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Dissertations / Theses on the topic 'Patient complaints'
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Hsieh, Yahui Sophie Public Health & Community Medicine Faculty of Medicine UNSW. "Rethinking quality of care in the context of patient complaints: the response of a hospital organisation to complaints in Taiwan." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/28209.
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The study explores the management of patient complaints at a private hospital in Taiwan (i.e. the Case Hospital). The case study aims to identify factors which influence the response of the hospital to patient complaints and whether it incorporates information derived from patient complaints in its quality improvement efforts. The study was conducted in two stages. The first stage was a cross-institutional comparison of quality management systems between a hospital in Britain and a hospital in Taiwan. The study explored how these hospitals managed patient complaints and whether they took such feedback into account in reviewing priority of services. The second stage included a detailed case study of the hospital in Taiwan (the Case Hospital), exploring the hospital???s responses to patient complaints, along with the factors which may have influenced these responses. The study was designed to triangulate data through the use of a multi-method approach to derive converging or diverging empirical evidence from a variety of data sources. Data were obtained through interviews with hospital senior managers, a senior social worker, government officials, and managers of non-government organisations. A questionnaire survey was administered to managers, and the Critical Incident Technique (CIT), along with observation, was applied, as well as analysis of documents. Principally, this study adopts the techniques of thematic analysis (Lincoln and Guba, 1985a) with an interpretivist approach to analyse the empirical data. The results of the study indicate that although the Case Hospital appeared to be concerned about patients??? complaints, it did not respond in a systematic way to the messages received. Hospital managers appeared to merely attempt to pacify complainants while ignoring the underlying causes of their complaints. It was evident that there were no protocols in place as to how staff should handle complaints, and as a result, the hospital was failing to use the information about systemic problems provided by patient complaints to make any sustainable quality improvement. In other words, whilst the Case Hospital was attempting to resolve patient complaints on a case-by-case basis (doing things right for the patient, or in the terms of Argyris (1990), using ???single-loop??? learning), it was not reviewing or acting on these complaints as a collective group to identify systemic problems and deficiencies (doing right things, i.e. ???double-loop??? learning). The study found that the organisational response to complaints was influenced by features of the complaints and institutional attributes. Features of complaints affected the response pathways to complaints, such as patients??? status, the severity of complaints, and the nature of complaints. In terms of systemic features, the organisational response to complaints was influenced by the interaction between managerial factors (e.g. organisational structure and organisational culture), operational factors (e.g. documentation and communication), and technical factors (e.g. complaints handling techniques and information systems). The values of the top hospital management have been recognised as a powerful influence on these factors. Generally, results show that although the Case Hospital tends to take action to address individual complainants, there was no evidence of sustainable quality improvement within the organisation as a result of complaints data. The study recommends that if the hospital intends to use patient complaints to improve quality of clinical care, a ???double-loop??? learning strategy should be adopted within the organisation. This study also argues that governments need to take more responsibility and demand more accountability from hospitals, in terms of complaints handling. The individual hospital would thus be able to respond to patient complaints in a systemic way. Hospitals need to be more accountable when using patient complaints to drive quality improvement in the future.
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Santos, Emmylou C. "Effects of patient and physician gender on the assessment of a medical complaint." Scholarly Commons, 2003. https://scholarlycommons.pacific.edu/uop_etds/2725.
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This study investigated the effects of gender, both patient and physician, on how a medical complaint is perceived and acted upon by health professionals. A 2 x 2 factorial design was used, with gender of physician and patient as the two factors, respectively. The participants were physicians (M.D.s) who were recruited by approaching local hospitals/clinics and requesting their participation in the research. They were asked to respond to a patient vignette and a questionnaire assessing the physician's beliefs about and intentions toward the patient. Using a 2 x 2 ANOVA with a specified .05 significance level, no statistically significant differences were found in the assessment of the perceived seriousness of a medical complaint, in the aggressiveness of the work-up provided, and in the diagnoses given to patients. The findings from this study are of value in exploring the existence of gender bias in the medical setting. The absence of gender bias, as it occurred in this study, is an encouraging finding for members of the health care community.
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Lagerkvist, Linnea, and Minna Murto. "Anmälningar till patientnämnden gällande kommunikation." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-294546.
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Bakgrund: I mötet med vården upplever många patienter att kommunikationen och bemötandet brister. Den nya Patientlagen är avsedd för att förbättra situationen. Patientklagomål som har skickats in till patientnämnden kan hjälpa till att förstå faktorer och hinder som finns och vilka delar av Patientlagen som behöver implementeras bättre för att förbättra kvalitet av vården för alla. Syfte: Att granska klagomål om kommunikation inkomna till en patientnämnd vad gäller bakgrundsfaktorer bland patienterna, analysera anmälningarna utifrån Patientlagens bestämmelser samt undersöka vilka åtgärder de har lett till. Metod: En empirisk studie med beskrivande design med en kvantitativ ansats användes. Materialet samlades in från en patientnämnds databas i Sverige. Alla ärenden som handlade om kommunikation på ett sjukhus i Mellansverige och som kom in under 2015 inkluderades. Resultat: I de flesta fall anmälde patienten själv (72,7 %) händelsen och de var ofta kvinnor (61,7 %). Medelåldern på de som anmälde var 44 år. Det verksamhetsområde som gav flest anmälningar var ortopedi (13,7 %). Anmälningarna visade problem med att uppfylla Patientlagens kapitel om inledande bestämmelser, information, samtycke och delaktighet. Patientnämnden hade kontakt med vården i över hälften av fallen samtidigt som en femtedel av anmälningarna inte ledde till någon åtgärd. Slutsats: I vården finns det brister på hur Patientlagens krav uppfylls för till exempel information, samtycke och delaktighet. Mer uppmärksamhet borde ges till att utveckla fungerande kommunikation mellan vården, patienten och anhöriga.Background: There is a lot of room for improvement in how patients experience their communication with the health care providers. The new Patient Law is intended to improve the situation. Patient complaints that are submitted to the Patient Advisory Committee can help to understand the factors and barriers that exist and which parts of the Patient Law that need more implementation to make health care better for all. Objective: This study examined complaints about communication that had been sent in to one Patient Advisory Committee in Sweden. From the complaints the study examined who makes the complaint (patient/relative, gender and age), in which care unit most of the complaints occur in and to which paragraphs of the Patient Law the complaint could be classified into. Finally the study examined what measures had been taken because of the complaints. Method: An empirical study with descriptive design with quantitative approach was used. The complaints were gathered from one Patient Advisory Committees database. All complaints concerning communication in one hospital in Sweden that were sent in during 2015 were included. Results: In the majority of all cases the patient reported the complaints themselves (72,7 %) and they were mostly women (61,7 %) The average age of those whom the complaints were about was 44 years. The care unit that got most complaints was orthopedics (13,7 %). The reports showed problems implementing Swedish Patient law’s chapter on initial regulations, information, consent and participation. The Patient Advisory Committee had contact with the health care providers in over 50 % of the cases but in 20 % of the cases the complaints did not lead to any measures. Conclusion: There are a lot of deficiencies in adhering to the Patient Laws requi,,rements for instance for information, approval and participation and more attention should be given to developing a well-functioning communication between the health care personnel, the patient and the relatives.
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Freiberg, Alice, Maria Girbig, Ulrike Euler, Julia Scharfe, Albert Nienhaus, Sonja Freitag, and Andreas Seidler. "Influence of the Kinaesthetics care conception during patient handling on the development of musculoskeletal complaints and diseases - A scoping review." BioMed Central, 2016. https://tud.qucosa.de/id/qucosa%3A30133.
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The Kinaesthetics care conception is a nursing approach for patient handling which aims to prevent work-related complaints and diseases. The evidence about the influence of Kinaesthetics on musculoskeletal disorders among persons who handle patients is unclear to date. The purposes of the scoping review are to gain insight into the current state of research regarding the clinical effectiveness of Kinaesthetics (in terms of perceived exertion and musculoskeletal complaints) among persons who handle patients and to identify potential research gaps. A scoping review was conducted. The search strategy comprised a systematic search in electronic databases (MEDLINE, EMBASE, AMED, CINAHL), a hand search, a fast forward search (Web of Science) and a Google scholar-search. The review process was carried out independently by two reviewers. Methodological quality was assessed for all studies using three methodological main categories (reporting quality, internal validity, external validity). Thirteen studies with different study designs were included. Seven studies investigated musculoskeletal complaints and nine studies the perceived exertion of nursing staff. Most studies were of very low methodology. Most studies reported a decrease of musculoskeletal complaints and perceived exertion due to Kinaesthetics. In conclusion, there is only little evidence of very low quality about the effectiveness of Kinaesthetics. Out of the studies it could be assumed that Kinaesthetics may decrease the patient handling related perceived exertion and musculoskeletal pain of persons who handle patients. But an overestimation of these results is likely, due to inadequate methodology of included studies. As a result, no clear recommendations about the effectiveness of the Kinaesthetics care conception can be made yet. Since a research gap was shown, further high quality intervention studies are necessary for clarifying the effectiveness of Kinaesthetics.
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Freiberg, Alice, Maria Girbig, Ulrike Euler, Julia Scharfe, Albert Nienhaus, Sonja Freitag, and Andreas Seidler. "Influence of the Kinaesthetics care conception during patient handling on the development of musculoskeletal complaints and diseases - A scoping review." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-217822.
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The Kinaesthetics care conception is a nursing approach for patient handling which aims to prevent work-related complaints and diseases. The evidence about the influence of Kinaesthetics on musculoskeletal disorders among persons who handle patients is unclear to date. The purposes of the scoping review are to gain insight into the current state of research regarding the clinical effectiveness of Kinaesthetics (in terms of perceived exertion and musculoskeletal complaints) among persons who handle patients and to identify potential research gaps. A scoping review was conducted. The search strategy comprised a systematic search in electronic databases (MEDLINE, EMBASE, AMED, CINAHL), a hand search, a fast forward search (Web of Science) and a Google scholar-search. The review process was carried out independently by two reviewers. Methodological quality was assessed for all studies using three methodological main categories (reporting quality, internal validity, external validity). Thirteen studies with different study designs were included. Seven studies investigated musculoskeletal complaints and nine studies the perceived exertion of nursing staff. Most studies were of very low methodology. Most studies reported a decrease of musculoskeletal complaints and perceived exertion due to Kinaesthetics. In conclusion, there is only little evidence of very low quality about the effectiveness of Kinaesthetics. Out of the studies it could be assumed that Kinaesthetics may decrease the patient handling related perceived exertion and musculoskeletal pain of persons who handle patients. But an overestimation of these results is likely, due to inadequate methodology of included studies. As a result, no clear recommendations about the effectiveness of the Kinaesthetics care conception can be made yet. Since a research gap was shown, further high quality intervention studies are necessary for clarifying the effectiveness of Kinaesthetics.
