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Ferguson, Angus H. "Should a doctor tell? : medical confidentiality in interwar England and Scotland." Thesis, University of Glasgow, 2005. http://theses.gla.ac.uk/3150/.
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Medical confidentiality is integral to the doctor - patient relationship and an important element in efficient and effective medical practice. However, it is generally acknowledged that medical confidentiality can not be absolute. At times it must be broken in order to serve a ‘higher’ interest - be it public health or the legal justice system. Yet, very little is known about the historical evolution of the boundaries of medical confidentiality in Britain. The absence of detailed historical research on the subject has meant that contemporary writers have tended to use citations of the Hippocratic Oath or short quotations from key legal cases to place their work into longer term context. The current thesis provides a more detailed examination of the delineation of the boundaries of medical confidentiality during a period of intense debate - the interwar years of the twentieth century. The increase in state interest in the health of the population, the growth in divorce after the First World War and the prominence of the medical issues of venereal disease and abortion, all brought unprecedented challenges to the traditional concept of medical confidentiality. Having examined the, oft-cited, benchmark precedent for medical confidentiality from the late eighteenth century, the thesis proceeds to examine the ways in which medicine had changed by the interwar years. The high-point of the debate in the early 1920s is examined from the perspective of the three key interest groups - the Ministry of Health, the British Medical Association and the Lord Chancellor. Overall, the work provides insight into the historical delineation of medical confidentiality in Britain, both in statute and common law. As such it lends a longer-term context to current debates over the boundaries of medical confidentiality in the twenty-first century.
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Murphy, Richard. "Health professionals and ethnic Pakistanis in Britain : risk, thalassaemia and audit culture." Thesis, University of St Andrews, 2005. http://hdl.handle.net/10023/2802.
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The central theme or 'red-thread' that I consider in this thesis is the concept of risk as it is perceived by and affects the two sides of the medical encounter -in this instance ethnic Pakistanis and Health Professionals- in Britain. Each side very often perceives risk quite distinctively, relating to the balance between the spiritual and temporal realms. This is particularly germane in matters to do with possible congenital defects within the prenatal realm for the ethnic Pakistani, and predominantly Muslim, side of this encounter. Thus one of the factors considered in this thesis is how senses of Islam impact upon the two sides. By ethnic Pakistanis Islam is seen as central to all life decisions, whilst Health Professionals view Islam with some considerable trepidation, little understanding it or its centrality to the former's decision-making processes. This is particularly significant with regard to attitudes to health and health care. In the initial stages of the project I had thought first cousin marriage (FCM), seen by ethnic Pakistanis as desirable and by Health Professionals as putting ethnic Pakistanis at-risk to be central to the argument, but concluded that concerns around FCM were a 'red herring', merely a trope for the tensions between the two sides -at once both British and at-risk from audit culture. Although no longer central, FCM remains a viable touchstone in consideration of the two sides' perceptions of genetic risk. In this thesis the medical encounter between ethnic Pakistanis and Health Professionals is performed within the realm of the so called New Genetics. Here the respective understandings of the New Genetics are informed by the enculturation processes that shape the two sides' world view. Furthermore, I will agree with Lord Robert Winston's and others' concern that any attempt to eradicate an adaptive genetic mutation, in this instance, thalassaemia, from the gene pool is not only undesirable in the short term, but also that such eradications may have an adverse, and far reaching, effect on whole population groups in the future. The main thrust of my argument is that audit culture not only compounds risk for both sides, but also perpetuates institutional racism within the National Health Service (NHS), by promulgating what I have called the language myth. That is to say that much institutional racism is the unwanted by-product of the NHS's attempts to become more patient centred and its continuing efforts to develop systems of best practice. This professionalisation process within the NHS can be seen to impact most strongly in relation to communication -particularly the claimed language barrier between the two sides. This 'barrier' has worrying policy implications for any meaningful communication between the two sides, notably relating to obtaining informed consent from ethnic Pakistani patients -with a resultant increase in risk for the two sides and clear economic consequences for the NHS.
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Liu, Lixun. "Exploring ethnic inequalities in cardiovascular disease using Hospital Episode Statistics." Thesis, St Andrews, 2009. http://hdl.handle.net/10023/819.
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de, Andrade Marisa. "Pharmaffiliation : a model of intra-elite communication in pharmaceutical regulation." Thesis, University of Stirling, 2011. http://hdl.handle.net/1893/6500.
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In 2005, the House of Commons (HoC) Health Committee produced a report on The Influence of the Pharmaceutical Industry – the first of its kind since 1914. The inquiry concluded that there were ‘over-riding concerns about the volume, extent and intensity of the industry’s influence, not only on clinical medicine and research but also on patients, regulators, the media, civil servants and politicians’, and stressed the need ‘to examine critically the industry’s impact on health to guard against excessive and damaging dependencies’ (HoC 2005, p. 97). It also noted that it is important to comprehensively analyse pharmaceutical regulation in order to ascertain whether there are systemic problems: In some circumstances, one particular item of influence may be of relatively little importance. Only when it is viewed as part of a larger package of influences is the true effect of the company’s activity recognised and the potential for distortion seen. The possibility that certain components of any such campaign are covert and their source undeclared is particularly worrying. (HoC 2005, p. 97) This study addresses this recommendation and was primarily conducted to examine whether recognised concerns are merely ad hoc or as a result of systemic flaws in the current system of pharmaceutical regulation. The work addresses a gap in the academic literature by drawing on the fragmented criticisms of the pharmaceutical industry in order to produce a model to illustrate how various stakeholders collaborate with drug companies to promote licensed products, and to explore the nature of the relationships between these elite stakeholders. The thesis begins with a literature review which determines who is involved in pharmaceutical regulation; how the regulatory system works; and explores the key role of communication in this process (Chapters 1 to 3). The recurrent theme is the neglect or exclusion of the patient/consumer, which leads to the development a model of intra-elite communication in drug regulation called Pharmaffiliation (Chapter 3). The thesis then looks for evidence to support or refute this model, using multiple methods (Chapter 4). Four case studies (with specific selection criteria) are chosen to test the model’s constructs and indicators (Chapters 5 to 8). The research uncovers systemic problems in the current system of pharmaceutical regulation which can ultimately harm the patient/consumer, and the implications of these findings are discussed (Chapter 9). Solutions on a micro-level include consumer involvement in decision making processes, which can be enhanced through public education and awareness campaigns and the instigation of public inquiries whenever drugs are withdrawn from the market (HoC 2005, p. 105). On a macro-level, however, this will involve critically exploring neoliberal capitalism and the empowerment of the citizenry (Street 2001).
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Archer, Patricia Margaret Alice. "A history of the Medical Artists' Association of Great Britain 1949-1997." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311981.
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Grubb, Penelope Ann. "The impact of information technology upon primary health care in Great Britain." Thesis, University of Hull, 1991. http://hydra.hull.ac.uk/resources/hull:4567.
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This is a study of the impact of information technology on health care in Great Britain. Its major aim is to identify means by which information technology may improve the quality of health care in specific areas within the health services.The study concentrated upon general practice and was split into three stages. The first was a survey of general practice computing, conducted to give an overview of the use of computers in general practice. Following this, was a more detailed study of general practice miniclinics. The final stage was an in-depth investigation into the use of computers in the care and treatment of diabetes.
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Beniuk, Kathleen. "Integrating evidence-based medicine and service design : a study of emergency department crowding." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.610514.
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McCormack, Brendan. "An exploration of the theoretical framework underpinning the autonomy of older people in hospital and its relationship to professional nursing practice." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.670229.
