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1
Harvey, Janet. "Behind the medical mask : medical technology and medical power." Thesis, University of Warwick, 1992. http://wrap.warwick.ac.uk/36139/.
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This thesis explores the role of technology as a resource in the structure of medical domination of birth and death, stressing technology's pivotal position at the intersection of control and uncertainty. Based in Intensive Care and Obstetrics (between which the health status of patients diverges sharply), it notes the convergence of technology used and examines the contest for control within the labour process. This includes using technology to facilitate a 'standardized' birth or death; a more retrospectively defensible event. In general, the 'burden of proof' is concluded to lie with those wishing not to intervene rather than the reverse. Given the (cognitively male) biomedical model, mind-body dualism is an assumption embedded in medical technology: this is especially significant in childbirth, where it fractures the woman's ontological experience of giving birth. Its positivistic and pathological emphasis is associated with a reification of processes and a commodification of their 'solution': which becomes located in technology. It is argued that commodification in health provision will increase with the further application of market principles to the NHS. It is concluded that 'uncertainty', endemic to medicine and a possible challenge to control, is proactively manipulated and pressed into the service of medical domination. Technology is used to mask uncertainty and aid the medical profession's control of patients/relatives, and subordinate work groups. A technological fix may be viewed as the opposite to re-discovering societal dreams and myths, however, more paradoxically, it is concluded that dreams and myths have become attached to technology. Thus, the symbolic role of technology is: to provide hope of continued survival (or cure), the veiling of existential uncertainty and the offer of 'absolution' - should all efforts fail (a freedom from guilt in the assurance that "everything possible was tried"). Its 'heroic' project is viewed as an existentially 'masculine' health provision and 'feminized' health care is posited as an alternative.
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Vohra, Amit. "Decision factors that determine choice of medical specialty amongst medical students, pre-vocational doctors, general practice registrars and general practitioners." Thesis, Curtin University, 2015. http://hdl.handle.net/20.500.11937/2446.
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In seeking to answer the research question, “What are the Decision Factors that Determine Choice of Medical Specialty Amongst Medical Students, Prevocational Doctors, General Practice Registrars and General Practitioners?”, this qualitative research utilised in-depth interviews to provide a unique perspective in an intergenerational study that explored key factors impacting on choice of medical specialty. Findings confirm that money and prestige are not important and that work-life balance and professional satisfaction are key to influence decisions.
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Varnam, Robert. "Patient perspectives on medical errors in general practice." Thesis, University of Manchester, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.514434.
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Patient safety is as an increasingly active field of research and policy in the UK and around the world. The prevailing academic model for understanding the cause of patient safety incidents considers failures in cognitive and system aspects of care to playa role, with an emphasis on system factors in preventing harm. General practitioners (GPs) are the first port of call for a wide range of undifferentiated medical, psychological and social problems, presented by patients with whom they may form lasting relationships. The priorities and processes of care in general practice are consequently less clearly defined, more individualised and more strongly influenced by the people involved than in the hospital settings where the existing model was developed. Research in general practice has thus far been conducted from a professional standpoint, using doctors' reports to detect and understand safety incidents. Patients may bring a valuable new perspective to understanding the nature, incidence and cause of adverse events in general practice, allowing the existing model to be refined. This study aimed to provide a detailed description and analysis of patients' perspective on episodes of care they regarded as regrettable. A qualitative approach was used, conducting in-depth interviews with 34 patients whose healthcare experiences made them likely to be good key informants regarding patient safety issues in general practice. An adaptive theorising approach was used, to allow grounded insights arising from the empirical data to be interpreted in the light of, and to add to the development of, theories about the causation of adverse events. The results showed respondents' evaluations of GPs' medical performance to be contingent on their expectations, prior experiences and the doctor-patient relationship. They understood the quality and safety of GPs' care to be determined by their knowledge, skills and an attitude of professional commitment, using this understanding to inform the attribution of responsibility or blame for their experiences of care. This approach differed from the prevailing academic model in that it focussed on errors more than adverse outcomes, placed a strong emphasis on the importance of personal and relational factors in error causation and paid relatively little attention to the role of system factors. It identified diagnostic error as a significant issue in general practice, highlighting the dependence of technical aspects of care upon the GP's personal and interpersonal performance. Having sufficient professional commitment to choose to perform well was seen as a prerequisite for the safe application of knowledge and skills. Even where little or no physical harm was sustained, errors attributed to a failing in professional commitment could result in Significant psychological distress, loss of trust, and changes in future help-seeking behaviour. Interpersonal aspects of care and personal factors in GP performance appear to be key influences on safety in this context. This has implications for the focus of safety improvement efforts, which may need to take more account of the role of the individual professional, alongside issues of human factors and system design. A renewed emphasis is recommended on traditional values of altruistic professionalism and personal responsibility. Patients may make good partners in improving safety, provided it is acknowledged that their perspective is subject to socially patterned biases, and that they are sometimes hesitant to challenge medical authority.
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Pannick, Samuel. "Improving interdisciplinary care on the general medical ward." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/44373.
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General medical wards deliver the majority of inpatient care. Despite technological and therapeutic advances, these wards expose 10% of patients to preventable adverse events, and disproportionately contribute to preventable hospital deaths. Improving ward team performance is often proposed as a mechanism to improve patient outcomes. The overarching goal of this thesis is to identify effective strategies to improve interdisciplinary team care on the medical ward. Chapter 1 introduces key concepts in healthcare quality, and specific issues in the delivery and measurement of interdisciplinary ward care. The existing literature for ward improvement strategies is then described. A narrative review identifies common targets for ward interventions [chapter 2], and a systematic review evaluates interdisciplinary team care interventions, finding little evidence of significant impact on objective patient outcomes [chapter 3]. The development and evaluation of prospective clinical team surveillance (PCTS) is then reported. PCTS is a novel interdisciplinary team care intervention, engaging staff to identify barriers to care delivery, with facilitation and feedback. A programme theory and mixed methods evaluation are presented, using a stepped wedge, cluster controlled trial [chapter 4]. Mixed-effects models show a significant reduction in excess length of stay with high fidelity PCTS [chapter 5]. Surveys, focus groups and auto-ethnography identify PCTS' mechanisms of action, and its impact on incident reporting, safety and teamwork climates [chapter 6]. Implementation outcomes, facilitators and barriers are described in chapter 7. Other perspectives on improvement are also explored. A model of organisational alignment is developed [chapter 8], and an interview study with patients and carers elicits their priorities [chapter 9]. Finally, chapter 10 summarises the findings, highlighting opportunities to develop medical ward outcome sets and construct a model of interdisciplinary team effectiveness. These can be used to support improvements in interdisciplinary care, through changes in policy and practice.
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Smith, Russell G. "Medical discipline : the professional conduct jurisdiction of the General Medical Council, 1858 - 1990 /." Oxford [u.a.] : Clarendon Press, 1994. http://www.gbv.de/dms/spk/sbb/recht/toc/278562558.pdf.
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Tso, Simon Ho Yuen. "The graduate-entry medical student : challenges to transition through medical school." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/99890/.
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This study aims to make a sociological contribution to understanding the experience of medical students from graduate-entry medicine degree programmes. In this study, I asked the research question ‘what are the challenges experienced by graduate-entry medicine degree programme students during their transition through medical school training?’ Medical students from the University of Warwick Medical School graduate-entry medicine degree programme were invited to take part in this interview-based study. A volunteer sample of 21 medical students took part in a stage one semi-structured one-to-one interview. Fourteen of 21 medical students took part in a follow-up stage two interview between four to thirteen months later. Their interview transcripts were transcribed verbatim and analysed using thematic analysis. Results showed there were three key transition periods within the University of Warwick Medical School’s graduate-entry medicine degree programme. Medical students encountered a range of challenging issues throughout their medical school journey that could be categorised under three conceptual themes: challenges associated with the curriculum, challenges associated with their social role and generic life challenges. Learning, professional identity development and managing coping strategies were the three key challenging issues dominating their transition experience. These challenging issues were in keeping with my findings from literature review on the medical school experience of undergraduate-entry and graduate-entry students. This study has made one original sociological contribution to understanding the professionalism issue about how medical students manage health advice requests from their family and friends. The findings from this study could be useful to educators and medical schools in enhancing their student support services. It could also be useful to prospective and existing medical students in understanding the realities of undertaking a graduate-entry medicine degree programme.
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Meechan, Kenneth Alastair. "The regulation of British medical practice." Thesis, University of Glasgow, 2002. http://theses.gla.ac.uk/1587/.
