A retrospective study was performed to determine the prevalence of foot pathologies of horses subjected to magnetic resonance imaging for foot lameness and to determine the long-term outcome of horses after medical treatment. The MR studies of 95 horses were interpreted retrospectively by a boarded certified radiologist. Follow-up information was obtained from medical records, owners and referring veterinarians via telephone questionnaires. Long term response to treatment (minimum of 12 months) was recorded. Horses were divided in two different groups based on the diagnosis and on the treatment using intrasynovial antiinflammatory drugs or not. Logistic regression analysis was performed to compare the outcome between the two groups. The null hypothesis was that the proportion of horses treated successfully between treatment protocols was similar. A diagnosis based on magnetic resonance imaging was made in all horses. Approximately 30% of horses had ≥ 4 lesions, which were determined to be responsible for the lameness and 70% of horses had navicular bone abnormalities. Treatment was determined by individual clinician judgment. No significant difference was found in the long-term outcome between treatment groups. This result suggests that intrasynovial antiinflammatory drugs may not provide additional benefit over corrective shoeing, rest followed by controlled exercise in horses with lesions of structures associated with the navicular apparatus or the distal interphalangeal joint. / Master of Science

SAMMANFATTNING Nyckelord: ApoDos, LSS, sjuksköterska, kvalitetssäkring, läkemedelsbehandling Bakgrund: I enlighet med sjuksköterskans kompetensbeskrivning och ApoDos riktlinjer, ligger ett stort ansvar på sjuksköterskan gällande uppföljning av patienters läkemedelsbehandlingar. Sjuksköterskan skall även samverka med andra aktörer i vårdkedjan och sträva efter en god informationsöverföring mellan dessa, i syfte att kvalitetssäkra vården. Syfte: Utifrån sjuksköterskans erfarenheter beskriva rutiner för uppföljning av läkemedelsbehandlingar, hos patienter med ApoDos och boende enligt LSS, samt identifiera eventuella välfungerande- och bristande rutiner. Metod: Studien har en deskriptiv design med kvalitativ ansats. Fem intervjuer genomfördes med sjuksköterskor, samtliga verksamma på LSS-boenden inom Uppsala kommun. Det inhämtade materialet analyserades enligt en reviderad version av Graneheim och Lundmans (2004) metod för innehållsanalys. Resultat: Resultatet visar att det finns vissa bristande rutiner och ett behov av bättre kommunikation samt tydligare riktlinjer för ansvarsfördelningen mellan olika aktörer vid uppföljning av patienternas läkemedelsbehandlingar. De deltagande sjuksköterskorna är dock överlag nöjda med systemet ApoDos och det finns inget som tyder på att de bristande rutinerna har ett samband med ApoDos-systemet. Konklusion: Studien visar att vissa rutiner bör ses över och omprövas samt att ett förtydligande av ansvarsfördelningen mellan sjuksköterska och läkare skulle kunna leda till förbättringar vid uppföljning av läkemedelsbehandlingar. Det krävs dock vidare studier inom området för att klarlägga ett bredare perspektiv av dessa rutiner. / ABSTRACT Keywords: multidose drug dispensing system, LSS, nurse, quality improvement, medical treatment Background: The nurse has a great responsibility regarding medical treatment follow-ups and must also seek a good interaction with other participants in the continuum of care, in order to assure the quality of care. Aim: From a nurse’s perspective describe routines for medical treatment follow-ups, regarding patients with multidose drug dispensing system and accommodations according to LSS, as well as identify possible well-functioning and deficient routines.  Method: The study has a descriptive design with qualitative approach. Five interviews were conducted with nurses, all working at accommodations according to LSS in Uppsala Municipality. The data was analyzed according to Graneheim and Lundman's (2004) method of content analysis. Results: There are some deficient routines and a need of better communication and more clear guidelines for the division of responsibilities regarding the patients’ medical treatment follow-ups. Overall, the participating nurses are content with the multidose drug dispensing system and there is nothing indicating that the deficient routines are associated with this system. Conclusions: The study shows that certain routines should be overhauled and reconsidered and that a clarification of the division of responsibilities, between nurses and doctors, could lead to improvements at medical treatment follow-ups. However, to elucidate a broader perspective of routines for medical treatment follow-ups, further studies are required.