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Humphris, Rachel Grace. "New migrants' home encounters : an ethnography of 'Romanian Roma' and the local state in Luton." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:3af69cfa-2cd7-4972-afb2-14d92238d25a.
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This ethnographic study explores how 'Romanian Roma' migrants in the UK, without previous relationships to their place of arrival, negotiate their identity to make place in a diverse urban area. The thesis argues that state forms are (re)produced through embedded social relations. The restructuring of the UK welfare state, coupled with processes of labelling, means that the notion of public and private space is changing. Migrants' encounters with state actors in the home are increasingly important. I lived with three families between January 2013 and March 2014, during a period of shifting labour market regulations and the end of European Union transitional controls in January 2014. Through mapping families' relationships and connections, I identify encounters in the home with state actors regarding children as a defining feature of place-making. The thesis introduces the term 'home encounter' to trace the interplay of discourses and performances between state actors and those they identified as 'Romanian Roma'. Due to the restructuring of UK welfare, various roles assume different 'faces of the state'. These include education officers, health visitors, sub-contracted NGO workers, charismatic pastors and volunteers. The home encounter is presented as a public 'state act' (Bourdieu 2012) where negotiations of values take place in private space determining access to membership and welfare resources. In addition, blurring boundaries between welfare regulations and immigration control mean that these actors' seemingly small decisions have far-reaching consequences. The analysis raises questions of how to understand practices of government in diverse urban areas; the affect of labelling, place and performance on material power inequalities; and processes of discrimination and othering.
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White, Christopher P. "NHS resource allocation 1997 to 2003 with particular reference to the impact on rural areas." Thesis, St Andrews, 2009. http://hdl.handle.net/10023/825.
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Carter, Holly R. "The Effects of Age, Sex, and Class Stratification and the Use of Health Care Services among Older Adults in the United Kingdom." Thesis, University of North Texas, 1999. https://digital.library.unt.edu/ark:/67531/metadc2256/.
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As the population ages, providing health services for the growing number of older people will become an increasingly difficult problem. In countries where the health services are provided by the government, these problems are involved with complicated issues of finance and ethics. This is the case of the National Health Service, the government institution providing health care for the citizens of the United Kingdom. Knowing what social factors influence health care usage can be a link to match usage and funding. Literature has shown that health care utilization can be predicted by social factors, as well as the medical model, and from this orientation social variables were drawn from the 1994 General Household Survey. Social factors were analyzed to determine relationships that exist between certain types of health care use and these factors. Age, sex, and class, the three main factors shown in literature to affect usage, were then analyzed to determine if services are allocated on the basis of these factors or the basis of need from illness and disability. Results of the study show that of the predisposing variables, age, sex, and class, are associated with most types of health care use. From the enabling variables, both source of income and visits from friends and relatives are associated with most types of health care. Of the illness determinants, disability, limiting illness, restricted activity days and eyesight difficulty were all related to health care use. When intervening control variables were introduced, the intervening control variables of difficulty with activities of daily living and difficulty with instrumental activities of daily living had an explanatory effect on the use of home help, district nursing, consultations with a general practitioner at home, consultations with a general practitioner at a surgery or health clinic, and inpatient stays. These services were offered more according to need than the factors of age, sex, and class.
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Whiting, Martin. "The veterinary profession, social closure and public interest in the UK." Thesis, Royal Veterinary College (University of London), 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.701679.
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Morrice, Andrew Alexander George. "'Honour and interests' : medical ethics in Britain and the work of the British Medical Association's Central Ethical Committee, 1902-1939." Thesis, University College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391665.
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Ritch, Alistair Edward Sutherland. "Medical care in the workhouses in Birmingham and Wolverhampton, 1834-1914." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/5910/.
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This study of the medical role of the urban workhouses of Birmingham and Wolverhampton after the New Poor Law addresses the following questions: what were the standards of medical and nursing practice and what treatments were used to alleviate inmates’ suffering? It considers the nature of illnesses encountered covering acute non-infective illnesses, infectious disease and chronic disability, and highlights the important role the workhouse played in providing institutional care, especially in the isolation of epidemic diseases. Birmingham workhouse had a well-developed medical service prior to the New Poor Law and this continued until the mid-nineteenth century. By comparison, Wolverhampton workhouse did not meet satisfactory levels of medical and nurse staffing until near the end of the century. The study provides a new perspective on medical care in workhouse infirmaries by showing how standards varied over time within the same institution and how medicalisation of the workhouse began in the early years after the New Poor Law. Medical care in workhouses has been viewed as important only in the context of the development of the National Health Service but this study demonstrates that it provided significant, and at times high quality, medical treatment for the poor.
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Lamproukou, Markella. "The experience of chartered counselling psychologists working within the NHS, where the counselling psychology philosophy meets with the medical model : a phenomenological inquiry." Thesis, Regent's University, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.646086.
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Counselling psychology springs from humanistic and existential/phenomenological values arguing for the need to see human beings in a holistic manner. This value system is a move towards well-being rather than pathology and sickness. The philosophical underpinning of counselling psychology gives a unique identity to the profession, raising different questions for counselling psychologists’ working within NHS settings, which is governed by the medical model. At a time that our profession faces enormous challenges and questions about its future, this study explored the experience of seven chartered counselling psychologists working within different NHS settings using the Interpretative Phenomenological Analysis (IPA) method.︣The analysis of the study revealed six major themes: (1)The process of creating a therapeutic identity; (2) Valuing the counselling psychology founding principles in practice; (3) Working within the medical model;(4) Experiencing tensions: the power of the context; (5) Dealing with the tensions; (6) Current changes and the future of counselling psychology in the NHS.︣The results showed in greater detail that the participants held a strong therapeutic identity; practiced in accordance with the counselling psychology values; experienced different tensions while working within the NHS, but have found different ways to deal with these tensions, including holding a pluralistic stance, assimilating the medical model with their own value base system and prioritizing the clients’ needs over the NHS guidelines. Lastly, the analysis indicated that the recent changes have contributed additional feelings of anxiety and uncertainty to the participants regarding the future of the profession.
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Taylor, Andrew Wilfrid. "The social dimensions of Christian spirituality in the thought of Kenneth Leech /." Thesis, McGill University, 1985. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=65999.
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Dapar, Maxwell Patrick. "An investigation of the structures and processes of pharmacist prescribing in Great Britain : a mixed methods approach." Thesis, Robert Gordon University, 2012. http://hdl.handle.net/10059/714.
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The aim of this research was to investigate the structures and processes of pharmacist prescribing in Great Britain, focusing on primary care settings. A ‘sequential-mixed methods’ was employed in the conduct of the research. The first phase was a cross-sectional postal questionnaire of all pharmacist prescribers (n= 1654 in January 2009), to quantify the extent and nature of prescribing and key factors associated with prescribing practice. Response rate was 42.3% (n=695). The pharmacy practice setting was significantly associated with prescribing (those in hospital or general medical practice were more likely to have prescribed (p< 0.05), than respondents in community practice). Factor analysis of attitudinal statements on prescribing implementation revealed factors, grouped as: ‘administrative structures and processes’, ‘perceptions of pharmacists’ prescribing role’ and ‘facilities for prescribing’. Scores for ‘facilities for prescribing’ varied depending on practice setting. Respondents in community practice recorded lower median scores compared with those in general medical practices. However, there were no statistically significant differences in median scores between respondents based in GP and hospital settings. In-depth qualitative work undertaken in the second phase further explored facilitators of, and challenges to prescribing practice (e.g. the lack of defined prescribing roles) identified in phase one. Semi-structured interviews were conducted with a purposive sample of 34 prescribers. Prescribers were selected from diverse settings, including secondary care from England and Scotland, to highlight key factors contributing to prescribing success which could potentially inform extrapolations of successful practice from one setting to the other. The ‘framework’ approach to qualitative data analysis was rigorously applied, revealing that the professional isolation and issues around access to clinical data and administrative support in the community setting may have negatively impacted on prescribing implementation. Notably, a perceived lack of clarity and definition of the pharmacist prescribing role was a key theme in hindering prescribing practice of pharmacists irrespective of setting. Participants described ‘ideal’ roles which they perceived as potentially providing clarity, definition and direction to facilitate implementation. The original data generated through this research highlights that prescribing implementation is less than desired, especially in community pharmacies. Pharmacist prescribing appears to have progressed little since supplementary prescribing developments in 2004, even with the much heralded arrival of independent prescribing in 2006. Interestingly, phase 2 participants suggested a ‘hybrid supplementary/independent’ prescribing model, as more likely to succeed. In this model, pharmacist prescribers favour a cooperative practice arrangement in which doctors diagnose and pharmacists prescribe. The implication of these findings and specific recommendations for policy makers, other key stakeholders and practitioners are discussed in detail within the thesis.
