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1
Sharma, Luv. "Examining the impact of hospital technology and administrative innovation on performance: An Econometric investigation". The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1466436879.
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Sutton, Jane C. "Accidents to patients in hospital". Thesis, University of Nottingham, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.292535.
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Griskonis, Sigitas. "Patients' perceived satisfaction with hospital services". Thesis, Nordic School of Public Health NHV, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3250.
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ackground. There are a number studies related to patients’ satisfaction with health care. Since the Baltic States regained independence in 1990, a reform of the health care system took place in which a serious consideration is paid to health care quality. Patients' views are becoming increasingly important in the current health system. They provide information on effectiveness of healthcare and how it may be improved.The main objective of this study was to investigate inpatients experiences with the care and treatment given in Klaipeda hospitals in order to improve the quality of care and patients’ satisfaction. Material and methods. A cross-sectional survey with questionnaires was made. The subjects of the investigation were patients (from 18 years old), hospitalized in internal and surgery departments in different Klaipeda city hospitals. The survey questions were divided into sections that broadly followed the patient's experience in the hospital. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multiple logistic regression to estimate Odds for each of the independent variables in the model.Results. The study shows that 60-80 % of the respondents were satisfied with different parts and aspects of health care services. Satisfaction with getting enough time for discussion with the doctor was higher for younger, male and employed patients. Those from the city needed more understandable explanation from doctor about health condition or treatment plan. Doctors listened more to male patients compare to female. Those results were statistically significant. Conclusions. Majority of the patients were satisfied with hospitalization order in Klaipeda hospitals. Better physician communication skills can improve patient satisfaction and clinical outcomes. Physicians could more effectively facilitate patient involvement by more frequently using partnership-building and supportive communication. Hospital cleanliness is quite important factor to overall satisfaction with hospital care. Waiting time is a significant component of patient satisfaction and depends from patients’ characteristics and their behavior. Different aspects of reception can influence patients’ satisfaction and must be considered. Information about continuity of the treatment were needed more for patients with an increased need for follow up, younger and living alone patients. It is important to provide the setting customers expect and create an environment that meets or exceeds customer needs for safety, security, support, competence, physical comfort, and psychological comfort.ISBN 91-7997-146-6
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Schwartz, Michael Adam. "Communication in the doctor's office deaf patients talk about their physicians /". Related electronic resource: Current Research at SU : database of SU dissertations, recent titles available full text, 2006. http://proquest.umi.com/login?COPT=REJTPTU0NWQmSU5UPTAmVkVSPTI=&clientId=3739.
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Scott, Eileen Margaret. "Hospital acquired pressure sores in surgical patients". Thesis, Teesside University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417233.
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Hennessy, Carrie Olsen. "Monitoring Psychiatric Patients’ Preparedness for Hospital Discharge". Antioch University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1521494115246141.
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Parnes, Debbie Margo. "The impact of office design on orthodontic office production: a qualitative assessment of the opinions of doctors, staff, and patients". Master's thesis, Temple University Libraries, 2011. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/211862.
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Oral BiologyM.S.
According to a report by the American Society of Interior Designers (1998), there are three primary components of productivity: employee satisfaction, customer satisfaction and financial performance. Factors that affect productivity are many in a small business, such as an orthodontic office. One such factor is the office design. The objective of this study was to qualitatively assess the impact factor of office design on employee satisfaction, customer (or patient) satisfaction, and financial performance. Two types of interviews and one survey were used in this study. The first interview was with the orthodontist(s) and the second was with staff of the orthodontic practices. The survey was for patients and/or parents of patients. Out of the 270 orthodontists practicing in a 50-mile radius surrounding Philadelphia who were contacted by mail, 35 orthodontists agreed to participate, for a response rate of 13%. Give the limitations of the study, the first twenty orthodontists to respond and coordinate an office visit were identified as the sample for this study. A total of 66 staff members were interviewed throughout the 20 office visits. Each participating office was given 50 letters to pass out to patients informing them of the online survey. Of the 1000 letters left at offices, only 42 patients participated in the online survey, for a response rate of 4.2% Based on the results collected from this study, the following conclusions were drawn: 1. Age of the office does not correlate with efficiency or practice volume. 2. Staff members used more positive adjectives to describe newer offices and staff enthusiasm was greatest at newer offices. 3. A lack of space and issues with colliding bodies and crowding were the most common problems with orthodontic office design, reported by staff and doctors alike. 4. Staff members most often spend 15 minutes for an average adjustment appointment. The office layout or design does not seem to be a factor in appointment length. 5. Female doctors more often had offices that reflected their personal preferences. 6. Most doctors believe that their office layout contributes most to efficiency within their office. 7. Trends in orthodontic office design include: an open treatment bay, a stand-up consult area, and a multipurpose room. Additionally, most offices are embracing technology and placing sterilization within their treatment area.
Temple University--Theses
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Motlhake, Malefsane Priscilla. "Non-compliance amongst T.B. patients at Moreteletsi Hospital". Diss., Pretoria : [s.n.], 2005. http://upetd.up.ac.za/thesis/available/etd-01312006-112314.
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Cheater, Francine M. "Urinary incontinence in hospital in-patients : a nursing perspective". Thesis, University of Nottingham, 1990. http://eprints.nottingham.ac.uk/13306/.
