Private General Hospital Research Articles

Adesão ao Tratamento em Gestação de Alto Risco

No Brasil, aproximadamente 15% das gestações são de alto risco, sendo os diagnósticos de diabetes gestacional e hipertensão as causas mais frequentes dessa condição. Para a efetividade dos tratamentos indicados nesses casos, bem como alcance de desfechos favoráveis, é essencial a adesão da paciente às recomendações fornecidas pelas equipes de saúde, o que torna fundamental a avaliação desse indicador. A pesquisa apresentada avaliou a adesão de participantes de um programa de atendimento interdisciplinar a gestantes de alto risco desenvolvido em um hospital geral privado por meio de três instrumentos: Questionário Morisky-Green de adesão ao uso de medicação, Questionário de Adesão ao Tratamento e Pergunta descritiva de avaliação qualitativa. Durante oito meses, 83 gestantes responderam aos questionários, que possibilitaram identificar níveis de adesão ao longo do tempo de participação no programa, situações de não adesão mais frequentes, bem como variáveis que interferem nas medidas de adesão ao uso de medicação e ao tratamento global. Considera-se que os índices levantados são passíveis de uso como indicadores clínicos e gerenciais, possibilitando a comprovação da efetividade e melhoria constante das rotinas de saúde. Tais mecanismos são úteis para definição de protocolos, discussão de casos clínicos e mesmo para feedbackàs próprias pacientes.

An empirical study of the impact of service quality on patient satisfaction in private hospitals, Iran.

Objective:Perceived service quality is the most important predictor of patient satisfaction. The purpose of this study was to investigate the impact of the service quality on the overall satisfaction of patients in private hospitals of Tehran, Iran.Method:This cross-sectional study was conducted in the year 2010. The study’s sample consisted of 969 patients who were recruited from eight private general hospitals in Tehran, Iran using consecutive sampling. A questionnaire was used for data collection; contacting 21 items (17 items about service quality and 4 items about overall satisfaction) and its validity and reliability were confirmed. Data analysis was performed using t-test, ANOVA and multivariate regression.Result:this study found a strong relationship between service quality and patient satisfaction. About 45% of the variance in overall satisfaction was explained by four dimensions of perceived service quality. The cost of services, the quality of the process and the quality of interaction had the greatest effects on the overall satisfaction of patients, but not found a significant effect on the quality of the physical environment on patient satisfaction.Conclusions:Constructs related to costs, delivery of service and interpersonal aspect of care had the most positive impact on overall satisfaction of patients. Managers and owners of private hospitals should set reasonable prices compared to the quality of service. In terms of process quality, waiting time for visits, admissions, and surgeries must be declined and services provided at the fastest possible time. It should be emphasized to strengthen of interpersonal aspects of care and communication skills of care providers.

Reasons for Non-vaccination among Patients Who Acquired Measles: Lessons from the Local Measles Epidemics in Japan.

A survey was conducted at a private general hospital, exploring the reasons why children with measles had missed opportunities for vaccination during the local measles epidemics that occurred in Japan between 1999 and 2003. The answers from parents/guardians of confirmed measles patients (n = 120) indicated the following: more than half of the parents/guardians were too busy or forgot to have their children immunized and 32% refrained from immunization due to anti-vaccine views. Healthcare workers should consider that parents/guardians who are willing to immunize their children may miss opportunities to do so because they are busy, and not because of anti-vaccine attitudes. Healthcare workers should keep in mind that it is important to provide honest information on the potential risks and benefits of the vaccine, while informing parents/guardians of the vaccination schedule.

Nurses and care workers’ perceptions of their nurse-patient therapeutic relationship in private general hospitals, Gauteng, South Africa