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This thesis begins by considering that modern medicine as a profession has tremendous scope for both good and ill, and as an enterprise consumes a vast amount of the national wealth. Against this background, the thesis considers how and why medicine is regulated, and what the effects of this regulation are. The study aims to assess the regulation of the medical profession against the interests of the state, the profession, and the consumers of health care, to see whether the regulatory mechanisms adopted adequately safeguard the interests of all parties concerned with the practice of medicine. The methodology chapter spells out the analytical techniques which the bulk of the thesis utilises and delimits the scope of the research to cover only bodies having a legal genesis and which are universal in application. A series of "core evaluation criteria" are identified against which the four regulatory mechanisms are assessed. Chapters 3 to 6 contain the bulk of the actual research into the four main areas of regulatory endeavour which the study considers; each is analysed in turn in terms of the purpose, mechanism and effect of the regulatory machinery being considered and then assessed against the core evaluation criteria. Finally, the conclusions chapter draws together the different threads which the sector-specific analyses have identified as being points of concern, and the system as a whole is evaluated to see whether the interests of the relevant stakeholders are adequately safeguarded, to identify any regulatory gaps which exist in the present system, and to point out the direction which anyone seeking to improve the system should consider
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MacDonald, Malcolm. "The social construction of medical discourse." Thesis, University of Warwick, 1994. http://wrap.warwick.ac.uk/3980/.
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The social construction of the discourse of medical institutions is analysed, drawing on both speech act and structural theories. Discourse is defined as a symbol system which has an ideological effect. This effect is linked to the maintenance of the interests of hegemonic social groups. Michel Foucault's archaeological method accords primacy to the relations which exist between institutional and social processes in the formation of discursive relations. Foucault's genealogical method also describes how the identity of the modern subject is constituted within the power nexus of coercive institutions. Medical discourse is paradigmatic of Basil Bernstein's model of pedagogic discourse. Pedagogic discourse is constructed according to the intrinsic grammar of the pedagogic device. This comprises distributive, recontextualizing and evaluative rules. These operate in three institutional contexts: the field of production, the field of reproduction and the recontextualizing field. M. A. K. Halliday's systemic linguistics defines three metafunctions of the text which operate in relation to its context of situation: the textual, ideational, and interpersonal. The textual characteristics of three principal modalities, or genres, of medical text are described in relation to their institutional contexts: the medical research report within the field of production, the medical interview within the field of reproduction and the medical textbook within the recontextualizing field. As a medical text shifts from the field of production to the recontextualizing field, certain transformations take place in the ideational options of tense, transitivity and process and the interpersonal options of modality. These syntactic transformations, organized by codes of the pedagogic device, symbolically authorize the recontextualized medical text.
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Akinyemi, Akinola Olanrewaju. "Atlas-based segmentation of medical images." Thesis, University of Glasgow, 2011. http://theses.gla.ac.uk/2623/.
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Atlas-Based Segmentation of medical images is an image analysis task which involves labelling a desired anatomy or set of anatomy from images generated by medical imaging modalities. The overall goal of atlas-based segmentation is to assist radiologists in the detection and diagnosis of diseases. By extracting the relevant anatomy from medical images and presenting it in an appropriate view, their work-flow can be optimised. This portfolio-style thesis discusses the research projects carried out in order to evaluate the applicability of atlas-based methods to a variety of medical imaging problems. The thesis describes how atlas-based methods have been applied to heart segmentation, to extract the heart for further cardiac analysis from cardiac CT images, to kidney segmentation, to prepare the kidney for automated perfusion measurements, and to coronary vessel tracking, in order to improve on the quality of tracking algorithms. This thesis demonstrates how state of the art atlas-based segmentation techniques can be applied successfully to a range of clinical problems in different imaging modalities. Each application has been tested using not only standard experimentation principles, but also by clinically-trained personnel to evaluate its efficacy. The success of these methods is such that some of the described applications have since been deployed in commercial products. While exploring these applications, several techniques based on published literature were explored and tailored to suit each individual application. This thesis describes in detail the methods used for each application in turn, recognising the state of the art, and outlines the author's contribution in every application.
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Beilby, Justin J. "Fundholding in Australian general practice /." Title page, table of contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09MD/09mdb422.pdf.
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Williams, Patricia A. "An investigation into information security in general medical practice." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/274.
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Increased demand by governments and patients for better healthcare communication has seen a growth in adoption of electronic medical records, with general practice as the cornerstone of this distributed environment. In this progressively more electronic state, general practice is charged with the responsibility to ensure confidentiality and privacy of patient infonnation. However, evidence suggests that protection of patient information is poorly handled in general practice. The deficiency in awareness of vulnerability and risk, together with the lack of appropriate controls and knowledge, leaves medical practice insecure and potentially vulnerable to information security breaches.
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Waring, Justin J. "The social construction and control of medical errors : a new frontier for medical/managerial relations?" Thesis, University of Nottingham, 2004. http://eprints.nottingham.ac.uk/11819/.
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This thesis explores changes in medical professional work and regulation in the context of emerging 'patient safety' health policies. The study engages with three components of this policy. First, to what extent is the concept of error promoted in theory and policy being taken up within managerial practice and is this coterminous with the medical interpretation and construction of error? Second, how do medical professionals regard the introduction of new reporting systems to collect information about errors in their work? Third, what new organisational systems are being developed to analyse and control errors and how do these diverge with those approaches advocated and practiced by medical professionals? It has been estimated that one in ten of all inpatient admissions experience some form of error in the delivery of care, totalling 850,000 events a year. Given such findings a new policy framework is being developed to improve 'patient safety' in the NHS. Following the Human Factors approach a new error management system is being introduced that consists of incident reporting procedures for the collection of information about errors, matched by techniques to identify the "root causes", and promote organisational change. Of importance for this thesis is the impact of policy on established forms of medical regulation. Through predominantly qualitative research techniques, this study has been carried out within a single NHS hospital case-study involving medical and managerial occupational groups. The empirical findings suggest, firstly, that the medical construction of error is indeed divergent from that advocated in policy and practiced in management and leads to distinct trajectories for the control of error. Secondly, medical professionals are generally disinclined to participate in managerial forms of incident reporting, and where such a system is in place there is a high degree of localised professional leadership. Thirdly, it was found that alongside new managerial systems for the control of errors, there were also a range of professional-led systems embedded within medical work and the local organisation of the hospital that had precedence of other centralised hospital systems. In consequence, the ability of managerial systems to penetrate the working environment of medicine was negligible. In conclusion, it is argued that while this policy could appear to challenge the basis of medical professional regulation the social, cultural and structural context of medical work is adapting to maintain a high degree of medical control and resist managerial encroachment.
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Khadidos, Alaa. "Medical image segmentation using edge-based active contours." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/90829/.
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The main purpose of image segmentation using active contours is to extract the object of interest in images based on textural or boundary information. Active contour methods have been widely used in image segmentation applications due to their good boundary detection accuracy. In the context of medical image segmentation, weak edges and inhomogeneities remain important issues that may limit the accuracy of any segmentation method formulated using active contour models. This thesis develops new methods for segmentation of medical images based on the active contour models. Three different approaches are pursued: The first chapter proposes a novel external force that integrates gradient vector flow (GVF) field forces and balloon forces based on a weighting factor computed according to local image features. The proposed external force reduces noise sensitivity, improves performance over weak edges and allows initialization with a single manually selected point. The next chapter proposes a level set method that is based on the minimization of an objective energy functional whose energy terms are weighted according to their relative importance in detecting boundaries. This relative importance is computed based on local edge features collected from the adjacent region inside and outside of the evolving contour. The local edge features employed are the edge intensity and the degree of alignment between the images gradient vector flow field and the evolving contours normal. Finally, chapter 5 presents a framework that is capable of segmenting the cytoplasm of each individual cell and can address the problem of segmenting overlapping cervical cells using edge-based active contours. The main goal of our methodology is to provide significantly fully segmented cells with high accuracy segmentation results. All of the proposed methods are then evaluated for segmentation of various regions in real MRI and CT slices, X-ray images and cervical cell images. Evaluation results show that the proposed method leads to more accurate boundary detection results than other edge-based active contour methods (snake and level-set), particularly around weak edges.
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Smith, Leanne. "Modelling Emergency Medical Services." Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/47743/.