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Urinary incontinence is a common health problem with not only physical, but also far-reaching psychological and social implications for the sufferer, her family and carers. Assisting patients with meeting their eliminatory needs is a fundamental part of nursing care. Incontinence is encountered in almost every sphere of clinical practice and is a problem with which nurses are often directly concerned. Nurses, in association with other members of the health care team, have considerable potential to help patients regain continence, or when this is not possible, to ensure that the individuals concerned, and their relatives or carers, can cope effectively with the problem, both physically and psychologically. This is an area of nursing care, however, which to date has attracted little research. The studies undertaken in this thesis sought to examine the nursing assessment and management of the care of patients with urinary incontinence in acute medical and care of the elderly wards. The research comprises of a sequence of studies which examined the problem from a number of perspectives. Methods of data collection included nurse and patient self-, reports, the examination of nursing and medical documentation, direct observation and self-completed questionnaires. Findings indicated that urinary incontinence was common in acute medical and care of the elderly wards, and that a considerable proportion of patients had indwelling catheters to manage the problem. Nurses were not always aware of patients' incontinence problems and their assessments concerning important aspects of the symptom were frequently unreliable. Further inadequacies in nurses' assessments, as well as in the management of the care of patients with incontinence, were identified from an examination of the nursing and medical records, and observations of verbal hand-over reports. Qualified nurses and learners appeared ill-informed about the causes of incontinence, and the majority had little knowledge of the range of factors which need to be considered to ensure that a systematic assessment of the problem is carried out. Despite considerable scope for the provision of rehabilitative care for incontinence sufferers, many nurses appeared to have a limited appreciation of their potential for initiating such care. Evidence collected from the nursing and medical records, the verbal hand-over reports and nurses' questionnaires, suggested that the management of patients with incontinence still focuses predominantly on measures which aim to contain the problem with little attention being given to rehabilitative interventions. A considerable proportion of the charge nurses, and the majority of the other qualified nursing staff, stated they had not received any continuing in-service education relevant to the promotion of continence or management of incontinence since their basic training. Nurses exhibited positive attitudes, overall, towards the management of incontinence but their responses indicated that a number of common misconceptions surrounding the problem persist. The enrolled nurses demonstrated significantly less positive attitudes towards the management of patients with incontinence than other grades of nurses. Similarly, the nursing staff who worked in the slow-stream rehabilitation care of the elderly wards showed significantly less positive attitudes towards incontinence than the nurses working in other types of wards. The implications of the findings of these studies for nursing practice, education and further research are discussed.
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Opincariu, Marius. "Counseling the terminally ill patients with cancer in hospital". Online full text .pdf document, available to Fuller patrons only, 2003. http://www.tren.com.
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Dhatariya, Ketan. "The management of hospital in-patients with diabetes mellitus". Thesis, University of East Anglia, 2017. https://ueaeprints.uea.ac.uk/65366/.
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In the UK, the prevalence of diabetes in adults in the general population is currently reported as just over 6% in 2014-15 [1]. This rose from a prevalence of 5.5% in 2010. However, the most recent data from the 2016 United Kingdom National Diabetes In-patient Audit reported that the prevalence of diabetes amongst hospitalised in-patients was 17% [2]. This represented a rise of over 15% since the first National Diabetes In-patient Audit was carried out in 2010, and was the same rise in prevalence seen in the general population during that time. Thus diabetes is disproportionately over represented in the in-patient population. It has been recognised for many years that in-patients with diabetes experience ‘glucose-related’ harms. Any form of dysglycaemia is associated with increased harms – in terms of poor outcomes (however that is defined) and also increased mortality [3]. For many years it was well recognised that having long term high glucose concentrations was associated with an increased risk of developing the long term micro and macrovascular complications of diabetes. It was only with the publication of the two seminal trials, the Diabetes Control and Complications Trial in type 1 diabetes and the United Kingdom Prospective Diabetes Study in type 2 diabetes that showed conclusively that in an outpatient population tight glycaemic control was associated with a reduced risk of developing those complications [4,5]. However, to date whilst there are a great deal of data to show that high glucose concentrations are associated with harm in hospitalised in-patients with diabetes, there are almost no data to show that improving glucose concentrations is associated with benefit. However, most authorities agree that glucose concentrations between 6.0 and 10.0mmol/l (with an acceptable range of 4.0 to 12.0mmol/l) are likely to be most beneficial (or rather, least likely to be associated with harm). In the UK there is an organisation called the Joint British Diabetes Societies for Inpatient Care group (JBDS), of which I am a senior member. JBDS is a group of professionals interested in the care of in-patients with diabetes. This group, which is funded by Diabetes UK and the Association of British Clinical Diabetologists and is a collaboration between these two national organisations and the National Diabetes Inpatient Specialist Nurse Group, had as it’s ‘mission statement’ the focus on producing evidence based or, where this was not possible, consensus based, clinical guidelines for the management of diabetes in hospitalised in-patients. These guidelines were designed to be used by non-specialists, and written in a user friendly way to make them clinically useful. I have been involved in writing or contributing to most of the guidelines produced by the group, and have been the lead author on two of the most widely read / used documents – peri-operative care and diabetic ketoacidosis. Indeed, as a result of my involvement in these writing groups, I am now recognised as an international expert on these two subjects. I am regularly invited to speak on these subjects, but also invited to write about them as well. This thesis is a journey through various aspects of my involvement in in-patient care for patients with diabetes from the time I was first appointed as a consultant in Norwich in 2004 to the spring of 2017. In particular my hypothesis is that because of the work I and others have published, the management of in-patients with diabetes has improved the care of this vulnerable group.
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Garcia-Arce, Andres Patricio. "Strategies for Reducing Preventable Hospital Readmissions on Medicare Patients". Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6653.