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Collis, Karen. "Shaftesbury and learned culture." Thesis, University of Oxford, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.669898.
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Adams, Jane M. "The mixed economy for medical services in Herefordshire c. 1770 - c. 1850." Thesis, University of Warwick, 2003. http://wrap.warwick.ac.uk/2640/.
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This study considers the mixed economy for medical services in Herefordshire between 1770 and 1850. Medical services were an integral part of wider systems of welfare and were provided within a mixed economy that included private practice, state provision, philanthropic activities and mutual societies. Significant resources were spent within the sector and influence over their deployment was of direct interest to parishes, the municipal council, magistrates, philanthropists and individual members of the elite. Four types of medical services are reviewed. These are the provision of personal care by medical practitioners in the private, public and charitable sectors, the establishment of Hereford General Infirmary, changes in institutional services for the insane and developments in public health. Two underlying themes are discussed throughout the thesis. The first of these is the complexity of the mixed economy for medical services. Important changes over the period are identified and the interrelationships between the various sectors investigated. The dominance of public, private or charitable provision shifted in the period as a result of both national and local factors. The second theme explored is the interplay between politics and the systems and institutions providing medical services. The importance of political considerations in shaping local policy towards medical services is demonstrated through detailed case studies. These include examining the link between the launch of the subscription appeal for Hereford Infirmary and the parliamentary election campaign in 1774, approaches taken towards the management of the cholera epidemic of 1832 and the campaign to establish a public lunatic asylum in the late 1830s.
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Robinson, Emma Louise. "Liberty compromised? : George Orwell, English Law and the Second World War." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7329/.
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This thesis considers George Orwell’s response to the emergency legislation of the Second World War. Considering legal and historical sources alongside his biography and corpus it reassesses the impact of Orwell’s works in the context of his patriotism, Englishness and views on the law. This thesis argues that Orwell’s experiences in Burma and Spain established his expectations – as an Englishman – for the law during a crisis. It juxtaposes Orwell’s pre-war anxiety regarding potentially ‘fascising measures’ to his relative silence when emergency powers were introduced in England, suggesting Orwell tacitly endorsed controversial measures, including internment, in the unique context of the early war. The thesis considers wartime compromises Orwell felt were necessary, noting his complicity in curtailing freedom of speech at the BBC, before his critical voice re-emerged regarding the normalisation of emergency powers. New readings of 'Animal Farm' and 'Nineteen Eighty-Four' highlight both their resonance with the English wartime regime and the dangers implicit in emergency legal systems, drawing out Orwell’s concern that eroding English values and legal traditions removed a bulwark against totalitarianism. Given his changing positions concerning individual freedoms this thesis consequently argues for a more nuanced appraisal of Orwell’s reputation as an unwavering defender of civil liberties.
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Malecka, Joanna. "The ethics, aesthetics and politics of Thomas Carlyle's 'French Revolution'." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8182/.
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‘The Ethics, Aesthetics and Politics of Carlyle’s French Revolution’ examines the work of Thomas Carlyle as a crucial aesthetic intervention in the modern reception of the French Revolution in Europe. It interrogates the prevalent critical constructions of Carlyle’s work and finds them to proceed predominantly from the Whig historical agenda, structured around such key nineteenth-century concepts as utilitarianism and civilisational and moral progress. Within this critical framework, Carlyle’s largely conservative cultural stance and Christian spirituality are hardly allowed any creative potential and, ever since the famous fabrication of James Anthony Froude who depicted Carlyle as ‘a Calvinist without the theology’, they have been perceived as artistically-stunted, irrational, and out of touch with the nineteenth-century political, social and cultural realities. In examining Carlyle’s involvement with German Romanticism on the one hand, and with contemporary British periodical press on the other, this thesis proposes a more comprehensive reading of Carlyle’s politics, aesthetics and spirituality in an attempt to represent his radically open, catholic and indeed cosmopolitan artistic agenda which taps into the Scottish Enlightenment concept of rationality, Calvinist scepticism towards nineteenth-century progressivism and acute perception of evil in this world, and post-Burkean Romantic aesthetics of the sublime. We chart the aesthetic movement from Carlyle’s early dialogue with Schiller and Goethe to ‘The Diamond Necklace’, Carlyle’s first artistic rendition of the French pre-revolutionary scene, delivered as a (Gothic) moral tale and anticipating The French Revolution (a historical work that uniquely employs the Gothic genre within historical narrative, arguably unparalleled in British post-Burkean Romanticism). The critical reception of The French Revolution in Britain is examined, with special attention paid to the highly unfavourable review by Herman Merivale in The Edinburgh Review, in order to challenge the Whig line in Carlylean criticism and to expose the fundamental artistic, political and moral disagreement between Carlyle and Merivale. Carlyle’s Calvinist stance sees both Merivale’s and Thomas Babington Macaulay’s facile exorcism of the categories of good and evil from their historical agendas as irrational given the recent French terror (which, in Carlyle’s reading, released its demons precisely through such a botched ethical deal). Similarly, I highlight Carlyle’s close dialogue with John Stuart Mill both in their correspondence, and in the publications in the London and Westminster Review, while I argue that this intellectual exchange is crucial for the reading of The French Revolution as a text challenging Mill’s utilitarianism, and written within the institutional framework of the contemporary periodical press. Finally, Carlyle is seen to make capital of the concepts of Gothic and sublime, introduced by Edmund Burke and popularised by the Anti-Jacobin Review in Britain, by applying them directly to the French mob in search of a new spiritual tongue for his times (a move that even a nineteenth-century radical liberal thinker such as Mill sees as politically, if not artistically, far too subversive and revolutionary). Creative non-conclusiveness and playful deconstruction of the prevalent post-revolutionary narratives of 1789 characterise Carlyle’s deeply spiritual and artistically-sophisticated text, which, in an orthodox Christian reading, rejoices in the messy, dark and complex residue of human history, through which Christian providence acts in mysterious and unexpected ways that do not allow for any simple, de-mythologised reading.
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Bland, Rosemary. "Senior citizens, good practice and quality of life in residential care homes." Thesis, University of Stirling, 2006. http://hdl.handle.net/1893/70.