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Emergency Medical Services (EMS) play a pivotal role in any healthcare organisation. Response and turnaround time targets are always of great concern for the Welsh Ambulance NHS Trust (WAST). In particular, the more rural areas in South East Wales consistently perform poorly with respect to Government set response standards, whilst delayed transfer of care to Emergency Departments (EDs) is a problem publicised extensively in recent years. Many Trusts, including WAST, are additionally moving towards clinical outcome based performance measures, allowing an alternative system-evaluation approach to the traditional response threshold led strategies, resulting in a more patient centred system. Three main investigative parts form this thesis, culminating in a suite of operational and strategic decision support tools to aid EMS managers. Firstly, four novel allocation model methods are developed to provide vehicle allocations to existing stations whilst maximising patient survival. A detailed simulation model then evaluates clinical outcomes given a survival based (compared to response target based) allocation, determining also the impact of the fleet, its location and a variety of system changes of interest to WAST (through ‘what-if?’ style experimentation) on entire system performance. Additionally, a developed travel time matrix generator tool, enabling the calculation and/or prediction of journey times between all pairs of locations from route distances is utilised within the aforementioned models. The conclusions of the experimentation and investigative processes suggest system improvements can in fact come from better allocating vehicles across the region, by reducing turnaround times at hospital facilities and, in application to South East Wales, through alternative operational policies without the need to increase resources. As an example, a comparable degree of improvement in patient survival is witnessed for a simulation scenario where the fleet capacity is increased by 10% in contrast to a scenario in which ideal turnaround times (within the target) occur.
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Crookes, Patrick. "Personal bereavement and Registered General Nurses." Thesis, University of Hull, 1996. http://hydra.hull.ac.uk/resources/hull:3907.
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The purpose of the study was to 'examine the idea that the processes of normal grieving can be impaired or complicated by virtue of an individual being a nurse or midwife'. A mixed methodology was utilised to allow data to be collected at both exploratory and descriptive levels, and to provide reinforcement via the triangulation of data relating to key concepts, derived from a variety of methods. At the exploratory level, the study examined the incidence of factors said to predispose towards complicated grief (Murray-Parkes 1972), within a population of nurses and midwives. This alongside consideration of factors within the socialising environment of hospital nurse/midwifery, which might engender or reinforce certain personality traits. The study also investigated the respondents' views on their role within their family. Interviews with bereaved nurses and midwives, then explored the implications of these traits and norms of behaviour, for those who had actually experienced the death of a loved one. This provided data at the level of description, as relationships between identified concepts were examined.In the event, the data suggested that certain predisposing factors to complicated grief: a 'coper' self-concept; a strong sense of personal independence from others; and a perceived lack of functional social support, both at home and at work, were prevalent within the group studied. They also indicated a range of difficulties which may arise when nurses and midwives become consumers of the services they usually provide, and the related problem(s) of being the 'family nurse'. Interviews with bereaved nurses and midwives, then identified how one or more of these issues can impact upon the experience of family hospitalisation, and ensuing bereavement, to the detriment of individual nurses and midwives - particularly by predisposing them to delayed onset of their grief, perhaps for months or even years.
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Bouhaimed, Manal Mansour. "Medical ethics : a study of moral developments in medical students at Kuwait University." Thesis, University of Glasgow, 1997. http://theses.gla.ac.uk/1976/.
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There are few in depth attempts to address the question: why teach ethics to medical students? This thesis argues that, identifying moral growth and development as the primary goal in teaching medical ethics is essential. Lawrence Kohlberg's moral development theory is the starting point for this research. This is important to understand the work of the researcher at the Medial School in Kuwait. The instrument used in assessing the moral reasoning of medical students at Kuwait University is the Defining Issues Test (DIT), which was devised at the University of Minnesota. The study hypothesis is that the rigid, authoritarian medical education in Kuwait University that lacks any emphasis on medical ethics will inhibit the expected growth in moral development of medical students. With a disappointing response rate of only 27.8%, it was found that normally expected growth did not occur in the first four years of medical education, suggesting that the educational experience somehow inhibited student's moral reasoning ability rather than facilitating it. The results of this study cannot be understood in isolation from the general understanding of the fabric of the researcher society, which was detailed in Chapter Five. The implication of this study is basically that medical education that ignores the moral nature of medicine will fail its own purpose, the needs of its students and the welfare of society.
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Rodgers, Sheila E. "Research utilisation by nurses in general medical and surgical wards." Thesis, University of Edinburgh, 2000. http://hdl.handle.net/1842/22600.
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There has been extensive speculation about the lack of research utilisation in nursing but little attempt to quantify this phenomenon outside of North America. The current demands for evidence-based practice necessitate research utilisation as one element of that process. The study reported in this thesis aimed to investigate the extent to which nurses utilise research and further, to identify factors that promote and those that hinder research utilisation. The study was limited to nurses working in general medical and surgical wards. The study comprised a survey on the extent of research utilisation and potential influencing factors, and follow up interviews to explore the effect of identified influencing factors on research utilisation. Seventy three percent (680/936) of the nurses returned questionnaires to measure the level of utilisation of 14 research-based practices and assess the presence of potential influencing factors. The total mean research utilisation score for all nurses across all 14 nursing practices suggests that on average, nurses had heard of, believed in and were beginning to use the practices. Several factors were significantly associated with research utilisation including completion of higher education, studying research, reading research-based journals, surgical rather than medical nursing, the organisational culture and management style, the promotion of accountable practice, a clear strategy for research at nursing management level, hospital size and nursing skill mix. These were further explored in the interviews. The discussion of the findings focuses on those that illuminate the influence of both the individual and the organisation on research utilisation and also consider the interaction between individual practitioners and the organisation.
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Mahncke, Rachel J. "Measuring and applying information security governance within general medical practice." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2016. https://ro.ecu.edu.au/theses/1797.
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Australia is in the process of adopting a national approach towards the secure electronic exchange of health information. The health information contributions of general practices as the primary point of patient medical care, will be critical to the success of an interoperable national healthcare system. Sharing information creates vulnerabilities by increasing exposure to information security threats. Consequently, improvement in information security practice within general practice may positively contribute towards improved patient care by providing access to timely and accurate information. There is renewed focus within general practice on information security, inter alia the introduction of: the Royal Australian College of General Practitioners (RACGP, 2014) Computer and Information Security Standards (CISS, 2013); privacy law reform in 2014; an evolving national electronic heath record system; litigation relating to information breaches; and continuing Australian public support for mandatory data breach notification legislation.The implementation of reliable information security procedures within general practices will be critical to secure the exchange of confidential patient information. Protecting patient health information requires appropriate security measures in regards to technologies, policies, and procedures as well as ensuring that staff are well trained and aware of these security activities. Adherence to industry standard security activities will enable general practices to take responsibility for their information security thereby minimising the threat of lost or stolen information. To meet the rising number of information security threats, general practices need to adopt a framework of accountability and control to address and demonstrate effective information security management and governance. The governance component of information security remains insufficiently addressed within Australian general practice at present.This thesis demonstrates an application of international standards at a strategic level, and proposes a functional process improvement framework against which general practices can assess and implement effective information security governance. This interpretation and operationalisation of international governance of information security standard ISO/IEC 27014:2013 (ISO, 2013), had not previously been undertaken. Further, application of information security governance within the Australian general practice environment had not previously been undertaken, and formed the basis for establishing a positive information security culture.A qualitative action research methodology was utilised for the collection of national data. Further, iterative action research cycles were applied to develop the practical information security governance framework for use within general practice. Following a review of the literature, a preliminary framework was developed to include industry best practice standards and information security compliance criteria applicable to general practice. This initial governance framework extends the industry security standards developed by the RACGP CISS (2013), ISACA’s COBIT 5 (2012), NEHTA’s NESAF (2012) governance framework and Williams’ TIGS-CMM model (2007c). Information security experts validated the information security governance framework during focus groups and interview data collections, which included representatives from key Australian healthcare organisations.Following development, the governance framework was applied and tested within general practices during iterative cycles of interviews. General practice participants conducted a self-assessment against the framework, responded to semi-structured interview questions, and policy documentation was analysed. The governance framework was revised following these iterations and cycles of action research. The objective of this research method was to achieve a ‘theoretical saturation’ of the theory whereby the patterns in the general practice interviews indicated when no new information was being yielded (Mason 2010). A final cycle of a general practice interview was conducted to verify the appropriateness of the information security governance framework within Australian general practice.The contribution of this research was both theoretical and practical. A holistic governance framework and process was synthesised and formulated, which aimed to assist general practices to meet their legal and industry related compliance security responsibilities, by securing information assets in an escalating threat environment. The governance approach was designed to be achievable and sustainable for general practices over time, whilst encouraging incremental improvement in security performance. To address the people aspect of security, the governance process incorporated a risk-based structure for the review of security breaches and performance measures, to assist in making the necessary governance decisions by amending policies and processes, and accessing the required training. This strategic approach extends international and industry best practice of information security governance for use in Australian general practice, with the aim of improving the protection of confidential health information
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Rodriguez, Luna Juan Carlos. "Particle sorting and automatic particle identification for advanced medical diagnostics." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/9072/.
