Yes / The reuse of existing datasets to identify mechanisms for improving healthcare quality has been widely encouraged. There has been limited application within dementia care. Dementia Care Mapping (DCM) is an observational tool in widespread use, predominantly to assess and improve quality of care in single organisations. DCM data has the potential to be used for secondary purposes to improve quality of care. However, its suitability for such use requires careful evaluation. This study conducted in-depth interviews with 29 DCM users to identify issues, concerns and challenges regarding the secondary use of DCM data. Data was analysed using modified Grounded Theory. Major themes identified included the need to collect complimentary contextual data in addition to DCM data, to reassure users regarding ethical issues associated with storage and reuse of care related data and the need to assess and specify data quality for any data that might be available for secondary analysis. / This study was funded by the Faculty of Health Studies, University of Bradford.

The World Health Organization (WHO) (WHO, 2004:20) describes a community as a social group of any size, with its members residing in a specific locality, sharing government and a common cultural and historical heritage. In the context of health, a community can be considered as those who are affected by similar health issues, or it can simply be defined as stakeholders, such as health professionals or patients. Community participation is collaboration in which people voluntarily, or due to some incentive, collaborate with externally determined projects, either contributing their labour and/or resources for some expected benefit. Within the health system community participation can either be guided by law or regulations, for instance, the White Paper for Transformation of the Health System in South Africa and the South African patients' bill of rights charter, or it can be on a voluntary basis without any guidelines. The researcher believes that the focus should be on how the community can participate in the decisions that affect their health. The research was aimed at exploring and describing a rural community’s perceptions on community participation in Primary Health Care (PHC) services rendered to improve the quality of the current PHC services. The main question asked was: What does effective community participation in PHC services entails to improve the quality of health care according to the community members’ perspectives in a rural community? A qualitative research approach was used to conduct the research on the perceptions of community members on community participation in PHC services. The research took place in Dewetsdorp, a rural area situated in the Xhariep district of the Free State province in South Africa. Data was collected by means of focus groups, making use of a semi-structured interview schedule consisting of four questions in an endeavour to reach an answer on the research question. Three focus groups realised; one consisting of the community leaders as members of the community, another consisting of members from Non-Governmental Organisations (NGOs) and the last consisting of community members utilising the PHC services in Dewetsdorp. Digitally voice recorded focus groups were transcribed for data analysis. Data saturation occurred after three focus groups, with an average of seven participants per group. The themes that emerged from the focus groups are discussed with literature integration. The findings of the research suggest that the community members of Dewetsdorp have a strong sense that community participation should form part of the PHC services. They expressed the view that they play an important role that should be acknowledged and they want to be respected as partners who are willing to take ownership of the PHC services in their community through participation. From the research results and conclusions, the researcher compiled recommendations for nursing education, nursing research and primary health care nursing practice. / MCur, North-West University, Potchefstroom Campus, 2015

The World Health Organization (WHO) (WHO, 2004:20) describes a community as a social group of any size, with its members residing in a specific locality, sharing government and a common cultural and historical heritage. In the context of health, a community can be considered as those who are affected by similar health issues, or it can simply be defined as stakeholders, such as health professionals or patients. Community participation is collaboration in which people voluntarily, or due to some incentive, collaborate with externally determined projects, either contributing their labour and/or resources for some expected benefit. Within the health system community participation can either be guided by law or regulations, for instance, the White Paper for Transformation of the Health System in South Africa and the South African