Our health is what we value most. Medicine as a scientific branch has made a great step forward in the last decades. Due to this fact, the demographical structure of inhabitants changed significantly. People reach higher age, we are able to treat diseases, which used to cause death. Nevertheless, we are not anymore in a phase, when financial costs equal treatment needed for all people in Czech Republic. Therefore, the topic Ethics in healthcare is an actual one. The aim of this thesis is the description and following analysis of actual problems in Czech healthcare. There are stated the main problems in Czech healthcare, where the relationship between ethics and economics is mostly visible. The proposal for improving the actual situation, is to extend the Ethical code of Czech Medical Chamber, as the document, which brings the main ethical standards in healthcare. The next proposal for improving the actual situation in Czech healthcare, is to make new ethical codes for different medical specialties. It is also advised to place the Ethical code of Czech Medical Chamber on visible places. The used method is compilation of literature and interviews with professionals and medics for analytical approaches. In this thesis, data from Czech Institution for Health Information and Statistics are used. There are also used articles form healthcare magazines and from general periodicals.

Infraestruturas de Informação foram inicialmente conceituadas como objetos técnicos por autores que identificaram atributos necessários para a evolução de uma II. Entretanto, além dos seus condicionantes técnicos, infraestruturas de informação, evoluem também como resultado da ação gerencial e como tais, precisam ser vistas no contexto da sua contribuição aos objetivos das organizações ou mercados, dos arranjos organizacionais entre os parceiros-usuários e a governança do processo. No intuito de contribuir para os conceitos de II, este trabalho de pesquisa buscou aplicar os conceitos da Kernel Theory, com outras teorias já consagradas, em uma instituição de alta complexidade inserida no ambiente complexo da Saúde: um hospital. O estudo foi feito no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), centro de excelência e referência no campo de assistência, ensino e pesquisa e considerado um dos pólos brasileiros mais importantes de disseminação de informações técnico-científicas.A metodologia adotada foi a do estudo de caso único longitudinal, com abordagem qualitativa, tendo como base de análise a Kernel Theory, comparando seus critérios de evolução de IIs com critérios da Governança de TI, Teoria de Redes Interorganizacionais, Teoria Institucional e RBV (Resource Based View). Para a coleta de dados foi feita a análise documental e as entrevistas semi-estruturadas. Este estudo, além de oferecer a possibilidade de extensão da Kernel Theory, poderá fornecer orientação para a prática da gestão, oferecendo critérios de natureza organizacional e institucional que favorecem a evolução de IIs em ambientes organizacionais complexos. / Information Infrastructures (II) were initially conceptualized as technical objects by authors that identified attributes required for the evolution of an II. However, beyond its technical limitations information infrastructures may also evolve as a result of managerial actions and as such, must be considered in the context of its contribution to the goals of organizations and markets, the organizational arrangement between partners, users and the governance process. In order to contribute to the concepts of II, this research sought to apply the concepts of Kernel Theory with other already established theories at an institution of high complexity in the health sector: a hospital. The study was conducted at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) , a center of excellence and reference in the field of assistance, education and research and considered one of Brazil´s most important centers for the dissemination of technical-scientific information. Single case longitudinal study was the adopted research methodology, with a qualitative approach, using criteria from Kernel Theory compared to criteria from IT Governance, Theory of Interorganizational Networks, Institutional Theory and RBV (Resource Based View). Data collection was based on document analysis, structured and semi-structured interviews. This study, not only offers the possibility of extending the Kernel Theory, but can also provide guidance for management, providing criteria of organizational and institutional nature that can stimulate the evolution of IIs in complex organizational environments.

