A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Currently few studies have investigated the accuracy of using transcutaneous bilirubinometry after phototherapy especially in the outpatient setting. The purpose of this study was to evaluate the accuracy of transcutaneous bilirubin measurements (TCB) after phototherapy for neonates with jaundice. At the Maricopa Integrated Health System, neonates who undergo phototherapy for hyperbilirubinemia come in for outpatient follow‐up at the Comprehensive Health Center following their discharge. For those neonates, current protocol calls for serum bilirubin (TSB) to be measured to properly monitor bilirubin levels, however transcutaneous measurements were made and recorded as well. In this study, we compared the values of total serum bilirubin and transcutaneous bilirubin in jaundiced neonates who underwent phototherapy. From October 2013‐April 2015, a total 67 healthy infants were seen in the Pediatric Clinic who had received phototherapy in our hospital, only 36 (54%) of those met minimum data criteria to be included in the study. The absolute difference between mean serum bilirubin and transcutaneous bilirubinometry in healthy outpatient newborns who received inpatient phototherapy was 0.4 and is clinically insignificant. The average time from hospital discharge to return to clinic was 47 hours. We conclude that for the outpatient physician, transcutaneous bilirubinometry can be used following phototherapy, which facilitates faster, more convenient, and painless follow‐up visits.

Thesis (MPH)--University of Limpopo, 2010. / Introduction The neglect of men with respect to their role in family planning has contributed to a situation in which men remained passive or non-participatory in reproductive health related studies and have generally not been included in most of research on family planning and use of modern contraceptives (Mbizvo & Basset, 1996). Family planning saves women’s and children’s lives and improves the quality of life. In addition, family planning reduces fertility and help to relieve the pressures that rapidly growing populations place on economic, social and natural resources. Men’s participation in family planning can improve women and children’s health. Men are heads of families and play dominant roles in decision making crucial to women’s lives and women’s reproductive health. Aim and the objectives of the study: The aim of the study was to identify and describe factors affecting the participation of men attending out - patient services at Qoaling Filter Clinic. Methods and materials: • Study design The study used a descriptive cross sectional design. The factors were identified, described and the differences between the factors and participation determined. • Study population The population for the study consisted of men between 18 and 50 years who attended out-patient services at Qoaling Filter Clinic. • Study setting The data was collected from Qoaling Filter Clinic which is situated the southern region of Maseru, the capital of Lesotho. It is a mini hospital. • Sampling and sample size A cluster sampling was used. The researcher developed a sampling frame. Men who met the inclusion criteria were selected randomly. The formula used to compute the sample size was n/ [(1-(n/population)]. The sample size was 94. Results The findings of this study indicated that men knew some of the family planning methods. There was no difference in participation of men in family planning between men with more or less knowledge. There was a relationship between age, residing area, knowledge and participation. The majority of men indicated that if they were given information and there were special clinics for men, family planning services utilization would increase and they can be more involved in family planning services and support their wives and partners. Conclusion Men’s knowledge on family planning can improve their participation in utilizing the services and supporting their partners. Through participation men can help slow the spread of HIV and AIDS and sexually transmitted infections, unwanted pregnancies and criminal abortions

Since National Health Insurance (NHI) was practiced in 1995,its public satisfaction was nearly 70% in the first year while the financial status got worse and worse years by years (15.3 billion of deficit in 1999,27.8 B deficits in Y2000, and around 37.7 B in Y2001). Therefore, Bureau of National Health Insurance (BNHI) had to not only care about cost saving, social fairness but also maintain medical care quality. In order to balance the worse finance, BNHI enforced many strategies, such as case payment (1997), outpatient and inpatient co-payment, high rejection rate of requested medical cases, global budget (Dental clinic in 1998, Chinese ambulatory in 2000, primary-cared clinics in 2001/07, hospital in 2002/07), drug price reduction from November of 1996 to December of 2002 to save about 14.65 billion, rationalization of OPD service, increase insurer fee (2002/09)¡K.etc. Those implemented strategies incurred the impacts on patients, medical provider, pharmaceutical industry, and government. Therefore, the aims of this study is to explore balancing strategic variables for finding out optimal solutions among heavy financial loading from insurers, profit loss and arguments of so-called ¡§Drug price Black-Hole¡¨ from pharmaceutical industry, and quality of medical care from hospitals. This study was through the ways of two-phase interview. The first one phase is to have in-depth interview with legislators, MNHI ministers, hospital administratives, scholars who are specialized at public health, and managers of consumer society; this phase was aimed at validity for all variables that were identified from the study. Until the second phase, we would focus on validated variables from phase one to design questionnaires for telephone interviewing with all stakeholders such as common people, phsicians from hospitals, managers from pharmaceutical industry, officials from BNHI. The study will try to reveal the strategic variables from different dimensions to find out concrete balancing strategies and suggestions to stakeholders in order for coping with the inevitable impacts under system thinkings in the future.