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This thesis is an examination of the definition and implementation of ‘good practice’ in residential care for senior citizens. The central contention is that ‘good practice’ is a term that has been variously defined. Different groups define it in different ways, and their definitions have changed over time. This reflexive qualitative study explores ‘good practice’ in local authority, voluntary and private residential care homes in Scotland from the perspective of policy, practice and the experience of senior citizens who live in them. The study is based on analysis of policy documents, historical studies, and reanalysed interview and survey data from two earlier studies conducted by the author and colleagues. The thesis shows that the notion of ‘good practice’ that emerges in policy and practice documents is a confused and often conflicting set of ideas. Historically, the earliest were driven by concerns over cost. In more modern times, statements about ‘good practice’ have had a more benevolent intent but are frequently flawed by paternalistic and ageist assumptions. It is shown that staff in residential homes typically adopt a different set of attitudes: their preoccupation is with safety and the avoidance of risk. Although benevolent in intention, these interpretations of ‘good practice’ are also at variance with what residents themselves actually want. Two particular models or styles of care are examined in detail. One of these is the use of ‘keyworkers’, often implemented in ways that fail to realise its potential. The other is the ‘hotel’ model of care. The potential of this model as an alternative to the statutory model is explored. The thesis concludes that it is a model that can realise the goal of enabling residents to exercise independence, choice and privacy while meeting their needs in residential care.
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Palmer, Thomas John. "Jansenism, holy living and the Church of England : historical and comparative perspectives, c. 1640-1700." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:38a685c6-ce86-437d-a651-8e54b88976e9.
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This thesis examines the impact in mid- to later-seventeenth century England of the major contemporary religious controversy in France. The debates associated with this controversy, which revolved around the formal condemnation of a heresy popularly called Jansenism, involved fundamental questions about the doctrine of grace and moral theology, about the life of the Church and the conduct of individual Christians. In providing an analysis of the main themes of the controversy, and an account of instances of English interest, the thesis argues that English Protestant theologians in the process of working out their own views on basic theological questions recognised the relevance of the continental debates. It is further suggested that the theological arguments evolved by the French writers possess some value as a point of comparison for the developing views of English theologians. Where the Jansenists reasserted an Augustinian emphasis on the gratuity of salvation against Catholic theologians who over-valued the powers of human nature, the Anglican writers examined here, arguing against Protestant theologians who denied nature any moral potency, emphasised man's contribution to his own salvation. Both arguments have been seen to contain a corrosive individualism, the former through its preoccupation with the luminous experience of grace, the latter through its tendency to elide grace and moral virtue, and reduce Christianity to the voluntary ethical choices of individuals. These assessments, it is argued here, misrepresent the theologians in question. Nevertheless, their thought did encourage greater individualism and moral autonomy. For both groups, their opponents' theological premises were deficient to the extent that they vitiated morality; and in both cases their responses, centring on the transformation of the inner man by love, privileged the moral responsibility of the individual. Their moral 'rigorism', it is suggested, focusing on the affective experience of conversion, represented in both cases an attempt to provide a sound empirical basis for Christian faith and practice in the fragmented intellectual context of post-reformation Europe.
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Baird, J. Aileen. "Medical and popular attitudes toward female sexuality in late seventeenth century England (1660-1696)." Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=22557.
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This thesis is an analysis of medical and popular views toward female sexuality in late seventeenth century England (1660-1696), based on the study of learned vernacular medical texts, personal sources and popular literature. In that period, women's subordinate social status to men was largely determined by their 'inferior' biology; "female illnesses" were considered to be a product of women's innate physiological 'weakness' as defined by humoral medical theory, and their reproductive organs were linked to their less restrained (than men's) sexual desires.This research examines those medical and social ideas that defined the female sex in late seventeenth century England, in conjunction with women's own records of their experiences; it is argued that while their physiology was used to justify their inferior social status, women's degree of self-autonomy in early modern England--particularly in the area of pregnancy and childbirth--was probably far greater than would be thought from an examination of the contemporary printed sources. This thesis also demonstrates how medical and social attitudes toward women mutually reinforced the secondary position of women in that society.
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康詠儀 and Wing-yee Veronica Hong. "A comparative study of healthcare financing systems in US, UK and HK." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41709858.
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Kilfedder, Catherine J. "An interactional model of occupational stress in health service employees." Thesis, University of Stirling, 2003. http://hdl.handle.net/1893/21835.
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This large scale study (869 participants from a mental health Trust) employed a questionnaire based on an interactional model of occupational stress to investigate (i) burnout in psychiatric nurses, (ii) occupational stress in medics and the professions allied to medicine, (iii) job satisfaction in health service management and support staff, and (iv) the moderating effect of social support in health service personnel. A range of analytic procedures were used including hierarchical regression analysis. Levels of burnout in nurses were low overall, although a significant proportion reported higher levels of emotional exhaustion. Among nurses, negative affectivity and predictability acted as common factors across the three constructs of the burnout syndrome. Medics and professions allied to medicine (P.AM. 's) reported similar levels of stressors to each other. Role ambiguity, role conflict and predictability, in combination with negative affectivity, accounted for most of the reported work related stressors of medics and P.AM. 's. Levels of job satisfaction in management and support staff was on a par with their peers elsewhere. Role ambiguity, role conflict, job future ambiguity, control and non-occupational concerns had an influence on job satisfaction among management and support staff. A significant proportion of nurses, medics and P.AM.'s reported low levels of work support. Those most at risk in this regard appeared to be highly educated, community based, non-shift workers. Higher levels of support were associated with increased job satisfaction and lower levels of both emotional exhaustion and psychological distress. The model adopted in the present study, although not necessarily applicable to all occupational groups, had utility in understanding the complex relationships between variables in this population from a mental health Trust. Despite common themes emerging across occupational groups, clear differences were also apparent, reinforcing the need for tailor-made interventions in occupational stress. The results also highlighted the necessity of including individual characteristics and nonoccupational stressors in any consideration of occupational stress. Further recommendations for each occupational group and the NHS in general are discussed.
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Rodgers, Ruth Mary. "Pharmaceutical ethics and professional discipline, 1993 to 1997 : an investigation into the Code of Ethics of the Royal Pharmaceutical Society of Great Britain : its implementation and influence on the disciplinary processes of the pharmacy profession dur." Thesis, Cardiff University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.425998.
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Fitzpatrick, David. "Hypoglycaemic emergencies attended by the Scottish Ambulance Service : a multiple methods investigation." Thesis, University of Stirling, 2015. http://hdl.handle.net/1893/21854.