Facilitation of a therapeutic relationship is an essential skill in nursing, particularly in mental-health care. Nurses and care workers in private general hospitals are exposed to the emotional effects of physical illness as well as the increase in admission of patients with mental-health needs. Poor nurse-patient relationships have been reported by patients and in the media. The researchers experienced incidents of apparent misunderstandings during nurse-patient interactions whilst working in private general hospitals. No studies have been done regarding how nurses and care workers perceive a therapeutic relationship with patients in terms of the patients’ emotional and mental-health needs. A quantitative, contextual and deductive study was conducted in three private general hospitals in Gauteng, South Africa with a purposive sample of 154 nurses and 30 care workers. Based on the concepts of a therapeutic relationship, empathy, positive regard, genuineness, concreteness and self-exploration, nurses and care workers’ perceptions of facilitating a therapeutic relationship were self-assessed using five-point scales in a questionnaire. Data were analysed using descriptive statistics and non-parametric statistical techniques. Specific hypotheses were tested to identify whether statistically-significant differences existed between the perceptions of two or more groups of nurses and care workers. Results showed a general insensitivity and lack of awareness and reflection on the part of nurses and care workers with regard to the patients’ emotional needs. When categories of nurses were compared, no statistically-significant differences were found between the perceptions of the various groups tested. There is a need for self-awareness, continued interpersonal skills training and supervision of nurses and care workers. A large percentage of the participants were younger than 40 years, subprofessional, with less than 10 years’ experience as nurses or care workers. Private general hospitals should therefore equip all nurses and care workers with the necessary skills to facilitate a therapeutic relationship and to understand the emotional needs of all patients with both physical and emotional needs.Fasilitering van ’n terapetiese verhouding is ’n essensiёle vaardigheid in verpleging en veral in geestesgesondheid. Verpleegkundiges in private algemene hospitale is blootgestel aan die emosionele gevolge van fisiese siekte asook die toenemende toelating van pasiёnte met geestesgesondheidsbehoeftes. Swak verpleegkundige-pasiёnt verhoudings is deur pasiënte en in die media gerapporteer, terwyl die navorsers van oënskynlike misverstande tydens interaksies tussen verpleegkundiges en pasiënte bewus geword het tydens hulle werk in private algemene hospitale. Geen studies is gedoen oor hoe verpleegkundiges en versorgers hulle terapeutiese verhouding met pasiënte in terme van hulle emosionele en geestesgesondheidsbehoeftes ervaar nie. ’n Kwantitatiewe, kontekstuele en deduktiewe studie was in drie private algemene hospitale in Gauteng, Suid Afrika gedoen, met ’n doelgerigte steekproef van 154 verpleegkundiges en 30 versorgers. Verpleegkundige persepsies van die fasilitering van ’n terapeutiese verhouding gebaseer op die konsepte van ’n terapeutiese verhouding, empatie, positiewe agting, opregtheid, konkreetheid en selfondersoek is met self-assessering op ’n vyf-punt skaal van ’n vraelys bepaal. Data was geanaliseer met beskrywende statistieke en nie-parametriese tegnieke. Spesifieke hipoteses was getoets om te identifiseer of daar statistiese-betekenisvolle verskille tussen twee of meer kategorieё van verpleegkundiges bestaan. Resulte dui op ’n algemene ongevoeligheid en lae bewustheidsvlak en refleksie van verpleegkundiges en versorgers ten opsigte van die pasiёnte se emosionele behoeftes. Geen statistiese-betekenisvolle verskille is tussen die persepsies van die verskillende groepe in die navorsing gevind nie. Daar is ’n behoefte aan self-gewaarwording en voortdurende opleiding in interpersoonlike vaardighede en ondersteuning aan verpleegkundiges en versorgers. ’n Groot persentasie van die deelnemers was jonger as 40 jaar, sub-professioneel, met minder as 10 jaar ondervinding as verpleegkundiges. Private algemene hospitale moet dus alle verpleegkundiges en versorgers toerus met die nodige vaardighede om ’n terapeutiese verhouding te fasiliteer om al hulle pasiënte se fisiese en emosionele behoeftes te verstaan.

Health care in sub-Saharan Africa: an explorative study of photography as a healing art

