No description available.

No description available.

No description available.

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 Medicine in Diagnostic Radiology. Johannesburg, 2012 / Background: There is a heavy reliance on registrars for afterhours CT reporting with a resultant unavoidable error rate. This study was done to determine this error rate. Material and Methods: A 2 month prospective study was undertaken. Provisional CT reports issued by the registrar on call were reviewed information relating to the errors made during the call were recorded and analyzed. Results: 1477 CT scans were performed with an overall error rate of 17.1%. A significant difference was found between trauma (15.8%) compared to non-trauma scans (19.2%). The difference between emergency scans (16.9%) and elective scans (22.6%) was not significant. Abdominopelvic scans elicited the highest error rate (33.9%). Increasing workload resulted in a significant increase in error rate. Missed findings were the most frequent errors (57.3%). Error rate decreased with increasing year of training.

To determine the level of self-assessed competence various registrars possessed in emergency skills as well as to identify any factors that may have contributed to their level of competence. Materials and Methods: Questionnaires were completed by registrars working in General Surgery, Internal Medicine, Psychiatry and Radiology in three academic hospitals in Johannesburg. Information regarding demographic data, educational background, work experience in emergency-related environments and resuscitation courses attended were collected. Registrars rated their level of perceived competence in a list of 25 emergency skills according to a ranking scale of 1 to 5. Results: A total number of 94 registrars participated in the study which amounted to an estimated response rate of 35%. General Surgery registrars had the highest mean competence scores of 3.7 and 3.9 for the respective basic and advanced skills groups. General Surgery and Internal Medicine registrars had the highest mean competence scores of 3.7 for the intermediate skills group. Psychiatry registrars had the lowest mean competence scores of 2.7, 2.4 and 1.5 in each of the skill groups. Registrars who had current certification in a PALS course had competence scores 0.6 units higher than others in both basic (p=0.027) and advanced (p=0.035) emergency skills. Conclusions: General Surgery and Internal Medicine registrars have a higher level of perceived competence in various emergency skills. The General Surgery group rated themselves the highest in levels of competence in the basic and advanced emergency skills groups. Current certification in BLS, ACLS, PALS and AMLS has a positive impact on registrars‟ self-perceived levels of competence in emergency skills. Registrars who had spent less time between community service and starting their specialist training had higher levels of self-perceived competence in intermediate and advanced emergency skills.

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

Information literacy (IL) is recognized as the overall critical literacy for the 21st Century. Although large amounts of digital information are available, there is concern within higher education that students lack the competencies to assess and analyse sources in terms of relevance to their courses. Information literacy skills are of critical importance in teaching medical students to engage with evidence-based medicine (EBM), often within a problem-based learning (PBL) curriculum. Information practices that underpin academic and professional life should be embedded into the learning experience of the subject, and not taught extraneously in isolated silos. Attitudes of teaching staff at the Faculty of Health Sciences, University of the Witwatersrand towards embedding evidence-based information literacy skills into the Graduate Entry Medical Programme 1 and 2 curriculum were examined. Existing integration of IL skills into the curriculum was shown to be limited, and not as high as perceived by educators. Five barriers against the integration of IL skills, and six opportunities for embedding information literacy, were identified in the curriculum. Awareness of evidence-based practice was found to be high, and collaborative teaching of IL skills with librarians was accepted by a large majority of educators. Dynamic Purposeful Learning (DPL) was proposed as a constructivist framework into which collaborative teaching of IL skills could be placed. DPL draws on active and collaborative learning, as well as cognitive scaffolding and apprenticeship, and is suited to PBL in the context of medical education.

