Abasract With the progression of time and the transformation of our society, the rights of mentally disabled patients are strongly advocated. The level of quality of services provided by medical institutions often reflects whether the rights of patients are respected. In addition, the degree of satisfaction of patients regarding the medical institution is often a strong indication of the quality of services of such an institution. The purpose of this research is to explore the perspectives from patients and medical personnel regarding the quality and the level of satisfaction of medical services, in order to understand which medical service quality factors could apply to the mental health institution and factors that are regarded as the reference of mental health institution . This research is based on SERVQUAL formal quantity form which is included in five medical service quality components offered by three scholars of Parasuraman, Zeithaml and Berry. According to the characteristic of medical industry to adjust, it fits in with the service characteristic of the hospital to concentrate on the patient. Using description method to collect data from a questionnaire , this study targeted 62 patients and 77 medical personnel of Psychiatric Hospitals . The results are as follows. (1)The mental patients are mostly distributed with in the 31-50 year age group , are unmarried and are high school education . Before being diagnosed as schizophrenic the patients were mostly unemployed. Medical personnel with long-term work eaperence and these of short-term are equal in number . The education level is mostly vocational school and university, the majority with professional titles are nursing staff and service period is from one year to five years. (2)Analyzing six factors from the form of the medical service quality, named as its attribution: assurance , empathy , tangibles , reliability , responsiveness and utilization of public space. (3)In 35 items of medical service quality, the first three items of greater satisfaction indicators for patient are: confortable living environment , nurses have sufficient nursing technology and knowledge. The first three items of greater satisfaction indicators for medical personnel are: the hospital can maintain the patient¡¦s confidentiality , medical personnel will help patients to solve problems, and medical personnel ensure safety and relabilityin contact with patients. In order to improve the patient's medical treatment quality satisfaction, there are three suggestions as follows. (1)To increase the extension and depth of pharmacist's medicine consultation. (2) Besides medical professional personnel, the hospital should also add service attitudes and evaluations of administrative personnel in other medical industries. (3) Medical professional personnel should consider patient's rights priority and offer patients the individual care and the model of treatment.

Orientador: Hélio Rebello Cardoso Junior / Banca: Marcos Cesar Alvarez / Banca: Luís Carlos Giarola / Banca: Ana Carolina Santini Betancurt de Abreo / Banca: Lúcia Helena Oliveira Silva / Resumo: O objetivo central deste trabalho é analisar a construção de serviços de atendimentos médicos na cidade de Londrina, desde 1933, ano da fundação da cidade, até 1971, ano que foi criada uma cooperativa médica. A cidade foi sede de um projeto de colonização na região norte do estado do Paraná, colonização compreendida como parte de um processo denominado de novas fronteiras agrícolas, com o predomínio do cultivo do café, na primeira metade do século XX, principalmente no interior do estado de São Paulo e parte da região norte do estado do Paraná. O porquê da pesquisa nesta cidade, é que nela está constituído, nos dias de hoje, um importante centro de atendimentos médicos. E a compreensão é que este centro foi constituído desde seus primeiros anos, na década de 1930. A análise desvenda como foram construídos os serviços de atendimentos médicos, tanto por iniciativas dos próprios profissionais, como de segmentos da sociedade ou ainda por autoridades constituídas. A tese norteadora da análise é que os médicos se configuram como um campo social específico, o campo social médico, pois eles são capacitados para desenvolverem, com autonomia relativa, as atividades de atendimentos aos doentes, realizando diagnósticos e encaminhamentos terapêuticos. Impulsionados para a realização de tais atividades, os médicos, também com autonomia relativa, devem assumir compromissos para fazer valer a autonomia ética de responsabilidade, em serviços constituídos na sociedade. Finalmente, considerando que os compromissos são próprios do acontecer humano, de sua criatividade cultural, os conflitos são possibilidades sempre presentes, que requerem compreensão e não culpabilidade, para que tanto a responsabilidade ética como o compromisso sejam efetivados. / Abstract: The main objective of the present study is to analyze the development of the Medical Attendance Services in Londrina, Paraná since the city foundation in 1933 until the beginning of the first Medical Cooperative. The city was the place of a Colonization in the north region of Paraná state, performed as part of a process entitled new agricultural frontiers, being coffee the prevalent culture in those times, the first half of the XX century, mainly in São Paulo state and part of the north region of Paraná state. The reason to explain the research in this city is that nowadays it constitutes an important center of Medical Attendance, and for the comprehension of these findings is necessary to return to the thirties. The research tries to analyze and find out how the medical services were built by medical initiatives as well as by society distinct segments, including the governmental authorities. The thesis moves toward a hypothesis that doctors have a specific social field, the medical field, ethically able to develop with relative autonomy the activities of patients' attendance, performing diagnosis and therapeutics. The doctors stimulated by these activities may also have commitments to establish the ethically responsible autonomy in the constituted services os the society. Finally, considering that the commitments are determinants of the human actions depending on the cultural background, there are always frequent possibilities of contends which require comprehension and no search for guiltiness in order to both ethical responsability and the commitments be offectives in medical practice. / Doutor