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The high expenditure of healthcare in the United States (U.S.) does not translate into better quality of care. Indeed, the U.S. healthcare system is recognized by its lack of efficiency and waste (which represents about 20% of the country’s healthcare expenses). Lack of coordination is one of the most referenced causes of waste in the U.S. healthcare system, and preventable hospital readmissions have been acknowledged to be evidence of poor coordination of care. In fiscal year 2013, the Centers for Medicare and Medicaid Services (CMS) established financial penalties for inpatient care reimbursements in hospitals with excessive readmissions. All the same, the preliminary results of this effort have yet to result in a consistent reduction of readmission rates. Research in healthcare policy is usually reported through case studies, which makes it difficult to apply that research to different spatiotemporal contexts. Additionally, relevant research can remain overlooked due to the challenge of translating it from other fields. Therefore, in order to create effective healthcare policies, a system that can provide the most accurate information to stakeholders about their decisions and the future impact of those decisions should be developed.
This dissertation proposes a decision-based support system that could aid hospital administrators in the design of disease-specific interventions that target specific groups of patients who are at risk for readmission. First, the use of disease-specific interventions that were designed to reduce readmissions will be explored. Second, a variety of predictive tools for readmissions will be developed and compared to complete the search for the best tool. Finally, an optimization model bringing together the two ideas will be formulated so that hospitals can use it to design interventions. This model will target specific patients depending on their risk for readmission and minimize the cost of intervention while ensuring quality hospital performance. In sum, this work will help hospital administrators to better plan in the reduction of readmissions and in the implementation of interventions. In addition, it will deepen knowledge about the impacts of economic penalties on hospitals and facilitate the construction of stronger arguments for decisions about healthcare policy.
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Cannaby, Ann-Marie. "Improving the process of hospital discharge for medical patients". Thesis, University of Leicester, 2003. http://hdl.handle.net/2381/29454.
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A combination of methods was used in the development of the discharge intervention for patients on medical wards, these included: (1) Patient interviews and professional focus groups which explored barriers to a successful discharge; (2) A systematic review of comprehensive discharge protocols examined the effects of standardising discharge practices; (3) Reviews of patient education methods informed the intervention's components; (4) Patient and professional surveys explored perspectives, perceptions of information needs and current practices which influenced the intervention's content and design. A pilot study tested the usability and acceptability of an educational intervention in hospital and the community. The facilitated intervention (computer presentation and booklet) was designed to give patients confidence to participate and ask questions about their discharge. Patient outcome measures included knowledge, SF36, a validated patient diary and self-efficacy questionnaire. Barriers to a successful discharge included lack of knowledge, poor communication and co-ordination of discharge and no clear definition of professionals' roles. The systematic review of discharge planning protocols showed no significant improvements in patient outcomes. Patient and professional questionnaires highlighted a lack of written information and patients identified the need for specific information, with greater importance placed on information post-discharge. The patient education intervention was piloted with 50 patients, 48 understood their diagnosis and 46 could explain their medication. Significant differences were found in the SF36 (pain, social functioning and activities) and the self-efficacy questionnaire (between discharge and one month post discharge). Patients found the intervention usable and reported increased confidence to ask questions. A definitive randomised controlled trial is required to establish the effect of the education package on patient outcomes.
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Kirk, Judy Gail. "Difference in quality of life of referred hospital patients after hospital palliative care team intervention". Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/10751.
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Includes bibliographical references (leaves 34-39).Since 1948, when the World Health Organization (WHO) defined health as being not only the absence of disease and infinity but also the presence of physical, mental, and social well-being (Constitution of the World Health Organization, 1952), quality of life issues became more apparent. The aim of the research undertaken was to establish whether the hospital palliative care team (HPCT) at the Johannesburg General Hospital was making a difference to referred hospital patients' quality of life. The HPCT was started at the Johannesburg General Hospital in 2001. The team functions as an advisory body on pain and symptom control. Palliative Care is an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. The method used was the FACT G questionnaire, which was completed by the patient group initially, and thereafter HPCT intervention. The questionnaire is used to measure quality of life (QOL). The study is a descriptive cohort design. The first 24 patients completed the informed consent prior to completing the questionnaire. The pre QOL questionnaire served as the baseline QOL scores prior to HPCT intervention. The initial QOL scores were then compared to the post QOL scores after HPCT intervention. Seven subjects were excluded from the research as six patients were discharged from hospital early due to a bed shortage and one patient died. The seven patients' results from the pre FACT G questionnaire were discarded and all subsequent calculations did not include their results. The increase in the total percentage scores (45.53 to 63.35) was statistically significant (p< 0.001) using the paired t-test. Thus the results show a significant difference between pre and post assessment QOL scores. The research demonstrates significant improvements in patients' quality of life (p<0.001) after HPCT intervention. It is hoped that future research would continue to show the value of HPCT and their effect of benefiting patients' quality of life.
15
Trofino, Joan Alhanati. "A study of the consistency of nursing care hours and patient length of stay per DRG category in selected joint commission on accreditation of health care organizations as measured by diverse patient classification systems /". Access Digital Full Text version, 1988. http://pocketknowledge.tc.columbia.edu/home.php/bybib/10810626.
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Gong, Zhiping. "Developing casemix classification for acute hospital inpatients in Chengdu, China /". Access full text, 2004. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20050314.195349/index.html.
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Submitted to the School of Public Health, Faculty of Health Sciences. Thesis (Ph.D.) -- La Trobe University, 2004.Includes bibliographical references (leaves 320-329). Also available via the World Wide Web.
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Garrett, Pamela Clinical School South Western Sydney Faculty of Medicine UNSW. "The hospital experience of elderly patients with limited English proficiency". Publisher:University of New South Wales. Clinical School - South Western Sydney, 2009. http://handle.unsw.edu.au/1959.4/43753.