Background and Purpose: Therapeutic art plays an important role in patient recovery in hospitals. Art therapy in prescribed terms captures the use of arts and words to express ones feelings. Unlike many developed parts of the world, art rarely plays a significant role in the healing processes at hospitals in sub-Saharan Africa. While waiting to see medical officers or during admissions in the hospital, patients often find themselves either staring at blank walls or looking at health informational images — two extremes of the imagery spectrum. This may psychologically have a positive or negative impact on the health of the patient. However, research shows the importance of art in the healing process as well as in comfort and the perceived level of care. Research conducted on patients who have undergone surgery indicates that patients who had photographs mounted in their wards recovered faster than their counterparts. Similarly, researchers have also found that digital storytelling is one of the viable ways to facilitate self-healing. With the availability of Information and Communication Technologies (ICTs), there is a possibility of improving healing, facilitated within this form of cognitive-behavioural and psychodynamic process of therapy. This on-going case study, explores the use of digital photography in facilitating healing process in a hospital. It explores the use of ICT-enabled therapeutic art installation in the medical wards to aid in clinical care and practice. Methods: A qualitative approach is employed to gain deeper insight and understanding of ICTs in therapeutic art. The study focuses on maternal and child healthcare (MCH). The research is being conducted in a private-general hospital in Ghana where most of the patients are middle-income earners. Through participatory processes, images created from the input of patients and health workers were installed in the female wards and waiting areas. Interviews and observations were used to obtain impressions from patients and hospital staff about the installation in the clinic. Twenty key informants comprising doctors, nurses and patients conveyed their views. Results: Preliminary results show that, patients prefer hospital environments with therapeutic art. It relieves them of boredom and makes them feel more comfortable and relaxed. Subsequently, artistic intervention takes their mind of their ailment. It may be realised that the use of ICT- enabled therapeutic art installation has potential in facilitating healing. Conclusions: The preliminary results suggest that through simple photos created from ICTs, patients and health workers mood could be improved in the hospital. This form of phototherapy also makes patient’s appreciate art. Further research could be conducted in other private and public hospitals in cities and rural areas in other sub-Saharan African countries to validate the study. Keywords: healing; ICT; maternal healthcare; photography; sub-Saharan Africa; therapeutic art

Ventilator-associated pneumonia prevention by education and two combined bedside strategies

The objective of the study was to reduce the ventilator-associated pneumonia (VAP) incidence rates through a rational prevention program. The study was a non-controlled clinical trial with a set of interventions in mechanically ventilated patients from April 2006 until June 2008. Pneumonia rates were analyzed as time series and their mean risks of development were compared before and after the interventions with a non-concurrent cohort using the same time frame (January 2004-March 2006). The study was conducted in a 14-bed medical intensive care unit of private general hospital in Rio de Janeiro, Brazil. The study included invasively ventilated patients (n = 224; intervention group) compared with 294 controls (historical cohort). An educational module about VAP prevention was introduced at the start of the trial (April 2006). A bundle checklist was used daily concomitantly with a standardized oral care in all patients afterwards. Main outcome measure The main outcome measure was reduction in VAP incidence rates. The observed mean rate before the intervention was 18.6 ± 7.8/1000 ventilator-days (95% CI 8.7-14.9), decreasing to 11.8 ± 7.8/1000 ventilator-days (95% CI 15.5-21.7) (P = 0.002) after the interventions. Under the adoption of non-informative prior distributions for the parameters of the proposed statistical model, there was a 70% posterior probability in favor of the hypothesis of risk reduction associated with the interventions, regardless their seasonality or secular trends. There was a 38% relative risk reduction. A reduction in VAP rates and on their risk after a set of preventive tools was observed. However, some other co-interventions not related to the primary interventions may have contributed to these results.

The Comparison of Productivity Change Gap of Public Hospitals and Private Hospitals in Korea

This study calculated meta Malmquist indices and their bootstraped estimates and then decomposed them into technical efficiency change(TEC), technology change(TC), pure technology catch up(PTCU), frontoer catch up(FCU), using annual data set of general hospitals from year 2007 to 2011 collected by Korean Hospital Association and then analyzed productivity change and technology gap of Korean general hospitals. The results and implications were as follows below. First, public general hospitals showed higher meta technical efficiencies than private general hospitals while exhibited lower technology gap ratio which meant a few large private general hospitals led the whole general hospitals. Second, group productivity of private general hospitals increased larger than public general hospitals due to the differences of PTCU rather than FCU. But, there was no statistically significant differences for technical efficiency, productivity change, technology gap. Thus, public general hospitals played the same role as the private general hospitals in terms of the number of patients treated. But, considering financial hardships of public general hospitals, public hospitals needed to share and learn medical and managerial skills of the best practice of private general hospitals.