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Lee, Robert Henry. "Comments, compliments and complaints : the use of patient feedback in the management of hospitals in the National Health Service in England." Thesis, King's College London (University of London), 2015. http://kclpure.kcl.ac.uk/portal/en/theses/comments-compliments-and-complaints(f800a5ff-be32-48e6-875e-76b3b38a091a).html.
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Feedback from patients has become increasingly important in the provision of health care and the management of health services in many countries in the last 30 years. Government policy in England and the published research literature from different countries have focused more on the collection than on the use of patient feedback. There are significant gaps in the research literature relating to the ways in which patient feedback is used in the management of health services. The purpose of this research is to examine how feedback from patients is (or is not) used in the management of hospitals in the National Health Service in England. This thesis contains the results of a qualitative study of the use of patient feedback in two purposively selected NHS foundation trusts in England. Data were collected through interviews with managers, from government and Trust documents and websites, and through the observation of meetings. The findings show that qualitative feedback about patients’ subjective experience of their illness and services is used by managers to engage with and motivate staff, but that the quantified results of surveys are used to establish criteria and standards for service improvement. Although compliments and commendations by patients are used to praise staff they are not used to help set explicit standards for service improvement. Boards of directors sometimes use feedback from patients to help set strategies for quality improvement, but appear not subsequently to use that feedback explicitly to monitor the implementation of these strategies or assure the quality of services. The thesis fills gaps in the published literature by demonstrating that, although patient feedback is used in a variety of ways in the management of staff and in the development of strategies to improve the quality of services, managers in general and boards of directors in particular do not always use that feedback systematically to assure and improve the standards of service for patients.
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Jangland, Eva. "The Patient–Health-professional Interaction in a Hospital Setting." Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-151420.
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The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design. The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work. The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.
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Leclercq, Valérie. "Guérir, travailler, désobéir: Une histoire des interactions hospitalières avant l’ère du « patient autonome » (Bruxelles, 1870-1930)." Doctoral thesis, Universite Libre de Bruxelles, 2017. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/253764.
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English :Between 1870 and 1930, medicine on the heels of the Pastorian revolution underwent profound changes while the hospital – a charitable institution traditionally dedicated to the care of the poor – was fast becoming one of the central sites of Western health care. Yet, it was still decades away from the advent of "patient rights" and the rise to prominence of the ethics of patient autonomy. What moral culture, then, prevailed inside hospitals and shaped the encounter between patients and health care professionals? What logics underlay interactions between the former and the latter? These are the questions that this thesis aims to answer. Drawing from the archives of two public hospitals in Brussels as well as from a series of deontological, literary, religious and jurisprudential sources, this work sits at the intersection of the social history of medicine, the history of authoritarian institutions, the history of patients and the history of medical ethics. It offers an examination of therapeutics interactions that primarily focuses on the day-to-day practices of various groups of historical actors (patients, doctors, interns, catholic nuns, priests, administrators, etc.). With an eye on the larger social context, it attempts to give a new historical depth to topics borrowed from the field of medical ethics, such as medical authority, care relationships, experimentation, religious healing, truth and benevolent lies, etc. By mining a rich collection of letters written by patients and their family members to the hospital administration, this thesis also sheds light on the views and actions of hospital users. Ultimately, it reveals the hospital as structured by a complex moral economy that is the expression of the deep paternalistic outlook of western societies. In this economy, therapeutic interactions rest on an ambiguous system of moral reciprocity that encourages the simultaneous performance of charitable love and social domination, of docility and rebellion.------------Français :Entre 1870 et 1930, la médecine, enrichie par les nouvelles possibilités de l’anesthésie, exultant devant le miracle antiseptique et les promesses de la révolution pastorienne, subit une transformation profonde. L’hôpital public, institution charitable traditionnellement dédiée au soin des populations pauvres, est en passe de devenir un des sites centraux de la thérapeutique occidentale. Pourtant, cette période de formation décisive de la médecine moderne est encore à des décennies de l’avènement des « droits des patients » et de ce bouleversement majeur qui verra, au milieu du 20ème siècle, l’éthique médicale entièrement reformulée autour de la notion d’autonomie du malade. Quelle culture morale prévaut alors à l’intérieur des institutions hospitalières et détermine les formes de la rencontre entre les patients et les soignants? Quels logiques sous-tendent l’agir des premiers et des seconds, dans le cadre de toutes ces activités qui amènent ceux-ci à interagir ensemble ?Ce sont les questions auxquelles cette thèse a l’ambition de répondre. Le contexte hospitalier lui-même est abordé ici comme un révélateur des dynamiques sociales structurant plus largement non seulement la médecine de l’époque, mais aussi les sociétés occidentales avant la Seconde Guerre mondiale.Les archives des hôpitaux bruxellois St-Jean et St-Pierre, supplémentées par une série de sources déontologiques, littéraires, religieuses et jurisprudentielles, constituent le terrain d’étude à partir duquel s’élaborent les propositions nombreuses de cette thèse. L’objet central de celle-ci – les interactions en milieu hospitalier – se situe à la croisée de quatre courants historiographiques :l’histoire sociale de la médecine, le récit interactionniste des institutions autoritaires, l’histoire des patients et l’histoire de l’éthique médicale. Prêtant une attention particulière aux pratiques des acteurs historiques, Guérir, travailler, désobéir se structure autour de six chapitres. Ceux-ci abordent des thématiques aussi variées que l’autorité des acteurs hospitaliers, la communication entre patients et soignants, ou encore la relation soignante. La thèse interroge aussi la dimension « utilitaire » de la rencontre thérapeutique dans un contexte de médecine publique (usage des corps de malades pauvres pour la science, l’enseignement, etc), les pratiques de détournement de l’institution hospitalière par les malades, et la nature du dialogue mettant en lien ces mêmes malades et l’administration hospitalière en cas de plainte. Au final, ce travail de recherche met à jour une économie morale complexe, expression du paternalisme profond des sociétés occidentales, qui fait reposer les interactions thérapeutiques sur un système ambigu de réciprocité morale.Doctorat en Histoire, histoire de l'art et archéologie
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Andela, Marie. "Considérations conceptuelle, méthodologique et contextuelle du travail émotionnel : impacts sur le burnout, les troubles somatiques des soignants et les risques de maltraitance des patients." Thesis, Besançon, 2014. http://www.theses.fr/2014BESA1006.
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L’objectif de cette recherche est de contribuer à mieux comprendre l’impact du travail émotionnel dans l’émergence du burnout et des troubles somatiques des soignants. Pour cela, le premier chapitre commence par exposer le concept de travail émotionnel, son histoire, son évolution et ses liens avec le burnout et les troubles somatiques. Tout en développant la critique sociologique du travail émotionnel d’Hochschild, nous exposons sa pertinence dans le contexte actuel de l’institution hospitalière. L’évolution du concept est ensuite présentée et nous proposons de nous focaliser sur l’approche intra psychique du travail émotionnel. Celle-ci privilégie trois composantes du concept : la dissonance émotionnelle, l’acting de profondeur et l’acting de surface. A partir de cette approche, notre revue de la littérature expose les liens de ces trois composantes au burnout, aux troubles somatiques et à la performance des salariés. Diverses problématiques associées à l’état actuel des connaissances portant sur le lien entre le travail émotionnel et la santé des salariés sont alors abordées et les chapitres suivants proposent d’apporter, par le biais d’études empiriques, des éléments de réponses à celles-ci. Le deuxième chapitre expose les problématiques liées aux limites méthodologiques des mesures actuelles du concept de travail émotionnel. Une mesure alternative est proposée : celle-ci distingue les deux processus de régulation jusqu’ici confondus dans la conceptualisation de l’acting de profondeur, à savoir la réévaluation cognitive et le déploiement attentionnel ; les deux stratégies de régulations expressives jusqu’ici confondues dans la conceptualisation de l’acting de surface, à savoir la suppression et l’amplification expressive des émotions. Enfin, ces processus de régulation ont clairement été dissociés de l’état de dissonance émotionnelle. Nos résultats présentent plusieurs intérêts. Premièrement, ils indiquent que la dissonance émotionnelle constitue la composante du travail émotionnel la plus fortement associée au burnout et aux troubles somatiques. Deuxièmement, cette étude révèle que les mesures actuelles de l’acting de surface et de profondeur englobent différents processus aux effets opposés sur le burnout. Alors que la suppression expressive des émotions est liée de façon positive au burnout, l’amplification expressive des émotions l’est de façon négative. Et si la réévaluation cognitive s’avère une stratégie de régulation négativement liée au burnout, le déploiement attentionnel apparaît plus délétère à la santé des salariés. Afin de déterminer la valeur ajoutée du travail émotionnel au modèle exigences-ressources, le troisième chapitre évalue les liens entre celui-ci et le burnout en prenant en considération différents stresseurs/ressources organisationnelles (exigences émotionnelles, charge de travail, justice organisationnelle…). Basées sur les principes du modèle exigences-ressources, les données indiquent que les composantes du travail émotionnel expliquent une part de variance importante du burnout et des troubles somatiques au-delà des parts de variance expliquées par les exigences et le manque de ressources organisationnelles. Puisque la dissonance émotionnelle joue un rôle prédominant dans l’émergence du burnout, le quatrième chapitre évalue dans quelle mesure la réflexivité des équipes de travail permet de modérer ses effets négatifs sur la santé des salariés. Les données indiquent que la réflexivité sociale modère les effets de la dissonance sur le burnout. Enfin, le chapitre cinq explore les liens entre le travail émotionnel, le burnout et la maltraitance des soignants vis-à-vis des patients. Les résultats confirment l’impact de la dissonance émotionnelle et du burnout sur les comportements de maltraitance. En effet, le burnout et la dissonance médiatisent les effets des stresseurs liés à l’environnement de travail sur la maltraitanceThe aim of this research was to better understand the links between emotional labor, burnout and somatic complaints. The first chapter constitutes a literary review that exposes the concept, its history, and its links with burnout and somatic complains: Hochschild’s sociological analysis of emotional labor is developed and its relevance to the hospital context is exposed. The evolution of the concept is then presented and we propose to focus on the intra psychic perspective of emotional labor which pays attention to three components of the concept: emotional dissonance, surface acting and deep acting. Based on this approach, we realized a literature review that exposed the associations between these three components and burnout, somatic complaints and job performance. Diverse problems associated with the comprehension of the impact of emotional labor on health outcomes are developed. The second chapter exposes the problems associated with the limitations of the measure used to evaluate the concept of emotional labor. An alternative measure is proposed: this one distinguishes the two emotion regulation processes included in the conceptualization of deep acting, which are, re-evaluation and attentional deployment. It also distinguishes the two expressive regulation strategies included in the conceptualization of surface acting, that are expressive suppression and expressive amplification. Finally, these emotion regulation processes are separate from the emotional dissonance state. Our results present several issues: First, they indicate that emotional dissonance is positively associated with burnout and somatic complains and that the variance part of these two variables are broadly explained by the emotional dissonance state. Second, they reveal that surface acting and deep acting measures include different processes with opposite effects on burnout: while expressive suppression is positively linked with burnout, expressive amplification is negatively related to it. Moreover, re-evaluation presents a positive impact on health outcomes while attentional deployment has a negative impact on them. The aim of the third chapter is to determine the added value of emotional labor to the job demands-resources model: links between emotional labor, burnout and somatic complaints were analyzed by taking into account different organizational demands and resources (emotional demands, workload, organizational justice…). Based on the job-demands-resources principles, our result show that emotional labor components explain a great part of burnout and somatic complaints beyond the parts of variance explained by demands and lack of resources. As emotional dissonance plays a determinant role in the burnout process, the fourth chapter examines to what extent reflexivity among work teams moderates its negative effects. Results indicate that social reflexivity moderates burnout induced by emotional dissonance. Finally, chapter five explores the links between emotional labor, burnout and mistreatments toward patients. Results confirmed the link between emotional dissonance and burnout on mistreatments. Indeed, burnout and emotional dissonance mediate the effects of stressors linked with the work context on mistreatment
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Profant, Judith. "Fatigue and sleep complaints in women treated for breast cancer /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2004. http://wwwlib.umi.com/cr/ucsd/fullcit?p3129934.