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The physical separation of micro-particles is very important in many research field as diverse as chemistry and medicine. The main goal of the current separation techniques is to extract micro-particles such as cells at a high processing rates and purity. Chromatography, for instance, is commonly applied for the detection and enrichment of pathogens, which is useful for the medical diagnostics of parasitic infections. Many separation techniques have been developed over the years, applying physical phenomena of different kinds and/or taking advantage of unique physical properties of the particles themselves. From all of these techniques, one that has remained popular over the years is Dielectrophoresys(DEP). One of the main reasons for its popularity is that it does not require markers of any kind; it takes advantage of differences in the particle’s polarizability, size and shape. Another distinctive characteristic of dielectrophoresis is its selectivity due to its capacity to be controlled using frequency and voltage amplitude and its suitability for small microfluidic systems. In very general terms the work I have done during my PhD studies was oriented towards the development of novel and robust technology for aiding in the micro-particle sorting and bio-particle recognition by using computer tools. The ideas and concepts I will be introducing throughout this document were allowed total freedom to evolve and change to better fulfill the main goals of the project and also to better adapt to the many technical challenges I had to face during my research. As well as developing a new dielectrophoresis method I have also tried to maximize the impact of this work by doing it in a truly accessible way for anyone, regardless if they are interested in basic research, a possible application or just looking to adapt this concepts and tools for a different purpose. The central work in this PhD thesis focuses on two main topics: - Computerized bio-particle tracking and identification using a machine-learning algorithm that incorporates a number of predictors, including colour histogram comparison. - A portable dielectrophoresis(DEP) electronic device able to tailor the potential across a microfluidic channel for particle separation. The first project is about computerized vision system designed to track and identify micro-particles of interest through the use of video microscopy, machine learning and other video processing tools. This system uses a novel particle recognition algorithm to improve specificity and speed during the tracking and identification process. We show the detection and classification of different types of cells in a diluted blood sample using a machine-learning algorithm that makes use of a number of predictors, including shape and color histogram comparison. This software can be considered as a stand alone piece of work. Its open source nature makes it ideal for scientific purposes or as a starting point for a different application. In the context of this PhD thesis, however, it is an invaluable tool for validating and quantifying experimental results obtained from the micro-particle separator experiments presented in Chapter 4. The central piece of work in this PhD thesis is introduced in Chapter 4. This project is about the development of a all-in-one continuous flow DEP based microparticle separator which uses a system of individually addressable electrodes to shape and control the particle’s potential energy profile across the entirety of a microfluidic channel. These tailored potential landscapes are created by averaging the electric field generated by 64 individual electrodes, where the electronic device has complete control over each electrode’s on/off state, frequency, AC voltage amplitude and pulse duration. All the characteristics of the potential landscapes are controlled wirelessly through a mobile phone application. These specially designed potential landscapes allow us to make lateral sorting and/or concentration of a binary mixture of particles at the same time they move through a microfluidic channel; all this without the need for buffer flows or additional external forces. One of the outstanding characteristics of this new sorting technique is that it relays exclusively on negative DEP. Most previous techniques require a combination of positive and negative DEP and possibly and external force of different nature to achieve particle sorting; all of which requires the use of a crossover frequency and hence a careful control of the conductivity of the suspending medium. Here by using only negative DEP we eschew the careful control over the conductivity of the suspending medium and the use of any other external force; all this contributes to make our device small and robust. In addition to this, our electronic device was designed to include all the supporting electronics it needs in a small and robust printed circuit board that can also be operated by batteries. We present simulation results to illustrate the physics behind this new technique along with experimental results demonstrating the separation of polystyrene beads.
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Spooner, Sharon. "Reflections on contemporary medical professionalism : an exploration of medical practice as refracted in doctors' narratives." Thesis, University of Liverpool, 2013. http://livrepository.liverpool.ac.uk/18175/.
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Background During a period of continuing changes in society and increasing availability of medical information, publication of patients’ views on experiences of health and illness have gained greater prominence. By contrast, studies of medical perspectives have tended to concentrate on reported discontent and implications for workforce planning while leaving broader insights and concerns under-investigated. Since the applied skills of highly trained and publicly funded clinicians are vital for safe and effective delivery of the nation’s health care, it seemed important to explore new ways to consider components of medical professionalism and to set these in current NHS contexts. Rationale and fieldwork Focussing attention on the individual perspectives of NHS doctors in order to hear and understand their experiences of work was central to development of this thesis. An interpretive epistemological approach to biographical narratives as told by a group of 12 doctors drawing on 25 years of NHS experience included use of Situational Analysis Mapping to support detailed analysis of their richly informative, first-hand accounts. As knowledgeable and reflective informants with stories from diverse clinical specialties and differing personal viewpoints, their narratives produced a range of views and observations shaped by their lived experiences as clinicians. Poetic representation of sociologically-informative narrative extracts provided an effective vehicle for engaging mixed audiences and has evoked emotionally resonant reactions from doctors. Findings Strong connections between individuals’ core principles and enacted responses were evident; doctors identified preferred working practices which they believed supportive of delivery of high quality health care. Key aspects of professionalism, including professional autonomy, self-regulation and application of clinical knowledge, were challenged by progressive introduction of new working processes and regulatory mechanisms. Increased recording of clinical and administrative data for performance monitoring and achievement of targets produced reactive strategies in individuals and teams while challenging their sense of professional position or developed medical identity. Poorly performing colleagues and difficult team interactions caused much disruption while blurred ethical boundaries exposed contestable decision-making and demonstrated the limited effectiveness of external regulatory monitoring. Conclusions This research indicates that contemporary NHS doctors may experience conflict between what is expected in managed medical practice and their interpretation of best professional performance. Better understanding of these fundamental relationships could constructively contribute to reconsideration of contemporary medical professionalism and assist with progressive workforce preparation for an effective future NHS.
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Loeben, Gregory Scott. "Medical futility and the goals of medicine." Diss., The University of Arizona, 1999. http://hdl.handle.net/10150/288943.
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I begin by exploring the distinction between the physiologic, quantitative, and qualitative conceptions of futility. I argue that if medical futility is going to be a useful and appropriate normative tool in the medical lexicon, it should not duplicate and confuse judgments which we already have the tools to make. Hence, I distinguish qualitative futility from the concepts of distributive justice, rationing, harm, and insufficient benefit. Lastly, I consider the argument that providing qualitative futility violates professional integrity. Next I consider the claim that futility judgments are a form of unjustified paternalism. I also explore the relationship of physician imposition of values and the ideas of individual patient well-being, and self-determination. I consider an argument put forth by Thomlinson and Brody that futility judgments actually support autonomy, concluding that their argument must be restricted to individuals whose choices can be shown to be inconsistent with their values and aims. Lastly, I provide a comparison of futility judgments and the ordinary/extraordinary distinction which shows futility to be normatively vague and clinically dangerous. Because of the potential for misuse and confusion, I compare futility and rationing judgments. I argue that rationing decisions are necessary but should be explicit rather than disguised as futility. The consequences of failing to adequately distinguish these two are unfairness to individual patients, and harm to the doctor-patient relationship and societal trust of medicine. I detail a number of models of the physician patient relationship and attempt to determine two things: (1) whether these allow for physician authority to withhold qualitatively futile care, and (2) how well these models can answer this question in the absence of an account of the goals of medicine. I conclude that various accounts offer little specific guidance about the physician's right to withhold qualitatively futile treatment. Finally, in chapter seven I attempt to ground the debate about medical futility in the larger context of a debate about the appropriate ends and goals of medicine, arguing that such limits require an extended social dialogue.
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Murphy, Sean Daniel. "Medical image segmentation in volumetric CT and MR images." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3816/.
