Ziel der vorliegenden Masterarbeit ist die Entwicklung von Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ im Klinikum Mutterhaus. Damit soll ein Instrument entwickelt werden, das patientenbezogene Dienstleistungen der Krankenhausapotheker an der intersektoralen Schnittstelle im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit messen und bewerten kann. Schwachstellen und Verbesserungspotentiale über den Verantwortungsbereich der Apotheke hinaus sollen identifiziert und in einen kontinuierlichen Verbesserungsprozess eingebracht werden können. Methodik: Zur Entwicklung der Qualitätsindikatoren wurde ein mehrstufiges Verfahren gewählt. Zunächst wurden die Qualitätsziele des Prozesses definiert und eine Prozessanalyse durchgeführt. Die Literaturrecherche auf nationaler und internationaler Ebene gab Anhaltspunkte zur Ableitung von Qualitätsindikatoren. Basierend auf der Prozessanalyse und der Literaturrecherche wurden Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ entwickelt. Anhand einer retrospektiven Datenerhebung wurden die entwickelten Qualitätsindikatoren auf ihre Aussagekraft und Eignung geprüft. Der Prozess wurde mit Hilfe der Qualitätsindikatoren gemessen und bewertet. Schlussfolgerung: Mit Hilfe von fünf Qualitätsindikatoren-Sets kann der Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ umfassend untersucht werden. Die entwickelten Qualitätsindikatoren sind geeignet, die pharmazeutische Dienstleistung im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit zu messen und zu bewerten. Sie ermöglichen die Evaluation des Prozesses und zukünftiger Verbesserungsmaßnahmen. Anhand der Qualitätsindikatoren wird zukünftig ein Monitoring der Dienstleistung möglich sein. / Purpose: The aim of this thesis is the development of quality indicators for the process "recommendations of the pharmacy to continue patient’s medication" at Klinikum Mutterhaus. An instrument is to be developed that can measure and rate the patient-related services of the hospital pharmacist at the intersectoral interface in terms of quality target in medication safety. Weaknesses and potential improvements should be identified and incorporated into a continuous improvement process. Methods: A multistage process is selected for the development of the quality indicators. First, the quality objectives of the process are defined and a process analysis is performed. A literature review on national and international level shall provide evidence for the derivation of quality indicators. Based on the process analysis and the literature review the quality indicators for the "Recommendations of the pharmacy to continue patient`s medication” are developed. In a retrospective data collection, the developed quality indicators are tested for their validity and suitability. The process is finally measured by the quality indicators and evaluated. Conclusion: With the help of five quality indicator sets the process "recommendations of the pharmacy to continue patient’s medication" can be fully investigated. The developed quality indicators are suitable to measure and evaluate the process in terms of the quality target medication safety. So the evaluation of the process and future improvements are possible. On the basis of the quality indicators a monitoring of the process can be established in the future.

The final thesis topic focuses on the issue of internal audits and their contribution to enhancing quality of the provided care. The aim of the final thesis was to find out how the nurses working shifts and head nurses assess internal audits. Next, the aim was to research nurses? opinions on further enhancing quality of the provided care. Another goal of the thesis was to explore internal auditors? professional qualifications and find out their opinion on the issue of internal audits. In the empirical part of the diploma thesis, I have chosen a quantitative and a qualitative research method. The quantitative research was carried out in the form of an anonymous questionnaire for non-medical workers. In the qualitative research I have applied in-depth interviews, carried out with three quality managers and three internal auditors. Furthermore, three internal audits of nursing units and three internal audits of medical documentation have been carried out. The results of the thesis may be practically used as a source of information about quality, continual enhancement of the quality of the provided care and ensuring quality by the means of internal audits.