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Purpose Over half a million Australians (561,413) speak limited English, with 29 per cent of those being aged over 65 years (ABS 2006). Little research has been conducted into the acute hospital experience of elderly patients with limited English proficiency. This thesis examines, in an acute hospital setting, the subjective experience of a consecutive convenience sample of 258 elderly acute or emergency patients from nine language groups, who prefer to speak a language other than English. Method Trained bilingual staff investigated communication methods used by hospital staff with participants in a multilingual telephone survey (MTS). Information for validation was obtained from a medical records audit (MRA). Hospital statistical information was linked with MTS and MRA data. The agreement between the MTS and the MRA was analysed using descriptive and inferential statistics. A score, the 'Communication Complexity Score' (CCS), was developed to reflect patient clinical complexity, and the association between this score and interpreter usage was assessed. Seven language-specific focus groups were conducted to identify factors associated with a positive, a negative, or a very negative experience. Constructivist grounded theory was used to analyse the discourse in the focus groups. Results Thirty-one per cent of patients reported using professional interpreters. Concordance was present between the MTS and MRA. A positive association was found between clinical complexity and interpreter usage. The CCS had good psychometric properties. Many patients reported positive experiences; however, a theme of powerlessness was identified. Language barriers, poor patient and family involvement, staff shortages or incompetence, and inattention to cultural mores were all factors associated with negative experiences. Some patients discounted their negative experiences and were reluctant to assert their healthcare rights. An explanatory construct for this phenomenon, the 'Happy Migrant Effect,' was developed. Contributing factors for this effect include: powerlessness; positive assessment of Australian healthcare compared with the patient's country of origin; patriotism; cultural norms proscribing acceptance; politeness; desire for social acceptability; self-denigration for not learning English; and fear of reprisals following complaint. Conclusion This research has important implications for healthcare policy and service delivery associated with the quality of care and safety of patients with limited English.
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Chou, Cheng-hui. "Patient characteristics related to hospital readmission in heart failure patients". Cleveland, Ohio : Case Western Reserve University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1220463022.
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He, Xiao. "FACTORS AFFECTING RURAL KENTUCKY PATIENTS HOSPITAL CHOICE AND BYPASS BEHAVIOR". UKnowledge, 2011. http://uknowledge.uky.edu/gradschool_theses/115.
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This study examines the underutilization of rural hospitals in Kentucky. The authors study hospital and patient characteristics to determine why and how rural patients bypass local rural hospitals and how they make their decision in the hospital choice. A Health Care Service Survey conducted in rural Kentucky and hospital data drew from American Hospital Directory are used. A binary probit model and a conditional logit model are applied. The results suggest that the hospital quality, prior experiences and the satisfaction of the local hospital, along with patients’ value of hospital size, reputation and patients’ insurance coverage influence rural patients’ hospital choice. The study offers seven policy implications to better utilize rural health care institutions.
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Onimode, Yetunde Ajoke. "Response to radioiodine in male hyperthyroid patients at Tygerberg Hospital". Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/4030.
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Thesis (MSc (Medical Imaging and Clinical Oncology. Nuclear Medicine))--University of Stellenbosch, 2009.ENGLISH ABSTRACT: Radioiodine therapy is reputed to yield poorer results in male patients than in females. We retrospectively reviewed the records of 308 patients treated with radioiodine-131 (RAI) for Graves’ disease (n=266, 86.4%), toxic multinodular goitres (n=35, 11.4%) and toxic solitary nodules (n=7, 2.3%). The mean age of the men was 44 ±13.6 years (range 14-77 years). Patients with GD were predominantly in the younger age groups, while those with toxic nodular goitres were in the older range. Two hundred and fifty-nine patients (84.1%) were treated with a single dose of RAI, while 49 (15.9%) required further doses. A second dose had to be administered to 38 patients, while 8 received 3 doses, 2 got 4 doses and 1 patient had 5 doses in all (these included a first dose received prior to referral to our Thyroid Clinic). Cure was determined as euthyroidism or hypothyroidism at the 3-month follow-up visit. The average pre-treatment T4 value was 68.9 ± 31.8 pmol/L (range 5.7 – 155 pmol/L); while the mean Tc-99m pertechnetate uptake value was 15.8 ± 10.9% (range 0.88 - 62.9). Patients with GD presented with more severe hyperthyroidism than the other patients; mean free T4 of 71.9 ± 31.1 pmol/L compared to 51.4 ± 29.9 pmol/L for the TMG group of patients, and 39.6 ± 26.8 pmol/L for the TSN group (ANOVA p<0.0001, confirmed by the Kruskal-Wallis test). Patients with TMG and TSN were treated with higher doses than patients with GD; mean first doses of 349.3 ± 88.5 MBq and 428.1 ± 28.6 MBq respectively, compared to a mean dose of 325.1 ± 69.3 MBq for patients with GD. Treatment with multiple doses of RAI correlated with higher values of T4 and T3 at presentation (p<0.0001). However, none of the baseline variables of age, T4 and T3, and first dose of RAI was significant predictors of free T4 outcome at 3 months. A consistently higher dose was administered to the male patients, compared to female patients of similar age, diagnosis and level of thyrotoxicosis (Tc-99m pertechnetate uptake). Despite this, male patients had similar outcomes as the female patients 3 months after therapy. Our findings lend weight to the theory that male patients are more difficult to treat than their female counterparts, seeing that the former had similar outcomes despite the significantly higher doses of RAI administered to the males.
