Objective: Evaluation of surgical quality ensures consistency of care and facilitates improvements in the quality of care delivered. Methods: An overview of surgical quality measurement is presented. A system for monitoring thoracic morbidity and mortality (TM&M) at the Ottawa Hospital is introduced and evaluated. Results of a needs assessment survey on the involvement in thoracic surgical research and quality improvement initiatives are presented. Results: Structure, process, and outcomes reflect different viewpoints on how to evaluate surgical quality. The feasibility of the TM&M system is evaluated using descriptive and univariate statistics, while its inter-rater reliability is assessed amongst the Canadian Association of Thoracic Surgeons. Conclusions: Outcomes have been fundamental in the evaluation of surgical quality. TM&M classification system advocates for a practice of continuous quality improvement and provides standardized and reliable feedback on surgical outcomes. Results of the needs assessment have built a strong foundation of knowledge on prospective ways to enhance the monitoring of surgical quality.

Linkages between influenza prevalence and climate (e.g. precipitation, temperatures, El Nino Southern Oscillation ENSO) have been suspected, but definitive evidence remains elusive. This analysis investigated a climatic relationship between influenza mortality (measured by multiple caused pneumonia and influenza deaths) and influenza morbidity (measured by isolates tested for influenza). Influenza-climate linkages were analyzed at multiple spatial scales (e.g. local analysis, and regional analysis) and multiple temporal scales (e.g. annualized mortality counts, and mortality counts based on cumulative percentiles). Influenza mortality and morbidity were found to have significant correlations to seasonal temperatures, precipitation, and ENSO. Influenza-climate associations varied spatially and temporally, and underscore the importance of considering geographic scale in investigative analyses of disease. Evidence for an influenza-climate relationship provides a greater understanding of the enviro-climatic factors that can contribute to an influenza epidemic, and provides an impetus for further studies that incorporate climatic factors in influenza risk modeling.

This research explores womens experiences of arm morbidity after breast cancer. Biomedical knowledge about arm morbidity is limited and often unclear, and there has been even less focus on the health issue from a sociological perspective. While studies do exist about the experiences of arm morbidity, more investigation is required to realize its influence on the daily lives of breast cancer survivors. The purpose of my research is to convey constructed meanings of arm morbidity experiences to indicate the impact it has on womens everyday lives.<p> Qualitative data were collected via twelve in-depth, semi-structured interviews, as six participants were each interviewed twice. The interviews were focused on a broad range of themes in order to create a comprehensive understanding of the womens experiences of arm morbidity in their daily lives. Phenomenological and feminist approaches were both used to guide the research process and analyze the data, and a range of sociological ideas also informed the analysis, such as chronic illness, disability, gender roles, and embodiment.<p> The illness narratives produced two broad areas relevant to the womens experiences. The first major topic involves the meanings directly related to experiences of arm morbidity as a health issue, and is divided into four themes: 1) experiencing bodies with arm morbidity, 2) treatment, 3) information and knowledge, and 4) support. The second major topic involves understandings of arm morbidity as it affects the womens lives, in which three themes emerge: 1) changing abilities and adjusting roles, 2) identity and health, and 3) the influence of illness on approaches to life.<p> As existing research is sparse, the womens narratives present a new level of depth to understandings of arm morbidity experiences that does not exist in current literature. It is evident that more study about arm morbidity is necessary to construct important knowledge and benefit both biological and sociological understandings of this survivorship issue.

Objective: Evaluation of surgical quality ensures consistency of care and facilitates improvements in the quality of care delivered. Methods: An overview of surgical quality measurement is presented. A system for monitoring thoracic morbidity and mortality (TM&M) at the Ottawa Hospital is introduced and evaluated. Results of a needs assessment survey on the involvement in thoracic surgical research and quality improvement initiatives are presented. Results: Structure, process, and outcomes reflect different viewpoints on how to evaluate surgical quality. The feasibility of the TM&M system is evaluated using descriptive and univariate statistics, while its inter-rater reliability is assessed amongst the Canadian Association of Thoracic Surgeons. Conclusions: Outcomes have been fundamental in the evaluation of surgical quality. TM&M classification system advocates for a practice of continuous quality improvement and provides standardized and reliable feedback on surgical outcomes. Results of the needs assessment have built a strong foundation of knowledge on prospective ways to enhance the monitoring of surgical quality.