Proper nutrition is essential for every human being, whether healthy or sick. Nutrition is, according to associate docent Kohout, one of the areas that is most neglected in health and social facilities in the Czech Republic. Standardized nutritional care should be established in all hospitals, representing a comprehensive nutritional and qualified solution for clients/patients. The standardized nutritional care involves systematic assessment of nutritional status of a client/patient and a search for clients/patients at nutritional risk. It further includes an appropriate diet according to the needs and capabilities of a client/patient and timely provision of adequate nutritional support to clients/patients who were identified as nutritionally at risk. Finally, standardized nutritional care also includes monitoring and documenting the effects of nutritional therapy, because the effect of individual measures cannot be monitored without proper documentation. The objective is to monitor the process of identification, evaluation and implementation of actions to ensure nutritional care in selected medical facilities from the perspective of the senior nursing management. Another objective is to map how significant quality indicator this is and what problems are seen in creating and maintaining a standard situation. Data collection was carried out by an interviewing technique using questionnaires. Respondents were from hospitals in the Czech Republic where we addressed the members of their senior nursing management. H1 ``The hospitals use established control mechanisms to find out about the nutritional status of compliance with established standards of nutritional care{\crqq} has been confirmed. H2 ``Nutritional screening is performed by nurses on all clients/patients at reception{\crqq} has been confirmed. H3 ``Nutritional screening during hospitalization is repeated only in clients/patients at risk{\crqq} has been confirmed. H4 ``Nurses develop nutritional screening within the cooperation of nurses with a nutritional therapist in the provision of standardized nutrition care{\crqq} has been confirmed, and H5 ``The results of nutritional screening are used by nurses as the basis for the saturation of clients{\crq}/patients{\crq} nutritional requirements{\crqq} has also been confirmed. The second objective was to map how significant quality indicator this is and what problems are seen in creating and maintaining a standard situation. The performance of nutritional screening has become the second most important quality indicator according to the research. As for the problems seen by respondents in relation to creating and maintaining a standard situation, it can be said, on the basis of the research results, that the biggest problems in creating and maintaining a standard situation is the lack of personnel, economic demands and approach of the personnel, their reluctance and disinterest. We attempted to explore the process of identification, evaluation and implementation of actions to ensure nutritional care in selected medical facilities from the perspective of the senior nursing management and then, based the results, to suggest ways of potential improvement of the current situation in the field of clients{\crq}/patients{\crq} nutrition.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Water resources preservation is a worldwide issue, mainly regarding to the availability to several human uses, including irrigated agriculture. The increasing concern about water quality and quantity is stimulating studies on dynamics of reservoirs and other water bodies. The acquired knowledge is of crucial importance for better management of a watershed and its components, especially when irrigated agroecosystems are present. The objective of this study was to characterize the quality of the water used in the Jacarecica I Irrigation District, situated in the Jacarecica River watershed, Sergipe, Brazil. The water quality was characterized using physicochemical and biological parameters obtained from water samples collected in January, March, May, July, and October of 2005. The field and laboratory measurements were pH, transparency, temperature, electrical conductivity, ammonia, nitrite, nitrate, total nitrogen, total phosphorus, dissolved oxygen, chlorophyll a, turbidity, sodium, potassium, calcium, magnesium, boron, chloride, bicarbonate, sulfate, fecal and total coliform. It was confirmed the utility of these parameters as water quality indicators for environmental monitoring purposes and for verification of the reservoir water adaptability to human and irrigation uses. The reservoir water ranged from eutrophic to oligotrophic depending on the season of the year and the sampling location, occurring reduction of the trophic state from the river to the dam. The limiting nutrient in the reservoir was the nitrogen during the dry season and the phosphorus during the rainy season. The reservoir water hydrochemistry was homogeneous with predominance of chloride sodic water. According to USDA classification, the reservoir water is C2-S1, in both dry and rainy seasons. Considering FAO’s guidelines, there were restrictions to water use due to sodium in the dry season and bicarbonate in both dry and the rainy seasons. / A preocupação crescente com a disponibilidade hídrica no que se refere a sua qualidade e quantidade vem estimulando o conhecimento da dinâmica dos reservatórios.Esse conhecimento é de fundamental importância para gerenciamento e manejo sustentável de uma bacia hidrográfica e da qualidade da água, principalmente quando se trata de agroecossistemas irrigados. Há uma tendência mundial na preservação dos recursos hídricos, visando garantir sua disponibilidade para usos como doméstico, agrícola, piscicultura, navegação, industrial, lazer, etc. Este trabalho tem por objetivo caracterizar através de parâmetros físico-químicos e biológicos a qualidade da água utilizada no Perímetro Irrigado Jacarecica I, bacia hidrográfica do Rio Jacarecica, município de Itabaiana, SE. Os parâmetros da água medidos foram: pH, temperatura, transparência, turbidez, sólidos suspensos, sólidos totais dissolvidos, oxigênio dissolvido, condutividade elétrica, sódio, potássio, cálcio, magnésio, boro, cloreto, bicarbonato, sulfato, amônia, nitrito, nitrato, nitrogênio total, fósforo total, coliforme fecal, em cinco campanhas de amostragem: janeiro, março, maio, julho e outubro de 2005. Estes parâmetros servem como indicadores ambientais da água da barragem, visando tanto o monitoramento ambiental como a sua adaptabilidade à prática da agricultura irrigada. Com base no Índice de Estado Trófico o reservatório apresenta características de sistemas oligotróficos a eutróficos, dependendo do período e da localização das estações amostradas. Observou-se ainda que ocorre redução do estado de trofia no sentido do rio para a barragem. O nutriente limitante do reservatório no período de estiagem é o nitrogênio e, durante o período chuvoso, a limitação passa a ser do fósforo. Constatouse um comportamento hidroquímico homogêneo, com predominância do tipo de água cloretada sódica. De acordo com o sistema de classificação do USDA a água pode ser classificada como C2-S1, tanto na estação seca como na chuvosa. Considerando as diretrizes da FAO houve restrição quanto ao uso para o sódio, nos meses de janeiro e março, e para o bicarbonato nos períodos de amostragem.

