In this thesis the applicability of a hospital patient flow model is used in addressing hospital resource allocation problems. Three separate but interrelated models are presented. First, the hospital patient flow model is discussed. The main feature of the hospital patient flow model is the matrix of technical coefficients, which gives the probability of patient transfers throughout the hospital. Given the hospital system's daily patient input, the model provides the patient demands upon the different hospital services. Results from the patient flow model are used in the development of a staff allocation model. The staffing model involves the minimization of a weighted quadratic penalty function. The weighting factors are based on the proportion of patients in each of three carelevels in the wards. The weights are also dependent upon whether overstaffing or understaffing is the situation. Constraints to the model include a desirable mix and number of the available nursing staff. Solution of the allocation model is obtained by using SUMT with a pattern search. A third model concerned with predicting hospital revenues is presented. Again, results from the hospital patient flow model are used to present estimates of the expected values and variance of a hospital's revenue. To illustrate the use of the models, results from a two-week study period of the Montgomery County Hospital are presented and discussed. / Master of Science

Submitted in fulfillment of the requirements for the degree of Master’s of Technology: Radiography, Durban University of Technology, Durban, South Africa, 2015. / Introduction Tuberculosis remains a leading cause of death, second to the Human Immunodeficiency Virus. The risk of latent tuberculosis infection and active tuberculosis disease is a known occupational hazard. In South Africa, a high tuberculosis burden country, the potential of Mycobacterium tuberculosis transmission to health care workers is high. This includes diagnostic radiographers and other radiology staff working in radiology departments. Purpose of the Study This study aimed to investigate the association of demographic and occupational factors with latent tuberculosis infection in radiology staff in public sector hospitals of the eThekwini Health District. Methodology This cross-sectional study was conducted from 26 February 2013 to 07 June 2013. Quantitative methods were used to test for associations of demographic and occupational factors with latent tuberculosis infection in participants. A sample size of 181 participants for an estimated population of 340 radiology staff was recommended at the proposal stage. The study consisted of two phases; the questionnaire survey (phase one) and the administration of a two-step tuberculin skin test (phase two). Data was obtained with regard to demographics, occupational history, social behaviours, medical history; and family and home histories. Demographic and occupational associations with latent tuberculosis infection were made in relation to the size of the first tuberculin skin test induration. Frequency distributions were developed to describe data categories. Pearson’s and Spearman rho’ correlation coefficients were used to test for correlations between the independent variables. The chi-square test was used to determine associations between the categorical independent variables and the dependent variable. Bivariate analyses were performed using these tests. The multivariate analysis was performed using logistic and linear regression on the dependent variable. Results A total of 182 questionnaires were returned from approximately 280 radiology staff. At the outset, all doctors working in the radiology department had to be excluded due to numerous failed attempts to enlist their participation. Fifty-three (29.12 percent) participants were excluded from phase one of the study and a further thirteen participants were excluded from phase two. The total sample was 116 participants. Of the 116 participants, 86.2 percent tested positive for latent tuberculosis infection at the first step of the two-step testing method used. One (0.86 percent) participant went on to convert at the second step, testing positive at this level. Demographic associations with latent tuberculosis infection included age (older) as an associated factor. A significant demographic association with latent tuberculosis infection was the use of alcohol (p-value 0.033 on the multivariate analysis). Occupational associations with latent tuberculosis infection included longer durations of employment. The annual income (higher income earners) displayed significant associations with latent tuberculosis infection (p-value 0.048 on the multivariate analysis). It is necessary in this study to note that participants include support personnel (lower income earners) making up 37.8 percent of the study, diagnostic radiographers making up 48.3 percent; and radiography managers/assistant managers (highest income earners) making up 13.8 percent of the study. Conclusion and recommendations The risk of transmission of Mycobacterium Tuberculosis to health care workers is a known occupational hazard. This study has described the prevalence of latent tuberculosis infection in radiology staff, at district and regional hospitals within the eThekwini Health District. With 23.62 percent of all participants already having active TB disease and 86.2 percent of the tested group displaying positive results for latent tuberculosis infection, using the tuberculin skin tests, the need for tuberculosis screening is essential. The findings of this study will be used as a health improvement mechanism for stakeholders, having identified potential gaps in medical screening in healthcare in Kwa-Zulu Natal. This study makes recommendations for the early detection of active tuberculosis infection and the monitoring of health care workers that are latently infected, thus assisting in reducing the rate of conversion of latent tuberculosis infection to active tuberculosis disease in radiology staff. This reduces long-term exorbitant costs related to health care associated infections, such as tuberculosis. It also reduces rates of transmission and cross infection to both co-workers and already immunocompromised patients, helping to curb the overall epidemic in South Africa.

