Text in English / Aim: The aims of this study were to investigate the treatment outcomes of patients with MDRTB and its determinants at referral hospitals in Ethiopia. The study also aims to develop a conceptual model for enhancing treatment of patients with MDR-TB in Ethiopia. Design and methods: A concurrent mixed methods design with quantitative dominance was used to investigate treatment outcomes of patients with MDR-TB and its determinants. Results: A total of 136 (n=136) patients with MDR-TB participated in the study, 74 (54%) were male and 62 (46%) were female. Forty-one (31%) of the patients had some co-morbidity with MDR-TB at baseline, and 64% had body mass index less than 18.5kg/m2. Eight (6%) of the patients were diagnosed among household contacts. At 24 months, 76/110 (69%) of the patients had successfully completed treatment, but 30/110 (27%) were died of MDR-TB. Multivariable logistic regression revealed that the odds of unfavourable treatment outcomes were significantly higher among patients with low body mass index (BMI <18.5kg/m2) (AOR=2.734, 95% CI: 1.01-7.395; P<0.048); and those with some co-morbidity with MDR-TB at the baseline (AOR=4.260, 95%CI: 1.607-11.29; p<0.004). The majority of the patients were satisfied with the clinical care they received at hospitals. But as no doctor was exclusively dedicated for the MDR-TB centre, patients could not receive timely medical attention and this was especially the case with those with emergency medical conditions. The caring practice of caregivers at the hospitals was supportive and empathic but it was desperate and alienating at treatment follow up centres. Patients were dissatisfied with the quality and adequacy of the socio-economic support they got from the programme. Despite the high MDR-TB and HIV/AIDS co-infection rate, services for both diseases was not available under one roof. Conclusions: Low body mass index and the presence of any co-morbidity with MDR-TB at the baseline are independent predictors of death among patients with MDR-TB. Poor communication between patients and their caregivers and inadequate socio-economic support were found to determine patients’ perceived quality of care and patients’ satisfaction with care given for MDR-TB. / Health Studies / D. Litt et Phil. (Health Studies)

The purpose of this project was to evaluate the effects of relationship-based care (RBC) on patient satisfaction. RBC is a caring model that promotes a caring and healing environment by establishing and maintaining therapeutic relationships between patient, self, and coworker. The Centers for Medicare & Medicaid Services links Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores with reimbursement to hospitals. It is essential to not only achieve high patient satisfaction scores in order to ensure full financial reimbursement, but also to ensure high quality, patient-centered care. The current project assessed samples from 2 medical surgical groups, one system-wide and the other only patients from a single inpatient unit with sample sizes approximately 2,900 and 250 respectively. Data were collected retrospectively 3 times using the Press Ganey webpage at pre implementation, 6 months, and 12 months post RBC training. Results from an ANOVA indicated only a slight increase in post intervention HCAHPS scores with no statistical significant improvement. However, this increase indicates a positive trend, suggesting that the implementation of RBC may have assisted in improving patient responses. This evaluation has implications for the continued implementation for the enhancement of patient-centered care. These findings suggest that a nursing care model provides a collective belief to define a specific attitude to deliver care, facilitate professional development, and improve outcomes. By following RBC, nurses share a similar philosophy toward a caring environment.

The Affordable Care Act of 2010 increased the number of patients seen in a northeast, urban trauma emergency department by 34%. This created a problem as it occurred simultaneously with a nursing shortage. Consequently, patient satisfaction scores fell below the national average benchmark. The rate patients left the emergency department without being seen was 2.6% higher than the national average and patient fall rates increased by 20%. A review of the literature to search for solutions led to the support of an hourly rounding project and an educational workshop promoting proactive nurse behaviors as a way to address the quality and safety gap. The goal of this scholarly project was to develop this evidence based, theory supported project and to conduct a formative and summative evaluation by an expert review panel in order to achieve consensus before implementation. An executive team was formed and led through the process of development of a detailed hourly rounding protocol and workshop, which will be implemented at the facility at a later time. A 10 member expert panel was formed. The panel members consented to participate in an explanatory session, to review all project materials, and to complete an anonymous 20 question survey tool. The panel also consented to review any changes made to materials as part of a summative evaluation. Descriptive analysis of the formative data demonstrated a 90% overall agreement that the workshop was comprehensive and covered key concepts within 5 categories. Minor requested revisions were made in response to formative results. The summmative review demonstrated 100% consensus on the revisions. This project will bring about social change by engaging nurses in proactively caring for patients in a safe and efficient manner.