Nursing workload in neurological intensive care units: Cross-sectional study

Nursing workload has been associated with quality of patient care. Thus, it is important to measure nursing workload in neurological intensive care units (neuro-ICUs). The aims of the study were to assess nursing workload in neuro-ICUs and identify independent factors associated with nursing workload. This descriptive, cross-sectional study was conducted in two neuro-ICUs with 11 beds each (for a total of 22 beds) of a private general hospital in the city of São Paulo, Brazil. Data from the first 24 hours of admission to the neuro-ICUs from 100 consecutive patients were collected from the hospital database. The Nursing Activities Score (NAS) was used to assess nursing workload in the neuro-ICUs. Data were analysed using descriptive and inferential statistics and multiple linear regression analysis. Statistical significance was set at α=0.05. Patients were mostly men (52.00%), had a mean age of 55.10 years, median length of ICU stay of 2 days, and survival rate of 94.00%. Fifty-nine percent of patients were transferred from the surgical ward. Mean NAS was 65.18% (standard deviation=6.63%) and the risk of mortality according to the Simplified Acute Physiology Score (SAPS II) and the Logistic Organ Dysfunction System (LODS) was 17.79% and 16.30%, respectively. The present results are important for the effective planning and use of nursing resources according to the care needs of patients in neuro-ICUs.

Broadband UVBの低量・低頻度照射によるアトピー性皮膚炎治療の試み : 本邦の医院・一般病院における紫外線治療の現状について考察

Broadband UVBの低量・低頻度照射によるアトピー性皮膚炎治療の試み : 本邦の医院・一般病院における紫外線治療の現状について考察

Hazardous medical waste generation rates of different categories of health-care facilities

Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kgbed−1d−1, using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012kgbed−1d−1, for the public psychiatric hospitals, to up to 0.72kgbed−1d−1, for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012kgbed−1d−1, for the psychiatric clinics, to up to 0.49kgbed−1d−1, for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively.

방사선사의 근골격계 질환 현황 조사

본 연구는 병의원에서 근무하고 있는 방사선들을 대상으로 근골격계 질환 현황 조사를 통해 추후 방사선사의 체계적이고 효율적인 자원 관리를 위한 기초자료로 이용하고자 한다. 본 연구를 위하여 2011년 7월 10일부터 31일까지 약 20일에 걸쳐 전국의 의원, 병원, 종합병원, 대학병원의 방사선사를 대상으로 설문조사를 하였다. 본 연구의 주요 결과는 다음과 같다. 첫째, 신체 부위별로 근골격계 증상 여부에 대하여 빈도분석을 한 결과, 목 부위는 22.5%, 어깨 부위는 33.1%, 팔/팔꿈치 부위는 8.3%, 손/손목/손가락 부위는 15.5%, 허리 부위는 32.4%, 다리/발부위는 전체의 16.9%로 나왔다(p<0.05). 둘째 직무스트레스, 사회심리스트레스, 피로도의 기술통계를 정리한 결과 직무스트레스 전체는 Likert 4점 척도에서 평균 2.48, 사회심리스트레스는 Likert 4점 척도에서 평균 2.27로 직무스트레스가 사회심리스트레스보다 약간 높게 나왔다. 피로도의 경우 Likert 7점 척도에서 평균 4.57로 '보통이다'보다 약간 높은 것으로 나왔다 (p<0.05). 결론적으로 본 연구는 향후 방사선사의 근골격계질환에 대해 예방활동을 전개하고자 할 때 체계적이고 효율적인 자원 관리를 위한 기초 자료로 도움이 되길 기대한다. This study was conducted to survey of the musculoskeletal disorders of radiological technologists and prevalence rate survey tool of musculoskeletal symptoms targeting the radiological technologists working currently in hospitals or clinics. For this study, survey was conducted from July 10th, 2011 to July 31st, 2011 for about 20 days with subject of radiological technologists in private clinics, hospitals, general hospitals and University hospitals. The main results of this study are as follows : First, frequency analysis on presence of musculoskeletal symptoms in each part of body showed that neck area was 22.5 %, shoulder area was 33.1 %, arm / elbow area was 8.3 %, hand / wrist / finger area was 15.5 %, waist area was 32.4 %, leg / foot area was 16.9% (p<0.05). Second, the results from summarizing the descriptive statistics of job stress, psychosocial stress and fatigue showed that the average of job stress was 2.48 out of Likert 4 points scale, the average of psychosocial stress was 2.27 out of Likert 4 points scale. Job stress was a little bit higher than the psychosocial stress. In case of fatigue, the average was 4.57 out of Likert 7 points scale and it was a slightly higher than 'normal' (p<0.05). In conclusion, we hope this study will be helpful to systematically and efficiently manage the resources as the basic material upon deploying the preventive measures about the musculoskeletal disorders of radiological technologists in the future.