As the economic developing, the demanding for various kind of medical and health caring is rising for the people in Taiwan and it lead to a more competitive medical market. The average life for people in Taiwan is getting higher, nevertheless, the population that suffering from chronic diseases is growing. However, people are expecting a considerate medical service. Therefore, how to increase the service efficiency and quality, and maintain the patient¡¦s right and further rising the satisfaction are becoming important issues for the medical institutes and the government. After the National Health Service was carried out in March, 1995, an enormous and constructive change has revealed. As the government finance has getting worse, the Bureau of National Health Insurance conducted the budget control policy in July, 2002. This policy caused the profit of medical institutes was reducing and the cost was getting higher. Besides, more and more new competitors joined this medical market, and plus, people asked for a better medical service and quality, medical institute is no longer profitable. In order to improve the circumstance, the medical institutes devoted in promoting the service quality and patient¡¦s satisfaction to maintain the fully support from the patients. This research is probe to one major medical center in South of Taiwan and to invest its medical service quality and the return willing of the patient. We released 400 questionnaires and 367 returned validly, the recycling rate is 91%. We adopted SPSS for windows 17.0 as the main tool to analyze the data and get the following conclusion: the medication environment and expectation, the process and the accuracy of diagnose, the waiting and diagnose hour, the attitude of nursing staff, the diagnose service and the return willing are all obvious. Meanwhile, the hardware and software of the medical institute, the service attitude of the nursing staff is greatly affecting the return willing of the patient. Therefore, the management of medical institute should think highly of the above sectors as main strategy to increase the return willing of the patient. And we will have better medical service.

The range of definitions involving ¡§service¡¨ is wide. For example, plumbers or lawyers offer technique or profession; consultants or teachers offer knowledge or information; meeting room or car rental agencies as well as people in movie industries offer facilities or space. Of course, a particular place like a hospital provides more than one service, including profession, skills, knowledge, space, etc. In Taiwan, the employment rate in service industry reached 50.2% in 2000. It was the first time the percentage exceeded the one in labor industry, and it is increasing gradually every year. The development of service industry is predicted to influence the economy in the future. The most important factor in service industry is the quality of service. Some even connect service quality with customer satisfaction as well as employees¡¦ rewards. Medical care is a kind of service, too. However, the complication and variation make it hard to measure the quality, especially when it is related to the quality of technique (result). The researchers have a lot of issues about the structures of service quality. In the earlier documents, people agreed with using SERVQUAL to measure the quality. However, European scholars have considered other aspects of service quality. They pointed out that there should be three aspects of service quality for customer satisfaction, including functional (procedure), technological (result), and impressional (image), etc. Although most of the scholars agreed that service quality has multi-structures, they don¡¦t have the same opinion about the essence and the content of it. In Taiwan, most of the people who study for the quality of medical service adopt the theory of P.Z.B. However, my report is trying to use Ward et al (2005) to study the chart of medical service quality. This is to test if the medical service quality of a particular clinic meets the expectation, then we can analysis the relationship of overall quality (patients¡¦ satisfaction) and service quality. Thus we can establish the pattern of prediction, and provide the particular clinic with the references to evaluate the medical service quality. China Steel established a particular clinic in order to respond to ¡§Employee Health Protection Regulation¡¨. The aim of having this clinic is to take care of the employees¡¦ health. The first priority is to provide the basic medical service for them. China Steel has about 8600 employees. The market has about 30 thousand people, including sub-manufacturers and families. Therefore, the clinic is designed to be much bigger than the average ones, and it has 24 staff. This clinic doesn¡¦t have to be responsible for whether it is making money or not. The results of service became the only standard to evaluate the operation. The development of pattern for measuring service quality is necessary for evaluating the results of it. In addition, it can be used to improve the service and promote the welfare of the employees¡¦ physical and mental health.