<p>The development and provision of equitable and acceptable standard of health services to all segments of the population has been the major objective of the 1993 Ethiopian National health policy. However, community based studies on satisfaction with public health care facilities reveal that the majority of the population are not satisfied with the services provided predominantly as a result of the long waiting times. Studies done on private health facilities on the contrary reveal that patients are satisfied with the service delivered within short waiting times in these clinics. Even though the speculated waiting time is thought to be long among the public health care facilities and short in private clinics, the actual waiting and service times have not been measured and compared. Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of &ldquo / acceptable&rdquo / waiting time among the providers and clients. Materials and methods: A cross sectional observational study using quantitative techniques was carried out amongst patients and staff at selected public and private health care facilities in Gondar District. Stratified sampling method was used to select facilities. All patients visiting the selected facilities and all staff who provided service to patients on the day of the study were included in the time-delimited sample. Data was collected by research assistants and health workers from all patients attending the health care facility by registering the arrival and departure time of each patient to the facility and to each service point on a patient flow card. Then data was cleaned and captured by a specific Waiting and Service Time database. Descriptive statistics was done on waiting and service times for each facility and this was summarized for each public and private health facility by using tables and graphs. Finally a comparison was made for private and public health facilities by using Wilcoxon-mann-whitney non parametric tests.</p>

Bakgrund: Personer som insjuknar i kolorektalcancer är ofta mellan 50-70 år gamla. Colon kan undersökas med bariumundersökning, koloskopi eller datortomografi colon (DT colon). Nyttan med DT colon är att tarmen liksom strukturer utanför tarmens vägg kan avbildas samt att cancern kan stadieindelas. Syfte: Att undersöka patienters upplevelser av DT colon hos patienter som uppvisar symtom på kolorektalcancer. Dessa upplevelser kan vara fysiska och psykiska. Metod: Sökningar utfördes i databasen Pubmed där sökord kombinerades. Efter granskning av abstrakt och studier i sin helhet inkluderades 11 studier som ligger till grund för resultatet. Resultat: Patienter upplevde lite smärta i fem av sju studier. Procentuellt skattades smärta som liten till obefintlig (82-96 %) och som stark (0-3 %) i tre studier. Upplevelse av obehag varierade mellan lite och lite mer än måttligt obehag i sju studier. I en studie skattade 81 % patienter DT colon som inte till lite obehaglig. Obehag under utvidgning av tarmen upplevde majoriteten som inte till lite obehagligt och mindre andel (30,7 % och 17 %) som ganska till mycket obehagligt i två studier. I en kvalitativ studie var utvidgning den mest jobbiga delen av undersökningen. Pinsamhet skattades som låg i två studier och i en kvalitativ studie kände sig patienterna generade. Oro mättes i sju studier där majoriteten var lite eller inte oroliga. Ingen eller lite rädsla upplevdes av patienter i tre studier. I en kvalitativ studie uttryckte några patienter att de varit rädda under DT colon varav en var rädd för att inte kunna hålla andan. Slutsats: Många upplevde lite smärta under DT colon men det fanns de som upplevde större smärta. Upplevelse av obehag varierade i studierna men ett fåtal upplevde mycket obehag. Vissa upplevde mycket och extremt obehag under utvidgning av tarmen. Patienter var lite generade men 1-3 % kände större pinsamhet. Patienterna var lite oroliga. Då få studier tog upp rädsla är det svårt att dra en slutsats.

Communication of hospital discharge instructions between patient and provider is an important component of hospital discharge to ensure that patients have the information they need to manage their post-acute care. Patient perception of this interaction is a key indicator of the quality of services provided. This study examined whether there is a correlation between hospital continuity and transition scores (a measure of patient perceptions of hospital discharge instructions) and hospital readmissions in Ontario. The final regression model for the outcome of all medical readmissions within three days of hospital discharge, showed a significant positive relationship (coefficient=0.0090, p=0.011). The estimate was smaller and not significant once the data was restricted to only community hospitals located outside of Toronto (coefficient=0.0085, p=0.060), and when restricted to urban community hospitals outside of Toronto (coefficient=0.0041, p=0.384). For the outcome of specific medical readmissions within 28 days of hospital discharge, no statistically significant relationship was found.

Communication of hospital discharge instructions between patient and provider is an important component of hospital discharge to ensure that patients have the information they need to manage their post-acute care. Patient perception of this interaction is a key indicator of the quality of services provided. This study examined whether there is a correlation between hospital continuity and transition scores (a measure of patient perceptions of hospital discharge instructions) and hospital readmissions in Ontario. The final regression model for the outcome of all medical readmissions within three days of hospital discharge, showed a significant positive relationship (coefficient=0.0090, p=0.011). The estimate was smaller and not significant once the data was restricted to only community hospitals located outside of Toronto (coefficient=0.0085, p=0.060), and when restricted to urban community hospitals outside of Toronto (coefficient=0.0041, p=0.384). For the outcome of specific medical readmissions within 28 days of hospital discharge, no statistically significant relationship was found.