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Background: Changing service demands require United Kingdom ambulance services to redefine their role and response strategies, in order to reduce unnecessary Emergency Department attendances. Treat and Refer guidelines have been developed with this aim in mind. However, these guidelines have been developed in the absence of reliable evidence or guiding mid-range theory. This has resulted in inconsistencies in clinical practice. One condition frequently included in Treat and Refer guidelines is hypoglycaemia. Therefore this thesis aimed to investigate prehospital hypoglycaemic emergencies in order to develop an evidence base for future interventions and guideline development. Research approach: A pragmatic and inductive applied health services research approach was employed. Multiple methods were used in a sequential explanatory design. Three linked studies were undertaken with the results of previous studies informing the development of the next. Study one: A scoping review of prehospital treatment of hypoglycaemic events. Aims: i) To describe the demographics of the patient population requiring ambulance service assistance for hypoglycaemic emergencies; ii) To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA), experience repeat hypoglycaemic events (RHE) after being treated in the prehospital environment. Methods: A scoping literature review was conducted using an overlapping retrieval strategy that included both published and unpublished literature. Findings: Twenty-three papers and other relevant material were included. Hypoglycaemia related ambulance calls account for 1.3% to 5.2% of ambulance calls internationally. Transportation rates varied between studies (25%-73%). Repeat hypoglycaemic emergencies are experienced by 2-7% of patients within 48 hours. There was insufficient detail to determine any relationship between repeat events and OHA. The low quality of included papers means that the results should be cautiously interpreted. The safety of leaving patients on OHA at home post hypoglycaemic emergency is unknown. Consequently patients taking OHAs who experience a hypoglycaemic emergency should be transported to hospital for observation. There was a lack of knowledge about the Scottish demographics of the patient population. Study two: A retrospective cross-sectional observational study of diabetes related emergency calls. Aims: To investigate i) the patient demographics and characteristics of hypoglycaemia related emergency calls; ii) the incidence of repeat hypoglycaemic events; and iii) the factors associated with emergency calls that result in individuals being left at home. Methods: A retrospective observational cross-sectional study conducted using Medical Priority Dispatch System® call data from West of Scotland Ambulance Control Centre over a 12 month period. Data were extracted on age, gender, dispatch code, time of call, deprivation category, and immediate outcome (home or hospital). Multiple regression analysis was used to determine predictors of remaining at home. Findings: 1319 calls for hypoglycaemia were received. Patient demographics were similar to the scoping review findings. Most patients remained at home (N = 916 vs N = 380; p < .001). RHE’s were experience by 3.1% within 48 hours, and 10.6% within two weeks. The most significant independent predictor for patients remaining at home was a prior call to the ambulance service (OR of 2.4 [95%CI 1.5 to 3.7]). Patients’ reasons for remaining at home and the causes of subsequent severe events are unknown. It is likely that non-clinical factors may explain some of this behaviour. Study 3: Investigating patients’ experiences of prehospital hypoglycaemic care. Aim: To investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency. Methods: In-depth interviews with adults with diabetes who had recently experienced a hypoglycaemic emergency treated by ambulance clinicians. Participants were recruited from Greater Glasgow and Clyde and Lanarkshire Health Board areas. Data were analysed using Framework Analysis. Findings: Twenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; patients’ impaired awareness of hypoglycaemia as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; patients felt the service provided was good; however ambulance clinicians’ advice was inconsistent. Thirdly, the influences on uptake of follow-up care; patient preferences for follow-up care were influenced by previous experiences of home, hospital and primary care. Post-hoc analysis identified three psychological theories that may explain these findings and provide a useful basis for intervention development: Common Sense Model (Leventhal et al, 1998); Health Belief Model (Rosenstock, 1966); Ley’s cognitive hypothesis model of communication (Ley and Llewelyn, 1995; 1981). Conclusion: Most people treated for severe hypoglycaemia by ambulance clinicians remain at home and do not follow-up their care. A few experience repeat hypoglycaemic emergencies. Key causal, but modifiable factors, contributing to this include:- impaired awareness of hypoglycaemia; inconsistent delivery of ambulance clinician referral advice; and patients’ perceptions of the costs and benefits of follow-up care. Ambulance services cannot address all these factors in isolation. The studies in this thesis have generated an evidence base and identified plausible candidate theories. This will support the future development of novel interventions to improve severe hypoglycaemic emergency follow-up.
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Leung, Kin-keung Kenneth, and 梁健強. "Management and disposal of clinical waste." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1997. http://hub.hku.hk/bib/B31253775.
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Sutton, David A. "The public-private interface of domiciliary medical care for the poor in Scotland, c. 1875-1911." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/1234/.
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This thesis explores domiciliary medical care for the poor in Scotland. Domiciliary care is understood as medical care provided in the home by qualified medical practitioners, or medical students. The poor are understood as those simply unable to ‘pay the doctor’ for the services they received. Focus is upon service provision, and therefore this thesis is a study of the different medical agencies engaged in the visitation of patients, and of the diverse ways medical practitioners as agents of different medical services facilitated or administered treatment. The period under focus is from 1875 to the National Health Insurance Act, 1911. Particular focus falls on urban Scotland, and Glasgow and Edinburgh. The interface between public and private provision is understood as the distinction between services provided for paupers, the legal poor, and services provided for the remainder, also unable to pay, and described as occupying ‘the boundary line between self-support and parish help’. Three types of service provider are identified: the poor law, medical charity, and medical missions. The thesis is divided into four main parts, buttressed by an introduction and conclusion. Chapter One sets the parameters to study of domiciliary medical care for the poor by identifying a literature of home visitation, and by identifying pressing issues concerning treatment in the homes of the poor of Glasgow and Edinburgh, like physical structure and family. Chapter Two is comprised of eight sections and looks at public provision in the form of the poor law medical services. Of particular interest are the local management, and the medical officers who provided the service. In turn focus is put upon the role of medical relief under the Poor Law (Scotland) Act, 1911; the structure of outdoor medical services in Glasgow and Edinburgh; the role of the local medical sub-committee of the parish board; and the parochial medical officers and their work. A prosopographical approach is taken to profile the parochial medical officers. Chapter Three, comprising five sections and conclusion, looks at private provision by medical charity. At issue is the range of charity dispensaries that provided outdoor services to the poor. A prospectus identifying the range of services is provided; outdoor medical services in Edinburgh and Glasgow are detailed; the interconnection between charity dispensary, domiciliary medical care, and medical educational requirements – particularly in Edinburgh – is investigated; and new developments occurring at the start of the twentieth century in health services requiring home visits are outlined. Chapter Four is comprised of nine main sections plus conclusion and looks at private provision by home medical missions. An overview of the literature of medical missions is provided, before focus falls, in turn, on medical missions in Edinburgh; medical missions in Glasgow; the medical work of medical missions; opportunities provided for women; how medical missions work was justified against criticisms; differences between providers; the response to provision from the Catholic immigrant community, and the work of the St Vincent de Paul Society.
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Palacz, Michal Adam. "Polish School of Medicine at the University of Edinburgh (1941-1949) : a case study in the transnational history of Polish wartime migration to Great Britain." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/31032.
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More than 400 Polish medical refugees were associated with the Polish School of Medicine (PSM) at the University of Edinburgh between 1941 and 1949. This dissertation argues that the history of the PSM can fully be understood only as a part of the refugees’ broader experience of impelled or forced migration during and immediately after the Second World War. The key findings of this case study demonstrate that the opportunity to study or work at the PSM enabled the majority of Polish exiles to overcome, to a varying extent, their refugee predicament, while medical qualifications, transferable skills and trans-cultural competency obtained in wartime Britain allowed them to pursue professional and academic careers in different countries of post-war settlement, thus in turn contributing to a global circulation of medical knowledge and practice, especially between the University of Edinburgh and Poland. This specific case study contributes to the existing knowledge of Polish wartime migration to Britain in three interrelated ways. Firstly, an overarching transnational approach is used to combine and transcend Polish and British scholarly perspectives on, respectively, emigration or immigration. Secondly, the conceptual insularity of the existing literature on the topic is challenged by analysing archival, published and digital sources pertaining to the PSM with the help of various theoretical models and concepts borrowed from forced migration and diaspora studies. Thirdly, the conventional historiography of Polish-British wartime relations is challenged by emphasising the genuinely global ramifications of the PSM’s history. By interpreting the history of the PSM with the help of different analytical tools, such as Kunz’s and Johansson’s models of refugee movement and Tweed’s theory of diasporic religion, this dissertation provides a conceptual blueprint for further research on Polish wartime migration to Britain. In turn, this case study contributes to the development of forced migration and diaspora studies not only by empirically testing the explanatory power of existing theoretical models, but also by suggesting possible new conceptual avenues, such as analysing the pre-existing trans-cultural experiences of both Polish medical refugees and their hosts at the University of Edinburgh, and adding to the ‘triadic relationship’ of diaspora, homeland and host society a fourth dimension, i.e. conflict and cooperation between different migrant or refugee communities within the same host society.