Today we live in a highly developed science, high technology and fast transmit-ted information time, the competition is more and more intense in all industries of course the medical. People in medical industry not only have to response the impact from the change of the national policy but accept the concept to service by patient¡¦s demand and needs. In the past, the staff of hospital needn¡¦t to care about the source of patient, the fair of payment policy and the sustainable management in their hospital. But these competitive advantages had disappeared after the National Health Insurance policy was executed from 1995 AD., the pressure of management are more and more heavy especially the practitioners. In order to manage sustainably, the staff of hospital not only have to control the cost of management but also create the advantages and good chances by understood the demand and needs of the patient. The research of the considering factors in medical treatment is one of the analysis in the patient¡¦s demand and needs. Generally, patient has to know what the illness he or she gets, then patient will choice the suitable hospital for their medical treatment. In this research we separate the illness into two parts¡GOne is the specialty illness (ophthalmology, dental, orthopedic, neurology, psychiatry, obstetrics & gynecology, radiology neoplasm¡K, these illness can be confirmed the part of body.), the other is common illness (catch a cold, a cough, stomachache, headache), we analysis the dif-ferences of the considering factors in medical treatment between specialty and com-mon illnesses. In this research, we analysis the medical industrial by Marketing domain, the marketing mix 7Ps is the skill we adapt because the medical industry is part of service industry. There are 34 sheets of paper related to medical research we study and 502 pieces of considering factors in medical treatment we sort by 7Ps, finally 33 pieces factors were extracted as the items of the questionnaire. There are 528 pieces of valid respondent questionnaire we get and we use them as the data in this research. We think we can provide the result of the research and the marketing suggestions for medical industry and the initial marketing 7Ps research of medical industry.

Due to the development of society, the rise of living standards, the increase of population, the availability of information, and the establishment of health care systems, the medical industry is not as prestigious as it was in the past. Under the economy where the market is changing from supplier-oriented to consumer-oriented, competitions between various medical facilities and patients¡¦ demands for better medical care quality grow, which then result in the rise of medical risks. Medical institutions no longer just focus on the treatment effects, but must also fully understand the conditions of the patients and effectively manage and utilize the resources at hand in order to raise the treatment quality and to stand above other competitors. The purpose of this research is to identify the various factors that prompt patients to seek medical treatments, and to raise patients¡¦ satisfaction and faithfulness towards medical institutions. The research was carried out using a survey/questionnaire approach. Patients that have been to two or more dental clinics were asked to participate in the survey, and those who were interested were chosen. The PZB service quality SERVQUAL scale was used. Out of the 150 questionnaires distributed, 123 were retrieved (82%), and 111 of those retrieved were valid for consideration (74%). The survey showed that (1) a gap exists between patients¡¦ expected treatment service and the actual service received; (2) patients hold high expectation towards the service quality; (3) patients decision to switch clinics partially depends on the received service; (4) the main factor that prompt patients to switch clinics is their concerns towards the ability of their doctors/physicians; (5) Instead of the actual service, assurance and reliability are more essential to the patients; and (6) clinics showing sincerity and making sure the patients feel secure are most important towards the patients. The research concludes that patients choose their medical institutions base on the received services. The five aspects of service all have almost equal importance, and all are influential towards patients¡¦ choices of medical institutions.

Abstract The biotechnology industry, include a series of new technologies, is recognized as a star industry in the 21st century by the countries all over the world. The development of these new technologies may drive another wave of industry upgrading and make the whole economic development in the future. In our ten major new industry, three items belong to biotechnology industry: pharmacy, health care and pollution prevention industry. Among them, the pharmacy industry, in large economic scale, Europe and American usually grasp the advantage and leading right all the time. And the native country pharmacy industry of Taiwan, occupies the inferior position, is unable to compete with it. Stem from the difference of the national habits, the health food product in Taiwan are researched and launched in higher speed than the advanced countries. So, if we can develop the health food industry with the biotechnology, we will have advantages. According to internationalized angle, we will have certain advantages not only in cost, resource, relatively free of economic scale, but also in the technological level of the industry, lead other relatively countries of the backward areas. This research finds we have to learn the way of Western medicine marketing skill at present, with ' academic marketing ' and ' evidence marketing ' , to develop the health food industry. Company in Taiwan should be a main operations objective by mould out the corporate image with high professional engineering leveling instead of consuming a large amount of fixed cost and time. Shorten enterprise balanced time to come is the most important thing. Never spend all money before ¡¥ Dream Come True ¡¥! This research proposes the following development tactics for reference: (1) Lock Chinese market, expand and sell in other areas actively. (2) Seeking the foreign capitals for strategic alliance and expanding the department scale of operation with more plural structure. (3) Shorten the time of research and develop the innovative products and maintain the position with leading technology of industry by the cooperation with college. (4) Implement the staff's study and growth, keep enterprise's running and growing up steadily , mould enterprise's high-quality image and create enterprise's brand intangible assets value forever. (5) Pay attention to external environment condition , regulation environment and overall influence of management environment at any time. ( 6) Lower costs in order to improve the competitiveness continuously. And continuously cahnge the products structure to make a profit to improve enterprises.