La maîtrise de la résistance bactérienne passe par une amélioration de la prescription des anti-infectieux en pathologie humaine. L'objectif de ce travail était de mettre au point et d'évaluer l'impact d'une intervention destinée à améliorer la qualité de l'antibiothérapie, en ciblant en priorité les prescriptions hospitalières. Nous avons voulu utiliser des stratégies dérivées des sciences sociales et de l'industrie, notamment les techniques d'amélioration continue de la qualité, pour changer le comportement des prescripteurs. Nous avons ensuite ciblé une étape-clé de la prescription antibiotique, i.e. la réévaluation des antibiothérapies probabilistes 24-96 heures après leur initiation, que nous avons sélectionnée à l'issue d'une revue de la littérature et d'une analyse quantitative par questionnaire des perceptions, attitudes et connaissances des prescripteurs ; le questionnaire permettait également d'approcher les barrières locales à cette intervention. Puis nous avons mis au point des indicateurs de processus permettant de mesurer cette réévaluation des antibiothérapies. Enfin, nous avons étudié l'impact sur la qualité de l'antibiothérapie d'une intervention utilisant une stratégie d'audit et de retour d'information, visant à améliorer la documentation de la réévaluation des antibiothérapies par des médecins non-infectiologues dans deux services. En conclusion, les stratégies d'amélioration continue de la qualité s'avèrent utiles pour promouvoir le bon usage des anti-infectieux. / Antibiotic stewardship is essential to curb bacterial resistance in humans. Our aim was to design an intervention to improve the quality of prescription of antibiotics, focusing on the inpatient setting. We used strategies derived from the social sciences and the industry, particularly continuous quality improvement techniques, to lead the doctors to change their behaviour. We focused on a key process of antibiotic prescribing, i.e. reassessment of antibiotic therapies 24-96 hours after their start ; we selected this process based on a review of the literature and on the results of a survey designed to assess the perceptions, attitudes and knowledge of the prescribers. This survey also enabled us to approach potential barriers to the intervention. We designed then a set of process measures of quality of care in the reassessment of inpatient empirical antibiotic prescriptions. Finally, we assessed the impact of an intervention designed to improve the documentation of the reassessment of inpatient empiric antibiotic prescriptions on the quality of these prescriptions ; this intervention was conducted on two wards and targeted non-infectious diseases specialists, using an audit and feedback approach. In conclusion, continuous quality improvement strategies are a valuable tool to improve antibiotic use.