Made available in DSpace on 2014-06-11T19:35:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-06-27Bitstream added on 2014-06-13T20:07:29Z : No. of bitstreams: 1 oberdiek_hi_dr_assis.pdf: 2459933 bytes, checksum: 53f625ea675521e23c0660734049eac1 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo central deste trabalho é analisar a construção de serviços de atendimentos médicos na cidade de Londrina, desde 1933, ano da fundação da cidade, até 1971, ano que foi criada uma cooperativa médica. A cidade foi sede de um projeto de colonização na região norte do estado do Paraná, colonização compreendida como parte de um processo denominado de novas fronteiras agrícolas, com o predomínio do cultivo do café, na primeira metade do século XX, principalmente no interior do estado de São Paulo e parte da região norte do estado do Paraná. O porquê da pesquisa nesta cidade, é que nela está constituído, nos dias de hoje, um importante centro de atendimentos médicos. E a compreensão é que este centro foi constituído desde seus primeiros anos, na década de 1930. A análise desvenda como foram construídos os serviços de atendimentos médicos, tanto por iniciativas dos próprios profissionais, como de segmentos da sociedade ou ainda por autoridades constituídas. A tese norteadora da análise é que os médicos se configuram como um campo social específico, o campo social médico, pois eles são capacitados para desenvolverem, com autonomia relativa, as atividades de atendimentos aos doentes, realizando diagnósticos e encaminhamentos terapêuticos. Impulsionados para a realização de tais atividades, os médicos, também com autonomia relativa, devem assumir compromissos para fazer valer a autonomia ética de responsabilidade, em serviços constituídos na sociedade. Finalmente, considerando que os compromissos são próprios do acontecer humano, de sua criatividade cultural, os conflitos são possibilidades sempre presentes, que requerem compreensão e não culpabilidade, para que tanto a responsabilidade ética como o compromisso sejam efetivados. / The main objective of the present study is to analyze the development of the Medical Attendance Services in Londrina, Paraná since the city foundation in 1933 until the beginning of the first Medical Cooperative. The city was the place of a Colonization in the north region of Paraná state, performed as part of a process entitled new agricultural frontiers, being coffee the prevalent culture in those times, the first half of the XX century, mainly in São Paulo state and part of the north region of Paraná state. The reason to explain the research in this city is that nowadays it constitutes an important center of Medical Attendance, and for the comprehension of these findings is necessary to return to the thirties. The research tries to analyze and find out how the medical services were built by medical initiatives as well as by society distinct segments, including the governmental authorities. The thesis moves toward a hypothesis that doctors have a specific social field, the medical field, ethically able to develop with relative autonomy the activities of patients’ attendance, performing diagnosis and therapeutics. The doctors stimulated by these activities may also have commitments to establish the ethically responsible autonomy in the constituted services os the society. Finally, considering that the commitments are determinants of the human actions depending on the cultural background, there are always frequent possibilities of contends which require comprehension and no search for guiltiness in order to both ethical responsability and the commitments be offectives in medical practice.

This thesis deals with the parts played by the Colonial Office and colonial governments in providing medical and health services in British West Africa. The themes addressed are: the provision of medical and health services; the organization of Colonial medical research; and the recruitment of medical officers. The inter-war period saw the development of a number of medical institutions established in government centres by the various colonial administrations. The provision of health care facilities in the rural areas was the responsibility of local authorities. During world war two, the Colonial Advisory Medical Committee produced for the first time a statement of policy on medicine and health for the Colonial Empire. This emphasised not only the provision of curative facilities but also the provision of preventive health care services. Apart from the provision of medical and health facilities, efforts were also made to stimulate interest in medical research. Medical research in British West Africa before WWII was carried out as part of the routine duties of Colonial Medical Departments. However, the Colonial Medical Research Committee, set up in 1945 by the Colonial Office, was to exert considerable influence on research policy in the region. The committee, which was dominated by the Medical Research Council favoured fundamental research. However, fundamental research was considered not relevant to the immediate needs of colonial peoples. Instead, there was established a medical research organization, with emphasis on applied research and the investigation of the most prevalent diseases in West Africa. Meanwhile, between the wars, the Colonial Office tackled the problem of recruiting medical officers by creating the post of Chief Medical Adviser and by the amalgamation of the colonial medical services (CMS). Upto the outbreak of the war, however, the Office was still unable to meet the personnel requirements for the CMS. This problem was further aggravated with the creation in 1940, of the National Health Service. The end of WWII also saw an increase in international cooperation. United Nations specialised agencies such as the World Health Organization began to take an active interest in the health problems of African peoples.

Compulsory medical service programs for physicians and other health care professionals have been installed in developing countries around the world. The underlying assumption for the creation of these programs is that the increased presence of physicians will improve the health status of rural populations which exhibit higher rates of morbidity and mortality compared to urban populations. This assumption, however, has been challenged by recent evaluative studies of compulsory service programs in Latin America. This paper reports on the physician's perspective of Ecuador's compulsory service program, known as medicatura rural. Based on responses to a self-administered questionnaire completed by 127 physicians who had fulfilled or were currently fulfilling their medicatura rural requirement, in-depth interviews with physicians and other officials, and visits to several rural placement sites, the paper examines some of the fundamental programmatic and logistical problems that have impeded the successful implementation of the program since its inception in 1970. While the majority of the physicians reported that the medicatura rural experience was both professionally and personally rewarding, many view the program as conceptually flawed with respect to its goal of improving the health status of rural communities. The physicians' suggestions for improving the medicatura rural, which elucidate some of the program's basic conceptual flaws and reflect the criticisms of compulsory medical programs in other Latin American countries, are discussed. Finally, Ugalde's (1988) recommendation for replacing compulsory medical service programs with a 'rural health corps' is considered.