patients' bill of rights charter, or it can be on a voluntary basis without any guidelines. The researcher believes that the focus should be on how the community can participate in the decisions that affect their health. The research was aimed at exploring and describing a rural community’s perceptions on community participation in Primary Health Care (PHC) services rendered to improve the quality of the current PHC services. The main question asked was: What does effective community participation in PHC services entails to improve the quality of health care according to the community members’ perspectives in a rural community? A qualitative research approach was used to conduct the research on the perceptions of community members on community participation in PHC services. The research took place in Dewetsdorp, a rural area situated in the Xhariep district of the Free State province in South Africa. Data was collected by means of focus groups, making use of a semi-structured interview schedule consisting of four questions in an endeavour to reach an answer on the research question. Three focus groups realised; one consisting of the community leaders as members of the community, another consisting of members from Non-Governmental Organisations (NGOs) and the last consisting of community members utilising the PHC services in Dewetsdorp. Digitally voice recorded focus groups were transcribed for data analysis. Data saturation occurred after three focus groups, with an average of seven participants per group. The themes that emerged from the focus groups are discussed with literature integration. The findings of the research suggest that the community members of Dewetsdorp have a strong sense that community participation should form part of the PHC services. They expressed the view that they play an important role that should be acknowledged and they want to be respected as partners who are willing to take ownership of the PHC services in their community through participation. From the research results and conclusions, the researcher compiled recommendations for nursing education, nursing research and primary health care nursing practice. / MCur, North-West University, Potchefstroom Campus, 2015

A l’hôpital, le bloc opératoire représente un environnement à risque pour le patient. La réalisation d’une chirurgie thyroïdienne demeure une tâche complexe dont le résultat dépend de la combinaison d’une multitude de facteurs qui demeurent mal connus. L’application des méthodes de contrôle qualité développées dans l’industrie peut être utile à leur découverte. Pendant quatre années, nous avons suivi la performance collective et individuelle d’une équipe chirurgicale à l’aide de cartes de contrôle. Des cartes de Shewhart et des cartes CUSUM ont été conçues pour analyser les variations des complications de la thyroïdectomie au cours du temps. Leur mise en place s’est accompagnée d’une réduction immédiate des hypocalcémies postopératoires, puis d’une stabilisation progressive des paralysies récurrentielles. La suractivité chirurgicale a été identifiée comme cause à l’origine d’une dégradation momentanée de la performance de l’équipe. Cette expérience de terrain a montré l’applicabilité des cartes de contrôle à la chirurgie thyroïdienne ainsi que leur intérêt pour aider les chirurgiens à interpréter la variabilité de leurs résultats et à maitriser les facteurs y concourant. Cependant, seules des actions concrètes destinées à améliorer la qualité de la prise en charge peuvent réduire la survenue de complications opératoires. Leur conception implique de mieux comprendre les facteurs influençant la performance du chirurgien et le travail en équipe au bloc opératoire pour garantir la sécurité du patient. / The operating room represents a high risk environment for the patient. Thyroid surgery remains a complex task whose outcome depends on the combination of poorly understood factors. Implementation of industrial quality control methods can be helpful in discovering them. For four years, we have monitored the individual and collective performance of a surgical team using control charts. Shewhart and CUSUM charts have been designed for analyzing the variations of thyroidectomy related complications over time. Their introduction immediately led to a reduction of postoperative hypocalcaemia, and then to a gradual stabilization of recurrent nerve palsy. The surgical overactivity was identified as a root cause of a temporary worsening of the team performance. This field study has shown the applicability of control charts in thyroid surgery and their value to assist surgeons in interpreting and controlling their results' variability. However, only concrete actions aiming at improving the quality of care may reduce the incidence of surgical complications. Designing these actions involves understanding the factors that influence the surgeon's performance and teamwork within operating room to ensure the patient safety.

