The objective of the thesis was to evaluate the quality of diabetes care in the Canadian Forces by determining the extent to which physicians adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. In addition, the effect of patient age, sex, rank and size of base on quality of care was assessed and the accuracy of a diagnosis of diabetes in an extract of the electronic medical record (EMR) was evaluated. Fourteen bases within the Canadian Forces were selected for investigation, representing roughly half of the Canadian Forces population. Cases of diabetes were ascertained based on laboratory criteria following a chart review. Twenty-one CDA guideline recommendations were considered. The Canadian Forces demonstrated greater than 75% adherence with each of 9 recommendations, 50-75% adherence with each of 7 recommendations and less than 50% adherence with each of 5 recommendations. The overall adherence with all applicable recommendations per patient was 60.3% (SE 0.66). Age, sex, rank and size of base were not important factors influencing guideline adherence. The sensitivity of a diabetes diagnosis in an extract of the EMR was 84.5%, the specificity was 99.8%, the positive predictive value was 85.1% and the negative predictive value was 99.8%. This is similar to the performance of provincial and national diabetes registries. The quality of diabetes care in the Canadian Forces compared favourably with that of the civilian population within Canada and internationally. The creation of a diabetes registry is expected to lead to further improvements in diabetes care.

Quality of care is conceptualised by professionals and in policy documents as: compliance with ‘best practice’ guidelines; improving satisfaction rates; fiscal efficiency; and ethical care. ‘Quality’ in palliative and supportive district nursing care has been conceptualised in all these ways. However, the empirical research in this area draws mostly on professionals’ and carers’ views with little research addressing patients’ views. With political rhetoric pushing for a ‘patient led’ NHS, research into how patients conceptualise quality in this area is necessary to both critique this rhetoric and/or facilitate its aims. Therefore, this research investigates patients’ and carers’ views on the quality of palliative and supportive district nursing care.Participants were recruited to an exploratory qualitative study resulting in a convenience sample of twenty six patients (all of district nursing caseloads) and thirteen carers. All participants were over eighteen, able to consent, lived in their own homes, were under the care of district nurses, and had palliative care needs. Eighteen participants had a cancer diagnosis, six had a non-malignant diagnosis, one had co-morbidities, and one participant did not disclosed their diagnosis. Semi-structured interviews were conducted with all participants, five participants were interviewed twice. Post-structuralist theories were used with discourse analysis techniques for the final analysis.The findings identify three of the most influential discourses in relation to the morality and quality of care: Firstly, ‘busyness’, and how its performance by district nurses masks patients’ and carers’ ability to critique care, instead producing a pseudo-quality which fixes patients and carers subjectivities. Secondly, ‘power/knowledge’ and the ways in which it prevents patients and carers accessing care which they need, and altering care to suit their needs. Thirdly, ‘the home’ and how it (re)forms district nursing care and district nursing care (re)forms the home; meaning that actions by district nurses must also consider the impact on the home as well as the patients and carers. In conclusion quality care may be produced by: ceasing to measure quality; involving patients and carers with commissioning and directing palliative and supportive care; supporting groups other than district nurses such as patients, carers and third parties to produce and distribute knowledge about district nursing care; increasing patients’ and carers’ ability to communicate with one another about their care.Further research may investigate: how patients and carers with palliative and supportive care needs may be involved in commissioning; the most appropriate wording and means to distribute knowledge about palliative and supportive district nursing care; ethnographic work to explore how district nursing and the home interact; more detailed theorisation of how the material and the discursive can be accounted for within post-structuralism.

The aim of this thesis is to elaborate a strategic analysis of Masaryk Hospital in the city Jilemnice and evaluation of quality of care in this medical facility. Masaryk Hospital in Jilemnice city is located in the Giant Mountains region in the Liberec Region and is the largest organization run by the city Jilemnice. The health sector in the region is developing quite dynamically and is thus evident that although the hospital is a non-profit organization run by the city, operates in a market environment, especially due to relatively visible competitive struggle between hospitals in its vicinity. It is a facility offering comprehensive acute health care, which operates six other wards and outpatient department.