Objetivo: Desenvolver um questionário em português que avalie letramento em saúde e verificar a possível associação entre letramento em saúde e adesão à terapia medicamentosa. Métodos: Entrevistas foram realizadas enquanto os indivíduos esperavam seu atendimento em postos de saúde da cidade de Bagé, na região sul do Brasil. O letramento em saúde foi avaliado pelo Teste de Letramento em Saúde (TLS). O TLS foi desenvolvido baseando-se na tradução e adaptação do TOFHLA (Test of Functional Health Literacy in Adults) para a realidade brasileira, considerando-se aspectos de linguagem e culturais. A adesão à terapia medicamentosa foi avaliada pelo Morisky e as dificuldades para adesão foram avaliadas pelo BMQ (Brief Medication Questionnarie). Resultados: A consistência interna do TLS foi alta (0,789). Sua pontuação média foi de 87,4 ± 10,2 e mais de dois terços da população (73,7%) tinha no mínimo o ensino médio completo. Aproximadamente 87% dos participantes possuíam letramento em saúde adequado, 10,5% limitado e 2,6% inadequado. Houve diferença estatisticamente significativa entre as pontuações médias obtidas entre as diferentes faixas etárias e de escolaridade. Os indivíduos com baixo letramento em saúde apresentaram mais do que o dobro de probabilidades de encontrarem dificuldades para aderir ao tratamento medicamentoso quando comparados aos indivíduos com letramento em saúde adequado (RP=2,19; IC95%=1,30 – 3,67). Conclusão: O TLS demonstrou ser uma medida adequada de letramento em saúde para indivíduos com alto nível de escolaridade. Porém, necessita maiores avaliações entre aqueles com menor escolaridade. Através do TLS, o impacto do baixo letramento em saúde na população brasileira pode ser avaliado, bem como a identificação dos indivíduos que necessitam de instruções especiais Além disso, o baixo letramento em saúde demonstrou estar associado com maiores dificuldades para aderir ao tratamento medicamentoso. Portanto, intervenções que proponham melhorar a adesão, devem, antecipadamente, verificar o nível de letramento em saúde destes, para assim elaborar estratégias capazes de atingir o entendimento dos pacientes em cada grau de letramento. / Title: Association Between Health Literacy and Medical Treatment Adherence. Objective: To develop a test to evaluate health literacy in Brazilian Portuguese and assess the association between health literacy and adherence to medical therapy. Methods: Interviews were carried out while participants waited for consults in primary care facilities in Bagé, south Brazil. Health Literacy was evaluated through the Teste de Letramento em Saúde (TLS). The TLS was based on translation and adaptation of the Test of Functional Health Literacy in Adults (TOFHLA) to the Brazilian scenario, considering cultural and language aspects. Adherence to medical therapy was evaluated by Morisky and difficulties for adherence were evaluated through Brief Medication Questionnaire (BMQ). Results: Internal consistency was high (0.789). Average score was 87.4±10.2, and over two thirds of the population (73.7%) had finished high school. Approximately 87% of participants had adequate health literacy, 10.5% had marginal health literacy, and 2.6% had inadequate health literacy. There was a statistically significant difference in average scores between groups with different age and education. Individuals with low health literacy (LHL) presented over twice as much chance of finding difficulties in adhering to medical treatment than individuals with good health literacy (PR=2.19; 95%CI= 1.30 – 3.67). Conclusion: TLS provides a proper way of accessing health literacy in individuals with high education level. However, further evaluation is needed among those with lower education. Through TLS, the impact of low health literacy in the Brazilian population can be assessed and the identification of individuals who need special instruction.Moreover, low health literacy has proven to be associated with greater difficulties to adhere to drug treatment. Therefore, interventions that propose improve adherence, should in advance determine the level of literacy in of health, in order to develop strategies capable of understanding of patients in each degree of literacy.