No momento em que a creche integrou o sistema educativo brasileiro, o Estado depara-se com o desafio de estabelecer parâmetros de qualidade e critérios de avaliação do atendimento oferecido às crianças de 0-6 anos. Desta maneira, uma avaliação instrumentalizada da qualidade de ambientes de creches poderia auxiliar nesta tarefa. Dada a inexistência de instrumentos brasileiros, esta pesquisa objetivou verificar a adequabilidade para o nosso contexto da versão traduzida da escala norte-americana Infant/Toddler Environment Rating Scale Revised Edition, utilizada internacionalmente para avaliar a qualidade do atendimento oferecido para crianças de 0-30 meses. Essa escala é composta por 39 itens agrupados em sete subescalas, que contemplam diversas dimensões do ambiente de creches: Espaço e mobiliário (5 itens); Rotinas de cuidado pessoal (6); Falar e compreender (3); Atividades (10); Interação (4); Estrutura do programa (4); Pais e equipe (7). Tais itens servem de guia para observações feitas nas várias áreas da creche, durante atividades rotineiras de uma turma de crianças e sua(s) educadora(s); com base nas condições observadas e nas descrições dos indicadores de qualidade da escala, o avaliador atribui pontuação de 1 (inadequado) a 7 (excelente) para cada item. Esta pesquisa englobou quatro etapas: (1)análise semântica; (2)treinamento e familiarização com a escala; (3)verificação da discriminabilidade; (4)verificação da concordância entre aplicadores treinados. Na Etapa 1, seis participantes avaliaram se as sentenças escritas nos indicadores de qualidade da escala expressavam claramente o que deveria ser observado. Dos 466 indicadores, 80% foram considerados compreensíveis por todas as participantes; os 93 indicadores considerados com dificuldades de compreensão semântica passaram por revisão e 57% foram reescritos. Na Etapa 2 (treino através de vídeo e aplicação da escala em três turmas, uma de creche universitária e duas de creche filantrópica), o índice de acordo obtido entre dois aplicadores na terceira turma (82%) permitiu encerrar o treinamento. Na Etapa 3, a escala foi aplicada em quatro turmas de creches com tipos diferentes de gestão (universitária, municipal, filantrópica e particular) a escala discriminou níveis diferentes de qualidade, conforme o escore total obtido (E.T.): as turmas Universitária (E.T.=4,97) e Municipal (E.T.=3,33) apresentaram nível de qualidade suficiente e as turmas Filantrópica (E.T.=2,7) e Particular (E.T.=1,57), nível de má qualidade. Na Etapa 4, dois aplicadores treinados avaliaram, simultânea e independentemente, duas turmas, uma de creche municipal e outra universitária; o Coeficiente de Correlação Intraclasse indicou uma concordância quase perfeita (0,83) e substancial (0,66), respectivamente para cada turma; a análise de concordância sugeriu um nível satisfatório de precisão da escala. As avaliações realizadas identificaram, em cada turma, aspectos positivos da qualidade do atendimento e aspectos que necessitam de melhorias, os quais foram apresentados às coordenadoras das creches, favorecendo reflexões/discussões sobre qualidade do atendimento e oferecendo a elas subsídios para trabalhar com as educadoras; pois, para promover um ambiente institucional de qualidade é importante que a equipe discuta e reflita sobre aspectos positivos já presentes e aqueles que necessitam de planejamento para serem implantados. Desta maneira, a escala pode ser um instrumento útil na promoção de qualidade do atendimento infantil em creches brasileiras. / At the moment that day care center was incorporated to Brazilian educational system, the State come across with the challenge of establishing quality parameters and criteria for evaluation of services provided to children of 0-6 years. Thus, assessment the environmental quality of day care center by an instrument could help in this task. Because of the nonexistence of Brazilian instruments, this research aimed to verify the suitability for our context of translated version of the North American scale Infant/Toddler Environment Rating Scale - Revised Edition, used internationally to assess the quality of services offered for children of 0-30 months. This scale consists of 39 items grouped into seven subscales, which include various dimensions of day care center environment: Space and furnishings (5 items), Personal care routines (6); Speaking and understanding (3) Activities (10); Interaction (4) Program structure (4) Parents and staff (7). These items serve as a guide for observations made in various areas of day care center, during routine activities of a group of children and their teacher(s); based on observed conditions and descriptions of quality indicators of the scale, the evaluator assigns scores of 1 (inadequate) to 7 (excellent) for each item. This study included four phases: (1) semantic analysis, (2) training and familiarization with the scale, (3) verification of the scales discrimination, (4) verification of agreement between trained evaluators. In the Phase 1, six participants judged if the written phrases of quality indicators of the scale expressed clearly what should be observed. Of the 466 indicators, 80% were considered understandable by all participants, the 93 indicators considered not understandable underwent revision and 57% have been rewritten. In the Phase 2 (training through video and application of scale in three playrooms, a playroom of an university day care center and two playrooms of a philanthropic day care center), the agreement between two evaluators in the third playroom (82%) allowed finishing the training. In Phase 3, the scale was applied in four playrooms of day care centers with different types of management (university, public, private and philanthropic) - the scale discriminated different levels of quality, according to the total score obtained (T.S.): the playrooms University (T.S. = 4.97) and Public (T.S.= 3.33) had sufficient level of quality and the playrooms Philanthropic (T.S.= 2.7) and Private (T.S.= 1.57), level of poor quality. In Phase 4, two trained evaluators assessed, at the same time and independently, two playrooms, a playroom of a public day care center and another university; the intraclass correlation coefficient indicated an almost perfect correlation (0.83) and substantial agreement (0.66), respectively for each class, the analysis of agreement suggested a satisfactory level of accuracy of the scale. The evaluations identified, in each class, the positive aspects of quality of service and aspects that need improvement, which were presented to the day care centers coordinators, encouraging reflections and discussions about quality of service and offering them subsidies for working with educators; because, to promote the quality of institutional environments is important that the team discuss and reflect on positive aspects already present and those that require planning to be implemented. Thus, the scale may be a useful tool in promoting quality of service provided to children in Brazilians day care centers.

<p>Istraživanje prikazano ovim radom imalo je za cilj da opi&scaron;e mentalno zdravlje<br />dece na hraniteljstvu ranog &scaron;kolskog uzrasta i da sagleda kakvu ulogu u aktuelnom<br />stepenu njihovog psihosocijalnog funkcionisanja ima kvalitet brige koji im je pružen u<br />hraniteljskoj porodici. Kvaliteta staranja o detetu je konceptualizovan iz okvira teorije<br />afektivne vezanosti kao posvećenost hranitelja detetu na sme&scaron;taju i podrazumeva nivo<br />emocionalne investiranosti i motivisanosti hranitelja da sa detetom uspostavi emotivno<br />blizak, stabilan i trajan odnos.<br />U uzorak istraživanja je uključeno 82 dece na sme&scaron;taju u hraniteljskim<br />porodicama, uzrasta od 5 do 11 godina, koji su &scaron;tićenici Centra za socijalni rad Grada<br />Novog Sada i vi&scaron;e op&scaron;tinskih centara na teritoriji Vojvodine (Novi Bečej, Bačka<br />Topola, Mali Iđo&scaron; i Vrbas), bez ozbiljnijih smetnji u psihomotornom razvoju i koja u<br />aktuelnoj hraniteljskoj porodici borave najmanje dva meseca. U uzorku je podjednak<br />broj dečaka i devojčica, pri čemu dominiraju deca koja su na sme&scaron;taju u standardnim<br />(nesrodničkim) hraniteljskim porodicama (90.2 %), u odnosu na srodničke.<br />Podaci o mentalnom zdravlju dece su prikupljani uz pomoć dve skale za procenu<br />dečije psihopatologije koje su popunjavale hraniteljice: Liste provere dečijeg pona&scaron;anja<br />za decu od 6-18 godina (Child Behavior Checklist for ages 6-18, CBCL/6-18,<br />Achenbah &amp; Reskorla, 2001) i Liste za procenu dece u socijalnoj za&scaron;titi uzrasta od 4-11<br />godina (Assessment Checklist for Children for ages 4-11, ACC, Tarren-Sweeney,<br />2007). Podaci o mentalnom zdravlju su prikupljani i za kontrolni uzorak dece koja<br />odrastaju u biolo&scaron;kim porodicama, ujednačenom po broju, polnoj i uzrasnoj strukturi sa<br />uzorkom dece na hraniteljstvu, kao i u odnosu na pol roditelja koji pruža podatke<br />(majke). Za operacionalizovanje i procenjivanje kvaliteta staranja o detetu od strane<br />hranitelja je kori&scaron;ćen polustrukturirani intervju &ldquo;To je moje čedo&rdquo; (&ldquo;This Is My Baby&rdquo;<br />interview&rdquo;, TIMB, Bates &amp; Dozier, 1998) koji se sastoji od standardizovanih pitanja u<br />vezi hraniteljicinih osećanja prema detetu i njihovog međusobnog odnosa i daje uvid u<br />tri dimenzije: prihvatanja deteta na sme&scaron;taju kao svog (eng. acceptance), posvećenosti u<br />podsticanju njegovog rasta i razvoja bez emotivne &ldquo;zadr&scaron;ke&rdquo; (eng. commitment) i<br />svesnosti o uticaju uspostavljenog odnosa sa detetom na detetov emocionalni i socijalni<br />razvoj, aktuelno i u budućnosti (eng. awareness of influence).