Depression is common and disproportionately affects those with chronic medical comorbidity, such as diabetes mellitus (DM). Only a limited amount of information is available concerning the quality of guideline-concordant treatment of depression and its influence on glycemic control among those with DM. This is the first study to address these issues in a veteran population with DM. This is a retrospective cohort study (1997-2005) of veterans with and without DM from the Roudebush Veterans Affairs Medical Center in Indianapolis. Veterans with and without DM and a new episode of depression were identified. Administrative, clinical, and pharmacy data were linked to assess initiation of treatment, follow-up care, antidepressant dosage and duration, and change in antidepressant agent based on the Veterans Health Administration (VHA) clinical practice guidelines for depression. HbA1c levels were assessed following initiation of antidepressant therapy. Treatment of depression was not consistent with guideline recommendations. Only 60% of subjects received treatment within 30-days of the depression diagnosis. Veterans with DM were more likely to have received treatment within the first two weeks than veterans without DM. Few subjects received appropriate follow-up care for depression (<40%) or an adequate duration of antidepressant therapy (<9%), although most (88%) received a dosage consistent with guideline recommendations when treatment was provided. Most subjects (>75%) were treated with a serotonigenic agent and only 23% experienced a change in therapy during the treatment period, almost 84% of which received an adequate trial of therapy prior to the change or augmentation in agent. Presence of DM was associated with significantly increased odds for receipt of guideline-concordant care for depression in most multivariate analyses. Receipt of guideline-concordant care for depression was not a significant predictor of glycemic control but was associated with a clinically meaningful reduction of 0.5% in HbA1c levels. This research demonstrates that under-treatment of depression is common and may influence at least one medical outcome. Findings also support that the relationship between depression and DM is complex and that further research is necessary to help align current practice with evidence-based practices in the VHA.

Orientador: Alessandro Lia Mondelli / Resumo: Introdução: O Brasil é classificado pela Organização Mundial de Saúde (OMS) como um país de endemicidade intermediária para o vírus da hepatite C (VHC). Para alcançar melhorias nos serviços de acompanhamento e atendimento pela Equipe Multidisciplinar é necessário cada vez mais o aprimoramento e eficácia nas condutas terapêuticas. Objetivos: Avaliar e comparar o atendimento multidisciplinar de 5 ambulatórios de Hepatite C do Estado de São Paulo; Avaliar o grau de satisfação dos pacientes quanto à qualidade do atendimento recebido por uma equipe multidisciplinar; Descrever o grau de dificuldade no acompanhamento do tratamento dos portadores de hepatite C; Relacionar e comparar a qualidade de atendimento entre os 5 ambulatórios, descrevendo as diferenças entre ambos. Método: estudo transversal, realizado por meio de aplicação de questionário semiestruturado a 425 pacientes dos Ambulatórios, UNESP/HCFMB; UNIFESP/EPM; USP/FMRP; FAMERP/S.J.RIO PRETO e SANTOS CRAIDES. Este trabalho foi aprovado pelo Comitê de Ética em Pesquisa número 1.850.408. Resultados: na avaliação do acompanhamento e atendimento dos serviços ambulatoriais nos diversos centros observaram-se diferenças estatisticamente significantes. A avaliação direta e indireta do atendimento médico e do atendimento de enfermagem foi classificada como boa e ótima, respectivamente. No entanto, os pacientes relataram não sentir diferenças no atendimento de cada profissional. Conclusão: Os resultados desta pesquisa apontam a neces... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: According with World Health Organization (WHO), Brazil is classified as a country with intermediary endemicity for the hepatitis C virus. In order to improve monitoring and follow-up services by the Multidisciplinary Group it is necessary to improve efficacy on the therapeutic conduct. Objetivos: Evaluate and compare the Multidisciplinary care among ambulatories of Hepatitis C of the State of Sao Paulo, regarding satisfaction monitoring and follow-up services provided by the ambulatories. Methodology: cross-sectional study, conducted by applying a half structuralized questionnaire to 425 patients of the following ambulatories:, CRAIDES/SANTOS; UNIFESP; FAMERP; USPFMRP and HCFMB. Approved by the Ethics in Research Committee. Results: In the evaluation of the follow-up and care of the ambulatorial`s services in the various centers, significant statistical differences were observed. The direct and indirect evaluation of the medical care and nursing care was classified as good and excellent, respectively. However, patients reported no differences in care from one professional to another. Conclusion: The results of this research suggest that, despite the great importance of the theme, in practice, users still demonstrated the lack of knowledge of the multiprofessional team during their treatment. However, they rate the medical and nursing staff during follow-up and outpatient care as good and great. Thus, the results indicate the need for those responsible for outpat... (Complete abstract click electronic access below) / Doutor

