programs; a program of screening for unknown atrial fibrillation and a program to detect colorectal cancer early. Further, the implementation of treatment with thrombectomy and novel oral anticoagulants were used to illustrate how factors outside the screening program itself have an impact on the evaluations. As shown by the result of the performed analyses, the major contribution of this thesis was that it provided a simple and systematic approach for the economic evaluation of multiple screening designs to identify an optimal design. In both the included case studies, the screening was considered costeffective in detecting the disease; unknown atrial fibrillation and colorectal cancer, respectively. Further, the optimal way to implement these screening programs is dependent on the threshold value for cost-effectiveness in the health care sector and the characteristics of the investigated cohort. This is because it is possible to gain increasingly more health benefits by changing the design of the screening program, but that the change in design also results in higher marginal costs. Additionally, changes in the screening setting were shown to be important as they affect the cost-effectiveness of the screening. This implies that flexible modelling with continuously updated models are necessary for an optimal resource allocation.