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Kennedy, Katherine A. "Is Nurse Aide Retention Associated with Nursing Home Quality?" Miami University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=miami1618591173416498.
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Pranckevičienė, Aistė. "Patients’ subjective complaints and evaluation of life during inpatient treatment of depression." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2008. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2008~D_20080422_114144-21291.
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The study analyses patients’ subjective complaints and subjective evaluation of life, and seeks to evaluate changes and relationships of these phenomena during inpatient treatment of depression, stressing the importance of subjective experience in understanding the burden of the illness, resources for recovery and treatment outcomes. The study seeks to analyze the structure of depressed patients’ subjective complaints, as well as to evaluate the utility of the subjective evaluation of life for treatment outcome evaluation. 195 depressed inpatients were assessed at the beginning of the treatment and at the time of discharge, using measures of subjective depressive complaints (Pranckevičienė, Goštautas, 2007), subjective quality of life (WHOQOL-Bref) and other clinical and social-demographic data. The results of the study show that additional attention to psychological and somatic components of patients’ subjective complaints is useful and compliments the analysis of depressed inpatients’ recovery process. The subjective evaluation of life should be interpreted as a more generic measure of consequences of depression, but not as a measure of depressed inpatient’s recovery resources. The results validate the need of psychological interventions during inpatient treatment.Disertaciniame darbe nagrinėjama depresija sergančių asmenų savijauta ir subjektyvus gyvenimo vertinimas stacionarinio gydymo laikotarpiu, šių reiškinių sąsaja bei pokyčiai gydymo metu. Siekiama atskleisti subjektyvaus asmens savo ligos ir sveikatos vertinimo svarbą prognozuojant sveikimo nuo depresijos rezultatus. Darbe siekiama detaliai išanalizuoti depresija sergančių asmenų savijautos struktūrą, taip pat patikrinti prielaidą, kad subjektyvus gyvenimo vertinimas gali būti laikomas psichikos sveikatos išteklių rodikliu. Teorinėms darbo prielaidoms patikrinti gydymo pradžioje ir pabaigoje buvo ištirti 195 depresija sergantys asmenys besigydantys psichiatrijos stacionare, naudojant klausimyną depresijos pokyčiams vertinti (Pranckevičienė, Goštautas, 2007), Pasaulinės sveikatos organizacijos gyvenimo kokybės klausimyną (PSOGK – Trumpas) ir kitas papildomas metodikas. Statistinė rezultatų analizė atskleidė, kad depresija sergančių asmenų savijauta yra daugiakomponentė ir psichologinių bei somatinių savijautos komponentų išskyrimas yra naudingas analizuojant depresija sergančių asmenų sveikimą stacionarinio gydymo laikotarpiu. Subjektyvus gyvenimo vertinimas neprognozuoja gydymo rezultatų, tačiau yra tinkamas subjektyvus visuminės sveikatos matas, nes gerai parodo funkcines ir kognityvines depresijos pasekmes, t.y. pasikeitusį suvokimą. Tyrimas iliustruoja psichologinės pagalbos svarbą stacionarinio depresijos gydymo laikotarpiu.
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Säfwenberg, Urban. "Presenting complaint and mortality in non-surgical emergency medicine patients." Doctoral thesis, Uppsala University, Department of Medical Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8583.
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In 1995 and 2000 a total of 29 886 non surgical ED visits at Uppsala University Hospital were registered. Presenting complaint, admittance to a ward, length of stay, in-hospital mortality, discharge diagnoses, 30-day and long-term mortality were registered. The presenting complaints were sorted into 33 presenting complaint groups (PCGs).
For different PCGs there was different in-hospital fatality rate. Compared to the largest PCG, chest pain, the gender and age adjusted OR was 2.12 (95% CI 1.01 – 4.44) for the miscellaneous complaint group and 2.04 (95 % CI 1.35 – 3.08) for the stroke–like symptom group. Within a given PCG the in-hospital mortality could vary depending on discharge diagnoses. By relating PCG and long term mortality to the expected mortality in the population, the Standardized Mortality Ratio (SMR) could be calculated. The SMR was found to be highest in seizure 2.62 (95 % CI 2.13 – 3.22), intoxication 2.51 (95% CI 2.11-2.98) and symptoms of asthma 1.8 (1.65 – 2.06). For the same discharge diagnoses the long term mortality could differ considerably depending on PCG at ED arrival (p<0.001).
Between 1995 and 2000 there was a 30 % increase in ED visits at the non surgical ED. PCGs representing lesser severe conditions had increased. Demographic changes could account for 45 % of the increment and the remaining increase could be ascribed to change in visiting pattern.
In the 2000 cohort 41.0 % of all visits were performed by re-visitors. The number of revisits and five-year mortality had an inversed u-shaped relationship were patients with three re-visits within the same year had an increased mortality compared to patients with more or less visits.
Conclusion: It is possible to define presenting complaint groups (PCGs) that are robust and consistent over time and useful as a tool for epidemiological studies in the ED.
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Eriksson, Elin, and Magnus Häglund. "Organisatoriska orsaker till vårdtagares missnöje med vården." Thesis, Högskolan i Gävle, Medicin- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-25885.
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Bakgrund Systemet för vård och omsorg är en invecklad konstruktion med många olika aktörer och yrkesgrupper, som lyder under olika styrning och har olika förutsättningar. Inom denna organisation kan många situationer uppstå som kan orsaka missnöje hos vårdtagare. Syfte Att beskriva organisatoriska faktorer inom vården, som orsakar missnöje hos vårdtagare, samt att beskriva urvalsprocesserna till de valda artiklarnas undersökningsgrupper. Metod Litteraturstudie baserad på tolv artiklar, både kvantitativa och kvalitativa, från åren 2007–2017. Huvudresultat Det största problemområdet för patienter var tillgänglighet. Väntetider av olika slag förekom ofta: väntan på att få en tidsbokning, lång tid i väntrum, väntan på behandling med mera. Specifikt för primärvården framkom svårigheter att få tid över huvud taget, och uppfattningar hos patienter om att primärvården inte kan hjälpa dem med deras problem. Missnöje med den fysiska vårdmiljön nämndes främst i form av personalbrist och brist på vårdplatser, men det förekom även andra klagomål relaterade till den fysiska miljön. Bristande samordning mellan olika aktörer och instanser vållar missnöje hos somliga patienter, bland annat i form av dålig kontinuitet i vården. Slutsatser Det finns en rad orsaker till vårdtagares missnöje som har sin grund i vårdens organisation. Med ett fokus på vårdtagarens känslor kan sjuksköterskan hjälpa vårdtagaren att utveckla och förbättra hur hen hanterar den problematiska situationen och känslorna som uppstår. Detta underlättas av att sjuksköterskan har kunskap om hur organisationen är uppbyggd, och förståelse för dess komplexitet. Denna kunskap och förståelse är även en god förutsättning för organisatoriskt förbättringsarbete.Background The health care system is an complex structure with many different actors and professions, who are subject to different management and different conditions. Within this organisation, many situations may arise that can cause dissatisfaction among care recipients. Aim To describe organisational factors in healthcare that cause dissatisfaction with carers, as well as to describe the selection processes for the selected articles' sample groups. Design Literature review based on twelve articles, both quantitative and qualitative, from 2007-2017. Main results The main problem area for patients was accessibility. Waiting times of various kinds were common: waiting to get an appointment, long time in the waiting room, waiting for treatment, and more. Specific to primary care were difficulties in getting appointments at all, and perceptions in patients that primary care could not help them with their problems. Dissatisfaction with the physical care environment was mentioned mainly in the form of understaffing and unavailability of hospital beds, but there were also other complaints related to the physical environment. Lack of coordination between different actors cause discontent in some patients, for instance due to poor continuity of care. Conclusions There are a number of reasons for care recipients’ dissatisfaction that have their foundation in the health care organization. Focusing on the patient's emotions, the nurse can help the patient in developing and improving the handling of the problematic situation and the feelings that arise. This is facilitated by the nurse having knowledge of how the organisation is structured, and understanding of its complexity. This knowledge and understanding is also a good prerequisite for organisational improvement.
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Russell, Megan Nezu Arthur M. "Treatment adherence, health status, and problem orientation in patients with chronic heart failure /." Philadelphia, Pa. : Drexel University, 2006. http://dspace.library.drexel.edu/handle/1860/749.
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Hoggatt, Celia. "Abuse Factors, Anxiety, and Somatic Complaint in Psychological Evaluation of Pain Patients." Honors in the Major Thesis, University of Central Florida, 2005. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/762.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucfBachelors
Arts and Sciences
Psychology
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Corey, Kimberly S. Bates. "RELATIONSHIP BETWEEN ILLNESS INSIGHT, COGNITIVE COMPLAINTS, AND EXECUTIVE FUNCTIONING IN EUTHYMIC PATIENTS WITH BIPOLAR DISORDER." University of Cincinnati / OhioLINK, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=ucin997804655.