Relapses in metastatic germ-cell tumors and relationship to international guidelines compliance: A study from the Institut Gustave Roussy.

323 Background: Germ-cell tumors (GCT) are rare but highly curable cancers even in patients with metastatic spread. We aimed at assessing whether relapse after upfront treatment could be explained by low compliance with international guidelines. Methods: All patients (pts) who were referred to Institut Gustave Roussy from 2000 to 2010 with progression or relapse after treatment for metastatic GCT were included. International guidelines available at the time of diagnosis were used as reference. A list of noncompliant criteria defined as disagreement with the recommendations with a potential impact on outcome was set up. Results: 78 pts were included. According to the IGCCCG classification, 18 pts (23.1%) had good, 25 pts (32%) had intermediary and 34 pts (43.6%) had poor prognosis. The first-line chemotherapy administered consisted of PEB regimen (70.5%) , PE regimen (15.4%) or other regimen (12.8%). Most patients were treated in cancer centers (52.5%, n=41), whereas 26.9% and 17.9% pts were treated in private or public general hospitals, respectively. Only 50% pts received treatment according to guidelines recommendations. This percentage was significantly higher in cancer centres than in public hospitals (75.6% versus 28.6%, p&lt; 0.001) or also when compared with private hospitals (75.6% versus 14,3%, p&lt;0.001). The most frequent noncompliance criteria were: time to surgery for residual mass (over 6 weeks after the latest chemotherapy cycle)(20.3%) and respected chemotherapy schedule (20.3%). Other noncompliance findings were: inadequate chemotherapy dose (15.6%), number of cycles (12.5%), decision regarding residual disease (12.5%), chemotherapy regimen (6.3%), follow up (4.6%), type of surgery (3.1%), staging(1.6%), IGCCCG classification (1.6%), or decision regarding chemotherapy after residual mass surgery (1.6%). Conclusions: This study suggests that the majority of relapse for metastatic GCT may be explained by a poor conformity to international guidelines and not only by aggressive tumor biology. These data represent a strong argument for treatment centralization in reference centers in patients with GCT.

Service quality of private hospitals: The Iranian Patients' perspective

BackgroundHighly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective.MethodsA cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions.ResultsThe result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p < 0.001). There was a significant difference between the expectations scores based on gender, education level, and previous hospitalization in that same hospital. Also, there was a significant difference between the perception scores based on insurance coverage, average length of stay, and patients' health conditions on discharge.ConclusionThe results showed that SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients.

P-527 - Trapped in thoughts: depression experiences from thai men

Depressive disorder is known to be higher in women than in men. Depressive symptoms in men are often undiagnosed and untreated because of the concern about masculinity and how men conceptualize depression. In Thailand, the experiences of Thai men with depression have received relatively little attention. The lack of understanding on patients' explanatory models can increase the likelihood that treatments suggested by health care providers will not be complied. The aim of this qualitative study was to describe the experiences of depression in Thai men. Twenty-one men with major depressive disorder were in-depth interviewed. Data were analyzed based on Colaizzi's method. The identified themes relating to the experience of depression included trapped in their thoughts, upside down, leaning on someting, life is spiralling down, and weakness. The study also found that male patients suffered from gender role internalization. They first sought help from physicians in a private clinic or general hospital for headache and insomnia, however, they were not educated about depression by their physicians. Symptoms management included engaging in pleasure activities, practicing Buddhism, and alcohol drinking. All participants expressed that understanding the diagnosis was a validation that they were not weak, instead, with a illness. Still, they did not want to be seen as a patient, and many stated ceasing taking medication. Many participants expressed that taking medication is a symbol of sickness. The findings suggest that effective psychoeducation program on depressive disorder is needed. Mental illness treatment should be integrated in a primary care setting.