The hospitals and their healthcare providers need to optimize simultaneously three outcomes: healthcare costs, healthcare options offered to customers, and information utilization efficiency. The adoption of electronic healthcare record (EHR) technologies is a potential managerial mechanism for balancing these outcomes. EHR offers patient management and decision support capabilities that can ameliorate health delivery outcomes for patients, doctors, and hospitals through better-informed business and care decisions. The analysis of data collected in an EHR system may lower costs and improve health care delivery (or both). In sum, it could be argued that EHR is a source of competitive advantage. Despite this prima facie appeal, many hospitals remain reluctant to adopt and implement EHR due to lack of insights into return on investment, unavailability of tested systems and data entry obstacles. To address this gap between the potential of EHR system and lack of its adoption, the purpose of this research is to investigate the role of EHR as a resource of competitive advantage for hospital. Essay 1, titled "Implementation and Adoption of EHR: A Conceptual Model based on Resource Advantage Theory", describes the antecedents and consequences of EHR adoption and implementation. Essay 2, titled "Exploring the Relationship Between Electronic Healthcare Record Adoption and Quality of Care", delves deeper into the operational performance of a hospital. This essay focuses on the impact of EHR on different aspects of patient care and thereby on the financial performance of the hospital. Essay 3, titled "The Effect of Resources on a Hospital's Financial Performance: The Moderating Role of Electronic Health Records Implementation and Adoption", is an empirical inquiry into the key factors that may influence hospitals' financial performance. These include organizational factors (such as, number of nurses and beds) and environmental factors (such as, location and received donations). Further, this essay explores the interaction effects between EHR and these factors. In summary, this research provides a conceptualization and an empirical investigation of EHR adoption and implementation and its impact on hospitals' operational and financial performance, an area receiving widespread attention from health care organizations, patient rights activists, public policy makers and the media. Future research can take two paths. First, further research should address questions related to the integration of EHR with other production and inventory management systems, and the prospective benefits attained from system integration. Second research is needed to investigate how parallel information transfer across multiple stakeholders may concurrently preserve Health Insurance Portability and Accountability Act, reduce health care delivery costs and optimize service quality.

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Empowerment betyder makt och att ha förmågan att ha kontroll över sitt eget liv. Empowerment används inom många olika verksamheter såsom vården, utbildning och ekonomi. Begreppet kan användas av alla som på något sätt arbetar med att hjälpa människor både inom den privata och offentliga sektorn. Det är därför av intresse att undersöka vad som är betydelsefullt för att sjuksköterskor ska känna empowerment. / Empowerment means power and the ability to have control over one’s own life. Empowerment is used in many different sectors such as healthcare , education and economics. Empowerment can be used by anyone who in any way works to help people in both private and public sectors. It is therefore of interest to investigate what is important for nurses to feel empowerment.

