Patienten mit Lippen-Kiefer-Gaumenspalten weisen häufig ein ästhetisches Defizit im Bereich der Nase auf und müssen sich nach Wachstumsabschluss nicht selten einer Nasenkorrektur unterziehen. Die in der Literatur publizierten Ergebnisse von Spaltnasenkorrekturen sind zum Teil kontrovers und bilden verschiedene Blickwinkel ab. Bewertungen von Patienten und Therapeuten unterscheiden sich mitunter erheblich. Ziel dieser retrospektiven Studie war es, zu ermitteln, welche funktionellen und ästhetischen Resultate mit Hilfe der Sekundärkorrektur der spaltbedingten Nasendysplasie zu erzielen sind und wie sich der Blickwinkel der Patienten von denen professioneller Juroren unterscheidet. Hierfür konnten 242 Patientinnen und Patienten mit Lippen-Kiefer-Gaumenspalten eingeschlossen werden, welche sich im Zeitraum vom 01.01.2001 bis 31.12.2013 an der Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie des Universitätsklinikums Leipzig einer sekundären Rhinoplastik unterzogen hatten. Aus Sicht der Patienten wurde hinsichtlich der Funktion in 82% der Fälle ein gutes Ergebnis erreicht. Bezüglich der Ästhetik beurteilten die Patienten das Ergebnis zu 74% als gut und zu 21% als moderat. Die identische Befragung der professionellen Jury ergab in 65% der Fälle die Einschätzung gut und in 26% der Fälle die Bewertung moderat. Die vergleichende statistische Analyse der Einschätzungen der beiden Kollektive ergab eine nur geringe Interrater-Reliabilität. Die Ergebnisse der Studie zeigen, dass in der Mehrzahl der Fälle gute Resultate erzielbar sind. Die Bewertungen der Patienten und jene der Ärzte differieren dabei deutlich.:1. Einleitung, historischer Überblick 1 2. Bewertung von Spaltnasenkorrekturen 3 3. Objektive Defizite der Spaltnase 5 3.1. Funktionelle Defizite 5 3.2. Ästhetische Defizite 6 4. Möglichkeiten und Grenzen der Spaltnasenoperation 8 5. Konzept und Fragestellung der Promotion 10 6. Publikation 11 7. Zusammenfassung 19 8. Anhang 21 8.1. Abbildungsverzeichnis 21 8.2. Votum der Ethikkommission 22 8.3. Selbstständigkeitserklärung 23 8.4. Lebenslauf 24 8.5. Danksagung 25

In hospitals of Addis Ababa, there is a high turnover of leaders while patient and health workers’ satisfaction is low, and safety and quality are in dire situations. The purpose of this study was to explore and propose strategies to improve effectiveness of hospital leadership in order to enhance the quality of health care provided in hospitals through improving health workers’ empowerment, job satisfaction and patient safety culture. Thus, a sequential explanatory mixed method research design was used. The research had three phases, in which the first phase used five structured questionnaires explored leadership styles, the health workers’ satisfaction and empowerment, patient safety culture, and the patient experience of quality of health care; while the second involved a qualitative study (content analysis); and third phase focused on the preparation of a strategy document. Data in the form of interview responses was gathered from 75 leaders, 542 health workers, 532 patients and 11 key informants. The analysis shows that, overall, hospital leaders considered themselves more transformational (M=2.98, SD=0.41) than transactional (M=2.85, SD=0.46). Job satisfaction of private and public hospital health workers were 70.8 % and 57.1 % respectively (P-value<0.001). In addition, private hospital workers had a higher score in structural and psychological empowerment than their pubic hospital counterparts; the difference was statistically significant in all dimensions (P-value <=0.03). The analysis reveals that public and private hospitals’ mean total patient safety scores were 3.58 and 3.77 respectively (P-value=0.02). Finally, the “overall rating of hospital” was better for private hospitals: 84.8% and 88.4 % respectively (P-value=0.03). The study makes a number of observations. It notes that, firstly, transformational leadership has direct and strong correlation with structural and psychological empowerment (r=0.70, P-value=0.04 and r=0.83, P-value=0.01 respectively). Secondly, structural empowerment has a direct and significant effect on psychological empowerment (β=0.28, P-value=<0.01); and minimal indirect effect on patient safety culture through psychological empowerment (β=0.05, P-value=<0.05). Thirdly, health worker job satisfaction also has had a direct effect on patient safety culture (β=0.44, Pvalue=< 0.01. The fourth and final observation is that psychological empowerment has had a direct and statistically significant effect on patient safety culture (β=0.19, Pvalue=< 0.01). These observations indicate that, although private hospitals are better in every dimension of this study, the current hospitals situation in Addis Ababa needs urgent attention. Hence, the identification and recommendation for the preparation of eight strategic priority areas along with key interventions seeking to improve the hospital leaders’ effectiveness. / Health Studies / D. Litt. et Phil. (Health Studies)