This research explores womens experiences of arm morbidity after breast cancer. Biomedical knowledge about arm morbidity is limited and often unclear, and there has been even less focus on the health issue from a sociological perspective. While studies do exist about the experiences of arm morbidity, more investigation is required to realize its influence on the daily lives of breast cancer survivors. The purpose of my research is to convey constructed meanings of arm morbidity experiences to indicate the impact it has on womens everyday lives.<p> Qualitative data were collected via twelve in-depth, semi-structured interviews, as six participants were each interviewed twice. The interviews were focused on a broad range of themes in order to create a comprehensive understanding of the womens experiences of arm morbidity in their daily lives. Phenomenological and feminist approaches were both used to guide the research process and analyze the data, and a range of sociological ideas also informed the analysis, such as chronic illness, disability, gender roles, and embodiment.<p> The illness narratives produced two broad areas relevant to the womens experiences. The first major topic involves the meanings directly related to experiences of arm morbidity as a health issue, and is divided into four themes: 1) experiencing bodies with arm morbidity, 2) treatment, 3) information and knowledge, and 4) support. The second major topic involves understandings of arm morbidity as it affects the womens lives, in which three themes emerge: 1) changing abilities and adjusting roles, 2) identity and health, and 3) the influence of illness on approaches to life.<p> As existing research is sparse, the womens narratives present a new level of depth to understandings of arm morbidity experiences that does not exist in current literature. It is evident that more study about arm morbidity is necessary to construct important knowledge and benefit both biological and sociological understandings of this survivorship issue.

Research Objectives: Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. The prevalence of depression and anxiety in COPD patients is generally higher than those reported in other chronic illnesses, and these mental diseases significantly affect the health expenditures and the course of the diseases on elderly COPD patients. The COPD patients with co-morbid depression, anxiety or other chronic diseases are more impaired and have 50% to 100% higher medical costs than those without depression and anxiety. COPD affects approximately 1.8 million people in Taiwan every year, however, little studies have examined the impacts of mental diseases on elderly COPD patients. This study aims to investigate the depression and anxiety status on COPD patients¡¦ medical care utilizations and health outcomes. Study Design: This study analyzed the nationally representative research database from National Health Insurance program between 2002 and 2006 in Taiwan, by exploring outpatient visits, hospitalizations, and medical expenditures of COPD and its associated co-morbidities. The data analyses were carried out by Chi-square test, multiple linear regression and multivariate logistic regression. Population Studied: Patient aged over 65 with primary diagnosis of COPD and co-morbidity diseases based on ICD-9-CM in Taiwan. To investigate the complications in COPD patients, four diseases such as diabetes, hypertension, heart failure and ischemic heart disease were included in the analyses. Principle Findings: Among the 5,735 COPD patients (59.81%, male), most of them were aged over 80 (28.67%) , and lived in urban areas (62.28%) in northern Taiwan (43.71%). The results indicated that those who were suffered from depression or anxiety increased medical utilization and costs. Multiple linear regression model showed that age, and hospital level significantly affect the expenditures for medicine of COPD patients with depression or anxiety (p¡Õ0.001). Multivariate logistic regression model presented that number of complications significantly affect the probability of hospitalization among the COPD patients with mental diseases (p¡Õ0.001). Conclusions¡G COPD symptoms were usually getting worsen over time and depression or anxiety affect the COPD patients significantly, though the mental diseases are usually under-estimated. The study results demonstrated that COPD patients suffered from depression and anxiety increased the risks on longer length of stay, higher medical expenditures and more complications. WHO predicts that COPD will become the third leading cause of death worldwide by 2030. Since mental diseases may worsen elderly COPD patients¡¦ health outcomes, physicians are advised to pay more attention to these types of patients. With on time and appropriate treatments, thus may help to improve quality of care and reduce medical expenditures for these patients.