Bakgrund: Sjuksköterskerollen är en komplex yrkesroll där sjuksköterskan ansvarar för att ge vård av hög och god kvalité. Sjuksköterskan har ett stort ansvar vilket finns beskrivet dels i lagtext och i ICN:s etiska kod. Bristande omvårdnadsarbete har setts förekomma i sjuksköterskeyrket i flera länder. Tidigare forskning efterlyser därför forskning kring varför sjuksköterskor ibland avviker från sitt ansvar. Olika avvikelser som görs inom vården kan leda till en sämre vårdkvalité och en ökning av vårdrelaterade skador.  Syfte: Studiens syfte är att belysa faktorer som enligt sjuksköterskan påverkar vårdkvalitén.  Metod: En litteraturöversikt som baseras på 15 vetenskapliga artiklar varav en med kvalitativ ansats och 14 med kvantitativ ansats. Artiklarna inhämtades från databaserna CINAHL och PubMed.  Resultat: Flera faktorer visades påverka vårdkvalitén enligt sjuksköterskan. Faktorerna som identifierades kunde formas till kategorier vilka var psykologisk arbetsmiljö, arbetstillfredsställelse, resurstillräcklighet och tillgänglighet, förmåners och uppskattningens påverkan, påverkad arbetsprestation och arbetsrelaterad stress. Faktorerna kunde enskilt påverka vårdkvalitén men det visade sig också att en faktor kunde leda till en annan.  Konklusion: Det kan vara svårt att bedriva vård av god kvalité då begreppet vårdkvalité är svårdefinierat. De ansvar som sjuksköterskan har vilket exempelvis beskrivs i Phil Barkers teori kan även vara svårt att upprätthålla då sjuksköterskan påverkas av olika faktorer på arbetsplatsen. / Background: The Nurse role is a sophisticated professional role where the nurse is responsible for providing care of high and good quality. The nurse has a great responsibility, which is described partly in the law text and in the ICN code of ethics. Inadequate nursing work has been seen in the nursing profession in several countries. Previous research therefore advertises for research on why nurses sometimes deviate from their responsibilities. Various deviations made within the care system can lead to more mediocre quality of care and an increase in carerelated injuries. Aim: The purpose of the study is to elucidate factors that affect the quality of care, according to the nurse. Method: A literature review based on 15 scientific articles, one with a qualitative approach and 14 with a quantitative approach. The articles were obtained from the CINAHL and PubMed databases. Result: Several factors were shown to influence the quality of care according to the nurse. The factors identified could be formed into categories which were psychological work environment, job satisfaction, resource adequacy and availability, the impact of benefits and estimation, impacted work performance and work-related stress. The factors could individually influence the quality of care, but it was also found that one factor could lead to another. Conclusion: Caring for good quality care can be difficult as the concept of quality care is difficult to define. The responsibility of the nurse, which are described, for example, in Phil Barker's theory, can also be challenging to maintain as various factors influence the nurse in the workplace.

Background: South Africa aims to end all preventable deaths of children under the age of five as part of their commitment to the Sustainable Development Goals. More than half of these mortalities occur in the neonatal period with perinatal asphyxia as one of the leading causes. This study investigated and identified the characteristics of perinatal asphyxia and its contributing factors at a district hospital in Cape Town. Methods: A retrospective descriptive case series was performed and included all suspected cases of perinatal asphyxia referred from Mitchells Plain District Hospital (MPH)) to a specialised centre in the years 2016-2018. A data collection tool was used to extract information. Data was processed with SPSS to produce descriptive statistics and to investigate associations between variables using the Chi-square tests. Results: The study included 29 cases of suspected perinatal asphyxia. Ten (34.5%) had abnormal amplitude Electroencephalograms (aEEG's) indicative of Hypoxic Ischaemic Encephalopathy (HIE) and four (13.8%) demised before day seven of life. Non-operative deliveries (p=0.005), lack of a doctor at the time of delivery (p=0.004) and neonatal chest compressions (p=0.044) were associated with abnormal aEEG's. Babies with Thompson score of equal to or more than 12 (p=0.006), neonatal seizures (p=0.036) and delayed arrival at referral hospital (p=0.005) were associated with abnormal aEEG findings. Mortality was associated with Thompson score ≥12 (p=0.007) and the need for neonatal intubation at delivery (p=0.016). Conclusions: Significant reversable factors were identified in the peri-and postpartum periods. More capacitated staff would have the greatest impact on outcomes. The profile of HIE is exceedingly complex and challenges the resources and services of district level of care. Therefore, these factors should be targeted for future development and investment to improve outcomes from district hospitals.