AFRIKAANSE OPSOMMING: Radiojodium terapie lewer na bewering swakker resultate in mans as in vroulike pasiënte. Die inligting van 308 pasiënte met Grave se siekte (n=266, 86.4%), toksiese multinodulêre tiroïed (n=35, 11.4%) en enkel toksiese nodules (n=7, 2.3%) wat met radiojodium (I-131) behandel is, is retrospektief nagegaan. Die gemiddelde ouderdom van die mans was 44 ±13.6 jaar (reikwydte 14-77 jaar). Die meeste pasiënte met Grave se siekte was in die jonger ouderdomsgroep, terwyl dié met toksiese multinodulêre tiroïed, ouer was. Tweehonderd nege-en-vyftig pasiënte (84.1%) is met ‘n enkel dosis radiojodium behandel, terwyl 49 (15.9%) meer as een dosis benodig het. ‘n Tweede dosis is aan 38 pasiënte gegee, terwyl agt 3 dosisse, twee 4 dosisse en 1 pasiënt 5 dosisse in totaal ontvang het (wat ‘n eerste dosis voor verwysing na die tiroïedkliniek, ingesluit het). Herstel is gedefinieer as eutiroïdisme of hipotiroidisme tydens die drie maande opvolgbesoek. Die gemiddelde T4-waarde voor behandeling was 68.9 ± 31.8 pmol/L (reikwydte 5.7–155 pmol/L); terwyl die gemiddelde Tc-99m pertegnetaatopname 15.8 ± 10.9% (reikwydte 0.88–62.9) was. Pasiënte met Grave se siekte het met erger hipertiroidisme as die ander pasiënte gepresenteer; met ‘n gemiddelde vry T4 van 71.9 ± 31.1 pmol/L vergeleke met 51.4 ± 29.9 pmol/L vir die toksiese multinodulêre tiroïedgroep en 39.6 ± 26.8 pmol/L vir die enkel toksiese nodule groep (ANOVA p<0.0001, bevestig met die Kruskal-Wallistoets). Pasiënte met toksiese multinodulêre tiroïed en enkel toksiese nodule, is met hoër dosisse as dié met Grave se siekte behandel; met ‘n gemiddelde eerste dosis van 349.3 ± 88.5 MBq en 428.1 ± 28.6 MBq onderskeidelik, vergeleke met ‘n gemiddelde dosis van 325.1 ± 69.3 MBq vir pasiënte met Grave se siekte. Behandeling met meer as een dosis radiojodium het gekorreleer met hoër T4- en T3- waardes by (p<0.0001). Geen van die basislyn veranderlikes (ouderdom, T4 en T3, en die eerste dosis radiojodium) was egter ‘n betekenisvolle voorspeller van die vry T4 uitkoms op 3 maande nie. Die dosis wat aan manlike pasiënte toegedien is, was konstant hoër, vergeleke met die vroulike pasiënte van dieselfde ouderdom, diagnose en vlak van tirotoksikose. (Tc-99m pertegnetaatopname). Ongeag hiervan, was die uitkoms by manlike en vroulike pasiënte 3 maande na terapie dieselfde. Ons bevindinge dra by tot die teorie dat manlike pasiënte moeiliker is om te behandel as hul vroulike eweknieë, aangesien mans soortgelyke uitkomste gehad het ten spyte van betekenisvol hoër dosisse radiojodium.
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Mohammed, Safwat Nirmeen Ahmed Sabry. "Hospital discharge planning and interface liaison for elderly care patients". Thesis, King's College London (University of London), 2004. https://kclpure.kcl.ac.uk/portal/en/theses/hospital-discharge-planning-and-interface-liaison-for-elderly-care-patients(73c7c480-a132-4a1a-b411-82eb7dbdcaea).html.
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Minn, Minn Soe. "Drug resistant tuberculosis in patients with AIDS at Bamrasnaradura hospital /". Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-MinnMinnSoe.pdf.
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Oo, Aung Myat Punnee Pitisuttithum. "Drug resistant tuberculosis in patients with AIDS at Bamrasnaradura hospital /". Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-AungMyatOO.pdf.
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Al-Awa, Bahjat. "Impact of hospital accreditation on patients' safety and quality indicators". Doctoral thesis, Universite Libre de Bruxelles, 2011. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209917.
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Ecole de Santé Publique Université Libre de Bruxelles
Academic Year 2010-2011
Al-Awa, Bahjat
Impact of Hospital Accreditation on Patients' Safety and Quality Indicators
Dissertation Summary
I.\
Doctorat en Sciences
info:eu-repo/semantics/nonPublished
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Fylan, Gwynn Elizabeth Margaret Mary. "Medicines management after hospital discharge : patients' personal and professional networks". Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14465.
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Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.
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Yeshayahu, Kfir I. "Routine Post-Procedure Recovery (RPPR) patients at Massachusetts General Hospital". Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/105954.
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Thesis: S.M., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2016. In conjunction with the Leaders for Global Operations Program at MIT.Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2016. In conjunction with the Leaders for Global Operations Program at MIT.
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 101-102).
This project offers improved strategies for managing the flow of surgical patients who are categorized as Routine Post-Procedure Recovery (RPPR) in Massachusetts General Hospital (MGH). Strategies were developed by analyzing the trade-offs in resource utilization of alternative recovery pathways. The unstandardized way in which the RPPR category is currently used creates a suboptimal utilization of hospital resources. RPPR is a booking category assigned to patients who are anticipated to be discharged within 24 hours of surgery completion. It is an internal booking category at MGH created to indicate Outpatients (as categorized by payers) whose recovery may mandate more than a few hours of hospital stay. The operational challenges incorporated in this patient population include: (i) vague definition of the category which leads to inaccurate classifications (booking category) of patients; (ii) high variability in booking practices among surgeons; (iii) high variability in patient length of stay; (iv) no established best-practice for recovery location or pathway. Problem definition and main areas for improvement were identified through data collection from hospital resources. Namely, clinician shadowing and interviews with administrative staff as well as statistical data analysis - utilizing the hospital's extensive digital databases. A key component to the recommendation development process was the grouping of surgical procedures with similar recovery pathways. This was essential to the analysis which focused on key metrics of those groups, such as patient length-of-stay, overnight stay, recovery pathways, and more. The goal of this study was optimizing the utilization of hospital resources for RPPR patients and developing actionable recommendations that would be implemented immediately. Our strategic solution approach focused on the development of a framework for establishing best practices for managing RPPR patients in increasing levels of detail. Best practices were determined for each procedure group, then for specific surgeon in each group and down to the specific patient. Each group of surgeons and procedures were provided with specific set of recommendations including booking category, recovery location and surgery time during the day. Through meetings with the surgeons and heads of different surgical departments, the project recommendations are being implemented in the hospital. Successful implementation will lead to improved operational efficiency in MGH, and will eventually benefit patients.
by Kfir I. Yeshayahu.