Bakgrund: I dagens samhälle uppsöker många människor akutsjukvård. Det kan vara att personen genomgått ett stort trauma eller har ett kritiskt sjukdomstillstånd. Vid varje besök med vården upplever patienten ett bemötande. Varje unik individ har även förväntningar om hur bemötandet kommer att vara på akutmottagningen.  Syfte: Syftet var att beskriva patienters upplevelse av sjukvårdspersonals bemötande på akutmottagning.  Metod: En litteraturstudie med kvalitativ ansats där resultatet från 12 vetenskapliga artiklar har analyserats enligt Forsberg och Wengströms (2016) innehållsanalys. Den teoretiska referensram som arbetet baseras på är Katie Erikssons omvårdnadsteori.  Resultat: Resultatet visar att det fanns brister inom bemötandet. En faktor som var av betydelse berodde på vilket trauma patienten hade genomgått eller vad de hade för sjukdomstillstånd. Majoriteten av alla patienter hade upplevt ett sämre bemötande på olika sätt.  Det kunde vara att de kände sig bortglömda, negligerade av personalen och bristande information om sjukdomstillstånd eller hur lång väntan skulle bli. Ett gott bemötande grundar sig ofta på att patienten blir respektfullt behandlad, att patienten erhåller information och att de känner sig sedda av personalen. Slutsats: Upplevelserna av bemötande varierar från patient till patient, då varje patient och situation är unik. Sjuksköterskan skall vara flexibel i sitt bemötande och kunna variera det beroende på patientens behov. Utifrån att många av dessa patienter är försatta i en sårbar och svår situation är kommunikationen en stor och central del i akutsjukvården. Den bör vara individanpassad, utifrån varje patient och situation.  Nyckelord: Akutmottagning, bemötande, omvårdnad, patienters upplevelse, sjukvårdspersonal. / Background: In today's society, many people seek emergency care. It may be that the person has undergone a major trauma or has a critical illness condition. At each visit with the patient, the patient experiences an encounter. Each unique individual also has expectations of how the reception will be at the emergency room.  Purpose: The aim was to describe patients 'experience of healthcare professionals' response to emergency care.  Methods: A literature study has been done with qualitative approach where the results from 12 scientific articles have been analyzed according to Forsberg and Wengström’s (2016) content analysis. The theoretical frame on which the work is based is Katie Eriksson`s nursing theory.  Result: The result show differences in how patients experience the encounter. Other factors that mattered depended on the type of trauma the patient had undergone or their condition. They majority of all patients had experienced inferior treatment in different ways. It could be that they felt forgotten, neglected by the staff and lack of information about illnesses or how long the wait would be. A good encounter is often based on the patient being treated respectfully, that the patient receives information and that they feel seen by the staff. Conclusion: The experiences of responding vary from patient to patient. Then every patient and the situation are unique. The nurse must be flexible in her treatment and be able to vary it depending on the patient's need for treatment. Communication is a major and central part of emergency care and should be individualized so that each unique patient has the opportunity to understand the information provided. Then these patients are vulnerable and put in a strange situation.  Keywords: Emergency clinic, medical staff, nursing, patients' experience, reception.

Introduction: Communication with relatives of critically ill patients is a rather neglected area in the Czech Republic. Intensive care focuses more on the patient, equipment and highly specialized treatment while contact with relatives is often minimized. Moreover, the conversation consists mainly of brief statements related to the current health status of the patient. It is important to pay more attention to this issue, especially so that the medical staff can offer the patient's family the best possible help in their difficult life situation. Objectives and Methodology: The aim of this thesis was to map the professional preparedness of general nurses and doctors in the areas of communication with the patient's family. Next, the thesis also attempted to determine the attitude of the medical staff to the families of patients hospitalized in the intensive care unit. Furthermore, it also aspired to map the experience of the patient's family members with the cooperation and interaction with the medical staff during hospitalization of the patient. Last but not least, the aim of the thesis was to propose solutions to improve the current situation. The quantitative research was conducted using structured questionnaires. One version of the questionnaire was intended for families of patients in the ICU...

Marital satisfaction is one of the main characteristics of a healthy family, and is known as an important predictor of overall quality of life. Stress is unavoidable in everyday life and it can affect marital relationships. Furthermore, employed married individuals encounter more stressors than do unmarried ones, especially when their jobs are demanding and stressful, such as working as medical professionals in hospitals. Applying effective coping strategies and receiving social support, especially from emotionally close persons, are protective factors which can help individuals deal with stress and buffer the negative effects of life stress on marital and life satisfaction. In the present cross-sectional investigation, marital satisfaction was studied in relation to socio-demographic variables, social support, ways of coping, and quality of life in medical staff in Tehran. Data were collected from 653 medical staff who worked in 12 hospitals affiliated with Tehran Medical University using socio-demographic questions, the ENRICH marital satisfaction questionnaire, the SF-36 questionnaire, the Social Support questionnaire, and the Ways of Coping questionnaire. The results indicated that marital satisfaction, quality of life and spousal support were significantly higher in men than women. Spousal support was significantly associated with marital satisfaction especially in women. Multiple regression analyses indicated that marital satisfaction, social support, and job satisfaction combined with socio-demographic variables explain between 12% and 28% of the variance in quality of life domains. Analysing the data with special focus on females revealed a significant negative relationship between subscales of marital satisfaction and using “seeking social support”, “confrontive coping”, “escape avoidance”, “distancing”, and “self-controlling” as ways of coping. Hierarchical regression analyses showed that job satisfaction, social support, and ways of coping explained between 24% and 38% of the variance in seven of the nine subscales of marital satisfaction. Therefore, focusing on the study findings could be helpful in promoting marital satisfaction and quality of life in married medical staff.