Antenatal depression (depression under graviditeten) drabbar 10–20% av gravida och innebär risker för både den gravida och barnet. Forskning visar att internetbaserad kognitiv beteendeterapi (IKBT) tycks vara effektivt jämfört med sedvanlig mödravård. Uppsatsen var en sambands- och prediktionsstudie som genomfördes inom den randomiserade DANA-studien för IKBT vid antenatal depression. En inomgruppsdesign med upprepade mätningar tillämpades där 40 kvinnor med antenatal depression deltog. Syftet var att undersöka (a) patientnöjdhet med bedömningssamtalet i relation till behandlingsföljsamhet, avhopp och minskning av depressionssymtom under IKBTbehandlingen, samt (b) jämföra förändring i depressionssymtom mot två tidigare studier. Resultatet visade att en högre patientnöjdhet med bedömningssamtalet signifikant predicerade en mindre minskning av depressionssymtom mellan screening och förmätning. Inga signifikanta samband hittades mellan patientnöjdhet med bedömningssamtalet och behandlingsföljsamhet eller avhopp. Slutsatser bör dras med stor försiktighet utifrån metodologiska begränsningar. Resultatet visade även att depressionssymtom jämfört med förmätningen signifikant minskade från andra veckomätningen i behandlingen till och med eftermätningen vecka tio. Detta bekräftade tidigare studiers resultat. Framtida randomiserade prövningar kan ge underlag till utvecklingen av bedömningssamtal och IKBT mot antenatal depression. / Antenatal depression (depression during pregnancy) affects 10–20% of pregnant women and involves risks for both the pregnant woman and the child. Research shows that internet-based cognitive behavioral therapy (ICBT) seems to be effective compared to conventional maternity care. The thesis was a correlational predictive study that was conducted within the randomized DANAstudy for ICBT during antenatal depression. An in-group design with repeated measurements was applied in which 40 women with antenatal depression participated. The purpose was to examine (a) patient-satisfaction with the assessment interview in relation to adherence, dropouts and remissionof depressive symptoms during ICBT treatment, and (b) compare changes in depressive symptoms against two previous studies. The result showed that a higher patient-satisfaction with the assessment interview significantly predicted a lesser reduction of depressive symptoms between screening and pre-measurement. No significant correlations were found between patient-satisfaction with the assessment interview and treatment adherence or dropouts. Conclusions should be drawn with great caution based on methodological limitations. The result also showed that depressive symptoms compared with the pre-measurement decreased significantly from the second weekly measurement in the treatment until the post-measurement week ten. This confirmed the results of previous studies. Future randomized trials may provide a basis for the development of assessment interviews and ICBT for antenatal depression.

In current market conditions, even a healthcare facility has to stack up against competition. An effective quality control of the health care provided, and an excellent perception of customers' needs are crucial, in order to achieve this objective. Customer satisfaction represents important feedback from the clients. Taking this into account, any healthcare facility should measure and evaluate satisfaction of the customers, having as an objective, a permanent improvement of the services provided. The aim of this thesis is to measure healthcare quality in a healthcare laboratory through evaluation of a questionnaire survey on patient satisfaction. The thesis consists of a theoretical and an empirical part. The theoretical part describes quality control systems in healthcare laboratories, defines the concepts of product, marketing and marketing mix "C". It also focuses on the patient, as a priority customer of the healthcare system, and defines the main reasons for examining their satisfaction. The empirical part gives firstly, an overview of activities of a particular healthcare laboratory. Subsequently, it describes the research performed and interprets the data received. There are 69.7 % of patients satisfied with the provided laboratory services. The satisfaction is determined by their age and by...