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Mäkelä, M. (Mailis). "Hoitoon ja kohteluun kohdistuva tyytymättömyys:potilaslain mukaiset muistutukset." Doctoral thesis, Oulun yliopisto, 2015. http://urn.fi/urn:isbn:9789526208275.
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Abstract The Act on the Status and Rights of patients (1993) enabled a change in the patient’s status from being a passive object of medical treatment to being an active and equal subject with a right of self-determination. According to the Act a patient has a right to show his dissatisfaction with the received care and treatment with a complaint. The aim of the first part of the study was to clarify the workings of patient feedback and complaint systems as well as the position of the health care professionals with whom patients had been dissatisfied with. The data was collected with a questionnaire from people in superior positions within the medical and nursing professions (n = 110). The aim for the second and third parts of this study was to find out about patients’ dissatisfaction with the medical care, nursing or treatment they received from a health care professional. Data for the second part of the study was collected from readers’ letters in newspapers during 2012 (n = 127), while the data for the third part was gathered from patients’ complaints during 1993-2012 (n = 956). The data for parts were analyzed by means of inductive content analysis. The results from the questionnaire show that a complaint is a negative thing. Sorting out of the facts concerning the matter and answering the complaint are felt to be slow and complicated. Patient feedback is seen as a more natural alternative to a complaint from the viewpoints of the patient, the health care professional and the working community. Dissatisfaction expressed by a patient is also a defeat for a health care professional. There is a lot of dissatisfaction with care and treatment in the readers’ letters concerning health care. To a great extent, it deals with access to health care, with the abilities of health care professionals and with general treatment. The amount of complaints increased significantly between years 1993–2012. However, the amount was small when compared to the number of patients then in health care. The complaints were mostly made by patients themselves. The main sources for dissatisfaction with health care are gaining access to health care, the professional abilities of health care staff as well as guidance and getting advice. Dissatisfaction with treatment is expressed as experiences of having been dominated or subjected to mental violence. Dissatisfaction with the health care organization is rare in all parts of the study. The experienced care is more significant than the environment. The content of complaints has not been studied before. The knowledge gained by this study can be utilized when developing the statutes on the complaints and feedback systems. The study also gives new insight into developing patient encounters as well as nursing and well-being at workTiivistelmä Potilaslaki (1993) mahdollisti, että potilaan asema muuttui passiivisesta hoidon kohteena olevasta objektista aktiiviseksi ja tasa-arvoiseksi toimijaksi. Potilaslain mukaan potilaalla on oikeus osoittaa tyytymättömyytensä saamansa hoitoon ja kohteluun muistutuksen avulla. Ensimmäisen osastutkimuksen tarkoituksena oli selvittää potilaspalaute- ja muistutusjärjestelmiä sekä potilaan tyytymättömyyden kohteeksi joutuneen terveydenhuollon ammattihenkilökunnan asemaa. Aineisto kerättiin kyselyllä hoitotyön ja lääketieteen esimiehiltä (n = 110). Toisen ja kolmannen osatutkimuksen tarkoituksena oli selvittää potilaan kokemaa tyytymättömyyttä terveydenhuollon ammattihenkilön harjoittamaan terveyden- ja sairaanhoitoon tai siihen liittyvään kohteluun. Toisen osatutkimuksen aineisto kerättiin yleisönosaston mielipidekirjoituksista vuoden 2012 ajalta (n = 127) ja kolmannen osatutkimuksen aineisto muistutuksista vuosilta 1993–2012 (n = 956). Osatutkimusten aineistot analysoitiin induktiivisella sisällönanalyysillä. Kyselyn tulosten mukaan muistutus on luonteeltaan kielteinen. Siihen liittyvien asioiden selvittely ja vastauksen laadinta koetaan hitaaksi ja monimutkaiseksi. Potilaspalautetta pidetään potilaan, työntekijän ja työyhteisön kannalta muistutusta luontevampana vaihtoehtona. Potilaan ilmaisema tyytymättömyys on tappio myös terveydenhuollon ammattihenkilölle. Terveydenhuoltoa koskevissa mielipidekirjoituksissa esiintyy paljon tyytymättömyyttä hoitoon ja kohteluun. Se kohdistuu suurelta osin hoitoon pääsyyn liittyviin asioihin sekä henkilökunnan osaamiseen ja kohteluun. Muistutusten määrä kasvoi vuosina 1993–2012 merkittävästi. Silti niiden määrä on vähäinen verrattuna hoidossa olleiden potilaiden määrään. Muistutukset olivat enimmäkseen potilaiden itsensä tekemiä. Hoitoon liittyvää tyytymättömyyttä aiheuttavat erityisesti hoitoon pääsyyn, henkilökunnan osaamiseen sekä ohjaukseen ja neuvontaan liittyvät asiat. Kohteluun liittyvä tyytymättömyys ilmenee kokemuksena alistamisesta ja henkisestä väkivallasta. Organisaatioon liittyvä tyytymättömyys on kaikissa osatutkimuksissa vähäistä. Koettu huolenpito on ympäristöä merkityksellisempi. Muistutusten sisältöä ei ole aikaisemmin tutkittu. Tutkimusta voidaan hyödyntää muistutuksiin liittyvien säädöksien ja palautejärjestelmien kehittämisessä. Tutkimus antaa uutta tietoa myös potilaan kohtaamiseen sekä hoitotyön ja työhyvinvoinnin kehittämiseen
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Peckham, Emily Jane. "Is homeopathic treatment more effective than giving time and attention to NHS patients with chronic complaints." Thesis, University of Leeds, 2012. http://etheses.whiterose.ac.uk/3910/.
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Many people seek individualised homeopathic treatment, however its use remains controversial. There have been suggestions that any improvement of the symptoms of those seeking individualised homeopathic treatment is solely down to the time and attention given to the patient by the homeopath. This aim of this thesis is to explore the question “is homeopathic treatment involving a homeopathic consultation and a homeopathic remedy any different to spending time with an empathetic practitioner, in the treatment of irritable bowel syndrome?” This study involved a systematic review of homeopathic treatment for irritable bowel syndrome and a randomised controlled trial comparing individualised homeopathic treatment to supportive listening and usual care. The primary outcome measure was the change in irritable bowel symptom severity score at 26 weeks. Differences between the three arms were assessed using independent t-tests and ANCOVA. A qualitative study nested within the randomised controlled trial involved qualitative interviews with a proportion of the participants in both the homeopathic treatment and supportive listening arms. This was to explore participants’ experiences of the treatment they received, and what, if anything about the treatment they felt led to any improvements. The systematic review of homeopathic treatment for irritable bowel syndrome identified two eligible RCTs, a meta-analysis of the results of these trials indicated a benefit of homeopathic treatment over placebo. However the results of this review should be viewed with caution as it is possible that there was a degree of bias associated with these two trials. In the randomised controlled trial, no significant differences were found between homeopathic treatment and supportive listening, when using t-tests or ANCOVA to compare mean change in IBS-SSS between baseline and 26 weeks. The qualitative interviews identified four different typologies that explained what patients believed to have led to changes in their general health and/or irritable bowel symptoms.
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Grönblom-Lundström, Lena. "Rehabilitation in light of different theories of health : Outcome for patients with low-back complaints - a theoretical discussion." Doctoral thesis, Umeå universitet, Epidemiologi och folkhälsovetenskap, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-33475.
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The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions. This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells. What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system. If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual. This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual.digitalisering@umu
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Kamourieh, Salwa. "Using fMRI to investigate speech-stream segregation and auditory attention in healthy adults and patients with memory complaints." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/29756.
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Poor memory for recent conversations is the commonest presenting symptom in patients attending a cognitive neurology clinic. They also frequently have greater difficulty following and remembering conversations in the presence of background noise and/or unattended speech. While the ability to participate in and recall conversations depends on several cognitive functions (language-processing, attention, episodic and working memory), without the ability to perform auditory scene analysis, and more specifically speech-stream segregation, recall of verbal information will be impaired as a consequence of poor initial registration, over and above impaired encoding and subsequent retrieval. This thesis investigated auditory attention and speech-stream segregation in healthy participants ('controls') and patients presenting with 'poor memory', particularly a complaint of difficulty remembering recent verbal information. Although this resulted in the recruitment of many patients with possible or probable Alzheimer's disease, it also included patients with mild cognitive impairment (MCI) of uncertain aetiology and a few with depression. Functional MRI data revealed brain activity involved in attention, working memory and speech-stream segregation as participants attended to a speaker in the absence and presence of background speech. The study on controls demonstrated that the right anterior insula, adjacent frontal operculum, left planum temporale and precuneus were more active when the attended speaker was partially masked by unattended speech. Analyses also revealed a central role for a right hemisphere system for successful attentive listening, a system that was not modulated by administration of a central cholinesterase inhibitor. Therefore, this study identified non-auditory higher-order regions in speech-stream segregation, and the demands on a right hemisphere system during attentive listening. Administration of a central cholinesterase inhibitor did not identify any benefit in the present patient group. However, my research has identified systems that might be therapeutic targets when attempting to modulate auditory attention and speech-stream segregation in patients with neurodegenerative disease.
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Milišiūnienė, Jolanta. "Paciento teisių gynybos būdai Lietuvos ir Danijos teisėje lyginamuoju aspektu." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2009. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2008~D_20090128_123750-70558.
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Magistro baigiamajame darbe nagrinėjamas pacientų teisių gynimo institutas Lietuvoje ir Danijoje. Temos aktualumą sąlygoja pacientų nepasitenkinimas Lietuvos sveikatos priežiūros sistema, kuris iš dalies yra sąlygotas nepilnavertiškai funkcionuojančios pacientų teisių gynybos sistemos. Danija pasirinkta kaip šalis, pasižyminti gerai sutvarkyta socialinio gerovės sistema bei aukštu gyventojų pasitenkinimo lygiu, kuris priklauso ir nuo pasitenkinimo sveikatos apsaugos sistema.
Darbo tikslas – sistemiškai išanalizuoti ir palyginti pacientų teisių gynybos būdus Lietuvos Respublikoje ir Danijoje, įvertinti juos bei pasiūlyti pacientų teisių gynimo tobulinimo kryptis Lietuvoje.
Vienas pagrindinių darbe naudojamų metodų - tai teisinių dokumentų analizė - analizuojami Lietuvos, Danijos, ES teisės aktai, reglamentuojantys pacientų teisių sampratą ir jų gynimo neteisminius ir teisminius metodus, teismų sprendimai, mokslinės publikacijos. Lyginimo metodu siekiama atskleisti pacientų teisių instituto panašumus ir skirtumus bei išryškinti lyginamos šalies privalumus ir trūkumus.