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This portfolio thesis addresses several topics in the field of 3D medical image analysis. Automated methods are used to identify structures and points of interest within the body to aid the radiologist. The automated algorithms presented here incorporate many classical machine learning and imaging techniques, such as image registration, image filtering, supervised classification, unsupervised clustering, morphology and probabilistic modelling. All algorithms are validated against manually collected ground truth. Chapter two presents a novel algorithm for automatically detecting named anatomical landmarks within a CT scan, using a linear registration based atlas framework. The novel scans may contain a wide variety of anatomical regions from throughout the body. Registration is typically posed as a numerical optimisation problem. For this problem the associated search space is shown to be non-convex and so standard registration approaches fail. Specialised numerical optimisation schemes are developed to solve this problem with an emphasis placed on simplicity. A semi-automated algorithm for finding the centrelines of coronary arterial trees in CT angiography scans given a seed point is presented in chapter three. This is a modified classical region growing algorithm whereby the topology and geometry of the tree are discovered as the region grows. The challenges presented by the presence of large organs and other extraneous material in the vicinity of the coronary trees is mitigated by the use of an efficient modified 3D top-hat transform. Chapter four compares the accuracy of three unsupervised clustering algorithms when applied to automated tissue classification within the brain on 3D multi-spectral MR images. Chapter five presents a generalised supervised probabilistic framework for the segmentation of structures/tissues in medical images called a spatially varying classifier (SVC). This algorithm leverages off non-rigid registration techniques and is shown to be a generalisation of atlas based techniques and supervised intensity based classification. This is achieved by constructing a multivariate Gaussian classifier for each voxel in a reference scan. The SVC is applied in the context of tissue classification in multi-spectral MR images in chapter six, by simultaneously extracting the brain and classifying the tissues types within it. A specially designed pre-processing pipeline is presented which involves inter-sequence registration, spatial normalisation and intensity normalisation. The SVC is then applied to the problem of multi-compartment heart segmentation in CT angiography data with minimal modification. The accuracy of this method is shown to be comparable to other state of the art methods in the field.
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Popovic, Celia Frances. "Why do medical students fail? : a study of 1st year medical students and the educational context." Thesis, University of Birmingham, 2007. http://etheses.bham.ac.uk//id/eprint/223/.
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A third of medical students at Birmingham Medical School fail one or more first year exams. Alarm has been raised about the apparent over-representation of ethnic minority students amongst those who fail. In this case study I ask: 1. Is there a connection between students’ ethnicity and performance in end of first year exams? 2. Is the experience of medical students at this medical school conducive to effective learning? 3. What, if anything, could be done to improve students’ learning? I show that there is a link between particular students and exam performance, but the link is with socio-economic background, not ethnicity. Students from a privileged background appear to perform better than students from a disadvantaged background. I argue that this may be due to an environment which is not conducive to effective learning. Using a range of research methods I describe how students are expected to support themselves intellectually to become independent learners while passive educational methods such as lectures and a heavy timetable are favoured and students receive limited formative feedback on their progress. The study ends positively, however, as I identify improvements that could be, and in some instances have been, made to the environment.
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McGuire, Nancy Kathleen. "Inpatient suicide in the general medical setting: an integrative literature review." Montana State University, 2011. http://etd.lib.montana.edu/etd/2011/mcguire/McGuireN1211.pdf.
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As many as 69% of individuals who kill themselves visit the Emergency Department (ED) for reasons unrelated to suicide and more than one in ten completed suicides are by individuals who were seen in an ED within two months of dying. Most were not screened for suicide risk (Knesper, 2010). Although 52% of inpatient suicides occur in psychiatric settings, focusing attention on these suicides while ignoring the 48% of suicides occurring in the general hospital units is not addressing the whole of the problem. This review centered around literature pertaining to inpatient suicide in the general hospital setting with a focus on the medical-surgical and emergency departments. Data base search terms selected were "inpatient," "suicide," "impatient suicide emergency department," and "inpatient suicide medical-surgical." Twenty-one articles met the inclusion criteria (i.e., the research was done using adults in the general hospital setting, published after January 1, 2006 in the United States, written in English and was peer reviewed) and six were identified as empirical evidence. These articles were reviewed to evaluate the methodology and clinical application, compared and contrasted for similarities and differences, and patterns and themes were identified and described. After review, these studies demonstrated that nurses can play a key role in reducing suicide rates by identifying patient risk, taking appropriate action, creating a safe environment and empowering nurses to assess, make decisions and follow-up and mandatory reporting. It is clear from the literature surveyed that more research regarding inpatient suicide is a critical need.
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Pearson, David John. "Exploration of clinical learning in general medical practice : a case study." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/6303.
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This thesis tells a story of a single year in the life of a primary care teaching practice from the multiple perspectives of clinical learners and those supporting learning. This story involves many people from junior medical students to nurses and doctors with twenty years of experience. It explores how they learn as clinicians. The research takes the form of a single descriptive case study based within a purposefully chosen GP teaching practice in West Yorkshire, England. The case study comprises interview, observational and documentary data collected over a single academic year in 2008/9. Interview data from 33 subjects were transcribed and analysed using thematic analysis within a modified grounded theory approach. The evidence from interview data was strengthened through direct and indirect observation and from documents relating to learning and teaching. I present a theory of how clinical learning occurs within the chosen practice, and on the nature of being a teaching practice. The findings are presented in the context of the existing literature of learning in this setting and within a theoretical framework of literature on social learning and communities of practice. Clinical learning appears to occur through engagement and opportunity. Engagement in learning is made up of four elements; recognition, respect, relevance and emotion. The elements are remarkably consistent across learner groups. Opportunity includes the availability, authenticity and immediacy of patient encounters; and the opportunity to learn with and from peers and professional colleagues. The research findings are consistent with existing work on social learning from other settings, but add to the literature. Engagement appears possible through recognition, relevance and respect and in the absence of meaningful participation, belonging or a clear trajectory of learning. Meaningful opportunities for clinical learning include those where patient encounters are made powerful through the authenticity that arises from the social and personal context of illness, and from the immediacy of hearing patient narratives de novo. The teaching practice studied in the case study is not dissimilar to others described in the literature of primary care learning, but this case study offers a far more detailed exploration of the elements which contribute to learning in the practice. These elements include strong whole practice support for learning, a skilled and committed clinical and educational workforce and a more indefinable additional element which is best summarised as a passion for education.
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Murray, Thomas Stuart. "Factors influencing the uptake of continuing medical education in general practice." Thesis, University of Glasgow, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.318636.
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Liountris, Demitri. "Exploring rape myth acceptance among general medical practitioners in South Africa." Master's thesis, Faculty of Law, 2021. http://hdl.handle.net/11427/32782.
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Rape myths have several negative effects on society, and can affect those who come into contact with victims of sexual assault on a professional level. One group of professionals that assist victims are general medical practitioners and in a country like South Africa, that has a high rate of rape, it is not uncommon for general medical practitioners to find themselves assisting victims. Previous research has suggested that professionals who assist victims such as police officers and lawyers are susceptible to rape myth acceptance. In South Africa, research suggests that medical health professionals can have negative views of victims, depending on a number of factors such as the victim's behaviour and alcohol consumption. Presenting data collected using the Illinois Rape Myth Acceptance Scale (IRMAS) from a sample of 44 general medical practitioners in South Africa, it was found that the participants had low levels of rape myth acceptance. The findings indicated that not only were rape myths not strong influences within the sample, myths that related to the concept of ‘real rape' were the least likely to be supported. Furthermore, additional questions in the survey revealed that general medical practitioners are not well-equipped to provide care to victims of sexual assault and more effort is needed with regards to service provision.
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Green, Alan James. "Moral particularism : implications in medical ethics." Thesis, Keele University, 2014. http://eprints.keele.ac.uk/622/.
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Particularism challenges the accepted idea of normative moral theory that morality can be reduced to a finite set of fundamental principles; it sees morality as quite capable of getting on without such principles. This thesis is concerned with asking what, if any, changes would be required in the practice of medical ethics if this is correct. It is proposed that current guidelines for professional clinicians and medical scientists constitute a “fleshed out” normative system which provides pro tanto rules for ethical practice. To investigate the implications of this in a particularist world, the idea of thin and thick moral concepts is extended to cover moral principles so that generalist professional guidance is seen as constituted of thick principles. This guidance aims to provide the required confidence for the doctor-patient relationship and in particular for the trust required between doctor and patient. Examples of the development of protocols for early phase clinical trials in cancer, and of resource allocation in a resource limited system are used to investigate the difference in decision making, and thus in the decisions themselves, between generalist and particularist professionals. In a generalist world trust is placed in the systems of trustworthiness (practice guidelines etc) and thus in the developers of such systems; in a particularist world moral decisions are made by the clinician and so trust is placed much more directly in that clinician. The implications of this analysis are that under particularism medical ethical training (initial and continuing) would focus more on the development of moral character of the various professionals and less of following guidelines. The complexity of modern medicine implies that such guidelines would still be required, but they would no longer represent pro tanto duties, but rather ceteris paribus advice.
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Webb, Helena. "Doctor-patient interactions during medical consultations about obesity." Thesis, University of Nottingham, 2009. http://eprints.nottingham.ac.uk/10818/.