Clinical nursing practice is on the cusp of significant and unrelenting change amid globalization, austerity measures and technological advancements as the world moves out of the industrial age into the knowledge age. With advances in technology, theory and research, the potential changes to future nursing practice are unlimited. Understanding the process nurses undertake to change their practice in light of these predicted trends is critical if outcomes for patients are to be safe and effective. Yet, there was a paucity of published research that investigate the process of nursing practice change. Thus, the purpose of this study was to describe the process registered nurses undertake to change their clinical practice. The study used an interpretive description methodology and involved interviewing 15 registered nurses with various backgrounds and experience in Doha, Qatar. Data were analyzed using constant comparison methods, simultaneous data collection and analysis, and intensive memoing. The findings revealed an overall theme of asing the dis-ease’, in addition to three sub-themes: disruption, actioning and stabilizing. The study provide simportant insights into how nurses change their clinical practice. A significant contribution of this study is the role of the individual in changing nursing practice. / Graduate / 2020-06-03

In March of 2010, the 44th President of the United States, Barack Obama, signed into law a health care reform bill that will change the medical and business approach to healthcare that has been witnessed for quite some time. The Patient Protection and Affordable Care Act, aims to eliminate several inefficiencies encountered in our current health care system, as well as extend coverage by providing affordable care for the roughly forty six million Americans currently uninsured. Many of the changes will be implemented over the next several years, but hospitals, businesses, physicians, and insurance companies are no doubt planning ahead for the effects these changes will have on their particular industry. Although there will be many facets of change affecting all of the previously mentioned occupancies, the goal of this paper is to investigate the effect healthcare reform will have on private medical practices in the United States. The following sections will cover ways in which medicine has been practiced in the pre-reform era, historical attempts made to pass health reform legislation, several of the issues our current system faces along with the reform changes implemented to fix them. Then I will investigate the effect these changes will have, if any, and conclude by relating everything back to independent medical practices.

<p>In this modern world, healthcare has becoming a popular word in human life. People pay their attention on their health protection and treatment, but at the same time, they need to bear the high expenditure for their healthcare processing.</p><p>It is a serious problem that the government income can not afford the large expense in healthcare industry. Especially in some developing countries, healthcare problem has become the problem for the nation development.</p><p>We would like to choose this basic way to solve this problem directly, to provide the channel to improve the efficiency of healthcare system, Cambio COSMIC.</p><p>The aim to analysis COSMIC for my case study is to find out the conclusion that how does the architect design the system from the stakeholders requirement to achieve the success of improving the efficiency of healthcare system. And how to measure the success for the system achieving to improve the efficiency of healthcare system is still required to indicate.</p>

According to the Institute of Medicine (IOM), the U.S. health care delivery system does not provide consistent, high-quality medical care to all people all the time. As a significant component of the health care delivery system, the state of Graduate Medical Education in the United States has prompted much analysis in recent years due to the general view that desired and actual outcomes are increasingly at variance with each other. One area of focus has been the implications of change for provider credentialing and funding of graduate medical education. With this research we test the hypothesis that residents perform valuable work in the teaching hospitals where they undergo training, to inform the issue regarding provider credentialing for residents. We developed a framework to compare second-year residents (PGY2), physician assistants with one year of experience, and nurse practitioners with one year of experience to measurably address the interchangeability of providers. Data was collected by obtaining expert opinions on the proficiency of the three provider options (resident, physician assistant, nurse practitioner) in performing a set of tasks/procedures by surveying the program directors of Internal Medicine residency programs in the United States. The other residency programs at the University of South Floridas College of Medicine were also surveyed to obtain measurable performance on the service providers.Statistical tools were used to analyze the survey responses, aggregate patient data and salary data for each provider. The data analysis and summary indicated that residents displayed higher levels of proficiency than physician assistants and nurse practitioners for the tasks investigated.