Darbą sudaro trys dalys. Pirmojoje dalyje nagrinėjama pacientų teisių samprata bei jų reglamentavimas Lietuvoje ir Danijoje. Antroji dalis skirta ikiteisminių pacientų teisių gynybos būdų analizei, išryškinant egzistuojančius esminius skirtumus Danijoje ir Lietuvoje teisės skųstis ir teisės į žalos atlyginimą srityje. Smulkiau analizuojamos sritys, kurios iš esmės yra skirtingos abiejose šalyse -... [toliau žr. visą tekstą]This Master thesis deals with the investigation of defence modes of patients rights in Lithuania and Denmark from the comparative perspective. The relevance of the topic is proved by the dissatisfaction of patients with Lithuanian health care system which partly exists due to non properly functioning patients rights defence system. Denmark was chosen as a country with properly arranged social welfare system and high satisfaction level of its inhabitants, which is also characteristic to their satisfaction with health care system. The aim of the thesis is to carry out comparative analysis of defence modes of patients rights in Lithuania and Denmark, evaluate them and define the possible ways for the improvement of the defence modes. An analysis of legal documents is one of the main methods used in this research. While using this method legal acts of Lithuania, Denmark and EU regulating the concept of patients rights and judicial and extrajudicial defence modes of patients rights, ad judgements, research publications are analysed. Whereas the comparative method is applied while seeking to reveal the existing similarities and differences, advantages and disadvantages of patients rights in Lithuania and Denmark. The first chapter of the thesis deals with the analysis of the concept of patients rights and their regulations in Lithuania and Denmark. The second chapter is devoted to the analysis of extrajudicial defence modes of patients rights while revealing the existing... [to full text]
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Jacobs, Sheri R. "Validation of the functional assessment of cancer therapy cognitive scale with bone marrow transplant patients." [Tampa, Fla.] : University of South Florida, 2004. http://purl.fcla.edu/fcla/etd/SFE0001078.
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Geraets, Jacques Jan Xavier Rosalie. "The clinical effectiveness and cost-effectiveness of a behavioral graded exercise therapy programme for patients with chronic shoulder complaints in primary care." Maastricht : Maastricht : Maastricht University ; University Library, Maastricht University [Host], 2006. http://arno.unimaas.nl/show.cgi?fid=7670.
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Sullivan, Regina. "The Relationship between Ventriculoperitoneal Shunts and Shunt Revisions versus Visual Complaints among Patients with Spina Bifida in the Arkansas Spina Bifida Research Project." Digital Archive @ GSU, 2012. http://digitalarchive.gsu.edu/iph_theses/231.
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Many patients with Spina Bifida suffer from hydrocephalus as a complication of their developmental disability and surgeons commonly treat this condition with ventriculoperitoneal shunts. Surgeons have speculated for years that these shunts may cause some type of visual disturbance because of their close proximity to the visual pathways in the brain. Little research has been done, however, to support or discourage this commonly held belief. Questions and data from the Arkansas Spina Bifida Research Project were used to examine whether ventriculoperitoneal (VP) shunts and VP shunt revisions increase reports of visual complaints for the individuals participating in this research project. This cross sectional design used responses to the vision questions from the 2005 Arkansas Spina Bifida Questionnaire. Results showed a 333% increase in reported vision complaints after receiving a VP shunt, but no significance with the increase in vision complaints for those having three or more VP shunt revisions. Females were 50% to 60% less likely to report vision complaints in both multivariate linear logistic models. While these results indicate the potential relationship between VP shunts and vision concerns, they must be viewed cautiously in light of study limitations due to the small sample size, selection bias, and study design.
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Bester, Beatrix Hendrina. "A descriptive study of patients presenting with a chief complaint of seizures to the prehospital emergency care practitioner of the Western Cape." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31572.
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Background
Seizures are considered one of the most common time-sensitive and potentially life-threatening medical emergencies presenting to emergency centres and attended to by prehospital emergency care practitioners. These require a rapid response, prompt identification and appropriate management. There is a paucity of information describing the demographics and prehospital management of patients presenting with seizures in South Africa.
Objectives
The aim of this study was to describe the demographics and prehospital management of patients presenting with a chief complaint of seizures and/or convulsions to prehospital emergency care practitioners within the Western Cape Government Emergency Medical Services.
Methods
This retrospective study included all Western Cape Government Emergency Medical Services calls indicating a chief complaint of seizures and/or convulsions between August 2017 and July 2018. Descriptive statistics were performed to describe basic demographics in this population. A sample of emergency calls originating within the City of Cape Town was selected for a clinical chart review to describe on-scene clinical presentation and vitals, response times, and prehospital treatment provided.
Results
A total of 24 746 seizure and/or convulsion cases were recorded during the study period. The highest frequency of patients was in the 21 - 40 year age group (31%), and 57% of patients were male. The subsample (n=3 075) yielded 1 571 cases with completed electronic patient care records. The mean dispatch and response times were 20 (±36) and 14 (±10) minutes respectively with a mean on-scene time of 25 (±13) minutes. No on-scene vital signs were recorded in 11.3% of patients. Recorded on-scene vitals indicated that 36% of patients presented with a tachycardia, 14% had an oxygen saturation of < 95%. Airway manoeuvres were performed in 30% of cases, and 50% of patients presenting with a SpO2 < 95% received supplemental oxygen. The benzodiazepine Diazepam was the most common medication administered, and 83% of medications were administer through the intravenous route.
Conclusions
Seizures are a recognised time-sensitive emergency, however in this sample of patients we observed a longer than expected dispatch time. Although the importance of recording baseline vital signs is recognised, there was a large proportion of undocumented vital signs 35 within the sample. Despite consensus recommendations that intramuscular midazolam are the preferred medication and route, IV diazepam was the most frequently administered. Seizures are an under-recognised burden on Emergency Medical Services within the Western Cape. This study provides an initial description of the epidemiology within this population, allowing for optimization of recognition and management in these patients.
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Tometich, Danielle B. "Symptom Severity and Importance in Metastatic Breast Cancer Patients: An Examination of Cognitive Complaints and Related Symptoms." Thesis, 2016. http://hdl.handle.net/1805/11017.
Full textAbstract:
Indiana University-Purdue University Indianapolis (IUPUI)Cognitive changes associated with cancer and its treatment have been well documented. However, the majority of research on cognitive symptoms in cancer has been conducted with early-stage breast cancer patients or survivors in remission. Little is known about cognitive symptoms in patients with late-stage or metastatic cancers. To address this gap in the literature, this study examines cognitive and related symptoms among metastatic breast cancer patients enrolled in a parent study of perceptions of symptom importance and interference. Eighty metastatic breast cancer patients were recruited from the Indiana University Simon Cancer Center to participate in this cross-sectional telephone interview study. The interview consisted of self-report measures, including measures of symptom severity, distress, and the importance of seeing improvement in specific symptoms post-treatment. I hypothesized that cognitive complaints would cluster with fatigue, sleep disturbance, depressive symptoms, anxiety, and pain. This hypothesis was tested using cluster analysis and was partially supported. Cognitive complaints were found to cluster with fatigue, sleep disturbance, depressive symptoms, and anxiety, but not pain. In addition, the extent to which ratings of symptom importance for cognitive symptoms differed from those of other symptoms (i.e., pain, fatigue, sleep problems, depressive symptoms, anxiety, nausea, lymphedema, hot flashes, and neuropathy) was explored using ANOVA and Tukey’s HSD tests. Cognitive complaints were rated as significantly more important than anxiety, depressive symptoms, neuropathy, swelling, nausea, and hot flashes. Importance ratings for cognitive complaints, pain, fatigue, and sleep problems were not significantly different. Developing patient-centered treatment approaches that take into account symptom clustering and patients’ treatment priorities may increase treatment adherence and optimize healthcare quality.
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Barros, Marta Sofia Penso de. "A prospective study to compare patient laryngo-pharyngeal complaints after laryngeal mask airway verus endotracheal tube insertion." Dissertação, 2012. https://repositorio-aberto.up.pt/handle/10216/72282.
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Barros, Marta Sofia Penso de. "A prospective study to compare patient laryngo-pharyngeal complaints after laryngeal mask airway verus endotracheal tube insertion." Master's thesis, 2012. https://repositorio-aberto.up.pt/handle/10216/72282.
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Henderson, Edward B. "The patient's words in the therapist's mouth : use of the patient's presentation of target complaints when communicating initial treatment goals /." 2002. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:3048388.
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Lee, Ying-Shuan, and 李英萱. "The Assessment of Status Quo Using Patient Complaints to Promote Patient-Centered Care— An Example of Department of Dentistry in Medical Center in North Taiwan." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/31612455209147517153.
Full textAbstract:
碩士國立臺灣大學
健康政策與管理研究所
101
Background： Since 1999, the Institute of Medicine (IOM) of Americian has published a set of quality care reports, indicating that the healthcare system faced many difficulties and proposing that the core value of current healthcare service is patient-centered care, which could be conducted to promote physician-patient relationship and improve health care outcome. In addition, patients make complaints when they are not satisfied with the healrh care service they receive. Objectives： The purposes of this study were to analyse patient complaints of the department of dentistry in a medical center located in northern Taiwan, to determine the frequency and nature of complaints, and further to explore the status quo of patient-centered care. Methods： The current study used Critical Incident Technique to analyze the patient complaints between 1 April 2008 and 31 December 2012. After excluding the complaints that were not readable or without complaint-related content, there were 238 patient complaints and 291 separate issues included in the analyses. Results： 158 of the complaints (66.39%) were made by the patients themselves, and around 30% were made by their relatives. The verbal complaints were 55%, more than the written format (45%). About 73% of complaints were resolved by providing an explanation. The complaints consisted of 5 dimensions and 33 items. 115 issues were related to communication and 87 issues (29.90%) were related to treatment. Conclusions： The majority of patient complaints were related to communication and treatment. Common manner to response patient complaint is to provide an explanation. Therefore, staff training and the development of an electronic complaint management system to track patient complaints were recommended to improve health care quality and patient-centered care.
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Chen, Li-jyun, and 陳麗君. "An Empirical Study of the Response from the Hospital toward Patient Complaints: Through the Channel of E-mail." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/32999916819820814592.