S.M.
M.B.A.
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Shoqirat, Noordeen. "The role of Jordanian hospital nurses in promoting patients' health". Thesis, Queen Margaret University, 2009. https://eresearch.qmu.ac.uk/handle/20.500.12289/7383.
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Background/Rationale: In recent years growing attention has been given to health and the development of health promotion within the hospital setting. This is in order to tackle the soaring medical costs and foster health improvement in the population. Given their unique relationship with patients, hospital nurses are urged to promote the patient’s health, yet internationally, little is known about their role in health promotion and, specifically, no Jordanian study was found that examines such a role. Purpose of the Study/ Setting: To understand the nature of nurses’ roles in heath promotion in a large teaching hospital in Jordan. Study Design/Methods: An in-depth constructivist case study design using a multiple method triangulation strategy was used. The study involved four phases. The first phase examined nurses’ role in health promotion using focus group discussions (n=8), non-participant observations and semi-structured questionnaires. The second phase focused on patients’ understanding of health and health promotion using focus group discussions (n=8). The third phase examined health promotion from the perspective of hospital stakeholders and a nursing educator. The fourth phase included documentary review of nurses’ job descriptions and nursing philosophy of care. Data Analysis: Whilst quantitative data were analysed using SPSS, qualitative data were thematically analysed using N-Vivo (2) and filing and colour index method. Findings: Generally, hospital nurses’ views towards their role in health promotion were positive. However, their perceived role and actual practice of health promotion were largely restricted to individualised information giving and behavioural change approaches. The thesis identified diverse contributing factors to this situation. This includes lack of time, shortage of nursing staff, lack of knowledge in heath promotion, power imbalance between doctors and nurses, low public image of nursing and gender issues related to nursing. Conclusion: The way hospital nurses’ role in health promotion is currently perceived and operationalised in practice is inconsistent with the recent health promotion ideas operating at the level of empowerment and political actions. Addressing the identified barriers therefore, together with a radical reform from curative services towards health promoting health agenda, is crucial. Unless this happens, hospital nurses’ ability to promote health might continue to be questioned. The thesis develops a conceptual model illuminating Jordanian hospital nurses’ role in health promotion together with contributing factors.
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Fylan, Beth. "Medicines Management after Hospital Discharge: Patients’ Personal and Professional Networks". Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14465.
Texto completo da fonteResumo:
Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.University of Bradford studentship
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Payne, Ashley Renee. "Home Care Factors Associated with Hospital Readmission of Psychiatric Patients". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4471.
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There has been inadequate attention to the aftercare of psychiatric patients, resulting in an increase in readmission rates plus longer hospital stays. There is a gap in the aftercare for psychiatric patients; The purpose of this qualitative retrospective study is to explore what may have contributed to readmission for psychiatric patients. The biopsychosocial model was used as the theoretical framework to support the direction of the research. The health belief model and transtheoretical model of change were used to further support for biopsychosocial model. The research questions were created to determine the influences on readmission, psychological well-being, explore the adaptation to aftercare and narrative of aftercare from the caregiver. This study used a content analysis to identify patterns and themes with a total of 10 participants. The data used had been previously collected by the behavioral transition team at Houston Methodist Hospital which consists of case notes, mental health diagnoses, hospital history and reasons for readmission. The findings include reports of psychiatric patients not adhering to their prescribed medication due to its side effects or cost, caregivers feeling overwhelmed, and the importance of psychoeducation. Once adjustments were made to the dosage or a prescription for less expensive medication, adherence improved, regular attendance to therapy sessions occurred, and the increase in the level of frustration from the caregiver. Psychiatric patients can benefit in post-discharge care if there is more focus on the reasons for hospital readmission by developing a treatment plan for the prevention of a relapse. This study may improve patient vulnerability to mental health issues and to assist psychiatric patients in establishing balance in their lives.
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Chou, Cheng-hui. "Patient characteristics related to hospital readmission in heart failure patients". Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1220463022.
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Belcher, John R. "Describing the process of homelessness among former state hospital patients". The Ohio State University, 1987. http://rave.ohiolink.edu/etdc/view?acc_num=osu1342716599.
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Bosh, Teresa K. "Prioritization of hospital patients for pharmacist intervention using cluster analysis /". The Ohio State University, 1996. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487940665437637.
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Livesley, Joan. "Children's experiences as hospital in-patients : voice, competence and work". Thesis, University of Salford, 2010. http://usir.salford.ac.uk/26780/.
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There is growing evidence that children's subjective interpretations of events may differ significantly from those of adults; yet children's voices and children's knowledge regarding hospital care remain largely unexplored. This study was undertaken to determine what counted as voice in work with hospitalised children, and explore children's subjective interpretations and knowledge as in-patients. Influenced by critical ethnographic methods, the study was undertaken in two phases with children who had been in-patients in one English tertiary referral children's ward. Phase one involved reconnaissance with 6 children to explore what mattered most to them regarding their in-patient experience. Phase two involved field work undertaken over six months, on a nephro-urology ward, and included in-depth work with nine children. Voice became manifest in what the children said but also through the non-verbal mechanisms of resisting and being silent. In this study, the children chose which voice to present when they participated in the study and that voice was accepted without question. Inductive analysis revealed that the children shared the experience of being in trouble. While they were in-patients, recognition of their competence was fluid=and contingent on structural and material factors. When their competence was denied, some of the children fought hard to re-establish their claim as authentic and knowledgeable individuals. However, while all of the children who participated in this study, regardless of ability, were capable commentators on their experiences, their capacity to work in their own best interests was sometimes challenged. During these episodes, they relied heavily on supportive adults. In the absence of supportive adults they often became marooned and subject to routinised care.