An Intensive Care Unit (ICU) is an extreme technological environment where different t)?es of equipment and devices, intended for the care of critically ill patients, are found. The use of technological equipment has assisted in reduction of morbidity, mortality, and length of hospital stay because the problems are diagnosed earlier. The purpose of the study was to explore the perceptions of nu$es who work in the Intensive Care Units about the effects of the use of technological equipment, with the intention of making recommendations for clinical practice, education of nurses and further research. A quantitative, descriptive, prospective, and non-experimental study design was utilised in this study, as well as a non-probability sampling method. Participants (n:60) were drawn from neurosurgical, cardiothoracic and main ICUs. Data collection was done by use of questionnaire. Descriptive and inferential statistics were used to analyse data.

The Helicopter Emergency Medical Service (HEMS) accident rate has driven operators from around the world to address the management of risks inherent to their operations. In-flight decision-making, pre-flight planning, failure to follow standard operating procedures, delayed remedial actions, and misinterpretation of environmental cues are all areas that need to be addressed for safe HEMS operations. HEMS operations are complex, being a joint exercise between the flight crew, paramedics and supporting agencies. Operations occur around-the-clock, in all-weather conditions, and often with no fore-warning. In a time critical operation, where precious minutes may cost lives, operators must decide which cases warrant a HEMS response and if so, whether the conditions are safe to conduct the mission. Intelligent systems are an emerging field offering benefits to a multitude of applications. This research forms a comprehensive investigation of the application of 'intelligent systems' to the pre-mission analysis of HEMS operations. The research has resulted in the development of a prototype decision support system capable of assisting in the pre-mission analysis of HEMS operations. The prototype system is capable of supporting flight coordinators and crew in the decision-making processes prior to HEMS operations and can potentially improve emergency medical services to the community.

Class of 2011 Abstract / OBJECTIVES: To assess the risk and return of publicly traded health insurance companies from 1986 through 2010. METHODS: Risk and return was assessed on these companies by identifying them with SIC 6231 and 6234 (Accident and Health Insurance and Medical Service Plans) along with their presence on the CRSP database. Risk and return was analyzed via alpha and beta for SIC 632x, which were calculated utilizing the CAPM, Fama-French 3 Factor and Carhart 4 Factor econometric models. Risk and return was further assessed by calculating a Sharpe ratio along with determining annualized mean excess return and volatility for SIC 632x and the overall market. Lastly, cumulative price paths for both SIC 632x and the overall market were calculated and a Monte Carlo simulation analysis in Matlab and Microsoft Excel was run to simulate 6500 portfolios to compare risk to return ratios for SIC 632x over the time period of 1986-2010 versus the time period of 2006-2010. RESULTS: Overall, 110 companies were identified with SIC 6321 and 6234 and 7938 observations were made. The results were reported in a cross sectional format with five time periods of five years each (1986-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2010 respectively). The descriptive statistics showed that SIC 632x had a higher rate of return than the overall market (1.21±14.15 compared to 0.88±4.49; however, they also had greater risk (0.89±14.15 vs 0.57±4.48). The CAPM model captured an overall alpha value of 0.44 while the 3 Factor model provided an overall alpha of -0.20 and the 4 Factor model provided an overall alpha of 0.31. The 4 Factor model had the highest overall r-squared value of 0.16. The overall annualized mean excess return was greater for SIC 632x than the overall market (10.71% vs 6.80%) while the volatility was also greater (20.30% vs 16.17%). Additionally, the Sharpe ratio was calculated and was greater overall for SIC 632x than the overall market (0.53 vs 0.42). Graphically, cumulative asset price paths were illustrated for both SIC 632x and market-based portfolios along with a mean variance efficient frontier for the SIC 623x portfolio set during the time periods of 1986-2010 and 2006-2010. These figures showed increased return for SIC 632x compared to the overall market while illustrating increasing risk and return rate trends for SIC 632x within the sector itself. CONCLUSION: Publicly traded companies providing accident and health insurance and medical service plans possess securities that have potentially higher returns but potentially higher risk relative to the overall market. Furthermore, the findings via the alpha, Sharpe ratio and Efficient Frontier simulation illustrated that the overall market provides a similar risk to return ratio compared to that of the analyzed companies in this study.