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The current “obesity epidemic” is a global concern for governments and healthcare organisations. Obesity is seen as a medical problem of excess body weight which can be resolved through interventions to encourage weight loss, most particularly diet and exercise regimes. Much existing sociological work focuses on moral understandings of obesity as a perceived symbol of individual greed and laziness in a culture that prioritises self-control and effort. This neglects the ways in which the condition is actively discussed and managed in relevant settings such as medical encounters. This thesis addresses this research gap by analysing talk during obesity-related medical consultations. Talk is central to all medical encounters and has particular resonance in treatments for obesity where most interventions are carried out by the patient away from the medical gaze. Patients must report on their treatment behaviours in ways that enable practitioners to evaluate them and offer further relevant advice. Talk is not only a means through which treatment is delivered but a form of treatment itself. Fieldwork took place in two UK NHS outpatient clinics specialising in weight loss treatment for obese patients. A sample of 18 patients and 1 doctor consented to have their consultations video-recorded over a period of 9 months. This resulted in 39 recorded interactions which were analysed according to the principles of Conversation Analysis (CA) to identify recurring patterns of interaction. The thesis describes how talk between doctor and patient functions to achieve certain tasks. In particular, it analyses how the specific institutional setting shapes and is shaped by talk. A dominant theme is that clinic interactions frequently invoke normative issues concerning knowledge, responsibility and effort. These issues are consistent with moral dynamics perceived to surround the condition of obesity and patient responsibilities. Doctor and patient collaboratively construct obesity as a moral issue. This has consequences for the conduct of the consultation. The findings extend existing CA knowledge on medical interactions and demonstrate the utility of an interactional approach to the sociological study of obesity. They also have relevance to healthcare policy and practice.
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Maclean, Alasdair Rhuairidh. "Consent to medical treatment and the competent adult." Thesis, University of Glasgow, 2006. http://theses.gla.ac.uk/5448/.
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In this thesis I analyse the concept of consent to medical treatment. I explore its ethical basis in autonomy and examine how other principles and ethical approaches might interact with the rules derived from autonomy. I then situate the relevant ethical obligations within the context f the healthcare professional-patient relationship which subsequently allows me to develop a textured model of consent. The model is predicated on the theory that consent is a secondary right, derivative on the underlying right which it controls. By giving or withholding consent, the autonomous person determines who may justifiably infringe the primary right. Importantly, however, the context of the professional-patent relationship highlights the relevance of consent, not just as permission, but also as agreement. I subsequently utilise the model of consent to analyse the current law, which is found to be deficient. I explore the conceptual difficulties of the split regulation between the torts of battery and negligence. I examine the current standard of disclosure and conclude that while it seems to be moving towards more autonomy respecting prudent patient standard, the courts may still be affording expert witnesses too much say in determining which risks should be disclosed. Most importantly I expose the thin and unsatisfactory conception of autonomy that appears to ground the current legal approach. Some of the common law’s deficiencies lie in tort law’s focus on the outcome rather than the process of the interaction between healthcare professional and the patient. There are three responses to these deficiencies. The common law could be allowed to continue its piecemeal development. The deficiencies of the common law could be patched up by developing professional regulation, or new legislation could be drafted to deal specifically with consent to medical treatment. If there is a genuine commitment to patient autonomy and patient centred care then I submit that legislation is justified.
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Yardley, Sarah Joy. "Understanding authentic early experience in undergraduate medical education." Thesis, Keele University, 2011. http://eprints.keele.ac.uk/3831/.
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Authentic early experience describes new medical students undertaking ‘human contact in a social or clinical context that enhances learning of health, illness or disease, and the role of the health professional’ (Littlewood et al. 2005). This thesis provides three original research contributions: a critical analysis of the application of socio-cultural and educational theories to authentic early experience; empirical data addressing two inter-related research questions; ‘How and why do students construct useful knowledge and meaning-making from authentic early experience?’ and ‘How and why do students make authentic early experiences work for them?’; and an interpretation of social processes and resultant consequences embedded in authentic early experience. Multiple theoretical perspectives were used to create a framework incorporating mixed qualitative methods. Scott’s concept of Mētis (1998) guided interpretation of not only how students created meaning but also when and how they chose to use it, and value it, relative to formally recognised knowledge. The study identified six specific findings which provide understanding of the complex consequences arising from authentic early experience. (1) Faculty and placement provider expectations of students were simultaneously too high and too low. (2) Dynamic social interactions are fundamental to meaning-making and knowledge construction (which are inextricably intertwined with identity evolution). (3) Social processes influencing authentic early experience can be described through dyads of variables which form intersecting workplace and educational spectra. (4) A holistic social view identifies unpredictable and unintended consequences of authentic early experience. (5) Students do not align the locus of ‘real learning’ with the locus of ‘real practice’. (6) Students create their own Mētis which crucially includes understanding about how to handle knowledge and meaning and how to make experiences work for them. The implications and potential applications of these findings are discussed.
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Greer, Andrew I. M. "Nanopatterning strategies for titanium based medical implants." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/5756/.
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This thesis documents the work of Andrew I. M. Greer undertaken for the fulfilment of the requirements for the Degree of Doctor of Philosophy. The project, funded by the EPSRC and MRC, is to develop a nanofabrication processing strategy compatible with titanium based orthopaedic implants. Such a development will facilitate the translation from current and historical in vitro analysis of cell-stimulating nanotopographical cues to in vivo studies upon an implant relevant material. The work presented opens by summarising the social motives and consequences before contextualising the project aims with reference to existing approaches in the field. The thesis progresses through a series of different nanofabrication approaches until an effective strategy satisfying the goals of the project is devised. Thereafter the strategy is explored with its results characterised from a material level through to a biological level. Ultimately the primary goal of the project is realised through the development of novel sol-gel chemistry capable of retaining a nanopattern and transforming into titania, the natural composition at the surface of a titanium based implant. Furthermore, nanofeatures previously too stringent to fabricate for a comprehensive biological study are readily achievable using the documented strategy and fundamental studies have been carried out which indicate that the features concerned are highly effective at up-regulating early indicators of bone formation.
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Nikukar, Habib. "Nanomechanotransduction of human mesenchymal stem cells : an application of medical nanobiotechnology." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4752/.
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In this project the influences on human adult mesenchymal stem cells using nanomechanical stimulation techniques has been explored. It is expected that human mesenchymal stem cells will find use in many autologous regenerative therapies and in tissue engineering. However, the ability to control stem cell growth and differentiation is presently limited, and this is a major hurdle to the clinical use of these multipotent cells especially when considering the desire not to use soluble factors or complex media formulations in culture. Also, unpredictable number of cells required to be clinically useful is currently a hurdle to using materials-based (stiffness, chemistry, nanotopography, etc.) culture substrates. According to known cellular reactions to environmental stimuli, it was expected that human cells show some reactions to nanoscale vibration that in the case of stem cells it could be a differentiation response. This thesis gives a first demonstration of using nanoscale mechanotransductive protocols (10-14 nm vertical displacements at 1 kHz frequency), “nanokicking”, to promote osteoblastogenesis in human mesenchymal stem cell cultures. On the basis of application of the reverse piezo effect, laser interferometry was used to develop the optimal stem cell stimulation conditions, allowing delivery of nanoscale cues across the entire surface of the Petri dishes used. A combination of biological techniques has then been used to demonstrate osteoblastogenesis. Furthermore, RhoA has been implicated as being central to osteoblastic differentiation in agreement with materials-based strategies. We validate this with pharmacological inhibition of RhoA kinase. It is easy to envisage such stimulation protocols being up-scaled to form large-scale osteoblast bioreactors as standard cell culture plates and incubators are used in the protocol.
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Peile, Edward Basil. "Evaluating process and outcome in the education of general practitioners." Thesis, Oxford Brookes University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289128.
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I set out to develop methodologies linking the educational processes adopted by General Practitioner trainers to outcomes, in terms of quality performance by their learners in later life as doctors. Evidence about educational process and about quality of practice must be collected and analysed in a format that takes full account of the judgements to be made for formative and summative assessment. This work iterates between considerations of evidence and judgements The first of three phases of research established a framework of categories and dimensions by which to describe educational behaviours of GP Trainers. This involved interviewing trained practitioners to find what had been of lasting value from training. The categories deriving from a Grounded Theoretical approach have proved useful in practice and have been incorporated into training assessments. Second Phase Research involved refining data collection methods for assessing prevalent educational behaviours in training practices. The process by which judgements are made about training was analysed and developed in the light of research findings, which support a trend towards self-assessment by trainers. The complexity of evidence collection is such that even experienced visiting teams struggled to construct meaningful aggregations across several categories in the course of a brief visit. Their limited data best serves to validate the self-assessments of trainers, carried out over an extended period of training, and involving potentially beneficial reflection-in-action and reflection-on-action. Finally, 31General Practitioners engaged in a pilot study of Insight 360® assessments of quality practice. Their self-assessments were compared against 331 patient assessments and 237 colleague perceptions. Literature review and preliminary experiments led to the conclusion that Multilevel Modelling (MLM) techniques are best suited to such data analysis. Even with small numbers, valid findings emerged around gender influences on self-perception, reinforcing the conclusion that MLM is needed if we are to relate complex data around quality of practice to the level of prior educational experience. .. Using the framework developed in this project, trainers can now be encouraged to examine their prevalent educational behaviours and record the evidence for formative and summative assessment. This work gives confidence that accumulated 3600 assessments of practitioners may in future be analysed using MLM techniques to shed light on different quality outcomes of varying educational processes
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Cassam, Carol L. "General practitioners have feelings too : the lived experience of antibiotic prescribing in a group of male general medical practitioners." Thesis, University of Surrey, 2015. http://epubs.surrey.ac.uk/807803/.