<br />Rezultati istraživanja ukazuju da deca na hraniteljstvu u poređenju sa svojim<br />vr&scaron;njacima koji odrastaju u biolo&scaron;kim porodicama, ispoljavaju značajno vi&scaron;e problema<br />mentalnog zdravlja, pri čemu prednjače problemi sa pažnjom, smetnje afektivne<br />vezanosti u vidu nediskriminativnog, pseudozrelog i nesigurnog pona&scaron;anja u<br />5<br />interpersonalnim relacijama, eksternalizujući problemi (agresivno pona&scaron;anje, kr&scaron;enje<br />pravila), abnormalni obrasci ishrane (čuvanje, skladi&scaron;tenje i krađa hrane) i<br />samopovređivanje. Mentalno zdravlje dece je determinisano nepovoljnim razvojnim<br />okolnostima koje prethode sme&scaron;taju ali i kvalitetom brige koja im je pružena u<br />hraniteljskoj porodici, pa se kod dece o kojima brinu hraniteljice visokog nivoa<br />prihvatanja i posvećenosti beleži manje emocionalnih problema, problema u pona&scaron;anju i<br />odnosu sa drugima. Rezultati ukazuju i na moderirajuće efekte kvaliteta staranja, u<br />smislu da je stepen prihvatanja i posvećenosti od strane hraniteljica posebno značajan za<br />decu koja su pre sme&scaron;taja u hraniteljsku porodicu imala visoko rizično iskustvo, čineći<br />ih znatno vulnerabilnijim u okolnostima niskog kvaliteta brige, kao &scaron;to i okolnosti<br />visokog kvaliteta staranja u ovoj grupi dece ostvaruju najintenzivniji protektivni i<br />kompenzatorni efekat.<br />Rezultati su diskutovani u svetlu teorije afektivne vezanosti, u smislu potvrde<br />kvaliteta staranja kao protektivnog činioca koji podstiče rezilijentnost dece i implikacija<br />relevantnih za praksu socijalnog rada u oblasti hraniteljstva.</p> / <p>The purpose of the research presented in this paper is to describe the mental<br />health of children in foster care at early school-age and to analyse the role that the<br />quality of care they receive in foster family plays in the current level of their<br />psychosocial functioning. The quality of child care has been conceptualized from the<br />framework of the attachment theory as the commitment of foster carers to the foster<br />children and it implies a level of emotional investment and motivation of the foster<br />carers to establish an emotionally close, stable and permanent relationship with the<br />child.<br />The research sample involved 82 foster children, aged 5 to 11, who are in the<br />care of the Centre for Social Work of the City of Novi Sad and several municipal<br />centres in the territory of Vojvodina (Novi Bečej, Bačka Topola, Mali Iđo&scaron; and Vrbas),<br />who are without serious difficulties in psychomotor development and who have been<br />with the current foster family for at least two months. The sample included the same<br />number of boys and girls, and the majority were children in standard (non-kinship)<br />foster families (90.2 %), as opposed to kinship foster families.<br />Information about the mental health of the children was collected using two<br />scales for the assessment of psychopathology in children, which were filled out by<br />foster mothers: Child Behaviour Checklist for ages 6-18 (CBCL/6-18, Achenbah &amp;<br />Reskorla, 2001) and Assessment Checklist for Children for ages 4-11 (ACC, Tarren-<br />Sweeney, 2007). Information about the mental health was also collected for the control<br />sample of children who live with biological families, identical in number, gender and<br />age structure with the sample of children in foster care, as well as in relation to the<br />gender of the parent providing the information (mother). In order to operationalize and<br />assess the quality of child care, the research used the semi structured interview &ldquo;This Is<br />My Baby&rdquo; (TIMB, Bates &amp; Dozier, 1998) which contains standardized questions in<br />relation to the foster mother&rsquo;s feelings towards the child and their mutual relationship<br />and it also provides insight into three dimensions: acceptance of foster child as her own,<br />commitment in encouraging their growth and development without emotional<br />&ldquo;reservations&rdquo; and the awareness of influence of the established relationship with the<br />child on the child&#39;s emotional and social development, now and in the future.