Darbo tikslas. Ištirti Lietuvos daugiaprofilinės ligoninės N skyriaus darbuotojų nuomonę apie konfliktų valdymą. Uždaviniai. 1. Įvertinti Lietuvos daugiaprofilinės ligoninės N skyriaus darbuotojų požiūrį į konfliktus darbe ir jų priežastis; 2. Atskleisti vyraujančias konfliktų valdymo strategijas tarp Lietuvos daugiaprofilinės ligoninės N skyriaus darbuotojų; 3. Įvertinti Lietuvos daugiaprofilinės ligoninės N skyriaus darbuotojų ketinimus gilinti žinias konfliktų valdymo srityje. Tyrimo metodika. Tyrime objektas – darbuotojai, dirbantys Lietuvos daugiaprofilinės ligoninės N klinikoje. Tyrimui atlikti buvo pasirinkta anketinė apklausa. Naudotas T. Killman konflikto būdo instrumentas. Kokybinių požymių tarpusavio priklausomumui vertinti taikytas chi kvadrato (χ2) kriterijus. Priklausomai nuo imčių dydžio, buvo taikytas tikslus Fisher's arba Monte Carlo (mažoms imtims) ir asimptominis χ2 kriterijus. Tyrimo kintamųjų struktūrai tirti panaudotas faktorinės analizės metodas. Rezultatai. Daugiau nei pusė respondentų (67,4 proc.) konfliktus įvertino visiškai neigiamai, visiškai teigiamai konfliktus vertina tik 7,2 proc. darbuotojų. Pseudokonfliktus, kaip dažniausiai vykstančius, įvardino 34,9 proc., tarpasmeninius – 31,0 proc. darbuotojų. Pusė respondentų (50,0 proc.), esant konfliktinei situacijai, naudoja vengimo strategiją, 27 proc. apklaustųjų bando ieškoti kompromiso ir tik 2 proc. bendradarbiauja. Didžioji dalis respondentų 76,9 proc. norėtų gilinti savo žinias šioje srityje... [toliau žr. visą tekstą] / Aim of the study. To reveal employees opinion on conflict management in N division of Lithuania multi-division hospital. Objectives. 1. Rate employees opinion on conflict at the workplace and conflict management in N division in Lithuanian multi-division hospital; 2. Reveal prevailing conflict management strategies among employees; 3. Reveal employees intention to deepen their knowledge of conflict management. Methods. Study object – employees of N division of Lithuanian multi-division hospital. Study questionnaire along with T. Killman conflict mode instrument was used. For qualitative assessment of interdependence of variables the chi-square (χ2) test was used. Depending on the size of the sample, Fisher or Monte Carlo (for small samples) and asymptomatic χ2 criterion were used. Factor analysis was used to investigate the structure of study variables. Results. More than half of the respondents (67.4 %) evaluated conflicts as a completely negative object and only 7.2 % of employees see it as a positive object. Pseudo conflicts, as usually occurring in the workplace, were named by 34.9 %, interpersonal – 31.0 % and structural – 22.9 % of employees. In a conflict situation half of the respondents (50.0 %) are using avoidance strategies, 27 % - are trying to find a compromise and only 2 % of employees cooperate. The majority of the respondents (76.9 %) would like to deepen their knowledge in this area. Most acceptable conflict management knowledge and skill development... [to full text]