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Roberts, John. "An investigation of medieval hospitals in England, Scotland and Wales, 1066-1560." Thesis, University of South Wales, 2008. https://pure.southwales.ac.uk/en/studentthesis/an-investigation-of-medieval-hospitals-in-england-scotland-and-wales-10661560(b0b57392-95f2-4916-a0bb-29db76d983a7).html.
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Until recent years research into medieval hospitals of England, Scotland and Wales has been a topic that has been somewhat neglected by historians and archaeologists. The majority of work carried out to date has focused on individual institutions, small geographical areas, or specific types of hospital. Whilst many of those studies have been well researched and highly informative, few have provided an insight into regional differences or similarities throughout these three countries. This thesis compares and contrasts a variety of aspects of medieval hospitals, such as the layout of the buildings, the saint(s) to whom they were dedicated, the type of people cared for in them, and the people who founded and ran them, in an attempt to identify any regional patterns that may have existed in medieval times. As the length of period studied spans almost five hundred years, it is possible to examine the changes in development of medieval hospitals. Rising and waning popularity for those saints who were venerated in connection with care for the poor and the sick is tracked throughout the centuries covered in these pages. Likewise, the choices of design for hospital buildings from the 11 th century to the 16th century are explored, along with the changes in the status of founders, and the number, type and gender of staff and inmates during that time frame. Periods of growth and decline in hospitals were apparent, the most notable being the falling number of hospital foundations across most of Britain in the late 13 th century and the early 14th century. This is examined on a regional scale, as well as nationally, with a view to gaining a better understanding of the causes that may have resulted in such a decline.
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Groninger, Katherine R. "Museum accountability in Britain and America : ethical standards and fiscal transparency in the twenty-first century." Thesis, University of St Andrews, 2011. http://hdl.handle.net/10023/2593.
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This thesis examines the current state of nonprofit museum accountability in the United Kingdom and United States, assessing methods of achieving fiscal and ethical accountability, as well as the factors that have influenced museum codes and policies to that end. The recent development of museum accountability is couched in corporate culture, government influence, and public expectations, making it an interdisciplinary concern. Yet museum professionalisation, including codes of ethics, conflict of interest management, and agreed-upon standards, has received little attention from researchers. This study engages in empirical research to assess museums’ responses to recent regulations, their execution of governance accountability, and the application of internal controls and fiscal transparency measures. These subjects appraise ethical governance and board member duties, in addition to audit practices and best practice policies. Research reveals inadequacies in the museum accountability systems in both Britain and America. As case studies serve to demonstrate, opportunities remain for financial and ethical misconduct, which can damage the public trust in museums. This thesis is the first broad empirical study to explain museum accountability in Britain or America, collating data across the entire museum sector, creating an industry-wide national framework from the quantitative and qualitative findings. No research has reported on the implementation of best practice measures according to the private, public and third sectors, stakeholders, and by the museum industry itself. Ultimately, this thesis provides unique evidence previously lacking in both the UK and US museum sectors, making it possible to posit and assess specific museums against an accurate national accountability framework.
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McEldowney, Rene P. "A century of democratic deliberation over American and British national health care : extending the Kingdon model /." Diss., This resource online, 1994. http://scholar.lib.vt.edu/theses/available/etd-06062008-164612/.
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Sehrawat, Samiksha. "Medical care for a new capital : hospitals and government policy in colonial Delhi and Haryana, c.1900-1920." Thesis, University of Oxford, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.670191.
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Owens, Brian McCullough. "Record-keeping in World War I, in relation to the development of modern bureaucracy in Great Britain and Canada : a study of government institutions and of the Royal Army Medical Corps and Canadian Army Medical Corps." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299178.
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Murphy, Anna. "The people's princess : Grayson Perry and English cultural identity." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:d53f1307-9cce-489c-ad27-0354d3f99b03.
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This thesis will consider the art and persona of Grayson Perry in relation to ideas of national identity. In particular, it will argue that Perry has been occupied with ideas of class and national identity throughout his career, but that these underlying concerns have often been subsumed, or obfuscated, by the foregrounding of other more obvious aspects of his work, such as his transvestism. At the centre of this thesis is the argument that Perry's vision of England, and the purportedly ambivalent way in which he presents it, functions as a way of negotiating - and repatriating - English national identity at a time of crisis. I want to further argue, however, that this has been complicated by Perry's self-positioning, and I propose that he has cultivated an air of subversion and transgression that has tempered the more affirmative aspects of his work. This half-subversive, half-affirmative stance allows him and his work to resonate with both those critical of the usual institutions of contemporary art - including many sections of the public and certain newspapers, tabloid and broadsheet alike - as well as the institutions themselves. This stance has implications not only for Perry's engagement with contemporary art but for his considerations of national identity as well, enabling an enquiry into, and ultimately a restitution of, 'Englishness' (and, to a lesser extent, 'Britishness'), by framing it within a rhetoric of ambivalence and diminishment rather than overt nationalism, the latter of which would have more problematic associations. Similarly, I want to suggest that it is this stance and its mediatory properties, coupled with his earlier self-positioning and his subtle but consistent foregrounding of domestic and demotic issues of national identity throughout his career, that has made Perry such a popular candidate to take on the task of reinvigorating this identity now.
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Brink, Jeanetha. "Corporate governance in public-private partnerships : a public sector management perspective." Thesis, Stellenbosch : Stellenbosch University, 2006. http://hdl.handle.net/10019.1/17443.
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Thesis (MPhil)--University of Stellenbosch, 2006.ENGLISH ABSTRACT: This assignment deals with the relevance of Public-Private Partnerships in the South African context and particularly the role it can play in realising the developmental goals of the economic policy. The value of the unique relationship that is possible between the public and the private partner goes beyond the formalised legal agreement as the mix of cultures and different managerial approaches hold benefits for both parties. There are many aspects of the PPP, especially as a management tool, which grow beyond the boundaries of a work of this length and which will hopefully entice the reader to further reading. However, in this work the main thrust of the argument is that the PPP offers an alternative, or maybe rather a supplementary vehicle to address a number of managerial problems experienced in the public sector.
AFRIKAANSE OPSOMMING: Hierdie werkstuk handel met die relevansie van die sogenaamde “Public-Private Partnership” in die Suid-Afrikaanse konteks en meer spesifiek die rol wat dit kan speel om die ontwikkelingsdoelwitte van die ekonomie te bereik. Die waarde van die unieke verhouding wat moontlik is tussen die publieke en die private party venoot verder as die formele regsverhouding aangesien die vermenging van die kulture en verskillende bestuurstyle voordele vir beide partye inhou. Daar is vele aspekte van die PPP, veral as ‘n bestuursmeganisme, wat buite die grense van ‘n werk van hierdie lengte gaan en hopelik word die leser gestimuleer om verder oor die onderwerp op te lees. Die vertrekpunt van hierdie werk egter is dat die PPP ‘n alternatiewe, of selfs ‘n bykomende meganisme om verskeie bestuursprobleme wat in die publieke sektor ervaar word, aan te spreek.
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Shamberg, Neil S. "Shell shock in the origins of British psychiatry." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1045637.
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This study has presented a comprehensive overview of the origins of modern British and American military psychiatry, chiefly in response to World War I shell shock. The study examined the state of British psychiatry during the nineteenth century, as the new railroads, mines, and factories produced accident victims with post-traumatic stress disorders. As World War I began, psychoanalysis was in its infancy, and most British psychiatrists faced with a victim of shell shock fell back on an eclectic mix of treatments, including electro-shock therapy, hot baths, massages, moral persuasion, lectures, exhortation, etc. While a few British and American psychiatrists practiced either psychotherapy or disciplinary methods exclusively, the majority of practitioners used a variety of methods, depending on the doctor's point of view and the circumstances of the case at, hand. Psychotherapeutic developments in the inter-war period are also explored and discussed.Department of History
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Jenkins, Kirsten. "Discourses of energy justice : the case of nuclear energy." Thesis, University of St Andrews, 2017. http://hdl.handle.net/10023/10255.