Background: Improved clinical effectiveness and therefore positive modification of multiple sclerosis (MS) with basic therapy can be achieved by long-term regular intake of drugs as prescribed but investigations have shown that a high percentage of patients do not take their medications as prescribed. Objectives: We assessed the satisfaction and adherence of patients with MS with their current disease-modifying treatment under clinical practice conditions. We compared different facets of satisfaction as well as their internal relationship and identified predictors in an exploratory manner. Methods: Therapy satisfaction in patients with relapsing–remitting multiple sclerosis (THEPAMS) was a noninterventional, prospective cross-sectional study performed throughout Germany in 2013 and 2014, and included patients with clinically isolated syndrome or relapsing–remitting MS. We applied a standardized approach to document satisfaction and adherence by patient-reported outcomes (Treatment Satisfaction Questionnaire for Medication) as well as by physician ratings. Results: Of 3312 patients with a mean age of 43.7 years, 73.3% were women and the mean level of disability according to the Expanded Disability Status Scale was 2.29; 13.3% did not receive any medication at the time of documentation, 21.3% received interferon β1a intramuscularly, 20.7% had interferon β1a subcutaneously, 17.0% had interferon β1b subcutaneously and 23.7% had glatiramer acetate. Adherence rates varied between 60% (lifetime) and 96.5% (current medication). Differences between current medications were found for side effects and convenience scores but not for effectiveness, satisfaction and adherence. Higher global satisfaction and effectiveness were associated with fewer relapses, longer duration of medication, lower disability score and the absence of several side effects. Conclusion: In a connected model of patient satisfaction, effectiveness, side effects, convenience and adherence, patients’ individual needs and concerns have to be addressed. Most differences were found with respect to side effects and convenience of treatment. Therefore, an improvement in these two domains seems to be the most promising proximate approach to elevate adherence levels.

As the U.S. population continues to diversify, hospitals need to understand and care for patients of diverse backgrounds and provide quality service for positive patient satisfaction scores. The purpose of this nonexperimental quantitative retrospective survey design was to determine what relationship exists between cultural competence initiatives (CCI) and patient satisfaction scores as reported by the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey in U.S. hospitals. The theoretical framework for this study was based upon CCI and patient satisfaction through the lens of service quality. The research questions were created to understand the relationship between CCI and patient satisfaction scores and weigh the cultural competence components relative to each other and their effect on patient satisfaction. The study's data was gathered from secondary sources: the HCAHPS and Diversity and Disparities: A Benchmark Study of U.S. Hospitals in 2013 (DDBS). Through a multiple linear regression analysis, the findings were CCI does have a significant but weak relationship with patient satisfaction. Leadership, a component of CCI, also resulted in a significant but weak relationship with patient satisfaction. The social change implications of this study are that by understanding the diverse cultural needs of its customers, health care organizations will be able to improve patient satisfaction scores. Understanding the relationship between CCI and patient satisfaction scores will aid health care organizations in determining if these initiatives are worth an investment of resources. A broader look at the significance to practice with improved patient satisfaction scores is an increased bottom line, marketing ability, and consumer attraction for hospitals.

This study examines two groups -international and domestic students at Portland State University (PSU) - in terms of their motivations to seek university-health services, and their satisfaction with university-health services. The Theory of Motivated Information Management (W. A. Afifi & Weiner, 2004) served as the foundation for this study to examine the preferences of students in terms of the ways they seek information about their health concerns. Differences in international and domestic students' anxiety, efficacy, and satisfaction with physicians were supported. International students reported more anxiety than domestic students. Domestic students reported being more efficacious than international students when talking to a medical provider about a current medical issue. Also, international students reported higher satisfaction with a medical provider at their last university health services visit. First, subjects were asked if they currently have a medical concern for which they might consider consulting a physician at PSU health services. If this scenario applied, subjects were asked to rate a variety of possible, theoretically informed motivations for seeking medical information by consulting a physician, to test the Theory of Motivated Information Management. Second, subjects were asked if they have previously consulted a physician at PSU health services. If this scenario applied, subjects were asked to provide satisfaction ratings of the physician and staff. The results contribute to the understanding of information-seeking processes and support the theory's effectiveness in this situation, explaining where international and domestic students are significantly different in regard to their responses.