Thesis (MEng)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: South Africa has a severe HIV (human immunodeficiency virus) burden and the management of the disease is a priority, especially in the public healthcare sector. One element of managing the disease, is determining when to initiate an HIV positive individual onto anti-retroviral therapy (ART), a treatment that the patient will remain on for the remainder of their lifetime. For the majority of HIV positive individuals in the country, this decision is governed by the results of a CD4 (cluster of differentiation 4) test that is performed at set time intervals from the time that the patient is diagnosed with HIV until the patient is initiated onto ART. A device for CD4 measurement at the point of care (POC), the Alere PIMA™, has recently become commercially available. This has prompted a need to evaluate whether CD4 testing at the POC (i.e. at the patient serving healthcare facility) should be incorporated into the South African public healthcare sector's HIV diagnostic service provision model. One challenge associated with the management of HIV in the country is the relatively large percentage of patients that are lost to follow-up at various points in the HIV treatment process. There is extensive evidence that testing CD4 levels at the POC (rather than in a laboratory, as is the current practice) reduces the percentage of patients that are lost to follow-up before being initiated onto ART. Therefore, though POC CD4 testing is more expensive than laboratory-based CD4 testing, the use of this technology in South Africa should be investigated for its potential to positively influence health outcomes. In this research, a multi-objective location science model is used to generate scenarios for the provision of CD4 testing capability. For each scenario, CD4 testing provision at 3 279 ART initiation facilities is considered. For each facility, either (i) a POC device is placed at the site; or (ii) the site's testing workload is referred to one of the 61 CD4 laboratories in the country. To develop this model, the characteristics of eight basic facility location models are compared to the attributes of the real-world problem in order to select the most suitable one for application. The selected model's objective, assumptions and inputs are adjusted in order to adequately model the realworld problem. The model is solved using the cross-entropy method for multi-objective optimisation and the results are verified using a commercial algorithm. Nine scenarios are selected from the acquired Pareto set for detailed presentation. In addition, details on the status quo as well as a scenario where POC testing is used as widely as possible are also presented. These scenarios are selected to provide decision-makers with information on the range of options that should be considered, from no or very limited use to widespread use of POC testing. Arguably the most valuable contribution of this research is to provide an indication of the optimal trade-off points between an improved healthcare outcome due to POC CD4 testing and increased healthcare spending on POC CD4 testing in the South African public healthcare context. This research also contributes to the location science literature and the metaheuristic literature. / AFRIKAANSE OPSOMMING: Suid-Afrika gaan gebuk onder `n swaar MIV- (menslike-immuniteitsgebreksvirus-) las en die bestuur van die siekte is `n prioriteit, veral in die openbare gesondheidsorgsektor. Een element in die bestuur van die siekte is om te bepaal wanneer `n MIV-positiewe individu met antiretrovirale- (ARV-)behandeling behoort te begin, waarop pasiënte dan vir die res van hul lewens bly. Vir die meeste MIV-positiewe individue in die land word hierdie besluit bepaal deur die uitslae van `n CD4- (cluster of differentiation 4-)toets wat met vasgestelde tussenposes uitgevoer word vandat die pasiënt met MIV gediagnoseer word totdat hy of sy met ARV-behandeling begin. `n Toestel vir CD4-meting by die punt van sorg (\POC"), die Alere PIMA™, is onlangs kommersieel beskikbaar gestel. Dit het `n behoefte laat ontstaan om te bepaal of CD4-toetsing by die POC (met ander woorde, by die gesondheidsorgfasiliteit waar die pasiënt bedien word) by die MIV-diagnostiese diensleweringsmodel van die Suid-Afrikaanse openbare gesondheidsorgsektor ingesluit behoort te word. Een uitdaging met betrekking tot MIV-bestuur in die land is die betreklik groot persentasie pasiënte wat verlore gaan vir nasorg in die verskillende stadiums van die MIV-behandelingsproses. Heelwat bewyse dui daarop dat die toetsing van CD4-vlakke by die POC (eerder as in `n laboratorium, soos wat tans die praktyk is) die persentasie pasiënte wat verlore gaan vir nasorg voordat hulle met ARV-behandeling kan begin, verminder. Daarom, hoewel CD4-toetsing by die POC duurder is as toetsing in `n laboratorium, behoort die gebruik van hierdie tegnologie in Suid-Afrika ondersoek te word. In hierdie studie is `n meerdoelige liggingswetenskapmodel gebruik om scenario's vir die voorsiening van CD4-toetsvermoë te skep. Vir elke scenario word CD4-toetsvermoë by 3 279 ARV-inisiasie fasiliteite oorweeg. Vir elke fasiliteit word toetsvermoë verskaf deur (i) die plasing van POC-toestelle by die fasiliteit, of (ii) verwysing vir laboratoriumgebaseerde toetsing by een van die 61 CD4-laboratoriums in die land. Die kenmerke van agt basiese fasiliteitsliggingsmodelle is met die kenmerke van die werklike probleem vergelyk om die mees geskikte model vir toepassing op die werklike probleem te bepaal. Die doelwitte, aannames en insette van die gekose model is daarna aangepas om die werklike probleem voldoende te modelleer. Die model is opgelos met behulp van die kruis-entropie-metode vir meerdoelige optimering, waarna die resultate deur middel van `n kommersiële algoritme bevestig is. Nege scenario's uit die verworwe Pareto-stel word uitvoerig aangebied. Daarbenewens beskryf die studieresultate die besonderhede van die status quo sowel as `n scenario waar POC-toetsing so wyd moontlik gebruik word. Hierdie scenario's word aangebied om besluitnemers van inligting te voorsien oor die verskeidenheid moontlikhede wat oorweeg kan word, wat wissel van geen of baie beperkte tot wydverspreide gebruik van POC-toetsing. Die mees beduidende bydrae van hierdie navorsing is stellig dat dit `n aanduiding bied van die optimale kompromie tussen `n verbeterde gesondheidsorguitkoms weens CD4-toetsing by die POC, en verhoogde gesondheidsorgbesteding aan CD4-toetsing by die POC, in die konteks van Suid-Afrikaanse openbare gesondheidsorg. Die navorsing dra ook by tot die ligingswetenskapliteratuur sowel as tot die metaheuristiekliteratuur.