Kualitas Layanan dan Loyalitas Pasien (Studi pada Rumah Sakit Umum Swasta di Kota Singaraja–Bali)

This Study aims to determine the influence of Service Quality dimensions of patien loyalty Private Hospital in the town of Singaraja – Bali, which include: first, the influence of the Service Quality to the Loyalty of patiens simultaneusly; secondly, the influence of Service Quality to the loyalty of patiens partially; third, the most dominan dimension inflence patien loyalty. Individual analysis unit is connected with the analysis of the organization, in which General Hospital patiens in the town of Singaraja – Bali. By using Slovin formula, this study of 100 patiens from 57.695 private General Hospital in the town of Singaraja – Bali, namely : Karya Darma Usada General Hospital, Kerta Usada General Hospital, Parama Sidi General Hospital and TNI General Hospital. Technique of data collecting conducted interviews using a questionnaire and model absorvasi techniques. To examine the pattern of relationships which formed the model, use analysis tools which can explain simultaneusly and the partially relations, which a multivariate using SPSS versian 15. The results of this study indicate that: first, Service Quality which consists of Tangible, Reliability, Responsiveness, Assurance, and Empathy simultaneously influence on Patient Loyalty; second, Quality Services consist of Tangible, Reliability, Responsiveness, Assurance, and Empathy partially influential on Patient Loyalty; third, Reliability is a dimension that has a dominant influence on patient loyalty.

Liderança Coaching: um modelo de referência para o exercício do enfermeiro-líder no contexto hospitalar

O presente estudo teve por objetivos avaliar a liderança exercida pelas enfermeiras com uso do coaching como ferramenta gerencial, identificar, mensurar e analisar a aquisição de competências percebidas pelas enfermeiras que atuam como coaches, Trata-se de um estudo descritivo, transversal, exploratório e de campo, com abordagem quantitativa. A Liderança Situacional foi selecionada como referencial teórico e o instrumento de pesquisa foi submetido a análises estatísticas e de conteúdo, aplicado em 111 enfermeiras líderes em um hospital geral, privado, de grande porte da cidade de São Paulo. Os resultados evidenciaram que houve incorporação de novos conhecimentos, confirmaram o modelo de Liderança Situacional ao reconhecer ser líder coach, tendo o estilo predominantemente orientado às tarefas e às pessoas, segundo a situação envolvida, e ainda, indicaram como habilidades preponderantes do coach: a comunicação, dar e receber feedback, dar e ganhar poder e exercer influência, que as atitudes refletiram o exercício o liderança coaching.

A case of diffuse uterine leiomyomatosis who had two successful pregnancies after medical management

To describe a case report of diffuse uterine leiomyomatosis who had successful pregnancy twice following conservative management. Retrospective report. Private general hospital. A nulliparous woman 25 years of age presented with menorrhagia and infertility. She had innumerable small fibroids of 4-42 mm size throughout the myometrium. Size of the symmetrically enlarged uterus was 131×80×60 mm, clinically corresponding to that of 12 weeks of gestation. She received a GnRH analogue (GnRHa; leuprolide acetate) 3.75 mg per month for 6 months. Reduction of uterus size, menstrual amount, conception, pregnancy outcome. Enlarged uterus reduced to almost normal size after 3 doses of GnRHa. She did not experience heavy bleeding during menstruation. She conceived spontaneously in the first cycle after discontinuation of GnRHa. Antenatal course was uneventful. A healthy male baby of 2.5 kg was delivered by cesarean section at 39 weeks. The placenta weighed 330 g. There was no postpartum hemorrhage. She conceived spontaneously for the second time in the first cycle after resumption of menses. Antenatal, intranatal (cesarean section), and postnatal courses of the second pregnancy were uneventful. The second neonate weighed 3.0 kg and the placenta 400 g. Conservative treatment may help to achieve successful pregnancy in case of diffuse uterine leiomyomatosis.

