https://www.um.edu.mt/library/oar/handle/123456789/43290 2026-04-04T23:08:42Z 2026-04-04T23:08:42Z https://www.um.edu.mt/library/oar/handle/123456789/43448 2024-05-16T13:34:00Z 2005-01-01T00:00:00Z

Title: The applicability of the technology acceptance model to doctors in the Maltese public health care system. Abstract: Information Technology (IT) plays a key role in the implementation of major reforms in healthcare. Such strategic plans demand that healthcare employees have a good knowledge of IT and are ready to integrate the use of computers at their work. However physicians may not necessarily realise the potential benefits and may not choose to adopt IT in clinical practice. Over the last two decades several researchers have investigated the psychological theories underlying technology acceptance. The Technology Acceptance Model (TAM), developed by Fred Davis in 1989, identified the constructs of Perceived Ease of Use (PEOU) and Perceived Usefulness (PU) as predictors of Usage and Acceptance. The research has been applied to doctors and other healthcare professionals. The aim of this research was to investigate the applicability of the TAM to Doctors in the Maltese Public Healthcare System. The study population consisted of doctors employed within the Public Healthcare System that was sampled using a randomized stratified technique. The six categories included House Officers, Senior House Officers, Registrars/Senior Registrars, Consultants, Doctors in Public Health and Primary Care. A postal survey based on Davis' instrument was used to collect the data. Information on Computer Usage, Patient Administration System (PAS) Usage and Satisfaction with the PAS were also incorporated in the questionnaire. A focus group discussion was subsequently conducted to obtain qualitative information and a more in-depth understanding of the reasons why doctors would resist adopting IT and the PAS. There were 195 returned questionnaires out of the 324 mailed invitations (response rate of 60.19%). Age characteristics showed a more equal representation of male and female doctors (56 vs 44%) in the younger age group than in the older age categories. Computer availability was higher for consultants (61.4%) and for doctors in public health (100%), but was limited for junior doctors working at ward level (8.1 %). Decreased availability of computers was noticeable in primary care (20.8%), at peripheral hospitals (14.3-33%) and at out-patients departments (31 % for consultants). Junior doctors and Primary Care doctors showed less ownership of e-mail accounts (64.9% and 54.2%) and Internet access (32.4% and 33.3%). With regards to IT qualification, junior doctors were more likely to have had IT accreditation. The applicability of the Technology Acceptance Model was tested using Linear Regression. It was found that the constructs of PEOU and PU predicted which doctors were more likely to use computers at their job. However increased computer usage did not antecede PAS Adoption. Likewise Satisfaction with the PAS did not predict PAS Adoption, which indicated that other factors were contributing to its lack of popularity. Analysis of the data from the focus group identified that the PAS was now an old system that needed upgrading. It was found that doctors did not incorporate the PAS in their duties possibly due to its limited features, overcrowding at computer stations, impracticability of inputting data at ward rounds, and time constraints but also due to lack of information of its potential benefits. In an era of computerisation, organisations have to make use of technology to become more efficient so as to gain a competitive advantage. The development of an IT Strategy for Health is recommended as a framework for further developments. Such strategy will include an action plan to make computers widely available in all sectors, and to outline how such systems can be upgraded accordingly. Access to e-mail, intranet and the Internet should be encouraged and made freely available to health professionals if they are to improve their communication, their access to knowledge and to improve the quality of care. The development of a structured training programme is suggested to enable healthcare professionals use these resources effectively. This research has highlighted some important aspects which may guide policy makers in the implementation of a new Hospital Information System for the Maltese Public Healthcare System. Description: M.SC.HEALTH SERVICES MANGT.

2005-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/32304 2020-11-25T14:21:11Z 2005-01-01T00:00:00Z

Title: The physiological role of prion protein in neurodegenerative disease Abstract: The cellular prion protein (Prpc) is a glycosylphosphatidylinositol (GPI)anchored membrane protein, highly conserved in mammalian species, that is expressed most abundantly in the central nervous systenl. Post-translational modification of native PrPC into its pathogenic isoform (PrPSC) is the molecular signature underlying fatal neurodegenerative diseases, known as transmissible spongiform encephalopathies (TSEs). Since generation of PrPSC results from a misfolding of PrPC, there is a marked depletion of PrPC in the brain as the disease progresses, with consequent loss of its normal activity. Thus, identifying the function of PrPC may be crucial to understanding the basis for neurodegeneration in prion diseases. The most salient observations to date as regards prion physiology include: (i) the role of PrPC in copper homeostasis; (ii) the involvement of PrPC in triggering signal transduction pathways; and (iii) the anti-apoptotic and antioxidant properties of PrPC. The true connections between these apparently disparate functions of the prion protein remain however enigmatic, and this question was therefore addressed in the present thesis. In the first part of this work, the N-terminal domain of murine PrPC comprising amino acids 23-106 was expressed intracellularly in yeast, thus reflecting the physiological generation of a PrP23-11 0/111 fragment (known as NI) during the normal cellular trafficking of mammalian PrPC, It was found that the murine PrP23-1 06 peptide protected S. cerevisiae cells against copper(II) toxicity, but did not modify the growth phenotype in response to zinc(ll) or nickel(II) ions. In addition, it was observed that heterologous expression of PrP23-106 protected neither wild-type yeast nor mutant strains lacking the gene for eu, Zn-superoxide dismutase (SOD), against oxidant toxicity induced by paraquat. Taken together, the results of the yeast work thus suggest a possible role for the mammalian NI fragment in intracellular copper buffering, but not a physiological SOD-like activity of the protein. The aim of the second part of the thesis was to identify a signalling kinase which is activated in both a copper and PrP-dependent fashion, and which acted as a modulator of neuroprotective signalling by PrPC, The collected data strongly indicates a functional link between PrPC expression and phosphatidylinositol 3-kinase (PI3K) activation, a protein kinase that plays a pivotal role in cell survival. Both mouse neuroblastoma N2a cells and immortalized murine hippocampal neuronal cell lines expressing wild-type PrPC had significantly higher PI3K activity levels than their respective controls. Moreover, PI3K activity was found to be elevated in brain lysates from wild-type mice, as compared to prion protein knockout mice. Recruitment of PI3K by PrPC was shown to contribute to cellular survival toward oxidative stress induced by 3-morpholinosydnonimine (SIN-I) and serum deprivation. Moreover, both PI3K activation and cytoprotection by PrPC appeared to rely on copper binding to the N-terminal octapeptide of PrPC. Based on these results, a model is proposed in which copper-bound PrPC, due to its plasma membrane localization, functions as a sensor for extracellular stress with the role of copper being that of triggering metal-dependent signals to PI3K, which in turn acts as a modulator of neuroprotective signalling. Given that conversion of PrPC to PrPSC in prion diseases leads to PrPC deficiency, pharmacological stimulation of lost PrPC signals identified in this work may provide a useful treatment approach for these fatal neurological illnesses. Keywords: prion protein, copper, oxidative stress, superoxide dismutase, Saccharomyces cerevisiae, NI fragment, phosphatidylinositol 3-kinase, neuronal survival.

2005-01-01T00:00:00Z