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The energy sector faces sustainability challenges that are re-working the established patterns of energy supply, distribution and consumption (Anderson et al. 2008; Haas et al. 2008; Stern 2008; Shove and Walker 2010). Amidst these challenges, socio-technical energy transitions frameworks have evolved that focus on transitions towards decarbonised, sustainable energy systems (Bridge et al. 2013). However, the ‘socio-‘ or social is typically missing as we confront climate and energy risks in a moral vacuum (Sovacool et al. 2016). The energy justice framework provides a structure to think about such energy dilemmas. However, the full extent and diversity of justice implications within the energy system have been neglected. Thus, borrowing from and advancing the framework this research explores how energy justice is being articulated with attention to three emergent areas of growth, the themes of: (1) time, (2) systems component and (3) actor. It does so through a case study of nuclear energy, which was chosen because of its points of enquiry with regards to these three areas of growth, and its historical and on-going importance in the UK energy mix. Using results from 36 semi-structured interviews with non-governmental organisations and policy actors across two case studies representative of the nuclear energy stages of energy production and of waste storage, disposal and reprocessing – the Hinkley Point and Sellafield nuclear complexes – this research presents new insights within each of these previously identified areas of development. It offers the contributions of (1) facility lifecycles, (2) systems approaches and (3) the question of ‘justice by whom?' and concludes that the energy justice framework can aid energy decision-making in a way that not only mitigates the environmental impacts of energy via socio-technical change, but also does so in an ethically defensible, socially just, way.
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O'Connor, Patricia. "Looking for harm in healthcare : can Patient Safety Leadership Walk Rounds help to detect and prevent harm in NHS hospitals? : a case study of NHS Tayside." Thesis, University of St Andrews, 2012. http://hdl.handle.net/10023/2804.
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Today, in 21st century healthcare at least 10% of hospitalised patients are subjected to some degree of unintended harm as a result of the treatment they receive. Despite the growing patient safety agenda there is little empirical evidence to demonstrate that patient safety is improving. Patient Safety Leadership Walk Rounds (PSLWR) were introduced to the UK, in March 2005, as a component of the Safer Patients Initiative (SPI), the first dedicated, hospital wide programme to reduce harm in hospital care. PSLWR are designed, to create a dedicated ‘conversation’ about patient safety, between frontline staff, middle level managers and senior executives. This thesis, explored the use of PSLWR, as a proactive mechanism to engage staff in patient safety discussion and detect patient harm within a Scottish healthcare system- NHS Tayside. From May 2005 to June 2006, PSLWR were held on a weekly basis within the hospital departments. A purposive sample, (n=38) of PSLWR discussions were analysed to determine: staff engagement in the process, patient safety issues disclosed; recognition of unsafe systems (latent conditions) and actions agreed for improvement. As a follow-up, 42 semi-structured interviews were undertaken to determine staff perceptions of the PSLWR system. A wide range of clinical and non-clinical staff took part (n=218) including medical staff, staff in training, porters and cleaners, nurses, ward assistants and pharmacists. Participants shared new information, not formally recorded within the hospital incident system. From the participants perspectives, PSLWR, were non threatening; were easy to take part in; demonstrated a team commitment, from the Board to the ward for patient safety and action was taken quickly as a result of the ‘conversations’. Although detecting all patient harm remains a challenge, this study demonstrates PSLWR can be a useful tool in the patient safety arsenal for NHS healthcare organisations.
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Hutchison, Catherine B. "A randomised controlled trial of an audiovisual patient information intervention in cancer clinical trials." Thesis, University of Stirling, 2008. http://hdl.handle.net/1893/442.
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Introduction and background Recruitment to cancer clinical trials needs to be improved, as does patient understanding about clinical trials, to enable patients to make an informed choice about whether or not to take part. The main reason that clinically eligible patients do not take part in clinical trials is because they refuse; poor understanding of the research has been associated with patient refusal. Audiovisual patient information (AVPI) has been shown to improve knowledge/understanding in various areas of practice but there is limited information about its effect in the cancer clinical trial setting, particularly in relation to recruitment rates. Understanding the research is necessary for informed consent, and it was hypothesised that if patient understanding about clinical trials was increased with AVPI, then this could result in a reduction in the number of patients refusing clinical trials, and therefore provide an ethical approach to improving recruitment. This study aimed to test the impact of an audiovisual patient information intervention on recruitment to randomised cancer clinical trials (refusal rates), patient understanding of the information given, and levels of anxiety. Reasons for patients’ decisions about trial participation were also assessed. Method An AVPI intervention was developed that aimed to address the common misconceptions associated with randomisation and clinical equipoise, as well as improve patient understanding generally of randomised cancer trials, and of other core clinical trial informational requirements, such as voluntariness. Patients were randomised to receive either AVPI in addition to the standard trial-specific written information, or the written information alone. A new questionnaire was developed to assess patient understanding (also referred to as knowledge) in the randomised trial setting and, following testing with patients and research nurses, this was shown to be reliable and valid. Patients completed self-report questionnaires to assess their understanding (new knowledge questionnaire) and anxiety (Spielberger State-Trait Anxiety Inventory), at baseline and after they had made their decision about clinical trial entry, when their perceptions of the intervention, as well as factors contributing to their decision were also determined (this tool incorporated Jenkins and Fallowfield’s (2005) questionnaire which assessed reasons for accepting and declining randomised cancer trials). Results A total of 173 patients with breast cancer (65%), colorectal cancer (32%) and lung cancer (3%) were entered into the main study. The median age was 60 (range 37-92 years). There was no difference in clinical trial recruitment rates between the two groups: 72.1% in the AVPI group and 75.9% in the standard information group. The estimated odds ratio for refusal (intervention/no intervention) was 1.19 (95% ci 0.55-2.58, p=0.661). Knowledge scores increased more in the intervention group compared to the standard group (U= 2029, p=0.0072). The change in anxiety score between the arms was also statistically significant (p=0.011) with anxiety improving in the intervention arm more than in the no-intervention arm. The estimated difference in the median anxiety change score between the groups is –4.6 (95% ci –7.0 to –2.0). Clinical trial entry was not influenced by tumour type, stage of cancer, age, educational qualifications or previous research experience, however, there was a modest association with deprivation status (p=0.046) where more affluent patients were the least likely to consent to a trial. Educational qualifications and stage of cancer were independently associated with knowledge: patients who were better educated had higher levels of knowledge about randomised trials, and patients who had limited stage of cancer had higher baseline knowledge than patients with advanced cancer. Acceptability of the intervention was high with 93% of those who watched it finding it useful, and 42% stating that it made them want to take part in the clinical trial. Personal benefit and altruism were key motivating factors for clinical trial participation, with reasons for refusal being less clear. Discussion and conclusions Although the potential for AVPI to increase clinical trial recruitment rates was highlighted in the literature, in this study, AVPI was not shown to have any effect on refusal rates to randomised cancer trials. However, by improving patient understanding prior to decision making, AVPI was shown to be a useful addition to the consent process for randomised cancer trials. AVPI addresses the fundamental ethical challenges of informed consent by improving patient understanding, and supports the ethical framework integral to Faden and Beauchamp’s (1986) theory of informed consent. The new knowledge questionnaire was shown to be a sensitive and effective instrument for measuring understanding of randomised clinical trials in the cancer setting, although it would benefit from further testing. The AVPI appears to reduce anxiety at the decision making time point and has been shown to be an acceptable medium for patients. This study confirms existing findings from studies assessing factors affecting decision making, with personal benefit and altruism being key motivating factors, and reasons for refusal being less clear. The need for further qualitative work in this area is highlighted to gain a deeper understanding of what is important to patients, in terms of why they refuse clinical trial participation. Implications for practice and further research Several implications for practice have been identified, including using AVPI as part of the standard information package for patients considering randomised cancer trials, and focussing on patient and staff education in this area. The knowledge questionnaire could be introduced to routine practice as a tool to determine patient understanding prior to decision making, allowing clinicians the opportunity to correct any misconceptions prior to consent. Further research focussing on AVPI specific to individual trials would be helpful, to determine if a more customised approach would be of benefit in terms of clinical trial recruitment. The importance of studying other aspects of the consent process such as the interaction between the clinician and the patient, in addition to more detailed exploration of the factors affecting patients’ decisions were highlighted.