Full textAbstract:
碩士國立中正大學
資訊管理所
95
The national health insurance has been implemented since 1995. Hospitals could hardly compete on price to survive because most people have it. As far as hospitals concerned, it’s impossible to higher the service quality to avoid complains from customers in such conditions. The studies about hospital-customers complains before probably discuss how to handle and recover complains, and the customers’ satisfaction with them, rather than the factors which influence hospitals to react them. So, this study tries to examine the factors which influence hospitals to react the customers’ complains based on two cases and the literature on this subject and Mystery shoppers. Since e-mail plays an important role for companies to communicate internally and externally, it is designed as a medium in this study. There are three destinations of this study. First, examine how these factors, the degrees and attributions of hospitals and the internet population in its district, influence the time and quality of hospitals to response complains e-mails to customers. Second, the degree of how much hospital care about customers complains. We discuss it with many factors, including whether hospitals assign specialists to handle it, set up SOPs, how much supervisors care about, and the influence of KM systems on the response time and quality. Third, discuss the degree of how much hospitals care about complains attributions and the percentages of e-mailed-channel complaints. As a result, we find out that both regional and local hospitals are better in the quality of response complains than center hospitals. Religious hospitals are better than state-run hospitals as well. Judging from the internet population, which is located in the district of certain hospital, the north hospitals are faster than the middle ones in the response time. The response time is influenced by specialists, SOPs and the degree of how much supervisors care about. The quality of response complains e-mails is influenced by specialists and KM systems.
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Liou, Ing-lan, and 劉英蘭. "Exploring the Relationship between the Medical Practitioner and the Patient from the Perspective of Complaints Filed by the Patient – Case Study on One Medical Center in the Nort." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/93690508695992022110.
Full textAbstract:
碩士元智大學
管理研究所
94
The research objective is to find out causes that presently impact the communications between the medical practitioner and the patient. The complaint cases filed by patients and recorded by the Social Service Section of one medical center are analyzed and a statistical report is attained. The statistics shows the most commonly filed complaints from the patients, issues, complained subjects and so on. Of issues listed on the top of complaints are “poor attitude” and “medical practitioners” as the most complained subjects. The two issues are earmarked to indicate how the medical practitioner-patient relationship goes. Through the two indicators, more issues such as medical behaviors, perceptions, and personal factors of the medical practitioner and the patient are further examined. Apart from the filed complaints from the patient, the research has also designed a questionnaire based on the medical practitioner’s viewpoints to survey the significance and difficulty exposed by the causes that have impacted communications between the medical practitioner and the patient. Through the questionnaire survey, the medical practitioner’s perception of medical treatment’s importance as opposed to the difficulty exposed in their medical practices is further explored and understood. The primary finds through the research are as follows: 1. The complainant makes complaints mostly through phone call. Most complainants are from the three groups: outpatients, patients for emergency care and inpatients. Among the three, outpatients outnumber the other two. 2. Medical practitioners are the most complained subjects and nurses come next. Most complaints are poor attitudes and communications. July is the month that receives most complaints. 3. On the analysis of most complaints filed out of the above three groups, poor attitudes displayed top the complaint list from the outpatient viewpoints, accounting for 30%. Medical negligence accounts for 20%, from the inpatient group. From the emergency care group, poor attitudes even take a higher share of complaints, 42% to be exact. 4. Considering the medical practitioner’s personal factors, the dominating ones that affect the communications between medical practitioners and patients are too many patients to treat and emotional factors. 5. From the survey on medical practitioners, their concerns on issues are actually more related to the patient’s family and too many repetitive questions raised by them on the patient’s illness conditions 6. On the surveyed perceptions of medical practitioners, to state clearly the prospect and the danger of the illness is the uppermost. To attain a positive interaction between the medical practitioner and the patient, it takes a good and smooth communication. How the medical practitioner enables the patient to sense his medical professionalism and makes the patient feel respected in a short time? Besides the strengthening of medical professionalism and expertise, the medical practitioners need to further their communication skills with the patients to achieve a sensible and smooth interaction and reduce negative impacts on their relationships.
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Melo, Sandra Cristina Fernandes. "Reclamações, nova metodologia de avaliação do risco clínico." Master's thesis, 2009. http://hdl.handle.net/10362/4638.
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RESUMO - A OMS estima que dezenas de milhares de doentes em todo o mundo sofrem consequências ou morrem devido a cuidados e práticas médicas pouco seguras (JHA, A., ed. lit., 2008). Este estudo surge com o intuito de gerar conhecimento acerca dos EA e promover a melhoria da gestão do risco com base na perspectiva do doente, obtida através das reclamações. As reclamações contêm informação primordial acerca das necessidades reais, manifestas e sentidas pelo doente e as pessoas que lhes estão próximas (familiares, cuidadores informais). Elas podem reportar EA e constituir um veículo importante da melhoria da qualidade. O objectivo geral do estudo é contribuir para a melhoria da qualidade dos serviços de saúde, particularmente no que diz respeito à melhoria da segurança do doente. Para tal, será desenvolvida metodologia de análise de reclamações, para avaliação da ocorrência de EA. O instrumento de colheita de dados consiste numa checklist de verificação de variáveis, para posterior caracterização e realização de testes estatísticos. ----------ABSTRACT - The WHO estimate that tens of thousands customers around the world suffer or die due to Care and unsafe medical practices consequences (JHA, A., ed. lit., 2008). The aim of this research is to generate knowledge about the adverse events and promote the improvement of risk management based on patient perspective, obtained through complaints. Claims/Complaints contain vital information about the real needs, perceived and manifest by the patient and those close to them (families, informal caregivers). They can report adverse events and provide an essential vehicle to quality improvement. The study overall objective is to contribute to health services quality improvement, particularly as regard to improving the patient safety. For this will be developed methodology of complaints analysis, to adverse events occurrence assessment. The instrument for data collect consists in a checklist to variables verification toward further characterizati
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Gomes, Celina Alexandra Dias. "Reclamações num serviço de Imagiologia: das causas às sugestões de melhoria na perspetiva dos profissionais de saúde." Master's thesis, 2017. http://hdl.handle.net/1822/46459.
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Dissertação de mestrado em Gestão de Unidades de SaúdeA qualidade dos serviços de saúde tem, nos últimos anos, vindo a suscitar um maior interesse e a assumir uma importância crescente, revelando-se uma das principais preocupações dos sistemas de gestão. Segundo Pereira, a qualidade no setor da saúde é valorizado pelo utente, na medida em que se trata de algo tão essencial como a vida. Deste modo, ao dirigir-se a um prestador de serviços no setor de saúde o utente valoriza vários pontos, nomeadamente o atendimento, a delicadeza, a disponibilidade, a forma como lhe transmitem a informação, as atitudes e comportamento dos profissionais, assim como as condições físicas (Donabedian, 1980a; Mezomo, 1992). Por conseguinte, a satisfação do utente é um aspeto importante da qualidade do atendimento, uma vez que os utilizadores normalmente reclamam quando não estão satisfeitos com os cuidados que recebem. Desta forma, a presente investigação, inserida no Mestrado em Gestão de Unidades de Saúde, visa conhecer a perceção dos profissionais do Serviço de Imagiologia de um Hospital com parceria público-privada (PPP) acerca do aumento das reclamações dos utentes. Pretendeu-se assim auscultar os vários profissionais do Serviço de Imagiologia (assistentes técnicos, assistentes operacionais, técnicos de radiologia, enfermeiros e médicos) por forma a elencar as razões que podem ter contribuído para tal número de reclamações. E, consequentemente, ajudar na identificação de melhorias que pudessem resultar numa melhor qualidade dos serviços prestados. Com base nos dados obtidos, apesar de 18% afirmar desconhecer o aumento substancial das reclamações, pode-se aferir que as perceções dos profissionais do serviço de imagiologia do hospital em estudo estão em consonância com as reclamações dos utentes. À semelhança de outros estudos (Bursch, Beezy, & Shaw, 1993; Thompson, Yarnold, Williams, & Adams, 1996), também neste a maioria das reclamações prende-se com o tempo de espera de atendimento para exames. Tal como acontece em muitas unidades de saúde, também neste caso a lista de espera representa a maior causa para este facto, promovida pela falta de recursos quer humanos, quer por condições físicas.
In recent years, the quality of health services has been growing and becoming increasingly important and a major concern of management systems. According to Pereira, the quality of the health sector is valued by the user, since it´s something as essential as life. In this way, when addressing a service provider in the health sector, the user values several points, namely care, sensitivity, availability, the way they transmit information, the attitudes and behavior of the professionals, as well as the Physical conditions (Donabedian, 1980a; Mezomo, 1992). Therefore, user satisfaction is an important aspect of quality of care. Since users often complain when they arent satisfied with the care they receive. In this way, the present investigation, inserted in the Master in Management of Health Units, aims to know the perception of the professionals of the Imaging Service of an Hospital with public-private partnership (PPP) about the increase of the complaints of the users. It was intended to listen to the various professionals of the Imaging Service (technical assistants, operational assistants, radiology technicians, nurses and doctors) in order to verify the reasons that may have contributed to such a number of complaints. And, consequently, help in identifying improvements that could result in a better quality of the services provided. Based on the data obtained, although 18% stated that they didnt know the substantial increase in complaints. It was verified that the perceptions of the professionals of the imaging service of the hospital under study are in accordance with the complaints of the users. As with other studies (Bursch, Beezy, & Shaw, 1993; Thompson, Yarnold, Williams, & Adams, 1996), the majority of complaints also concern the waiting time for exams. As in many health care facilities, the waiting list is also the major cause of complains, due to the lack of resources, both human and physical.
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SHIH-WEI, LU, and 盧世偉. "Polysomnographic and Personality Features in Patients Complaint of Epic Dreaming." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/85852261301191681797.