This work explored perceptions regarding the roles, norms and incentives influencing the performance of Clinical Officers (COs) in rural district hospitals in Kenya. In order to improve access to health care mainly in rural areas, COs are increasingly being used to perform tasks that were previously the preserve of physicians. The assumption underlying their use is that they are a viable option to doctors. Studies have shown with reference to HIV care and obstetric and gynaecological surgical tasks that COs’ performance is comparable to that of physicians. Other studies also show that the care offered by COs is cost effective when compared with the costs associated with physicians and obstetricians care. However, there is emerging work which shows that COs are not happy in their assigned role in the health system. These studies report CO’s dissatisfaction with the low remuneration, poor career progress and limited career options inherent their jobs as compared with those accorded to physicians. As revealed by a systematic review of mid-level worker literature, addressing these issues is at present difficult due to gaps in our understanding of CO functioning. The existence of these gaps is explained by the limited empirical work on COs in general. The aim of this thesis was to address this issue by exploring issues that affect their routine functioning in a typical rural hospital setting going beyond the fact that they are technically competent. To investigate these issues, a conceptual framework was adopted that explores the tension between what institutions demand and what individuals within them feel able to do. Qualitative methods comprising of interviews, participant observation, review of official policy and hospital level documents on COs, and review of hospital statistics were used. A comparative approach was adopted that sought to; (1) examine perceptions regarding influences on the performance of COs from a variety of sources (COs, doctors, nurses, supervisors, hospital managers, policy makers and policy documents); (2) compare perceptions of respondents based in three faith-based hospitals with those in three government facilities; and, (3), explore features of different work settings (outpatient department, specialist clinics and vertically supported clinics) within these hospitals that encouraged good CO performance. Preliminary findings were reported back to respondents in the six study hospitals. Analysis of the data showed three major issues. First, perceptions of CO roles are problematic despite an acknowledgement of the important function performed by COs in the health system. This is revealed by the variety of images regarding their roles that highlights the need for a redefinition of CO roles. An example of this is shown by the inconsistency between their importance as the ‘backbone of the health system’ versus the poor remuneration and career prospects that their position attracts. Second, there were differences in the norms of CO performance that have resulted in variations regarding what is expected of them. While there was much attention paid to norms of performance about technical aspects of work, less attention focussed on non-technical aspects of work. The adoption of a holistic approach to the notion of CO performance is needed that will enable facilities and the system to meet the needs of the CO which should prompt COs to reciprocate by working better. Third was the issue that there were minimal incentives were attached to COs work. In the public sector, there were some incentives but their availability depended on the work settings. For example, while COs in vertical clinics got training their colleagues in the outpatient department had few chances to get training opportunities. Faith-based hospitals did provide performance related bonuses that encouraged health workers to perform better although notably basic salaries in faith-based hospitals were no better than those given in the government sector. However, major incentives such as salary and promotions in the public sector are handled by the central government giving public sector hospital managers little opportunity to utilise such incentive mechanisms. Where hospital managers may have some leeway in implementing actions at the local level to improve performance, for example through improving CO recognition and working conditions, it was observed that public sector managers were generally less engaged in utilising such incentives. Therefore while it is important to consider and address system level factors that influence CO performance such as salaries and promotions, among others, facility managers would also appear to have some scope to improve performance. In discussing these issues, it is becoming clear that the assumption that COs are altruistic and will continue to work flawlessly in their assigned niche presents a naïve view of COs. This thesis shows that COs are also influenced by self–interest and find ways to overcome or work around any perceived barriers to their growth, some of which may work against the institution. This calls for a re-examination of who COs are, what they do and how they should be managed. Ways of resolving the tension that exists between COs and the health institution exist and can be derived from examining the coping mechanisms that COs have adopted to make their lives better. These coping mechanisms show areas that need attention. Further, there should be greater consideration of the important role that facility managers play in mediating and/or modifying system level influences by creating local environments suitable for better staff performance. Underlying all this is the fact that a long term view of COs is needed. The long term view must go beyond the notion of ‘substitute physician’ as Kenya has made huge investments in this cadre over the last 40 years or more and, with other countries, is likely to continue to rely on such a cadre for much clinical care. This thesis therefore concludes with recommendations that seek to address issues identified with the performance of COs in the Kenyan health system focusing on potential hospital level and system level solutions. Also included is a reflection of the relevance of findings for countries similar to Kenya that are currently using or seek to use COs as a physician substitute.