Thesis (Ph. D.)--University of Chicago, Dept. of Economics, June 2001. / Includes bibliographical references. Also available on the Internet.

Despite the widespread prevalence of bombing in Iraq, no study has investigated its psychological impact on civilians. This thesis aimed to address this gap in the literature. Four studies were conducted consequently using civilians in Iraq. The first study aimed to explore the subjective experience in response to the bombing attack. A qualitative approach was taken and twenty semi-structured interviews were employed and analysed using Interpretative Phenomenological Analysis (IPA). This identified seven categories including interpersonal relationships, loss of self, changes in attachment, shattering of world assumptions. Subsequent studies were then conducted to understand these themes as possible predictors of PTSD and psychiatric comorbidity in regards to bombing attacks. The second study was a prospective longitudinal design aimed to investigate the trajectory of PTSD symptoms, psychiatric comorbidity, and attachment styles among survivors. It also aimed to examine the role of a variety of variables, namely shattering of world assumptions, altered self-capacity, perceived social support to predict PTSD and psychiatric comorbidity. One hundred and eighty Iraqi civilians were recruited and assessed approximately 1 month and 5 months after their experience of being in a bombing attack using a battery of questionnaires. A control group data (n=178) of people who had not been exposed to a bombing was also collected. Results indicated that 19.4% and 57.2% of the participants met the screening criteria for partial and full PTSD symptoms at T1, which declined overtime. The bombing group displayed significantly higher rates of psychiatric comorbidity and insecure attachment than the control group. After controlling for the severity of bombing attack, controllability of events and affect dysregulation significantly predicted both PTSD and psychiatric co-morbidity symptoms. None of these dimensions predicted PTSD and psychiatric co-morbidity at T2. The complementary study 3 looked further at selected predictors indicated by the findings of study 1, namely death anxiety, coping strategies, religious coping and meaning in life. This study employed a longitudinal design in which 185 participants were recruited and assessed approximately 2 months and 7 months after bombing using a package of self-report questionnaires. Results indicated that religious coping and cognitive avoidance had a significant role to play in predicting PTSD and psychiatric comorbidity shortly after the bombing. Death anxiety was also emerged another picture in predicting PTSD and psychiatric comorbidity through mediators, namely religious coping and searching for meaning in life. Literature showed that PTSD and psychological distress are treatable after people had received various forms of professional and personal strategies. Study 4 employed mixed methods in order to provide further understanding regarding the helpful coping strategies that participants had attempted to use to manage their psychological distress. Six participants (n=3 recovered well, n=3 still struggle) were recruited for the qualitative phase and 243 for the quantitative. Social support was found as the most frequent and helpful strategy to manage post-bombing distress, followed by avoiding thinking about the bombing and religious strategies. Different psycho-social factors that hinder or foster recovery between participants were also highlighted. In conclusion, the findings confirmed related studies that, following bombing, there is a high risk that victims develop PTSD and psychiatric co-morbidity symptoms which decline to some extent over time. A variety of factors, such as social support and religious strategies were identified as helpful. However, these were also related to the victims’ prior attachment strategies. Implications for assisting victims and the population of Iraq are offered, in particular the need to support families and friends (social networks) in the context of very limited professional sources of support in a country where terrorism is rife.