The aim of this master s thesis is to establish continual program of health care quality improvement in a private multi-specialty medical facility Nebolejka based in Ukrainian city Kharkov. Thesis is divided into several parts. Theoretical part is focused on quality examination from the healthcare system point of view, deals with the analyses of Ukrainian healthcare system actual state. Practical part is focused on health care quali-ty evaluation in a private clinic Nebolejka. With a use of patient satisfaction survey a program of health care quality improvement was established. Its effectiveness was also verified via repeated patient satisfaction survey in short- term time period. This thesis is primarily useful for medical facility Nebolejka, because improvement of health care quality not surprisingly constitute to better competitive market position.

Développer des produits mieux acceptés en intégrant les préférences des parties prenantes constitue un principal défi pour les concepteurs et les chefs de projet. Comment évaluer et améliorer l'acceptabilité des utilisateurs est devenu une importante question de recherche. Les approches actuelles laissent cette question pour les dernières étapes du processus de développement de nouveaux produits (NPD), quand un prototype est presque fini et quand c’est trop tard pour apporter des modifications. Pour cela nos travaux se déclinent dans les contributions suivantes : • Principes et démarches de co-conception testés au travers deux études de cas. • Démarche de co-adaptation de l'habitat pour le maintien à domicile. • Démarche d'évaluation du niveau d'acceptabilité d'une solution basée sur les réseaux bayésiens. • Démarche d'amélioration du niveau d'acceptabilité évalué, permettant la recherche et simulation de scénarios d'amélioration, combinant les réseaux bayésiens et un algorithme de recuit simulé. Les modèles et démarches proposés ont été appliqués à des projets de conception dans le domaine de la santé pour lequel nous avons pu identifier des spécificités / Developing products that are better accepted by integrating users’ and stakeholders’ preferences is a major challenge for designers and project managers. How to evaluate and improve users’ acceptability has become an important research question. Current approaches leave the acceptability evaluation question for the last stages of New Product Development process (NPD), when a prototype is almost finished and when it is too late to make changes. For this our work is divided in the following contributions: • The test of the co-design approaches through two case studies. • A co-adaptation approach of the habitat for home-healthcare. • An assessment approach of the acceptability level of a solution based on Bayesian networks. • An improvement approach of the assessed acceptability level, enabling the research and simulation of improvement scenarios, combining Bayesian networks and a simulated annealing algorithm