Darbo tikslas: Įvertinti medikų nusiskundimų savo sveikata sąsajas su darbo sąlygomis. Darbo uždaviniai: 1. Ištirti medikų savo sveikatos vertinimą. 2. Įvertinti darbuotojų nuomonę apie darbo aplinkos rizikos veiksnius KMUK filialo Onkologijos ligoninėje. 3. Ištirti darbo sąlygų sąsajas su medikų nusiskundimais savo sveikatos būkle. 4. Pateikti rekomendacijas medikų sveikatos saugai KMUK filialo Onkologijos ligoninėje. Tyrimo metodika. Buvo atliktas vienmomentis paplitimo tyrimas. Anoniminės anketinės apklausos pagalba 2008m. vasario mėn. buvo apklausti KMUK filialo Onkologijos ligoninės medicinos darbuotojai. Buvo išdalinta 350 anoniminių anketų, atsako dažnis 71.4 proc. (n=250). Duomenys buvo apdorojami ir analizuojami naudojant statistinių duomenų analizės paketą SPSS for Windows 13.0. Rezultatai. Apklausta 227 moterys (90,8 proc.) ir 23 vyrai (9,2 proc.). Amžiaus vidurkis metais 42,8 ± 0,2: moterų - 42,6 ± 0,2, vyrų 44,1 ± 0,6. Dažniausiai ligoninės dirbantieji savo sveikatą vertino gerai (47,6 proc.) ir patenkinamai (42,8 proc.). Su stresinėmis situacijomis darbe susiduria 146 (18,0 proc.) darbuotojai. Daugiausia apklaustųjų 156 (19,2 proc.) nurodė, kad darbo aplinka užteršta cheminėmis medžiagomis. Daugiausiai jonizuojančios spinduliuotės poveikyje dirbo slaugytojos padėjėjos (26,7 proc.) (p=0,044). Su dezinfekcinėmis medžiagomis daugiausiai susiduria slaugytojos - 117, slaugytojos padėjėjos - 72, gydytojai – 22 ( proc.) ir 6 (proc.) laborantai. Kuo ilgiau darbuotojai... [toliau žr. visą tekstą] / Aim of the study: to evaluate the relationships between health complaints and work conditions among medical staff. Goals of the study: 1. to analyse subjective health assessment of medical staff; 2. to estimate personnel opinion work-related risk factors at Oncology Hospital; 3. to establish relationships between work conditions and health complaints among medical staff; 4. to set recommendations for health safety of medical staff at Oncology Hospital. Material and methods. The study design was cross-sectional prevalence study. Anonymous questionnaires were set for medical staff at Oncology Hospital (division of Kaunas University Hospital) in February 2008. Altogether 350 questionnaires were distributed, response rate 71.4% (n=250). Statistical data analysis was performed using statistical package „SPSS for Windows 13.0“. Results. Among responders there were 227 women (90.8%) and 23 men (9.2%). The average age was 42.8±0.2 (42.6±0.2 for women and 44.1±0.6 for men). Majority of medical workers evaluated own health as good (47.6%) or satisfactory (42.8%). Work under stress was actual for 146 of responders (18.0%). Pollution with chemical substances in working environment was prevalent in 156 cases (19.2%). Ionized radiation mostly affected assistant nurses (26.7%; p=0.044). Disinfection substances mostly affected nurses (n=117), nurse assistants (n=72), physicians (n=22), and laboratory workers (n=6). Workers affiliated with this workplace longer also relate more health changes... [to full text]

SUMMARY Management of Public Health KNOWLEDGE OF MEDICAL STAFF ABOUT PATIENTS’ RIGHTS AND POSSIBILITIES TO ASSURE THEM IN THE HOSPITAL Greta Girštautaitė Supervisor Danutė Dučinskienė, Dr., Department of Social medicine, Faculty of Public Health, Kaunas University of Medicine. – Kaunas, 2005. – P.61 Aim of the study was to evaluate knowledge of medical staff about patients’ rights and possibilities to assure them in Kaunas 2nd clinical hospital. Health care professionals’ view about confidentiality of patient’s information, knowledge about patient’s right to select physician, nursing specialist and health care institution, the right of complaint, the right to information, possibilities to assure patients’ rights in the hospital were assessed. Methods. Anonymous surveys of 260 physicians and nurses were carried out (response rate 72 percent). Results. The results revealed that 80,8 percent of medical staff claimed that information about patient must be confidential. 91,6 percent of health care professionals thought that patient can select health care institution. 83,8 percent of medical staff thought that patient can select a physician and nursing specialist. 29,2 percent of the respondents indicated that the patient who is dissatisfied with medical care services can apply to director of health care institution. 18,6 percent of medical staff indicated that don’t know where the patient can make a complaint against health care institution’s activity if patient is dissatisfied... [to full text]