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Turner, Alex. "Caring for patients with dementia in a general hospital setting". Thesis, Lancaster University, 2014. http://eprints.lancs.ac.uk/71547/.
Texto completo da fonteResumo:
This thesis is divided into three sections. Section one, the literature review, considers the experiences of general hospital staff caring for patients with dementia. 14 papers were included in the meta-synthesis. Five key themes were constructed from the analysis: the unknown and undesirable; constraints of the environmental and organisational context; emphasising the physical health of patients; recognising the benefits of person-centred care; and identifying the need for training. The synthesis identified how a lack of knowledge of dementia, particularly regarding behaviours that are considered challenging, can contribute to low staff confidence and negativity towards these patients. This, along with organisational constraints, can impact on ability to provide person-centred care. The benefits of dementia training have been recognised. Clinical and research implications of the findings are discussed. Section two, the empirical paper, considered the experiences of staff within general hospitals regarding the use of truth and deception when caring for patients with dementia. In particular, it explored their decision making processes when choosing whether to tell the truth or to deceive. A grounded theory methodology was used to construct a theoretical model of this process. The analysis identified how ‘triggers’ set in motion the need for a response. Various ‘mediating factors’ (including a lack of communication, the individual’s interpretation of their role and responsibility, and their ethical framework) influenced how staff chose to ‘respond’ to those triggers. Again, clinical and research implications have been recognised. Section three, the critical appraisal, offers a reflective account of the research journey. These reflections are organised into six categories that consider the researcher’s own decision-making processes when carrying out the empirical paper.
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Williams, Levonne. "The relationship between the two levels of patient education program implementation within the hospital environment and the impact of selected hospital attributes /". The Ohio State University, 1987. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487586889186837.
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Sweet, Ronda. "Improving Pain Management for Hospitalized Patients". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2385.
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Uncontrolled pain has proven effects on both physiological and psychological responses of hospitalized patients. These incapacitating sequelae most often negatively impact patient outcomes resulting in unnecessary suffering and prolong hospitalizations. First line nurses often have preconceived notions about a patient's pain without developing an individualized patient context that considers appropriate pain management knowledge translated from best practice standards. Guided by Bandura's social learning theory and Lippitt's change theory, the purpose of this quality improvement project was to determine if use of the Curriculum Outline on Pain for Nursing from the International Association for the Study of Pain (IASP) improved nursing knowledge of pain management for hospitalized patients. The Knowledge and Attitude Survey Regarding Pain was given as a pretest and posttest to assess the knowledge of 100 registered nurses from an acute care hospital, before and after an education intervention was provided. The results of the paired pretests and posttests indicated a statistically significant difference t(99) = 0.03, (p < 0.05) following use of the IASP Curriculum. Use of the IASP Outline Curriculum, coupled with sustainability strategies, has a strong probability of impacting nurses' knowledge and subsequently contributing to positive social change for the community of patients expecting optimal clinical outcomes from their nurses.
37
D'Anna, T. (Theo). "Evaluation of the aggregate interference in 2.4 GHz ISM band in home, office and hospital environments". Master's thesis, University of Oulu, 2015. http://jultika.oulu.fi/Record/nbnfioulu-201505071488.
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Abstract. In the last years, the wireless body area network (WBAN) research has grown considerably and the idea to apply WBAN to the medical and healthcare issues could materialize. A possible WBAN could exploit the ISM (industrial, scientific and medical) band, clustered around 2.4 GHz. The ISM band is just used by other communication systems and non-communication systems. These systems transmit signals, defined aggregate interference, that could hinder the WBAN communications.
In this thesis, the ISM band is investigated in order to understand if the amount of interference is too high to allow implementation of a new WBAN or if the coexistence between WBAN and the other systems is still possible.
The ISM band analyses are carried out using data collected in real-life measurements, in environments where a patient monitored by a WBAN could usually stay. Data was collected in an office and a home environments, situated in Florence, Italy, in “San Giuseppe” hospital located in Empoli, Italy and in Oulu University Hospital, situated in Oulu, Finland. In each location, data are collected during a week using a spectrum analyzer (SA). The information measured by the SA is the power, expressed in dBm.
In this work, a spectrum occupancy evaluation (SOE) has been developed to analyze the occupancy percentage of every frequency channel of the ISM band. The occupancy value is determined by a threshold, which divides the interference samples from the noise samples. In this work, the occupancy is evaluated using both a fixed threshold and a dynamic threshold, which value directly depends on the samples’ values. The results achieved using fixed and dynamic thresholds are discussed and compared.
In addition, a time domain analysis has been carried out in order to know the amplitude, the time distribution and the size of the interference contributions. The time domain results allow to predict the interference behavior, making possible the extraction of a statistical interference modelling.
The final results of the analyses depend strongly on the measurement location, the time and the measurement equipment. However, in most cases, the occupancy value is below 10%. Hence, the amount of interference is not so high as to prevent the implementation of a new WBAN or to determine an added smartness to the WBAN.
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Gerstenmaier, Jan Frank Wirongrong Chierakul. "Pulmonary manifestations in melioidosis patients /". Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd387/4838790.pdf.