Full textAbstract:
碩士輔仁大學
心理學系
93
Research background & aims: Epic dreaming is defined as the recall of relentless, neutral-content dreaming throughout the night, with feelings of exhaustion upon awakening and fatigue during the day. Previous researches have studied the polysomnographic (PSG) features of these patients. It was found that 21.4 to 25.0 % of them showed sleep-related breathing disorders (SRBD) and/or periodic limb movement disorder (PLMD). However, the rest of them showed unremarkable PSG findings. The present study further assessed the PSG, personality and psychopathologic common features of these patients. Methods: Twenty three patients (8 men,15 women; mean age 34 yrs) who complained of epic dreaming recruited from a neurologic clinic and 10 healthy control subjects (3 men, 7 women; mean age 30 yrs) participated in the study. Clinical interview concerning sleep and psychopathology and self-rating questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Chinese Health Questionnaire (CHQ-12), the NEO five-factor inventory (NEO-FFI), and Short-Form 36 Health survey (SF-36), were administered. One night of polysomnograph (PSG) recording were also conducted. Results: In terms of the sleep and mental diagnoses, 7 patients had specific sleep disorders, 6 patients had mental disorders, 5 patients had specific sleep disorders as well as mental disorders, and 5 patients did not have any specific sleep or mental disorders. Several sleep features on PSG were found. First of all, the patients with epic dreaming had higher sleep onset latency, stage 1 ratio, waking ratio during sleep, and lower sleep efficiency, stage 3, 4 ratio than controls. When comparisons among different diagnostic groups and control subjects were conducted, it was found that only the patients with mental disorders had lower sleep efficiency than controls, and the patients with both sleep and mental disorders had higher stage 1 ratio and lower stage 3, 4 ratio than controls. Secondly, the patients with epic dreaming had higher total arousals, spontaneous arousals, hypopnea associated arousals, and snoring arousals than controls. When comparisons among different diagnostic groups and control subjects were conducted, it was found that only the patients with specific sleep disorders had higher total arousals, hypopneas arousals, and snoring arousals than controls, and the patients with both specific sleep and mental disorders had higher total arousals and snoring arousals than controls. Thirdly, the patients with epic dreaming had lower delta power in all sleep stages and higher alpha, beta power in slow wave sleep than controls. When comparisons among different subgroups of patients and controls were conducted, the results showed that only the patients with specific sleep disorders had lower delta power at C3 in stage 3, at C4 in stage 1 and 4 sleep than controls, and the patients with both sleep and mental disorders had lower delta power at C4 in stage 1 than controls. In terms of the personality features, the result of NEO-FFI showed that the patients with epic dreaming had higher trait of neuroticism and openness than controls. When comparing the differences among different diagnostic groups and controls, the results showed that only the patients with mental disorders had higher level of neuroticism than controls. In terms of daily function, SF-36 showed that the patients with epic dreaming had lower physical function, role physical, general health, vitality, social functioning, role emotional, and mental health than controls. When the differences among the subgroups of patients and controls were compared, the results showed that the patients with both specific sleep and mental disorders had lower physical function and role physical than controls, the patients with mental disorders had lower general health, vitality, and mental health than controls, and the patients with pure epic dreaming had lower vitality than controls. Conclusions: The results indicate that patients complain of epic dreaming had some polysomnographic and personality features as a group. In terms of the sleep, the measure of arousals during sleep and power spectrum analysis indicated lower NREM sleep driver and higher level of cortical arousal during slow wave sleep. Also, they showed higher percentage of stage 1 sleep and lower stage 3, 4 sleep. In terms of the personality, the patients demonstrated higher neuroticism and openness to experience trait. However, these sleep and psychological features may be resulted from different pathologies in different patients. Keyword: epic dreaming, dream, sleep disorders, polysomnography, personality, psychopathology.
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Bei-YiSu and 蘇倍儀. "Psychological complaints and neuropsychological functions in patients with chronic complicated mild traumatic brain injury." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/2r9zdg.
Full textAbstract:
博士國立成功大學
健康照護科學研究所
106
Background and aims: Traumatic brain injury (TBI) is one of the leading cause of disability, and is recognized as a main health problem. Besides, brain damage has resulted in a condition that may be progressive, which emphasized that TBI should be managed as chronic disease. In Taiwan, the primary cause of TBI was motorcycle-related injury, and the vast majority of TBI is classified as mild TBI (mTBI). It is known that, even after mTBI, persistence of psychological complaints, incomplete neuropsychological recovery, and psychosocial maladjustments are highly prevalent. It is common in clinical practice to see patients with mTBI who complain about residual problems after brain injury, which may offer meaningful clinical information and are related to the nature of the disability, treatment needs, and functional outcomes. Nevertheless, the definition of mTBI is heterogeneous with a wide range of possible clinical outcomes, and the consequences of mTBI are often invisible. Thus, exploring the prognosis for subgroups of different severity degrees of mTBI was important. The dissertation comprises three original studies from this context. First of all, we investigated patients with complicated mTBI and different return to work (RTW) statuses in order to identify the risk factors of memory or emotional complaints. In the second study, we investigated the association between neurological factors and memory complaints in patients with chronic complicated mTBI and Glasgow Coma Scale (GCS) scores of 14 to 15. In the third study, we investigated the correlations between psychological complaints and brain lesions with neuropsychological functions in patients with chronic complicated mTBI and GCS score of 14 to 15. Methods: Study 1: retrospective analysis of medical records was conducted by physicians in a teaching hospital in Southern Taiwan, and complicated mTBI had been identified by means of computed tomography. Psychological complaints, including problems with memory and emotions, were collected by structured telephone interviews, 10–15 minutes long, and were held with subjects who agreed to participate in our study. We used demographic data and neurological factors to predict memory or emotional complaints without muscle power or response speed (MEMR) complaints. Study 2: medical records were retrospectively analyzed by physicians and clinical neuropsychologists in several teaching hospitals in southern Taiwan. Subjective memory complaints were determined in structured telephone interviews with patients in the chronic stage of complicated mTBI. Study 3: computerized tomography (CT) scans and medical records were retrospectively analyzed by physicians and neuropsychologists in southern Taiwan. We evaluated all patients’ psychological complaints and EF, including executive attention, working memory, verbal fluency, planning, and flexibility, measured by Comprehensive Nonverbal Attention test (CNAT), Comprehensive Nonverbal Memory Test (CNMT), Serial Verbal Memory Task (SVMT), Instrumental Verbal Working Memory of Daily Life (IVWM), Wisconsin Card Sorting Test (WCST), Tower of Landon (Toll), and Stroop test. Results: Study 1 showed that only the presence or absence of cerebral contusions predicted memory or emotional complaints without MEMR complaints in different employed status, and the odds ratio was 4.82–13.50 times higher for those with cerebral contusions than for those without. Study 2 showed that 133 patients (39.94%) complained about memory complaints (MCs), and 46 patients (13.81%) complained about memory complaints only (MCOs). No demographic factors were associated with MCOs. However, brain contusions and mixed types of hemorrhage (brain contusions and subarachnoid hemorrhage [SAH]) showed significant associations with MCOs. Study 3 showed that 15 patients (21.1%) with brain contusions had much less CL on CMNT (F = 8.544, P 〈 .01, η2 = 0.125), and total number of C errors on the ToL (F = 5.268, P 〈 .05, η2 = 0.076) than those without brain contusions. Thirty-one patients (43.7%) with frontal lesions on CT had significantly lower total ToL scores, more ToL commission errors, more impulsive CNAT errors, lower IVWM auditory scores, and less verbal fluency. Confounding factors were excluded after demographic factors had been controlled for. Discussions and Conclusions: The findings of these studies demonstrated that patients with complicated mTBI might have long-term sequelae. Brain contusions or mixed types of hemorrhage might be markers for detecting high-risk patients with subjective complaints. In addition, complicated mTBI with frontal lobe lesions might be also an indicator for predicting poorer EF, even in the chronic stage. In summary, complaints might imply meaningful information rather than represent noise, and brain pathology of mTBI needs more attention in clinical settings when considering prognosis and neuropsychological rehabilitation.
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McDonald, Murray L. "Demographic characteristics of patients attending DUT Chiropractic Day Clinic : a comparison of trends between 1994 and 2011." Thesis, 2014. http://hdl.handle.net/10321/1000.
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Dissertation submitted in partial compliance with the requirements for the
Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012.Background: The Durban University of Technology (DUT) chiropractic teaching clinic (CTC) represents a training facility for future chiropractors as well as providing a healthcare service to the local population. It is important to measure the demographic characteristics and presenting complaints of patients attending the DUT CTC as this information prepares the student interns for private practice. It also provides an insight into the popularity of chiropractic in the community. Objectives: This study sought to measure certain demographic variables and presenting conditions of patients attending DUT CTC and to assess whether these have changed over time. Method: A retrospective, cross-sectional descriptive study was performed by drawing patient files of new patients presenting to the DUT CTC for the months of February through April, during 2000, 2006 and 2011 (data from a 1994 study was included for analysis). The files had the following information regarding the patient collected: age, gender, ethnicity, occupation, medical aid, main presenting complaint, as well the duration of the most recent complaint. The data was analysed for trends using statistical software (SPSS v19). Results: Data from 1 311 patient files were analyzed. The number of patients attending the DUT CTC had reduced significantly since 2000. The mean age ranged from 37.0 – 39.7yrs across the samples with a trend of increasing age occurring between 1994 and 2006. Ages ranged from 2 weeks – 89yrs, with 20 – 29yrs being the most common group. Females formed 50.5 – 51.2% of the samples with no significant change over time. White (46.3 – 64.2%) and Indian patients (27.2 – 40.9%) formed the majority, with Black patients showing a trend of increasing representation (from 6.4% in 2000 to 15.8% in 2011). The most common occupations were student (19.7 – 26.8%) and clerical (17 – 23%), with a trend noted between 1994 and 2006 of a decreasing student proportion. This trend reversed from 2006 – 2011. Medical aid subscription among patients reduced significantly (p<0.05) from 56.2% in 1994 to 41.6% in 2011. The main presenting complaints were spinal (68.2 – 84.1%), with low back (30.7 – 40.7%) and neck/head (27.8 – 33.8%) being the most common. Most main complaints were of a chronic nature (45.8 – 61.7%), though a trend of reducing chronicity was noted between 1994 and 2006. A trend of increasing sub-acute complaints was seen between 1994 and 2011. Conclusions: The patients attending DUT CTC are similar to most international CTC’s in terms of patients’ age, gender, occupation, and main presenting complaint. Compared to existing data on South African private practice, the patients at DUT CTC are generally younger, less likely to be female, less likely to be White, more likely to be Indian or Black, less likely to have medical aid, more likely to present with low back pain as appose to neck/head pain, and more likely to present in the acute/sub-acute phase. Between 1994 and 2006, the trend shows that patients at DUT CTC were older, less likely to be White, less likely to be students, less likely to have medical aid, and less likely to present in the chronic phase.
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Jia-ChunCai and 蔡佳純. "Summary Generation for Chinese Patient Complaint based on Medical Entity Recognition and Medical Terminology Mapping." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/5t7jgs.
Full textAbstract:
碩士國立成功大學
醫學資訊研究所
107
In recent years, with the rise of health awareness and the gradual increase of personal Internet access rate. There are more and more online health consultation websites, and more and more users seek professional through online medical consultation platform, health related forums and social networking websites. The content of general user consultation on the Internet is more verbose and less structured than medical personnel. Therefore, for medical personnel, providing structured medical entity identification can assist medical personnel in medical diagnosis and consultation. Therefore, to solve the above-mentioned problems, a medical entity recognition model was proposed in this study to identify the ten entities including Symptoms, Disease, Health Information, Department, Treatment, Examination, Medication, Organs, Time and Abbreviation. For entities that are not extracted, we provide the ability for users to add entities themselves. Experiments have shown that the system we provide can reduce 40% time for medical text annotation. As the number of tags increases, the required tag time will be less and less. We map the layperson terms to medical terms through the medical term mapping method. It can reduce the “vocabulary gap” between the language that laypersons are familiar with and the terminology used in medical practice and research. In our medical summary generation, a medical summary is generated based on the extracted medical entity. In the experiment, the generated summary has a reduced number of words compared to the original medical text, and the original meaning is not much different.