<p>This report generally focuses on the process of getting medicine from the pharmacy in the hospital. The processes are different in Sweden and in China due to the different concrete conditions. Compared with the Swedish process the Chinese flow lags fairly far behind. To optimize the Chinese process by taking advantage of the Swedish process is the intention of this report; it also gives the advice on how to improve the performance for the Swedish process. By comparing the multiple theories for process improvement, I used Business Process Reengineering (BPR) theory to reengineer the Chinese process and used Continues Process Improvement (CPI) theory to ameliorate the Swedish process. The differences between BPR and CPI are also revealed in this report.</p>

The purpose of this study was to determine if the level of Nurse Manager (NM) emotional intelligence (EI) predicted registered nurse (RN) job satisfaction and RN perceptions of the practice environment. In addition, relationships to patient, nursing, and hospital outcomes were explored. Participants included RNs (N=659) and NMs (N=38) from 53 nursing units at eight hospitals located in the southeast region of the United States. A cross-sectional, correlational research design was used to test the hypotheses. Pearson product-moment correlation coefficients, simple linear and multiple regression statistics were conducted to analyze the data. Level of NM EI had a positive, not significant relationshp to RN job satisfaction and RN perceptions of the practice environment. A direct, positive significant relationship was observed between the variables NM EI and patient satisfaction with nursing care. There was a positive, significant relationship noted between the variables RN job satisfaction and RN perceptions of the practice environment. The indirect relationships between the level of NM EI and patient, nursing and hospital outcomes were not significant. There was a direct significant, positive relationship noted between the variables RN perceptions of the practice environment and patient satisfaction with nursing care. In addition, the interaction between RN job satisfaction and RN hours of care had a positive, significant relationship with unit level pressure ulcer rates. This study indicated that units with higher RN hours of care have increased pressure ulcer rates. In addition, results illustrate a marked increase in pressure ulcer rates on those units with higher levels of job satisfaction. In this study, pressure ulcer rates depended on the level of RN job satisfaction.

Previous research has examined patients’ level of satisfaction with the care, in an attempt to develop health care services that match patients’ expectations and needs. Nevertheless, there is still considerable debate among researchers over conceptual and methodological issues. This research programme investigated factors that contribute to patient satisfaction with health care in two fairly different European health care systems (the UK’s NHS and Greece’s ESY). A further aim was to develop a scale to assess patient satisfaction and health care evaluations within these two cultural contexts. In order to achieve those aims, a sequential exploratory strategy incorporating, qualitative and quantitative designs was used to explore patient health care evaluations, patient satisfaction, expectations, health care experiences, interpersonal qualities of the doctor-patient relationship and health care contextual factors at both micro and macro level. Three studies were conducted: Studies 1a and 1b examined levels of patient satisfaction with health care delivery in Greece and the UK respectively. More similarities than differences were found between the two samples, but aspects of health system evaluation differed. The data obtained from this study informed the development of the Patient Expectation and Satisfaction Scale (PESS). The psychometric properties of the preliminary version of the scale were subsequently tested in non clinical populations in Greece and the UK (Studies 2a and 2b). The pilot testing of the PESS was based on a proposed theoretical framework suggesting that patients’ expectations depend on the nature of past experiences and current expectations. The variable that influences some of the differences between the two countries is health culture in terms of contextual health care differences. Although findings revealed similarities between the two cultures, differences were found relating to dissatisfaction, health care evaluations, expectations and the quality of the doctor-patient relationship. A revised version of the PESS, based on these findings, was administered to hospital outpatient populations in both countries (Study 3). The Patient Satisfaction and Expectation Model that emerged from this analysis incorporated three levels of patient satisfaction: at the micro level, the macro level and the interpersonal level. The importance of patients’ understanding of professional competence and its salience as a predictor of the effectiveness of the doctor-patient relationship was highlighted. The quality of the doctor-patient relationship emerged as an important determinant of patient satisfaction and adherence. The overall findings of this research programme suggest that patient satisfaction is multidimensional; despite contextual differences between the two health care systems, a universal concept exists that includes health care expectations, health care experiences, interpersonal qualities and aspects relating to operational and organisational structures at both micro and macro level.