자폐 장애 아동 보호자의 언어치료 교육 서비스 만족도에 대한 실태조사

본 연구는 자폐 장애로 진단받은 아동의 주양육자 총 52명을 대상으로 현재 받고 있는 언어치료 교육서비스에 대한 만족도와 욕구를 조사하기 위해 실시되었다. 연구방법은 설문조사 방식을 사용하였고, 설문 내용은 치료 교육 기관의 환경(7문항)과 치료사가 제공하는 프로그램(7문항), 그리고 치료 교육 만족도 및 서비스 욕구(7문항)를 포함한 세 가지 측면으로 구분하여 작성하였다. 연구 결과, 치료 교육 기관의 환경면에서, 치료비 등을 이유로 복지관 이용자의 만족도가 가장 높았으며, 사설 치료실, 종합병원 순으로 낮게 나타났다. 치료사가 제공하는 교육 프로그램 면에서, 실시하는 프로그램의 적절성 및 상담 내용 등을 이유로 종합병원 이용자의 만족도가 가장 높았으며, 사설치료실, 복지관 순으로 낮게 나타났다. 치료 교육 만족도 및 서비스 욕구 면에서, 언어치료 및 전체 치료 교육 서비스에 대한 만족도는 다소 만족하는 수준인 것으로 나타났다. 자녀가 언어치료를 받게 되고 난 후, 좋아진 점으로 일상적인 생활 기술의 향상과 심리적 안정이 높게 나타났으며, 추후 받고 싶은 치료 교육과 관련하여 개별, 집단 언어치료 교육 서비스에 대한 욕구가 매우 높게 나타났다. 이상의 결과를 통해, 치료 교육 기관에서 제공하는 서비스의 문제점을 파악하고, 자폐 아동의 치료 교육 만족도를 높이기 위해 언어치료사 및 관련 영역 전문가들이 노력해야 할 여러 가지 함의를 얻을 수 있었다. This study was conducted to determine the degree of satisfaction and the demand for the current education service of language therapy. We surveyed a total of fifty two nurturers of children who had been diagnosed as autistic. A three-part questionnaire that covered the environment of the therapy institution (7 questions), the programs provided by the Speech-Language Pathologist (7 questions) and the degree of satisfaction and the demand for therapy education (7 questions) was used. The study results showed, in the area of the institution environment for therapy education, that the degree of satisfaction was highest for Social Welfare Center users due to the therapy costs. The level of satisfaction then decreased in the order of private clinic users and general hospital users. However, in the area of education programs provided by Speech-Language Pathologists, it was highest for the users of general hospitals due to the proper contents of the programs and consulting service. The satisfaction level then decreased in the order of private clinic users and Social Welfare Center users. Regarding the level of satisfaction with therapy education and related demand, the degree of satisfaction with language therapy and all therapy education services was generally satisfactory. After the language therapy, the children showed considerable improvement in their living skills (60% of survey respondents) and psychological stability (stress reduction, 30% of the total survey respondents). Regarding the future demand for therapy education, the degree of demand was high for the individual and group language therapy education service. In summary, the results of this study uncovered a number of problems related to services provided by language therapy education institutions and suggested various implications that Speech-Language Pathologists and relevant professionals should endeavor to use so as to enhance the satisfaction level of therapy education for autistic children.

The moderating role of leader-member exchange in the relationship between psychological contract violation and organizational citizenship behavior

This paper aims to explore the moderating role of Leader-Member Exchange (LMX) quality in the relationship between Psychological Contract Violation (PCV) and Organizational Citizenship Behavior (OCB). Data were gathered from a sample of 148 registered nurses working in a private general hospital. Results show that the negative relationship between PCV and OCB is stronger for nurses who have high LMX quality. Therefore, the study implies that the interaction of the behavior of all organizational agents and supervisors relates to OCB. Key words:

Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle

Ventilator-associated pneumonia (VAP) increases in-hospital mortality of ventilated patients to 46%, compared with 32% for ventilated patients who do not develop VAP. In addition, VAP prolongs time spent on the ventilator, length of intensive care unit (ICU) stay, and length of hospital stay. In this study, we implemented VAP bundle to decrease the rate of VAP infection. This is a pre- and postintervention trial beginning in 2006 to decrease the rate of VAP in adult ICUs after initiation of the Institute for Healthcare Improvement (IHI) VAP bundle compared with the VAP rate for the preceding 12 months. The study was conducted at a private general hospital in Saudi Arabia. The study included all adult patients who were on mechanical ventilation from 2006 to 2008. An interdisciplinary performance improvement team was formed. The team implemented an evidence-based VAP bundle adopted from the IHI. The implementation of the VAP prevention bundle resulted in the reduction of VAP rates from a mean of 9.3 cases per 1000 ventilator-days in fiscal year 2006 to 2.3 cases per 1000 ventilator-days in 2007 and to 2.2 in 2008 (P < .001). It is estimated that each VAP case increases the hospital length of stay attributable by 10 days and the mean hospital cost by $40,000. Thus, the potential decrease in hospital cost is $780,000 annually. Implementing the IHI VAP bundle significantly resulted in the reduction of the VAP rate with potential great cost avoidance.