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Allen, Katherine June. "Manuscript recipe collections and elite domestic medicine in eighteenth century England." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:7c96c4db-2d18-4cff-bedc-f80558d57322.
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Collecting recipes was an established tradition that continued in elite English households throughout the eighteenth century. This thesis is on medical recipes and advice, and it addresses the evolution of recipe collecting from the seventeenth century and throughout the eighteenth century. It investigates elite domestic medicine within a cultural history of medicine framework and uses social and material history approaches to reveal why elites continued to collect medical recipes, given the commercialisation of medicine. This thesis contends that the meaning of domestic medicine must be understood within a wider context of elite healthcare in order to appreciate how the recipe collecting tradition evolved alongside cultural shifts, and shifts within the medical economy. My re-appraisal of the meaning of domestic medicine gives elite healthcare a clearer role within the narrative of the social history of medicine. Elite healthcare was about choice. Wealthy individuals had economic agency in consumerism, and recipe compilers interacted with new sources of information and products; recipe books are evidence of this consumer engagement. In addition to being household objects, recipe books had cultural significance as heirlooms, and as objects of literacy, authority, and creativity. A crucial reason for the continuation of the recipe collecting tradition was due to its continued engagement with cultural attitudes towards social obligation, knowledge exchange, taste, and sociability as an intellectual pursuit. Positioning the household as an important space of creativity, experiment, and innovation, this thesis reinforces domestic medicine as an important part of the interconnected histories of science and medicine. This thesis moreover contributes to the social history of eighteenth-century England by demonstrating the central role domestic medicine had in elite healthcare, and reveals the elite reception of the commercialisation of medicine from a consumer perspective through an investigation of personal records of intellectual pastimes and patient experiences.
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Lemar, Susan. "Control, compulsion and controversy: venereal diseases in Adelaide and Edinburgh 1910-1947." Title page, contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phl548.pdf.
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Includes bibliographical references (leaves 280-305). Argues that despite the liberal use of social control theory in the literature on the social history of venereal diseases, rationale discourses do not necessarily lead to government intervention. Comparative analysis reveals that culturally similar locations can experience similar impulses and constraints to the development of social policy under differing constitutional arrangements.
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Sexton, John Bryan. "A matter of life or death social psychological and organizational factors related to patient outcomes in the intensive care unit /." 2002. http://wwwlib.umi.com/cr/utexas/fullcit?p3085063.
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Andress, Lauri Linder Stephen H. "The emergence of the social determinants of health on the policy agenda in Britain : a case study 1980-2003 /." 2006. http://proquest.umi.com/pqdweb?did=1324368231&sid=1&Fmt=2&clientId=68716&RQT=309&VName=PQD.
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Madill, A., and Paul W. Sullivan. "Medical training as adventure-wonder and adventure-ordeal: a dialogical analysis of affect-laden pedagogy." 2010. http://hdl.handle.net/10454/6075.
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Our purpose is to examine the possibilities of Bakhtinian dialogical analysis for understanding students' experiences of medical training. Twenty-three interviews were conducted with eleven British medical students intercalating in psychology. Forty emotionally resonant key moments were identified for analysis. Our analysis illustrates students' use of the professional genre to present their training as emotionally neutral. However, we show how medical training can be framed in more unofficial and affective-laden ways in which threshold moments of crisis are presented as space-time breaches characteristic of the genres of adventure-wonder and adventure-ordeal. This affect was often depotentiated in the narratives through brief allusion to the professional genre. This cycling between genres suggests that the students were searching for an appropriate way in which to frame their experiences, a central dilemma being the extent to which medical training makes sense within an immediate and affect-laden, or future-orientated and affect-neutral, pedagogy. Finally, we identify how consultants are an important aspect of the affective experience of medical training who, at their best, offer inspiring exemplars of flexible movement between official and unofficial ways of being a doctor. In conclusion, we demonstrate the potential of genres to make sense, and to organize the experience, of medical training spatially in terms of moving between personal and impersonal contact, temporally in terms of moving between the extraordinary and routine, and affectively in terms of moving between potent and neutral affect. Learning to use the professional genre is part of enculturation as a doctor and can be helpful in providing a framework restoring coherence and composure through engaging with, and reformulating, difficult experiences. However, it is important to take seriously the resistance many of the students demonstrated to the professional genre as a possible barometer of its acceptability to the general public.
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McCullough, B., Neil A. Small, and S. L. Prady. "Improving smoking cessation data collection via a health visitor community of practice." 2013. http://hdl.handle.net/10454/9788.
Full textAbstract:
A Collaborations for Leadership in Applied Health Research and Care (CLAHRC) funded study engaged health visitors in investigating the ways in which routinely collected data were captured, stored, transferred, analysed and then used to inform clinical practice. This report focuses on the establishment of a community of practice (CoP) to support these activities and then presents the outcome of the CoP's investigations into the collection and use of data on one key area of concern; maternal smoking behaviour. Evidence-based recommendations for clinical practice made by the CoP ranged from simple changes to the daily working practices of health visitors to ensure accurate data collection and dissemination of information, to major changes to processes and procedures relating to data quality and data sharing. The findings of the CoP emphasised the importance of cross-discipline communication and collaboration.
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Maimela, Charles. "Legal issues relating to the treatment of persons living with cancer." Thesis, 2017. http://hdl.handle.net/10500/24490.
Full textAbstract:
Cancer is regarded as a global disease and one of the leading killer diseases in the
world. The reason why cancer is so widespread and often misunderstood stems from
multiple factors, namely, the lack of knowledge about cancer, unfair discrimination of
persons living with cancer, inadequate or inappropriate treatment provided to patients,
the stigma attached to cancer, misdiagnosis and late diagnosis of persons living with
cancer, as well as the inadequate provision of screening programs to detect cancer at
an early stage.
The combination of these issues raises alarming medico-legal problems that merit
further attention. The thesis will explore the origin, nature, philosophical and clinical
aspects pertaining to cancer, as well as legal issues related to cancer and oncology.
The study will conclude with recommendations aimed at mitigating and addressing the
shortcomings that exist in the medico-legal framework. The study will also draw on a
legal comparison of relevant South African, English and American laws and
regulations. Since this thesis entails focussing on medico-legal principles, the study
will draw on aspects of medical law, labour law, law of contract, law of delict,
constitutional law and criminal law.Private Law
LL. D.
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Wilcock, J., S. Iliffe, S. Turner, M. Bryans, R. O'Carroll, J. Keady, E. Levin, and Murna G. Downs. "Concordance with clinical practice guidelines for dementia in general practice." 2009. http://hdl.handle.net/10454/6235.
Full textAbstract:
NoBACKGROUND: Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care. AIM: To determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. Design: Unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. METHODS: Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. RESULTS: We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing. DISCUSSION: The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.