Objetivo: Desenvolver um questionário em português que avalie letramento em saúde e verificar a possível associação entre letramento em saúde e adesão à terapia medicamentosa. Métodos: Entrevistas foram realizadas enquanto os indivíduos esperavam seu atendimento em postos de saúde da cidade de Bagé, na região sul do Brasil. O letramento em saúde foi avaliado pelo Teste de Letramento em Saúde (TLS). O TLS foi desenvolvido baseando-se na tradução e adaptação do TOFHLA (Test of Functional Health Literacy in Adults) para a realidade brasileira, considerando-se aspectos de linguagem e culturais. A adesão à terapia medicamentosa foi avaliada pelo Morisky e as dificuldades para adesão foram avaliadas pelo BMQ (Brief Medication Questionnarie). Resultados: A consistência interna do TLS foi alta (0,789). Sua pontuação média foi de 87,4 ± 10,2 e mais de dois terços da população (73,7%) tinha no mínimo o ensino médio completo. Aproximadamente 87% dos participantes possuíam letramento em saúde adequado, 10,5% limitado e 2,6% inadequado. Houve diferença estatisticamente significativa entre as pontuações médias obtidas entre as diferentes faixas etárias e de escolaridade. Os indivíduos com baixo letramento em saúde apresentaram mais do que o dobro de probabilidades de encontrarem dificuldades para aderir ao tratamento medicamentoso quando comparados aos indivíduos com letramento em saúde adequado (RP=2,19; IC95%=1,30 – 3,67). Conclusão: O TLS demonstrou ser uma medida adequada de letramento em saúde para indivíduos com alto nível de escolaridade. Porém, necessita maiores avaliações entre aqueles com menor escolaridade. Através do TLS, o impacto do baixo letramento em saúde na população brasileira pode ser avaliado, bem como a identificação dos indivíduos que necessitam de instruções especiais Além disso, o baixo letramento em saúde demonstrou estar associado com maiores dificuldades para aderir ao tratamento medicamentoso. Portanto, intervenções que proponham melhorar a adesão, devem, antecipadamente, verificar o nível de letramento em saúde destes, para assim elaborar estratégias capazes de atingir o entendimento dos pacientes em cada grau de letramento. / Title: Association Between Health Literacy and Medical Treatment Adherence. Objective: To develop a test to evaluate health literacy in Brazilian Portuguese and assess the association between health literacy and adherence to medical therapy. Methods: Interviews were carried out while participants waited for consults in primary care facilities in Bagé, south Brazil. Health Literacy was evaluated through the Teste de Letramento em Saúde (TLS). The TLS was based on translation and adaptation of the Test of Functional Health Literacy in Adults (TOFHLA) to the Brazilian scenario, considering cultural and language aspects. Adherence to medical therapy was evaluated by Morisky and difficulties for adherence were evaluated through Brief Medication Questionnaire (BMQ). Results: Internal consistency was high (0.789). Average score was 87.4±10.2, and over two thirds of the population (73.7%) had finished high school. Approximately 87% of participants had adequate health literacy, 10.5% had marginal health literacy, and 2.6% had inadequate health literacy. There was a statistically significant difference in average scores between groups with different age and education. Individuals with low health literacy (LHL) presented over twice as much chance of finding difficulties in adhering to medical treatment than individuals with good health literacy (PR=2.19; 95%CI= 1.30 – 3.67). Conclusion: TLS provides a proper way of accessing health literacy in individuals with high education level. However, further evaluation is needed among those with lower education. Through TLS, the impact of low health literacy in the Brazilian population can be assessed and the identification of individuals who need special instruction.Moreover, low health literacy has proven to be associated with greater difficulties to adhere to drug treatment. Therefore, interventions that propose improve adherence, should in advance determine the level of literacy in of health, in order to develop strategies capable of understanding of patients in each degree of literacy.

