Tikslas: Įvertinti hospitalinių infekcijų valdymo galimybes X ligoninėje. Uždaviniai: 1. Nustatyti hospitalinių infekcijų paplitimą, rizikos veiksnius ir struktūrą X ligoninėje. 2. Įvertinti medicinos darbuotojų žinias apie hospitalines infekcijas bei požiūrį į jų registraciją. 3. Pateikti pasiūlymus hospitalinių infekcijų valdymo tobulinimui. Tyrimo metodika. Tyrimas vykdytas 2011-2012 metais X klinikinėje ligoninėje. Atliktas hospitalinių infekcijų paplitimo tyrimas ir anoniminė medicinos darbuotojų anketinė apklausa. Išdalintos 220 anketų, gautos užpildytos 186 anketos. Atsako dažnis 84,5 ℅. Gautų duomenų statistinė analizė atlikta naudojant „SPSS 19.0 for Windows“ programą. Rezultatai. Vienmomentinio paplitimo tyrimo metu infekcijas buvo įgiję 12,8 proc. pacientų. Iš jų hospitalinės infekcijos sudarė net 5,4 proc. Didžiausią hospitalinių infekcijų dalį sudarė apatinių kvėpavimo takų infekcijos - 45,4 proc., 9,1 proc. – šlapimo takų infekcijos. Dažniausi rizikos veiksniai – operacija (30,2 proc.), pacientų gydymas antibakteriniais vaistais (29,7 proc.). Didžiausias infekcijų paplitimas registruotas chirurgijos (5,7 proc.) ir terapijos skyriuose. Išanalizavus apklausos rezultatus nustatyta, kad tik šiek tiek daugiau nei pusė darbuotojų (64,0 proc.) buvo pakankamai informuoti apie hospitalines infekcijas. Geriausiai savo žinias vertino chirurgijos profilio gydytojai (71,4 proc.) ir slaugytojos (67,4 proc.). Daugiau nei devyni dešimtadaliai apklaustųjų pabrėžė, kad HI... [toliau žr. visą tekstą] / Objective: Evaluation of hospital infections and its governance opportunities at hospital X. Goals: 1. Determination of hospital infections spread, risk factors and structure at hospital X. 2. To evaluate employees with medical background knowledge level of hospital infections and attitudes towards its registration process. 3. To make suggestions for hospital infections governance improvements. Research methodology. Research was conducted in 2011-2012 at clinical hospital X. The research of hospital infections spread as well as anonymous survey among employees were conducted. 220 questionnaires were distributed and 186 of them were fully completed. Response rate was equal to 84.5%. Data was analyzed using ,,SPSS 19.0 for Windows“. Results. Throughout onetime survey of the spread of hospital infections, 12.8% of patients were infected while 5.4% of them had hospital infections. The lower respiratory tract infections scored the highest share of hospital infections – 45,4%, while 9,1% corresponds to urinary tract infections. The most frequent risk factors - surgeries (30.2%) and treatment with antibacterial medicines (29.7%). The highest spread of hospital infections was registered between surgical (5.7%) and therapy departments. After analysis of the results, it was identified that more than half of all employees (64%) were sufficiently informed about hospital infections. Surgical doctors and medical assistants were the most confident about their knowledge. More than 90%... [to full text]

In der vorliegenden Arbeit wird eine emirische Untersuchung vorgestellt, in der mittels eines multimethodalen Zuganges eine Anforderungsanalyse für intermediäre Tätigkeiten umgesetzt wurde. Genutzt wurden zur Anforderungsanalyse Experteniterviews, eine Anwendung der Grid-Technik, sowie die Critical-Incidence-Technique.

Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke. / Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship

Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke. / Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship

Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke. / Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship

Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common and preventable cause of morbidity among individuals and hospital in-patient mortality. Further, it imposes a substantial burden upon the community and its health care system and economy. Studies performed in Western societies suggest that the annual incidence of DVT is about 0.8 to 1.2 per 1,000, PE about 0.3 to 0.6 per 1,000, and VTE about 1.0 to 1.8 per 1,000. However, it is not known if these estimates can be generalised to the Australian population because of differences in ethnic composition and other risk factors for VTE among the different populations. In this thesis, I undertook a prospective, community-based cohort study over a 13-month period in 2003 – 2004 to determine the incidence and crude event rate of symptomatic, objectively verified VTE in north-east metropolitan Perth. The study population was broadly representative of the national Australian population in terms of age, sex and ethnic distribution. Cases were identified through multiple overlapping sources. The incidence of DVT, PE and VTE in the community were 0.52 (95% confidence interval, CI: 0.41 – 0.63), 0.31 (95% CI: 0.22 – 0.40) and 0.83 (95% CI: 0.69 – 0.97) per 1000 per year, respectively. The annual incidence of DVT, adjusted to the World Standard population, was 0.35 (95% CI: 0.26 – 0.44) per 1000, PE 0.21 (95% CI: 0.14 – 0.28) per 1000 and VTE 0.57 (95% CI: 0.47 – 0.67) per 1000. The crude event rate for VTE was 0.85 (95% CI: 0.71 – 0.99) per 1000 per year. These findings suggest that the incidence of DVT, PE and VTE are lower than in other Western societies studied. Possible reasons include a lower prevalence of exposure to causal risk factors (genetic and environmental) and incomplete case ascertainment. Knowledge of the local incidence and event rate allows health planners to allocate appropriate resources and evaluate cost-effective preventive measures.

Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke. / Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship

Thesis (Ph. D.) - University of Göttingen, 2004.

Thematic Paper (M.C.T.M. (Clinical Tropical Medicine))--Mahidol University, 2007. / LICL has E-Thesis 0024 ; please contact computer services. LIRV has E-Thesis 0024 ; please contact circulation services.

Thesis (Ph. D.)--University of Göttingen, 2004. / Description based on print version record.