by Chan Siu Shan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1991. / Bibliography: leaves [111-119]. / Chapter Chapter One --- Introduction --- p.1 / Chapter Chapter Two --- Literature Review and Theoretical Discussion --- p.6 / Chapter I. --- The Debate --- p.6 / Chapter II. --- Management-oriented Perspective of Organizational Research --- p.11 / Chapter III. --- The Implicit Model of Actor: Rational or Behavioristic --- p.20 / Chapter IV. --- Reapproaching From Work and Occupation --- p.23 / Chapter V . --- The Incorporat ion of Occupational Image as A Classification Scheme --- p.27 / Chapter VI. --- The Addition of Social Relation Approach --- p.31 / Chapter Chapter Three --- "Objectives, Hypotheses and Conceptualization of Variables" --- p.35 / Chapter Chapter Four --- Research Design --- p.50 / Chapter I. --- General Profile of the Research --- p.50 / Chapter A. --- Population --- p.50 / Chapter B. --- Sampling Method --- p.50 / Chapter C. --- Sample Size --- p.51 / Chapter D. --- Method of Data Collection --- p.51 / Chapter E. --- Response Rate and Representativeness of the Resaerch Result --- p.52 / Chapter F. --- Demographic Profile of Respondents --- p.53 / Chapter II. --- Operationalization of Variables --- p.54 / Chapter Chapter Five --- Findings --- p.66 / Chapter I. --- Regression Analysis I: The Comparison Among the Three Approaches --- p.68 / Chapter II. --- Regression Analysis II： Test of Conditional Hypotheses --- p.72 / Chapter Chapter Six --- "Summry, Theoretical Interpretation and Practical Implication" --- p.86 / Chapter I. --- Assertion of the Occupational Image as a Valid Conditional Variable in the Explanation of Organizational Commitment --- p.86 / Chapter II. --- Further Disscussion on the Implication of Organizational Commitment --- p.92 / Chapter III. --- Limitation and Suggestion for Further Study --- p.102 / Chapter Appendix --- The Chinese Version of Questionnaire / Bibliography / Source of Questionnaire

Introduction: Care professionals suffering with poor wellbeing is a phenomenon that has been found to have a damaging effect upon individual employees, service users and organisations. Employees working in forensic settings are believed to be at increased risk of damaged wellbeing due to the unique demands of their working environment, including exposure to violence and aggression. This issue was addressed in two ways. Firstly, a systematic review of the literature on the effectiveness of person-centred interventions to improve the wellbeing of forensic professionals was prepared. Following this, an empirical study was completed which examined the ability of demands related to violence and aggression, and resources of two types (cognitive and contextual behavioural) to predict the wellbeing of employees in a high secure forensic mental health (FMH) hospital. Method: For the systematic review, relevant databases were systematically searched and 7 papers that met the inclusion criteria were identified. The included studies were quality assessed to identify strengths and weaknesses. For the empirical study, 142 employees at a high secure FMH hospital completed self-report questionnaires which examined their wellbeing, perceptions of the prevalence of aggression, beliefs about safety, attitudes towards aggression, and psychological flexibility. Results: The reviewed studies included psychological, educational and mixed type interventions. Evidence for the effectiveness of interventions was mixed, and problems with methodological quality common. The results of the empirical paper suggested that exposure to violence and aggression was not a good predictor of wellbeing. However, the beliefs staff held about safety and staff‘s level of psychological flexibility were predictive of wellbeing. Conclusions: The review concluded that the existing evidence for the effectiveness of person-centred wellbeing interventions for forensic professionals was generally of poor quality, and inadequate to provide firm recommendations. Further research to assess the effectiveness of interventions and the underlying mechanisms of wellbeing change in forensic settings was advised. The empirical paper concluded that job demands related to staff‘s cognitive appraisal of safety, and the contextual behavioural resource, psychological flexibility, were predictive of staff wellbeing. It was recommended that future interventions to improve the wellbeing of forensic professionals consider the psychological processes staff encounter in the workplace, with a particular focus on contextual behavioural resources, which have an existing evidence base in broader occupational fields. Further research using contextual behavioural interventions within forensic settings is recommended in order to develop the limited research on forensic professionals‘ workplace wellbeing.