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Li-Chuan, OU, and 歐麗娟. "The Study of Organization Climate between Inpatient’s Self-Efficacy and Complaint Behavior Intentions - Nurse-Patient Relationship as Mediator." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/27890483457016453598.
Full textAbstract:
碩士南台科技大學
企業管理系
95
Abstract This research is to study the correlation of the organization climate in nursing teams of different departments and the nurse-patient relationship with Inpatients’ self-efficiency and complaint behavior intention. The data were collected from nursing teams and inpatients at a regional hospital in south of Taiwan in March 2007. The structured questionnaire after the revise of experts was sent out to 107 nurses and 125 inpatients for investigation. The response rate of nurses and patients was 87.8% and 79.2% respectively. Methods of description statistics, principle component, reliability and validity, Linear Regression, ANOVA, Pearson correlation analyses were conducted to identify: (1) Organization Climate Scale, Nurse-patient Relationship Scale, and Self-efficiency Scale related to their theoretical domain were analyzed by principle component: eigenvector > 1, loading > 0.5, alpha coefficients domain was adequate > 0.75. (2) In Complaint Behavior Intentions scale, we follow experts’ opinion to distinguish the level of severity from 1 to 9. (3) The “job involvement” and “ownership” in different organization climate have significant influence on nurse-patient relationship (P<0.05). (4) In the analysis of nurse-patient relationship in different nursing teams, the result showed “the clinical care” was significantly correlative (P<0.001). The results from Regression analysis were: (1) Nurse-patient relationship can influence inpatients’ self-efficiency on medication cognition (R2:0.39, after adjustment R2:0.36, F-test:15.32, P<0.001). (2) Nurse-patient relationship can also influence inpatients’ complaint behavior intention on medical defects. The complaint behavior intention to physician’s medical defects has positive significance with “the clinical care” of nurse-patient relationship (F-test: 1.79, t-value 2.59, R2: 0.071, after adjustment R2: 0.031, P<0.05). (3) The complain behavior intention to the offer of nursing care information has positive significance with “the sincere care” of nurse-patient relationship (F-test: 1.68, t-value 2.12, R2: 0.067, after Adj- R2: 0.027, P<0.05). The family reaction has positive significant with “the comfortable care” of nurse-patient relationship ((F-test: 1.63, t-value 2.01, R2: 0.065, after adjustment R2: 0.025, P<0.05). Key works: Organization Climate, Self-Efficiency, Nurse-Patient relationship, Complaint Behavior Intention
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胡文郁. "A Study of Drug Complaint Behaviors and Associated Factors of Hypertensive Patients in the Out-Patients Department at a Medical Center of Taipei City." Thesis, 1990. http://ndltd.ncl.edu.tw/handle/12511851313082242619.
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Yen-ChunYueh and 樂晏均. "Gender Effects on the Consistency between Subjective Memory Complaints and Memory Test Performance in Patients with Complicated Mild Traumatic Brain Injury." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/97zjbv.
Full textAbstract:
碩士國立成功大學
行為醫學研究所
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Patients with complicated mild traumatic brain injury (mTBI) suffer from neuropsychological deficits and complaints. Gender affects patient complaints. This study sought to investigate gender effects on the consistency between subjective memory complaints and memory test performance in patients with complicated mTBI. This study taking a sample of the clinical samples, 478 of the head-damage diagnosis codes were included in a medical center in the southern country from 101 to 104 years. Of these, 81 agreed to participate in the neuropsychological assessment. Research tools included Physical and Mental Health Status Scale for assessing subjective memory complaints and the Guo's Verbal Memory Scale (GVM), the Scale of Instrumental Verbal Working Memory of Daily Life (SIVWM-DL), and Comprehensive Non-verbal Memory Test Battery (CNMT) for assessing memory function. A total of 74 subjects completed the study, 91% of the subjects had different levels of memory complaints. All subjects are in a normal memory range. In our study, most of the subjects had inconsistencies between subjective memory complaints and memory test performance. The consistency between memory complaining and test performance was lower for female than for male. The memory performance of male patients is more consistent with the neurophysiological variables at the time of injury than female. Female subjects have a higher degree of subjective memory complaints, and subjective memory complaints are less consistent with test performance.
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Clavel, Nathalie. "Étude des pratiques et des rôles de gestion favorisant l’engagement des patients dans les soins et l’amélioration de la qualité des services de santé." Thèse, 2019. http://hdl.handle.net/1866/23552.
Full textAbstract:
Contexte : dans les pays de l’OCDE, la plupart des organisations de santé ont mis en place
différentes approches afin d’accroître l’engagement des patients que ce soit au niveau des soins
ou au niveau de l’amélioration de la qualité. Au Canada, la province du Québec se caractérise
par un contexte particulièrement novateur en matière d’engagement des patients au sein des
organisations de santé. Alors que les démarches d’engagement se sont généralisées dans bon
nombre d’organisations, peu de connaissances existent sur leur mise en oeuvre dans différents
contextes cliniques et organisationnels. La littérature sur l’engagement des patients identifie
principalement les facteurs facilitants et entravants, sans comprendre les rôles et pratiques clés
des gestionnaires à différents niveaux des organisations de santé.
Objectif : l’objectif de la thèse est d’analyser les rôles et les pratiques des gestionnaires, à
différents niveaux des organisations de santé, dans la mise en oeuvre de l’engagement des
patients.
Méthodologie : la thèse repose sur la réalisation d’études de cas multiples (articles 1 et 3) et
d’une étude transversale (article 2), mobilisant des données qualitatives et quantitatives, qui ont
donné lieu à trois articles. Dans les deux premières études, des données qualitatives (entrevues,
groupes de discussion et documents) ont été utilisées afin d’explorer les rôles et les pratiques
des gestionnaires pour favoriser l’engagement des patients dans les démarches d’amélioration
de la qualité. La dernière recherche repose sur l’utilisation de méthodes mixtes (entrevues,
groupes de discussions, documents et questionnaires) en vue d’explorer les pratiques de gestion
visant à renforcer l’engagement des patients dans leurs soins. Au total, 74 entrevues ont été
réalisées auprès de gestionnaires à différents niveaux de gestion (stratégique n=26, tactique
n=28 et opérationnel n=20) et 11 groupes de discussion ont été effectués auprès de
professionnels de la santé (n=7) et de patients en oncologie et en santé mentale (n=4). De plus,
des questionnaires ont été administrés auprès de patients en santé mentale.
Résultats : la thèse met en évidence six résultats principaux. 1-Les pratiques de gestion sont un
levier important d’intégration de la perspective des patients dans les soins et les efforts
d’amélioration de la qualité. 2-L’intégration de l’engagement des patients implique une
coopération renforcée entre les gestionnaires à différents niveaux de gestion. 3-Le leadership
des gestionnaires se situe à différents niveaux de gestion en fonction du niveau d’intégration des
patients (organisationnel ou clinique). 4-Les pratiques des gestionnaires sont soutenues par un
ensemble de facteurs contextuels propices à l’intégration de l’engagement des patients. 5-
L’intégration de la participation des patients favorise l’émergence de nouvelles pratiques de
gestion au sein des organisations de santé. Enfin, 6-La mise en oeuvre de l’engagement des
patients crée des défis et des paradoxes auxquels les gestionnaires doivent répondre.
Contribution scientifique : les résultats de la thèse contribuent au développement des
connaissances dans le domaine de l’engagement des patients et ouvre la voie à un nouveau
champ de recherche sur la gestion de l’engagement des patients.Background: In OECD countries, most health organizations have implemented approaches to increase patient engagement in direct care and quality improvement. In Canada, the province of Quebec stands out by an innovative context in terms of patient engagement in healthcare organizations. While patient engagement approaches are becoming widespread in many organizations, little is known about their implementation in different clinical and organizational contexts. The patient engagement literature primarily identifies facilitating and impeding factors, without understanding the key roles and practices of managers at different levels of healthcare organizations. Objective: This thesis aims at analyzing the roles and practices of managers, at different levels of health care organizations, in integrating patient engagement in care and quality improvement. Methods: The thesis is based on multiple case studies (articles 1 and 3) and one cross-sectional study (article 2) using both qualitative and quantitative data and methods. In the two first studies, qualitative data have been used to explore managerial roles and practices that aims at enhancing patient engagement in quality improvement. In the last study, a mixed-methods approach has been used to understand managers’ practices that contribute to improve patient engagement in their care. In total, 74 interviews were conducted with managers at different levels of management (top-level n=26, mid-level n=28 and front-line level n=20) and 11 focus groups have been realized with health care professionals (n=7) and patients in oncology and mental health (n=4). In addition, surveys have been administered to patients in mental health. Findings: This thesis highlights six main results. 1-Management practices are an important lever for integrating the patient perspective into care and quality improvement efforts. 2-The implementation of patient engagement approaches requires enhanced cooperation between managers at different levels of management. 3-Managers’ leadership is situated at different levels of management, depending on the level of patients’ integration (organizational or clinical). 4-Managers’ roles and practices are supported by a set of contextual factors which foster patient engagement. 5-The integration of patient participation creates innovative management practices within healthcare organizations. Finally, 6-The implementation of patient engagement generates challenges and paradoxes that managers have to face. Scientific contribution: Our findings contribute to the development of knowledge in the field of patient engagement and can pave the way for a new research area on the management of patient engagement.
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Yang, Hui-Ling, and 楊蕙菱. "Evaluation the Effects of Memory Training on Elderly Patients with Mild Cognitive Impairment’ Objective Memory Performance, Subjective Memory Complaints, and Global Cognitive Function." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/37qe68.
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Cho, Er Chien, and 卓爾芊. "The association between triage acuity and key interventions and their derived clinical decision rule – A study of selected chief complaints of elderly emergency department patients." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/kt695p.
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Ramela, Irene Ntebo. "Patients' satisfaction with health care services provided in the city of Johannesburg municipality clinics." Diss., 2009. http://hdl.handle.net/10500/3901.
Full textAbstract:
The study aimed at describing patients’ satisfaction with health care services provided in the city of
Johannesburg. The research sample consisted of adult male and female patients who visited region E
clinics for health services. Questionnaires were used to collect data and descriptive statistics for data
analysis. Findings indicated that patients were generally satisfied with health care services provided.
Recommendations included ongoing staff training to improve quality of health care and public
information and education campaigns to foster community awareness and understanding of health
services, develop a sense of ownership thereof, and encourage positive participation.Health Studies
M.A. (Health studies)