Objetivo: Desenvolver um questionário em português que avalie letramento em saúde e verificar a possível associação entre letramento em saúde e adesão à terapia medicamentosa. Métodos: Entrevistas foram realizadas enquanto os indivíduos esperavam seu atendimento em postos de saúde da cidade de Bagé, na região sul do Brasil. O letramento em saúde foi avaliado pelo Teste de Letramento em Saúde (TLS). O TLS foi desenvolvido baseando-se na tradução e adaptação do TOFHLA (Test of Functional Health Literacy in Adults) para a realidade brasileira, considerando-se aspectos de linguagem e culturais. A adesão à terapia medicamentosa foi avaliada pelo Morisky e as dificuldades para adesão foram avaliadas pelo BMQ (Brief Medication Questionnarie). Resultados: A consistência interna do TLS foi alta (0,789). Sua pontuação média foi de 87,4 ± 10,2 e mais de dois terços da população (73,7%) tinha no mínimo o ensino médio completo. Aproximadamente 87% dos participantes possuíam letramento em saúde adequado, 10,5% limitado e 2,6% inadequado. Houve diferença estatisticamente significativa entre as pontuações médias obtidas entre as diferentes faixas etárias e de escolaridade. Os indivíduos com baixo letramento em saúde apresentaram mais do que o dobro de probabilidades de encontrarem dificuldades para aderir ao tratamento medicamentoso quando comparados aos indivíduos com letramento em saúde adequado (RP=2,19; IC95%=1,30 – 3,67). Conclusão: O TLS demonstrou ser uma medida adequada de letramento em saúde para indivíduos com alto nível de escolaridade. Porém, necessita maiores avaliações entre aqueles com menor escolaridade. Através do TLS, o impacto do baixo letramento em saúde na população brasileira pode ser avaliado, bem como a identificação dos indivíduos que necessitam de instruções especiais Além disso, o baixo letramento em saúde demonstrou estar associado com maiores dificuldades para aderir ao tratamento medicamentoso. Portanto, intervenções que proponham melhorar a adesão, devem, antecipadamente, verificar o nível de letramento em saúde destes, para assim elaborar estratégias capazes de atingir o entendimento dos pacientes em cada grau de letramento. / Title: Association Between Health Literacy and Medical Treatment Adherence. Objective: To develop a test to evaluate health literacy in Brazilian Portuguese and assess the association between health literacy and adherence to medical therapy. Methods: Interviews were carried out while participants waited for consults in primary care facilities in Bagé, south Brazil. Health Literacy was evaluated through the Teste de Letramento em Saúde (TLS). The TLS was based on translation and adaptation of the Test of Functional Health Literacy in Adults (TOFHLA) to the Brazilian scenario, considering cultural and language aspects. Adherence to medical therapy was evaluated by Morisky and difficulties for adherence were evaluated through Brief Medication Questionnaire (BMQ). Results: Internal consistency was high (0.789). Average score was 87.4±10.2, and over two thirds of the population (73.7%) had finished high school. Approximately 87% of participants had adequate health literacy, 10.5% had marginal health literacy, and 2.6% had inadequate health literacy. There was a statistically significant difference in average scores between groups with different age and education. Individuals with low health literacy (LHL) presented over twice as much chance of finding difficulties in adhering to medical treatment than individuals with good health literacy (PR=2.19; 95%CI= 1.30 – 3.67). Conclusion: TLS provides a proper way of accessing health literacy in individuals with high education level. However, further evaluation is needed among those with lower education. Through TLS, the impact of low health literacy in the Brazilian population can be assessed and the identification of individuals who need special instruction.Moreover, low health literacy has proven to be associated with greater difficulties to adhere to drug treatment. Therefore, interventions that propose improve adherence, should in advance determine the level of literacy in of health, in order to develop strategies capable of understanding of patients in each degree of literacy.

Approved for public release, distribution unlimited / Approved for public release; distribution unlimited. / Healthcare costs throughout the United States are on the rise, drawing increased scrutiny from government officials and Congress. The cost of pharmacy operations and pharmaceuticals is growing at a rate that is alarmingly higher than that of the total cost of military healthcare itself. Recent congressional legislation has essentially given the Department of Defense the ultimatum to cut costs for beneficiaries wherever possible, or risk having benefits arbitrarily cut by Congress. In the face of this possibility, cutting costs through better business practices must be explored, particularly within the area of pharmacy operations. This project explores the potential cost savings that can be realized by implementing Lean Six Sigma (LSS) methodology in the pharmacy operations of the DoD Medical Treatment Facilities (MTF). This research proves that implementing Lean Six Sigma methodology will improve military pharmacy operations, often at little cost, while realizing significant savings and increased customer satisfaction.

Background: Malaria is one of the mosquito-transmitted diseases that is killing millions of people every year, with the highest prevalence in Africa. In Tanzania, more than 90 percent of the inhabitants are at risk of being infected with malaria. The malaria parasite Plasmodium falciparum does not obtain specific symptoms and differential diagnoses can make it difficult to diagnose malaria. If malaria gets developed into a severe stage, it can affect organs and eventually cause death. Nurses have the role to educate inhabitants on how to prevent malaria. Purpose: The aim of this study was to describe nurses ́ experiences when caring for patients infected with malaria in Tanzania. Method: Study with a qualitative approach. A content analysis with a manifest structure was carried out, based on individual semi-structured in-depth interviews with nurses. Result: Nurses found it difficult to differentiate malaria from other diseases, like typhoid or meningitis. Nurses focused mostly on patients’ physical by working with medical treatment and education about malaria prevention. Conclusion: This study highlighted the importance for nurses of being educated about malaria and knowing how to assess its condition as it can be a mortal disease.