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Thematic Paper (M.Sc. (Clinical Tropical Medicine))--Mahidol University, 2006.LICL has E-Thesis 0011 ; please contact computer services. LIRV has E-Thesis 0011 ; please contact circulation services.
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Wu, Po-man, e 胡寶文. "Statistical analysis of cancer of cervix patients at Queen Mary Hospital". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1991. http://hub.hku.hk/bib/B31976815.
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Tang, Yuen-ming Lewis, e 鄧遠明. "Clinical outcomes for patients with traumatic brain injury in Kowloon Hospital". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31969938.
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Wong, Shui Wai, e 黃瑞威. "The living arrangements of discharged stroke patients from H.K. Buddhist Hospital". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1988. http://hub.hku.hk/bib/B31248263.
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McGlone, Pauline. "Factors affecting the food intake of patients in a British hospital". Thesis, London South Bank University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297918.
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Tang, Yuen-ming Lewis. "Clinical outcomes for patients with traumatic brain injury in Kowloon Hospital". Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk/hkuto/record.jsp?B23295818.
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Bounyadeth, Somboun. "Cutaneous findings in HIV positive patients at Pramongkutklao Hospital Skin Clinic /". Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-SombuanB.pdf.
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Smith, Cara. "Protecting the Rights of Limited English Proficiency Patients During Hospital Discharge". Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/491897.
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Urban BioethicsM.A.
Discharge instructions were originally created to alleviate the burden of transitioning from inpatient hospitalization to outpatient care. The US healthcare model's evolution throughout the 20th and 21st centuries has firmly distinguished inpatient providers from outpatient providers, with little continuity between them. As a patient leaves inpatient care there is an increasing need for clear discharge instructions to help navigate complex diseases and care regimens. However, comprehension of discharge instructions, both oral and written, is a major obstacle for many populations, with certain demographics especially affected. Populations with limited English proficiency (LEP), for example, are commonly provided discharge instructions in English, preventing them from fully engaging in their care and from understanding information that is paramount to a smooth transition to outpatient settings. Many factors contribute to the failure to provide this and other care in LEP patients' primary languages. Factors include but are not limited to: misinformation regarding price of interpreter services and time necessary to use these services, biases against LEP populations, and ignorance regarding the effect this has on the LEP population. This paper discusses the background of discharge instructions, reasons for development, the price LEP patients pay when we fail to provide care in their primary language, and possible reasons why we fail to provide that care.
Temple University--Theses
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Makondo, Rulani. "Adherence to lifestyle modification recommendations in hypertensive patients at Parirenyatwa Hospital". University of the Western Cape, 2018. http://hdl.handle.net/11394/6899.
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Magister Public Health - MPHBackground: Hypertension (HTN) complications are one of the leading causes of disability and mortality worldwide, with increasing trends noted in Africa. The most neglected causes of uncontrolled HTN and its complications are unhealthy diets, excess alcohol consumption and physical inactivity. Adherence to recommended lifestyle modifications remains low in Zimbabwe. This study seeks to explore the factors influencing adherence to World Health Organisation (WHO) lifestyle modification recommendations in patients with hypertension at Parirenyatwa Hospital, Harare. Methodology: An analytic cross-sectional study design was utilized. 328 hypertensive patients aged at least 18, receiving care at Parirenyatwa Hospital were recruited into the study. A self-administered questionnaire was used to collect information on demographics, knowledge and adherence to WHO recommended lifestyle modifications from participants. Statistical Package for Social Scientists (SPSS) version 20 was used for data analysis. The Spearman test was used to test for linear correlation among variables and the 5-point Likert Scale was utilized to categorize the extent of practice of dietary and physical activity recommendations by WHO.
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Bowen, Jennifer Anne. "Patients' perceptions of factors that affect recovery from illness in hospital". Thesis, Swansea University, 2009. https://cronfa.swan.ac.uk/Record/cronfa43075.
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Eyegue-Sandy, Katherine. "Decreasing Thirty Days Hospital Readmission Rates of Adult Heart Failure Patients". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3767.
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Heart failure is a complex heart disease that incapacitates more than 5 million people, is associated with increasing healthcare cost, and remains the leading cause of admission in the United States. As the United States faces increasing financial burden related to readmission of heart failure patients within 30 days of discharge, many healthcare institutions are evaluating interventions to determine the most effective opportunities to improve systems, including nursing practice. The purpose of this doctoral project was to improve readmission rates within 30 days of discharge from an acute care facility through the development and implementation of a standardized, evidence-based, patient-centered discharge education toolkit using the Teach-Back method. Orem's self-care theory and the situation-specific theory of heart failure self-care were utilized as a theoretical framework to inform this doctoral project. The sources of evidence were obtained from the Get With The Guidelines-Heart Failure database and through a review of nursing and health-related databases. Descriptive statistics were used to compare the pre- and posteducation session readmission rates. The rate of readmissions occurring within thirty days of discharge pre- and post-educational session retrieved from the GWTG-Heart Failure database were 9.4% and 0.0% respectively. These results showed that this discharge toolkit reduced heart failure 30-days readmission rates. The limitations and strengths of this project will be used to guide further research on heart failure readmission and self-care management. This DNP project will promote positive social change for clinicians, who can use this discharge toolkit to improve self-management in adults with heart failure and thus decrease the costs related to readmission.
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Hsiao, Hung-I. "Hospital Admissions of Patients with Asthma: A Short Term Trend Analysis". University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1439296276.
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Strachan, Eric D. "Evaluation of education and skill training regarding involuntary hospitalization for psychiatric inpatients". [Lincoln, Neb. : University of Nebraska-Lincoln], 2004. http://www.unl.edu/libr/Dissertations/2004/StrachanDis.pdf.
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