<br />The results of the research indicate that the children in foster care, as compared<br />to their peers growing up with biological families, display significantly more mental<br />health problems, and the most frequent ones are attention problems, attachment related<br />difficulties in the form of indiscriminate, pseudo mature and insecure interpersonal<br />8<br />behaviours, externalising problems, aggressive and rule-breaking behaviour, eating<br />problems, food maintenance behaviour and self-injury. The mental health of the<br />children is determined by the unfavourable development circumstances prior to<br />placement in foster care, but also by the quality of care that they receive in foster<br />family, and so the children in the care of foster mothers with a high level of acceptance<br />and commitment display fewer emotional, behavioural and interpersonal problems. The<br />results also indicate the moderation effects of the quality of care, in the sense that the<br />level of acceptance and commitment by the foster mothers is of particular significance<br />for the children who had high-risk experience before they were placed in foster family,<br />which made them significantly more vulnerable in the circumstances of low-quality<br />care, just like the circumstances of high-quality care with this group of children<br />produced a more intensive protective and compensatory effect.<br />Results are discussed in the light of the attachment theory, in terms of<br />confirmation of the quality of care as a protective factor which encourages the resilience<br />of children, as well as the implications relevant to the social work practice in the field of<br />foster care.</p>

Background: The safety of critically ill patients during inter-hospital transfer is recognised as a globally important issue. However, little evidence exists pertaining to the care provided by transfer nurses throughout the processes of inter-hospital transfer in rural community hospitals where there is a high risk of adverse clinical events occurring during transportation. Aim: The overall aim of the study was to explore transfer nurses' understanding of the delivery of quality of care during the transfer of critically ill patients from rural community hospitals to a tertiary regional hospital in Thailand. Design and Methods: The theory of symbolic interactionism (Blumer, 1986) and focused ethnography methodology were used. Data were collected using multiple qualitative methods including sixteen semi-structured interviews with transfer nurses, fourteen observations of critically ill patients' transfers from three rural community hospitals to a tertiary centre and twenty-three subsequent handover events and the analysis of transfer documents from four hospital settings (e.g. one regional hospital and three rural community hospitals) in Thailand. Translation from Thai into English and back translation into vernacular language was required. Inductive, thematic analysis was conducted to identify major themes by using qualitative data analysis software, NVivo 10 to assist data management during the analysis. Results: Five major themes emerged including (i) protective factors influencing safe transfer care, (ii) barrier factors influencing safe transfer care, (iii) behavioural patterns in transfer care processes, (iv) maintaining the health condition of the patients, and (v) overcoming adverse events. These particular themes elaborate the meaning of the quality and patient safety of transfer care, the provision of care for safe transfer care, and significant contextual factors that influence the quality of inter-hospital transfer care for critically ill patients. In addition, Donabedian's model (Donabedian, 1966, 1988) incorporated within the concept of context and culture was utilised to assist in conceptualising the framework for the quality of inter-hospital transfer care of critically ill patients in Thailand. Conclusion: The Donabedian model is useful as it is simple, but it does not include detail of the organisational context and culture as determinants of care quality. A conceptual framework for the quality of inter-hospital transfer care of critically ill patients in Thailand was therefore proposed. This study has expanded on current theoretical knowledge of the quality of inter-hospital transfer care by elaborating the patterns of thought and the behaviour of transfer nurses during provision of care throughout the processes of the inter-hospital transfer. It also highlights the limitations of organisational structure and the environment in which transfer work takes place, including issues on handover processes in hospital transfer care. The results can be useful to transfer nurses in that they facilitate greater understanding of the provision of better quality of care. They also help to inform hospital policy makers how to ensure safety of critically ill patients being transferred from community hospital settings.