This study is a mixed-method study that seeks to develop a set of institutional dementia care indicators to evaluate quality of care and inform the improvement of quality of life (QOL) for Taiwanese people with dementia living in care homes. It also uses comparative analysis to compare the different features of policy and its delivery in dementia care between Scotland and Taiwan, a comparison designed to aid the development of dementia care policy, and the establishment of quality indicators for institutional dementia care, in Taiwan. This study employed the person-centred care approach at the micro perspective, and the total quality management (TQM) approach at the macro perspective, in order to inform a seamless care model for people with dementia living in care homes. Data were collected in two stages: comments from experts in dementia care were recorded in an exercise using “Delphi” methodology; subsequently the opinions of service receivers were recorded in a fieldwork exercise. The Delphi exercise (stage one) acted as the pre-test, involving 24 experts in dementia care in Scotland and Taiwan in evaluating the usefulness and applicability of proposed quality indicators for institutional dementia care. Quantitative and qualitative data from the Delphi panel were analyzed. The fieldwork (stage two) collected 237 questionnaires (from 122 residents with dementia and 115 family members) in 14 Taiwanese care homes for people with dementia (including special care units within care homes). The field test data were analyzed using reliability and item analysis, confirmatory factor analysis (CFA), and descriptive and inferential statistics. Initially, 43 proposed quality indicators for institutional dementia care were identified through literature review. However, after two Delphi rounds, only six key dimensions (41 quality indicators) were identified by consensus as the important items for use in measurement of quality of care for people with dementia living in Taiwanese care homes. Through reliability and item analysis, and CFA, this research developed a model which is a three-factor structure (social care, health and personal care, and environment) with 18 quality indicators. The 18 quality indicators have high reliability, validity, and credibility and load onto a second order factor which represents quality of care for people with dementia living in care homes. Further analysis was then conducted to explore how relative ratings on these three factors differed according to measured characteristics of the residents and their family members. In general, only a few strong patterns of difference emerged and multiple linear regression analysis suggested that differences in ratings could not be attributed to influences of socio-economic and socio-demographic differences between respondents. The study concludes that the Delphi method could be used as a methodology for health services research to integrate the opinions of multidisciplinary dementia experts and that CFA is an effective technique to study the empirical factor structure. The findings suggest that the 18 quality indicators could be suitable criteria for people with dementia and their family members to evaluate care quality and select an appropriate care home. The indicators also have important policy implications for the Taiwanese Government and regulations intended to ensure that care homes meet the requirements of service receivers.

This study is devoted to investigating and developing WSN based localisation approaches with high position accuracies indoors. The study initially summarises the design and implementation of localisation systems and WSN architecture together with the characteristics of LQI and RSSI values. A fingerprint localisation approach is utilised for indoor positioning applications. A k-nearest neighbourhood algorithm (k-NN) is deployed, using Euclidean distances between the fingerprint database and the object fingerprints, to estimate unknown object positions. Weighted LQI and RSSI values are calculated and the k-NN algorithm with different weights is utilised to improve the position detection accuracy. Different weight functions are investigated with the fingerprint localisation technique. A novel weight function which produced the maximum position accuracy is determined and employed in calculations. The study covered designing and developing the centroid localisation (CL) and weighted centroid localisation (WCL) approaches by using LQI values. A reference node localisation approach is proposed. A star topology of reference nodes are to be utilized and a 3-NN algorithm is employed to determine the nearest reference nodes to the object location. The closest reference nodes are employed to each nearest reference nodes and the object locations are calculated by using the differences between the closest and nearest reference nodes. A neighbourhood weighted localisation approach is proposed between the nearest reference nodes in star topology. Weights between nearest reference nodes are calculated by using Euclidean and physical distances. The physical distances between the object and the nearest reference nodes are calculated and the trigonometric techniques are employed to derive the object coordinates. An environmentally adaptive centroid localisation approach is proposed. Weighted standard deviation (STD) techniques are employed adaptively to estimate the unknown object positions. WSNs with minimum RSSI mean values are considered as reference nodes across the sensing area. The object localisation is carried out in two phases with respect to these reference nodes. Calculated object coordinates are later translated into the universal coordinate system to determine the actual object coordinates. Virtual fingerprint localisation technique is introduced to determine the object locations by using virtual fingerprint database. A physical fingerprint database is organised in the form of virtual database by using LQI distribution functions. Virtual database elements are generated among the physical database elements with linear and exponential distribution functions between the fingerprint points. Localisation procedures are repeated with virtual database and localisation accuracies are improved compared to the basic fingerprint approach. In order to reduce the computation time and effort, segmentation of the sensing area is introduced. Static and dynamic segmentation techniques are deployed. Segments are defined by RSS ranges and the unknown object is localised in one of these segments. Fingerprint techniques are applied only in the relevant segment to find the object location. Finally, graphical user interfaces (GUI) are utilised with application program interfaces (API), in all calculations to visualise unknown object locations indoors.

No description available.