Background:  Outpatient clinics are struggling to deal with increasing workload and demand for services and hence to meet performance indicators and waiting time targets.  Outpatient services are trying to achieve effective and efficient health care in overcrowded, busy clinic settings.  Open access clinics have been advocated as a way of improving outpatient services. Methods:  A cluster randomised trial was undertaken of a guideline based open access urological investigation service for two common conditions - prostatism and microscopic haematuria.  The trial used a balanced incomplete block design.  The study involved sixty-six (73%) of general practices in the Grampian region of Scotland.  Data were collected before and after the intervention on general practitioners’ pre-referral and post-referral management, hospital management, patient outcome and costs.  Analysis was by intention-to-treat and multilevel modelling was adopted for analyses conducted at the individual patient level. Findings:  General practitioners’ compliance with referral guidelines increased (difference in means 0.5; 95% confidence interval 0.21 to 0.81, P>0.001).  Approximately 50% of patients were referred though the new system.  There were no changes in the number or casemix of referrals.  The intervention reduced waiting time from referral to initial outpatient appointment (ration of means 0.7; 0.55 to 0.89, prostatism patients only) and increased the number of patients who had a management decision reached at initial appointment (odds ratio 5.8; 2.9 to 11.5, P<0.00001, both conditions).  Patients were more likely to be discharged within 12 months (odds ratio 1.7; 0.9 to 3.8, P=0.11).  Overall the new service was probably cost saving to the NHS. Interpretation:  The guideline based open access investigation service streamlined the process of outpatient referral and resulted in a more efficient service with reduced outpatient waiting times.

Thesis (M.H.S.A.)--University of Michigan, 1982.

Thesis (M.H.S.A.)--University of Michigan, 1982.

No / Objective To assess the outcome of the vaginoscopic approach to outpatient microhysteroscopy using a 2.5-mm semi-rigid hysteroscope without using a speculum, tenaculum or analgesia. Design A prospective observational study. Setting Outpatient hysteroscopy unit of a large district general hospital. Subjects 24 women referred to the outpatient hysteroscopy unit with abnormal uterine bleeding. Results A total of 24 women had vaginoscopic outpatient microhysteroscopy. Of the procedures, 20 (83.4%) were successful using the technique and four (16.6%) failed procedures occurred. Pain was not encountered during the procedure. Conclusion Outpatient hysteroscopy with a semi-rigid 2.5-mm microhysteroscope using the vaginoscopic approach is a well-tolerated and successful technique for the evaluation of abnormal genital tract bleeding.

The impact of the introduction of hospital medical day care programs on inpatient use was studied, to see if there was a reduction in average lengths of stay, cases or patient days, for those diagnostic categories in the programs. The provincial government funded these programs to create an alternative to hospitalization. Studies on the issue of whether or not day care is an alternative or substitutes for inpatient use were examined. Interest in ambulatory care is growing because of the increasing age of the population, increasing duration of chronic illness and increasing costs of hospital services. Three programs at Lions Gate Hospital in North Vancouver, B.C. were chosen: Chronic Obstructive Lung Disease (CO.L.D.) program, Diabetic Day Care,and the Neuro (Neurology) program. The population for study were divided into four groups: those from North and West Vancouver who used Lions Gate Hospital, patients from the rest of the Greater Vancouver Regional District (G.V.R.D.) who used other G.V.R.D. hospitals, arid to allow for 'spill-out' cases, those from North and West Vancouver who used other hospitals in the province and those from the rest of the G.V.R.D. who used Lions Gate Hospital. The methodology involved the use of a multiple time series design which would allow some comparison before and after the introduction of the CO.L.D. program, as well as comparison between the North Shore and the rest of the G.V.R.D. A regression analysis, using a dummy variable for the CO.L.D. program, on average length, of stay, cases and patient days showed no statistically significant results. The data collection period, 1970 to 1979/80, does not provide conclusive answers for Diabetic Day Care, introduced at Lions Gate Hospital in 1966 and in some of the hospitals of the rest of the G.V.R.D. in 1972, or for the Neuro program, introduced at Lions Gate Hospital in 1979. However, population and age adjusted cases and patient days for all three programs are consistently higher in the rest of the G.V.R.D. when compared with North and West Vancouver and deserve further investigation. The implications from this study, that there is no impact from medical day care, programs on rates of inpatient use, is consistent with similar studies on Diabetic Day Care and Day Care Surgery. The health care system does not seem to be able to respond to innovations of this type and they are additions to existing services. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Purpose – To examine the relationship between outpatient service quality expectation, perception and their effect on satisfaction at Gauteng public hospitals. Problem - Gauteng Public healthcare facilities are perceived to be offering deficient and poor quality service to their outpatient clients. Methodology – The SERVQUAL questionnaire tool is used, it encompasses the six dimensional structures of quality. 406 outpatients at public hospitals are the respondents. Limitations – Data collection environment could have led to the collection of inaccurate data. Data collection errors could exist due to the fact that the field workers had to translate questions for the candidates. These limitations limit the conclusions that can be drawn on the study. Findings/implications – The majority of outpatient expectations are not met. Patients are dissatisfied with the overall service quality provided by their outpatient departments. This has the effect of making patients reluctant to attend such facilities and could lead to treatment non compliance.

Purpose – To examine the relationship between outpatient service quality expectation, perception and their effect on satisfaction at Gauteng public hospitals. Problem - Gauteng Public healthcare facilities are perceived to be offering deficient and poor quality service to their outpatient clients. Methodology – The SERVQUAL questionnaire tool is used, it encompasses the six dimensional structures of quality. 406 outpatients at public hospitals are the respondents. Limitations – Data collection environment could have led to the collection of inaccurate data. Data collection errors could exist due to the fact that the field workers had to translate questions for the candidates. These limitations limit the conclusions that can be drawn on the study. Findings/implications – The majority of outpatient expectations are not met. Patients are dissatisfied with the overall service quality provided by their outpatient departments. This has the effect of making patients reluctant to attend such facilities and could lead to treatment non compliance.