Background: To achieve better health outcomes it is important to identify those aspects of health care delivery system that determines patient satisfaction. The health care planners must therefore be cognizant of the opinions and expectations of those who utilize health care facilities to achieve better health outcomes. This also applies to maternal satisfaction. The study aimed to measure mothers satisfaction with maternity care and its association with various socio-demographic characteristics. Method: The study presented here is a quantitative cross-sectional study that utilizes secondary data from facility-based survey conducted in 12 different tertiary hospitals of Nepal and included client exit interviews  (n=43756). The maternal satisfaction association with different exposures and potential confounders was determined using multivariate logistic regression analysis. Statistical Package for Social Sciences (SPSS) was used for data analysis. Results:. Better information and counselling is seen to be associated with higher satisfaction and recommendation [AOR: 1.67 [1.60-1.75]] and [1.68[1.57-1.80], respectively. Higher level of delivery preparation indicates lower overall satisfaction [AOR: 0.70 [0.66-0.74]]. Mothers were seen to be less satisfied with the religious and cultural aspects of the maternal health services. Mothers age and sex of child was not seen to be significant with any outcome. Conclusion: Better information and counselling indicates more satisfaction and recommendation. Mothers delivery preparation is seen as a significant predictor of their overall satisfaction; therefore, this should be a part of education and information strategy for mothers from the different backgrounds.

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)

Ambulatory surgery centers (ASCs) play an important role in providing surgical and diagnostic services in an outpatient setting. They can be owned by physicians who staff them. Previous studies focused on patient “cherry picking” and over-utilization of services due to physician ownership. Few studies examined the relationship between physician ownership and quality of care. Using a retrospective cohort of patients who underwent colonoscopy, this study examined the effect of physician ownership of ASCs on the occurrence of adverse events after outpatient colonoscopy. Agency theory is used to as a conceptual framework. Depending on the extent to which consumers are able to assess quality of care differences across health care settings, physician ownership can function as a mechanism to improve quality or as a deterrent to quality. Four adverse event measures are used in this study: same day ED visit or hospitalization, 30-day serious gastrointestinal events resulting in ED visit or hospitalization, 30-day other gastrointestinal events resulting in ED visit or hospitalization, and 30-day non-gastrointestinal events resulting in ED visit or hospitalization. Physician ownership status is determined based on a court decision in California in 2007. Data sources include the State Ambulatory Surgery Databases (SASD), State Inpatient Databases (SID), Emergency Department Databases (SEDD), State Utilization Data Files, the Area Resource File (ARF), and HMO/PPO data from Health Leaders. After controlling for confounding factors, the study found that colonoscopy patients treated at a physician-owned ASC had similar odds of experiencing same day ED visit or hospitalization and 30-day non-gastrointestinal events resulting in ED visit or hospitalization as those treated in a hospital-based outpatient facility. But the former had significantly higher odds of experiencing 30-day serious gastrointestinal events and 30-day other gastrointestinal events resulting in ED visit or hospitalization. The results are robust to changes in propensity score adjustment approach and to the inclusion of a lagged quality indicator. They suggest that physician ownership of ASCs was not associated with better quality of care for colonoscopy patients. As more complex procedures are shifted from hospital-based outpatient facilities to ASCs, expanded efforts to monitor and report quality of care will be worthwhile.