Objetivo: Determinar la asociación entre la satisfacción del paciente y la motivación académica del estudiante de odontología de pregrado en un centro universitario de salud de una universidad privada de Lima. Materiales y Métodos: El estudio fue transversal. La muestra estuvo conformada por 65 estudiantes de pregrado de Odontología, y 195 pacientes que acudieron por primera vez al centro de salud. (260 personas en total). El cuestionario SERVQUAL evaluó la satisfacción del paciente, y fue entregado en dos momentos: antes y después de la consulta odontológica. El EMA (escala de motivación académica) midió la motivación del estudiante, y fue entregada en una sesión para su llenado. Para la asociación de las variables principales (motivación académica y satisfacción) se realizó una regresión de Poisson con varianza robusta y se reportaron prevalencias crudas y ajustadas con todas las variables incluidas en el estudio, con un IC [95%]. Resultados: Se encontró un 62.05% (121) de pacientes satisfechos; y la mayoría de los estudiantes presentaron una motivación extrínseca alta con 76,92% (50). Se observó que los estudiantes con la motivación anteriormente mencionada tuvieron la mayor cantidad de pacientes satisfechos con un 77.50% (97). Sin embargo, no se encontró relación entre las variables. Conclusión: La mayoría de los pacientes estuvieron satisfechos con el servicio a pesar de que la mayoría de los estudiantes no se sentía motivado. No se encontró que la motivación académica esté asociada a la satisfacción del paciente. / Objective: To determine the association between patient satisfaction and academic motivation of the undergraduate dentistry student in a university health center of a private university in Lima. Methods: The study was cross-sectional. The sample consisted of 65 undergraduate dentistry students and 195 patients who attended the health center for the first time. (260 people in total). The SERVQUAL questionnaire evaluated patient satisfaction and was delivered in two moments: before and after the dental visit. The EMA (Academic Motivation Scale) measured student motivation and was delivered in one session to be filled out. For the association of the main variables (academic motivation and satisfaction), a Poisson regression with robust variance was performed and crude and adjusted prevalence were reported with all the variables included in the study, with a CI [95%]. Results: 62.05% (121) of satisfied patients were found; and most of the students presented high extrinsic motivation with 76.92% (50). It was observed that students with the aforementioned motivation had the highest number of satisfied patients with 77.50% (97). However, no relationship was found between the variables. Conclusion: Most of the patients were satisfied with the service even though the majority of the students did not feel motivated. Academic motivation was not found to be associated with patient satisfaction. / Tesis

Nuklearmedicin är en specialitet där Flour18-fluorodeoxyglukos positronemissionstomografi/datortomografi (18F-FDG PET/DT) är en vanligt förekommande undersökning. Den vanligaste indikationen för att genomgå undersökningen är misstänkt eller känd cancer. Syfte: Syftet var att studera patienters upplevelse av information i samband med en 18F-FDG PET/DT-undersökning. Metod: En kvantitativ tvärsnittsstudie genomfördes på nuklearmedicinska avdelningen där 100 patienter som uppfyllde inklusionskriterierna tillfrågades om medverkan i studien. Efter undersökningen ombads studiedeltagarna att besvara en enkät innehållande nio studiespecifika frågor gällande informationen med fem tillhörande svarsalternativ. Resultat: Studiens resultat visar att 93,4% av studiedeltagarna upplevde den skriftliga informationen som tydlig och lättförståelig. Samtliga enkätfrågor erhöll en median på 4 vilket överensstämmer med svarsalternativet 5 “Instämmer helt”. Resultatet visar att 86 studiedeltagare (94,5%) var nöjda med den muntliga informationen samt att 78 studiedeltagare (88,7%) var nöjda med den skriftliga informationen. Resultatet påvisade att informationen gällande den radioaktiva isotopen erhöll 7 "Instämmer i låg grad" och informationen efter undersökningen erhöll 3 "Instämmer inte alls". Slutsats: Majoriteten av patienter som genomgår en 18F-FDG PET/DT-undersökning är nöjda med informationsinnehållet i samband med undersökningen. Informationen gällande den radioaktiva isotopen samt informationen efter undersökningen behöver dock förbättras. En mer omfattande studie som inkluderar fler studiedeltagare under en längre tidsperiod bör genomföras för ett mer generaliserbart resultat hos den aktuella patientgruppen. / Nuclear Medicine is a speciality in which Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a common examination. The most common indication for undergoing the examination is known or suspected cancer. Aim: Our aim was to study patients’ experiences regarding the information during an 18F-FDG PET/CT examination. Method: A quantitative cross-sectional study was carried out at the Nuclear Medicine department in which 100 patients who met the inclusion criteria were asked to participate. The participants were asked to answer a questionnaire regarding the information containing of nine study-specific questions with five options. Results: The results of our study showed that 93,4% of the participants perceived the written information as direct and easily comprehensible. All questions received a median score of 4, which corresponds with alternative 5 “Strongly agree”. The result shows that 86 participants (94,5%) were satisfied with the verbal information and that 78 participants (88,7%) were satisfied with the written information. The results showed that the information regarding the radioactive isotope received 7 “Disagree” and the information after the examination received 3 “Strongly disagree”. Conclusion: The majority of patients who undergo an 18F-FDG PET/CT examination are satisfied with the information during the examination. However, the information regarding the radioactive tracer and the information after the examination needs to be improved. A larger study that includes more participants over a longer period of time is suggested to be conducted for more generalized results.

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