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Thousands of medical prescriptions are generated everyday by general practitioners (GPs) and one of the most frequently prescribed groups of medicines is antibiotic therapy (Duerden et al. 2011). Despite the many studies that have previously explored clinical decision making, there remains a lack of understanding about how GPs make clinical prescribing decisions. This study was undertaken because the lived experience in clinical decision making has not been widely studied and there is a gap in the literature. This study is the first of its kind to use a phenomenological approach to explore the lived experience and emotional side of antibiotic prescribing in the context of medical prescribing. The aim of this study was to explore, interpret, and understand the lived experience of antibiotic prescribing in general practice. To explore the lived experience of antibiotic prescribing, I used the methodological framework of hermeneutic interpretative phenomenology. Unstructured, face-to-face interviews were conducted with ten GP participants. I transcribed the interviews and based the analysis on Kvale’s six steps of data analysis. Medical prescribing is a complex process based on many factors that include intuitive feelings, clinical knowledge, and professional experience. There are many influences that evoke GPs’ emotions and these emotions then drive the prescribing decision. Influences are both internal, such as the knowledge and experience of the GP and external, such as patients, families, and national policy. Writing a prescription is one of the most frequent procedures undertaken in general practice, yet it often remains a challenging experience and causes many GPs to feel anxious, uneasy, and sometimes overwhelmed. Behind the confident and composed public face of GPs lies a professional group of clinicians who are caring and empathetic but often feel anxious and vulnerable. The findings of the study have implications for practice, education and research.
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Hayward, Robert M. "A Coarse Mesh Transport Method with general source treatment for medical physics." Thesis, Atlanta, Ga. : Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/31696.
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Thesis (M. S.)--Nuclear and Radiological Engineering and Medical Physics, Georgia Institute of Technology, 2010.Committee Chair: Rahnema, Farzad; Committee Member: Wang, Chris; Committee Member: Zhang, Dingkang. Part of the SMARTech Electronic Thesis and Dissertation Collection.
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Williams, J. Gary. "Supervised autonomy : medical specialties and structured conflict in an Australian General Hospital /." Title page, contents and abstract only, 1991. http://web4.library.adelaide.edu.au/theses/09PH/09phw7242.pdf.
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Robertson, Dianne. "An exploratory study of medical students' interpersonal skills in general practice consultations /." Title page, contents and abstract only, 1990. http://web4.library.adelaide.edu.au/theses/09SPS/09spsr649.pdf.
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Jones, Keith Richard. "An investigation into the use of diagnostic equipment in general medical practice." Thesis, University of Derby, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322268.
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Greenwood, J. R. "The market and the state : The pharmaceutical representative and general medical practice." Thesis, University of Nottingham, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380978.
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Saunders, Robert Edward. "Pharmacists in general medical practice : a case study of clinical commissioning groups." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5106/.
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Pharmacists have been identified to address the increasing workload in United Kingdom (UK) general practice. A pilot has been commissioned by National Health Service England (NHSE) to upskill pharmacists for this purpose. Evaluation is underway and early reports indicate that there have been integration issues. The value of pharmacists working in general practice and the level of training required for the role are not fully understood. The research reported in this thesis was started before the NHSE pilot. It was conducted to understand the background of Clinical Commissioning Group (CCG) practice pharmacists (PPs), and their interactions with stakeholders. The rationale was to provide an insight into their working relationships and to generate recommendations to support the integration of pharmacists into general practice. The project was conducted in four CCGs in the West Midlands in 2014 using an interpretive/collective case study approach incorporating mixed methods for data collection. Quantitative data was collected on the background, employment and activities of PPs. Qualitative data was collected on stakeholders’ views of the CCG PP role from commissioners, general practitioners (GPs), and patients. Different commissioning models for PPs were studied to provide a deeper understanding of PPs’ interactions. The workload problems in general practice subsequently modified the focus of this thesis to determine the value of PPs to general practice, the level of training required and to propose a model for the integration of pharmacists into UK general practice. The thesis study identified some determinants of integration found in previously published studies but also discovered new areas specific to the integration of pharmacists into UK general practice. These areas can be grouped into three elements - the pharmacist’s skills and attributes, practice level facilitation and national level support. They are presented as a unique Model for the Successful Integration of Pharmacists into General Practice Teams.
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Shalajeva, A. V. "Terminology of infectious diseases as a part of general medical terminological system." Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18937.
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Day, Cascia. "Delirium amongst HIV-infected general medical admissions in Cape Town, South Africa." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33693.
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Background Delirium is associated with increased mortality and hospital length of stay. Limited data are available from HIV-infected acute hospital admissions in developing countries. We conducted a prospective study of delirium amongst acute medical admissions in South Africa - a developing country with universal ART access and high burdens of TB and noncommunicable disease. Methods Three cohorts of adult acute medical admissions to Groote Schuur and Victoria Hospitals, Cape Town, South Africa were evaluated for prevalent delirium within 24 hours of admission. Reference delirium testing was performed by either consultant physicians or neuropsychologists, using the Confusion Assessment Method (CAM). Findings The study included 1182 acute medical admissions; with 318 (26·9%) HIV-infected Median(IQR) age and CD4 count was 35(30-43) years and 132(61-256) cells/mm3 respectively, with 140/318(44%) using ART on admission. Delirium prevalence was 17·6%(95% CI 13·7-22·1%) amongst HIV-infected patients and was an independent risk factor for inpatient mortality. In multivariable logistic regression, factors associated with delirium were age ≥55 years(AOR 6·95[2·03-23·67], p=0·002) and urea ≥15(AOR 4·83[1·7- 13·44], p=0·003), while ART use reduced risk (p=0·014). Low CD4 count, unsuppressed viral load, and active TB were not predictors of delirium; nor were other traditional risk factors such as non-opportunistic, acute infections or polypharmacy. Interpretation Delirium is common and predicts poor outcome in HIV-infected acute medical admissions in endemic settings despite increased ART use. Older HIV-infected patients with renal dysfunction are at high risk for inpatient delirium while those using ART on admission are protected.
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Otis, Kevin H. "Metacognition : a valuable aid to understanding for medical students in problem-based learning." Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/2596/.
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This study involved the first year medical students at the University of Glasgow and was designed to instil the students with metacognition. The students were briefly introduced to the concepts of context specificity, rote memorisation, and the variation in leaning styles. They were then given instruction in concept mapping stressing the metacognitive comfort of chunking and linking information. Emphasis was placed on thoughtful reflection and the integration of various disciplines. The students were told that the quality and effectiveness of their concept maps could not be assessed by anyone else. Following their normal process the students, in small groups, read the patient scenario, listed the main issues on the board and discussed each in turn. When the discussion was completed six to eight questions were generated based on gaps in knowledge highlighted during the discussion. The students individually sought answers to the questions posed. Before returning to their group for a final discussion of the questions the test subjects were asked to: put away all notes and texts, reread the scenario, using the 3-part NCR form provided construct a concept map indicating how you understand the problem, tear off bottom page of the form. The students were then instructed to take out notes and texts and make any corrections or additions desired, then tear off the bottom page of their form. The two concept maps were turned in at the beginning of the next PBL session. The students retained the top sheet of the 3-part form for their notes. Data was collected from 9 PBL groups for 10 scenarios, 546 2-part maps in all. The collected concept maps were analysed for general layout and quantity of data but not for accuracy. This analysis yielded some insight into concept formation and a quite surprising consistency of data bits for an individual over a variety of scenarios.
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Masiza, Melissa. "Factors affecting the adoption and meaningful use of electronic medical records in general practices." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1018561.