Meeting the health care needs of people with chronic conditions presents one of the greatest challenges for 21st century health care system renewal. Appropriate redesign of health care delivery with this complex patient population in mind requires information from many sources. Although much is known about the patient experience of chronic illness much less is understood about how patients navigate their health care delivery context. The purpose of this qualitative study was to examine the point of view of patients dealing with multi-morbidity. These people have a unique understanding of how health care delivery links across time, place, and settings because of the care they require for their multiple chronic conditions. An interpretive descriptive design was used to examine patient navigation from the perspective of 20 adult patients with chronic kidney disease, and co-existing diagnoses of diabetes mellitus and/or cardiovascular disease. The findings generated from iterative, constant comparative analysis add important patient perspectives about health care system navigation. From the consumer perspective health care navigation is challenging, requiring (a) ongoing discovery about the complex social structures that make up the health care system, and (b) learning how to strategically use this knowledge to manage the health care system. The findings highlight the disjunctures and misalignments in the health care delivery system, the cumulative health care-related burden of multiple chronic conditions for consumers, and consumer concerns about subtle inequities in the health care system. As health care renewal efforts gain momentum new knowledge from the perspective of consumers, such as that captured in this research, is important. The consumer perspective provides a valuable opportunity for stakeholders in health care policy- and decision-making to contextualize and make greater sense of the information used in making decisions about health care service delivery for vulnerable populations, like patients with multiple chronic conditions.

Darbo tema: Gydytojų sveikatos ir ją lemiančių veiksnių vertinimas. Tyrimo tikslas ir uždaviniai: Šio tyrimo tikslas - įvertinti Lietuvos gydytojų subjektyvią sveikatą ir ją lemiančius veiksnius. Tyrimu siekiama nustatyti Lietuvos gydytojų savo sveikatos vertinimą, jaučiamus sveikatos sutrikimus, sergamumą, psichologinę sveikatą, gydytojų požiūrį į atliekamą darbą ir pasitenkinimą finansine padėtimi pagal lytį, amžių, specialybę, darbovietę ir šeimyninę padėtį. Metodika: Tyrime dalyvavo didžiųjų Lietuvos miestų ir apskričių ligoninių ir poliklinikų gydytojai, apklausos dieną buvę darbe ir sutikę dalyvauti. Tyrimo tikslui ir uždaviniams pasiekti, atliktas momentinis (paplitimo) epidemiologinis tyrimas, kuris atliekamas anoniminės anketinės apklausos būdu, naudojant PSO gyvenimo kokybės klausimyną. Iš viso analizuojamos 377 anketos (88,7 proc. visų numatytų apklausti gydytojų). Didžioji dauguma respondentų – 292 (77,5 proc.) buvo moterys, 85 (22,5 proc.) – vyrai; 149 apklausoje dalyvavusių gydytojų dirbo ligoninėse ir 218 – poliklinikose. Tiriamųjų amžius nuo 26 iki 70 metų. Statistinė duomenų analizė atlikta naudojantis SPSS 17,0 versijos statistiniu duomenų analizės paketu ir WinPepi programa. Vertinant kokybinių požymių statistinį ryšį, panaudotas Fišerio tikslusis (F) ir Chi-kvadrato (x2) kriterijus. Tyrimo rezultatai ir išvados: Daugiau kaip pusė tiriamų gydytojų savo sveikatą vertino gerai ir buvo ja patenkinti. Turintys sveikatos sutrikimų nurodė apie 70 proc... [toliau žr. visą tekstą] / Subject of assignment: Evaluation of physicians health and factors affecting health. The present study object and tasks: The present study was conducted to estimate subjective health and factors affecting Lithuanian physicians health. To achieve study task it is try to establish own health estimation, sense of health disorder, sickness rate, psychological health of Lithuanian physicians and their point of view to work performance, satisfaction of their financial position according to sex, age, speciality, working place and marital status. Method: Physicians from biggest Lithuanians towns and districts hospitals and outpatient clinics took part in present study, those who the day of questioning was at work place and agreed to participate in research. To achieve the research object and tasks was carried out instantaneous (spreading) epidemiological investigation. Research done by using an anonymous form, using WHO life quality questionnaire. All together analysed 377 forms (88,7 % of all foreknow examined doctor’s). The participants consisted of – 292 (77,5 %) females and 85 (22,5 %) males.149 participants has been working in the hospitals and 218 – outpatient clinics. Participants age from 26 to 70 years. Statistic data analysis was done by using SPSS 17.0 version statistic data analysis packet and WinPepi program. Qualitative signs statistic connection was estimated by using Fischer exact (F) and Chi-square (x2) criterion. Present study findings and conclusions: More than... [to full text]