La démarche d'accréditation JACIE est une démarche volontaire à laquelle se soumettent des programmes de greffe de cellules souches hématopoïétiques (CSH), couvrant les trois activités partenaires (clinique, prélèvement de cellules et ingénierie cellulaire) et leurs interfaces. L'objectif est d'assurer un niveau minimal de qualité, de gestion des risques et d'harmonisation dans la mise en oeuvre des programmes de greffe de CSH en onco-hématologie. La construction et l'exploitation des indicateurs qualité doivent démontrer des progrès objectifs en matière de qualité et de sécurité des soins en retour des investissements consentis pour la mise en place de la démarche JACIE. Dans ce travail, nous proposons d'identifier et d'évaluer la pertinence des indicateurs mis en place dans le cadre de la démarche JACIE à mesurer des bénéfices tangibles (matériels et immatériels) tant pour les patients receveurs d'une greffe, que pour l'établissement de santé qui contribue à leur prise en charge. Pour cela, une enquête a été diffusée auprès de 82 centres accrédités JACIE en France puis dans les autres pays d'Europe. Dans le cadre de l'évaluation des soins pour laquelle la mis en place d'indicateurs est une approche de gestion des risques, nous avons cherché à déterminer si d'une part la construction des indicateurs dans les centres avait suivi une méthodologie de référence et d'autre part si tous les processus à risque de la greffe de CSH faisaient l'objet d'une surveillance / JACIE relies on transplant programs voluntarily applying for accreditation: it is important to understand that programs, rather than centres, apply meaning that all three infrastructures and teams (cell collection, cell processing and patient care unit) jointly engage in the accreditation process. The purpose of JACIE standards is to ensure a minimal level of quality, and harmonize laboratory and clinical practices in the field of onco-hematology. Implementation and follow-up of indicators do not necessarily reflect on quality and safety of patient care. The first aim of this study is to identify indicators set in place by the programs and to assess how their measure could be translated in qualitative benefit or quantitative benefit for the patient or the hospital. A survey was launched to 82 programs that were holding a valid accreditation, starting with French centres, and then extending to accredited programs in other European countries. Quality indicator is a tool for assessing healthcare delivery and indicator approach is commonly employed for risk management in healthcare systems. Thus, the second aim of this study is to understand whether a method was used to implement efficiently the indicators and to evaluate if all the HSCT processes are monitored

Este trabalho concentra-se no aumento da robustez à taxa de erros em redes de sensores sem fio industriais (RSSFI). Para alcançar tal objetivo, é preciso, de algum modo, contornar os problemas intrínsecos da comunicação sem fio, que são, o ruído ambiental, interferências e desvanecimento por multipercurso. O multipercurso pode ser considerado um dos principais fatores que tornam as comunicações nas redes de sensores sem fio (RSSF) um verdadeiro desafio quando comparadas com outros meios, como a transmissão em fibra óptica, cabo ou mesmo transmissões de rádio ponto-a-ponto. Nesse sentido, propõe-se a diversidade de antenas como uma solução para minimizar os efeitos do multicaminho, com o objetivo de melhorar a confiabilidade do enlace de rádio para permitir o emprego de RSSF densas. O potencial da diversidade de antenas em RSSF não está totalmente explorado em aplicações industriais. Esta dissertação apresenta ainda, a técnica “Combinação de seleção” para RSSFI através de um algoritmo que seleciona a porta do receptor que apresenta o melhor indicador de qualidade de enlace e realiza a comutação das antenas nos módulos de rádio. Os resultados são analisados para dois tipos de enlaces, isto é, com e sem diversidade de antenas na recepção, e discute-se opções para melhorar o PER (“Packet Error Rate”) com as atuais técnicas de diversidade. / This work concentrates on the increase of reliability and robustness in Industrial Wireless Sensor Networks (IWSNs), decreasing the Packet Error Rate (PER). To achieve this objective, is need to somehow circumvent and reduce the underlying problems of wireless communication, which are: environmental noise, interference, and multipath fading. The multipath can be seen as the main factor which becomes the communications in the Wireless Sensor Networks (WSNs) a real challenge when compared to other types of means such as a transmission in fiber, cable or even point-to-point radio transmissions. In this sense, it is proposed antenna diversity as solution to reduce these effects, with the aim to improve the reliability of the radio link to allow the use of dense WSNs. The potential of antenna diversity in WSN is not fully exploited in industrial applications. In this sense, this dissertation presents the "Combination of selection" technique for IWSNs through an internal algorithm that selects the receiver port that has the highest LQI ("Link Quality Indicator") and performs an antenna switching in the radio modules. Also, options to improve PER using diversity techniques are discussed.