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Patients typically enter the healthcare systems at the primary care level from where they are further referred to specialists or hospitals as necessary. In the private healthcare system, primary care is provided by a general practitioner (GP). A GP will refer a patient to a specialist for treatment when necessary, while the GP remains the main healthcare provider. The provision of care is, thus, fragmented which results in continuity of care becoming a challenge. Furthermore, the majority of healthcare providers continue to use paper-based systems to capture and store patient medical data. However, capturing and storing patient medical data via electronic methods, such as Electronic Medical Records (EMRs), has been found to improve continuity of care. Despite this benefit, research reveals that smaller practices are slow to adopt electronic methods of record keeping. Hence this explorative research attempts to identify factors that affect the lack of adoption and meaningful use of EMRs in general practices. Four general practices are surveyed through patient and staff questionnaires, as well as GP interviews. Socio-Technical Systems (STS) theory is used as a theoretical lens to formulate the resulting factors. The findings of the research indicate specific factors that relate to either the social, environmental or technical sub-systems of the socio-technical system, or an overlap between these sub-systems. It is significant to note that within these sub-systems, the social sub-system plays a key role. This is due to various reasons revealed by this research. Furthermore, multiple perceptions emerged from the GP and patient participants during the analysis of the findings. These perceptions may have an influence on the adoption and potential meaningful use of an EMR in a general practice. Additionally, the socio-technical factors identified from this research highlight the challenges related to encouraging the adoption and meaningful use of EMRs. These challenges are introduced by the complexities represented by these factors. Nevertheless, addressing the factors will contribute towards improving the rate of adoption and meaningful use of EMRs in small practices.
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Zhang, Qiang. "Appearance modelling, pathology classification and evidence pinpointing for medical image analysis." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/95311/.
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We propose several methods to address the tasks of appearance representation, variation modelling, landmark detection, pathology classification and evidence pinpointing in medical image analysis. Object class representation is one of the key steps in various medical image understanding techniques. We propose a part-based parametric appearance model built on Gaussian pyramids we refer to as a Deformable Appearance Model (DAP). A DAP models the variability within a population with local translations of multiscale parts and linear appearance variations of the assembly of the parts. The fitting process uses a two-step iterative strategy: local landmark searching followed by shape regularisation. We present a simultaneous local feature searching and appearance fitting algorithm based on the weighted Lucas-Kanade (LK) method. A shape regulariser is derived to calculate the maximum likelihood shape with respect to the prior and multiple landmark candidates from multi-scale parts, with a compact closed-form solution. We apply the DAP for the tasks of variation modelling and landmark detection. To reduce the redundancy in the representation, we further propose to replace the Gaussian pyramids with wavelet pyramids in the DAPs. The new appearance model is referred to as a Wavelet Appearance Pyramid (WAP). Logarithmic wavelets are adopted to decompose the images into pyramidal complementary channels, each of which represents the image with simple textures at a given scale. The complementary property of the wavelets allows the reconstruction of the object appearance from the image channels. The Supervised Descent Method (SDM) is adopted to model implicitly the prior knowledge and fit the model to new instances. We apply the WAPs for the tasks of landmark detection and pathology classification. To learn on large scale datasets annotated with only class labels and no landmarks, we propose a weakly-supervised method utilising the theories of sparse learning and stochastic optimisation. We pay attention to identifying which specific regions and features of images contribute to a certain classification. In the medical imaging scenario, these can be the evidence regions where abnormalities are most likely to appear, and the discriminative features of these regions supporting the pathology classification. The learning is weakly-supervised requiring only the pathological labelling of the data by clinicians and no other prior knowledge. It can also be applied to learn the salient description of an anatomy discriminative from background, in order to localise the anatomy before a classification step. We formulate evidence pinpointing as a sparse descriptor learning problem. Because of the large computational complexity, the objective function is composed in a stochastic way and is optimised by the Regularised Dual Averaging (RDA) algorithm. We apply the evidence pinpointing method for the tasks of anatomy localisation and pathology classification. We test our object representation and evidence pinpointing methods on the problem of Lumbar Spinal Stenosis (LSS). We validate the performance of DAPs and WAPs on around 200 studies consisting of routine axial and sagittal MRI scans. Intervertebral sagittal and parasagittal cross-sections are typically inspected for the diagnosis of LSS, we therefore build the appearance models on L3/4, L4/5 and L5/S1 axial cross-sections and parasagittal slices. For the task of landmark detection, experiments validate the performance of the DAPs as promising in terms of convergence range, robustness to local minima and segmentation precision compared with conventional shape and appearance models. A further improvement using WAPs is observed in landmark detection and pathology classification. We validate the evidence pinpointing method on three weakly annotated datasets on 600 axial images. Experiments show that compared with supervised methods trained with labels and landmarks, our method gives favourable results trained on larger scale data with only class labels, which demonstrates the learning ability of our method under weak-supervision.
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Steven, Ian D. "Different approaches to the general practitioner management of hypertension /." Title page, table of contents and summary only, 1992. http://web4.library.adelaide.edu.au/theses/09MPM/09mpms843.pdf.
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Kleine, Klaus. "Micromachining with single mode fibre lasers for medical device production." Thesis, University of Liverpool, 2009. http://livrepository.liverpool.ac.uk/1295/.
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This Thesis is based on several research and development programs to implement the use of fibre lasers in the manufacturing of medical devices like stents and pacemakers. In general, the medical device manufacturing industry has a high demand for laser micromachining applications. The content of the thesis describes laser micromachining of metallic components with single mode fibre lasers. At the started of the research work for this thesis, most laser machining processes used flash-lamp pumped solid-state lasers for those applications. Reliable laser operation and low maintenance are required to meet the yields and up-time requirements for medical devices, such as stent cutting and pacemaker welding. Many lasers for micromachining applications are configured to operate near the diffraction limited beam performance to achieve very small feature sizes. It is challenging to maintain such a laser system performance in a production environment. The fibre laser provides a number of attractive features that could address the needs to maintain high up-time and high yields: • A single mode fibre laser does not require mirror alignment. • Diode pumped fibre lasers reduce maintenance due to eliminating the lamp change. • The compact air-cooled design helps to save expensive clean room space on the production floor. By 2000 the increases in average laser power extended the use of the fibre lasers into industrial applications such as cutting and welding.. The lasers investigated in this thesis generated 50 W to 200 W of laser power, representing the highest power levels commercially available at that time. For the microcutting of medical implants such as stents and guide wires, kerf width and sidewall surface quality are of special interest. Developing processes capable of achieving these criteria was the primary objective of the research described in this thesis. A secondary concern is the heat affected zone created by the laser machining process. Operation conditions to minimize this effect are also discussed in this thesis. Many microwelding applications in the electronics, telecom and medical device industry require smaller and smaller laser joining areas. The quality of a laser welded joint is very dependant on the temporal and spatial parameters of the laser beam. These parameters must be adjusted to match to the processing speed and the materials being welded. Switching continuous wave fibre lasers can achieve the parameters for processes requiring low average power. However the pulse-to-pulse stability can effect the process and has been investigated. Some welding applications require focus spot diameters in the order of 50 μm and pulse energy levels as low as 10 mJ. The fibre laser’s excellent single mode beam quality provides the desired spot size and laser power density. The research summarized in this thesis was performed to prove that fibre lasers are viable tools for micromachining. This thesis compares fibre laser machining results with those using legacy laser processes and describes ways to improve the quality of the fibre laser machining process.
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Öberg, Strådal Sara. "Depictions of physical order : diagrams in late Medieval English medical manuscripts." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6484/.
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Diagrams and schemas included in medieval medical manuscripts are understudied within art historical scholarship. This thesis discusses the multivalence of meanings — medical, social and theological — generated within schemas included in sixteen different medical codices, produced in England in the fourteenth and fifteenth centuries. Through text-image analysis, by considering the diagrams in relationship to the texts that immediately surround them and the other texts included within the same codex, the following chapters show that diagrams, through different means, emphasised or legitimized the surrounding texts and medical practices. Additional analysis is interpictorial: the visual motifs are considered in relationship to similar and related pictorial subjects, familiar from other manuscripts and artistic contexts. Through consideration of the intervisual references to devotional art and other scientific schemas, the multiple meanings of the medical diagrams are further elucidated. Another feature of the codices that is studied is their status as physical objects, how they were held, used, leafed through and transported. Lastly, by situating the codices and their diagrams within a late medieval English social, ideological and religious milieu, a deeper understanding of their function is achieved. This thesis shows that rather than being simple tools used in medical practice or representations of medical theories, diagrams included in medical manuscripts functioned in multiple, prescriptive and descriptive, ways to define theological, civic and gendered ideas around social order.
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Gross, Pierre Henri. "A document architecture and conferencing system for a network of multimedia medical workstations." Thesis, University of Ottawa (Canada), 1989. http://hdl.handle.net/10393/5951.
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