To see the other types of publications on this topic, follow the link: Division of Medical Quality Assurance.
Dissertations / Theses on the topic 'Division of Medical Quality Assurance'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Division of Medical Quality Assurance.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Linko, Solveig. "Measurement tools for quality assurance in medical laboratories." Helsinki : University of Helsinki, 2003. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/linko/.
Full text
2
Moraba, MM, and JSJ Odendaal. "Methodology of presenting analytical quality assurance courses for medical technologists." Medical Technology SA, 2005. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1000983.
Full textAbstract:
A survey on the quality of service provided by state laboratories in the Limpopo Province was conducted during the period 2000
2002. The focus was on accuracy and precision. The service quality evaluation was based on standard deviation index, % deviation
and % clinically rejectable results. The scores obtained were evaluated in terms of internationally pre determined cut off limits.
Education and training were cited by 97% of the interviewees as the major contributory factors to the poor performance.
Subsequent to the discussion, a course in quality assurance was designed, presented and evaluated, as above. Although the post
intervention performance results did not meet the international performance standard at the given time yet; they were much closer to
norm and significantly better than the pre course performance results.
The conclusion is that newly designed course will contribute in reaching the international cut off standard for clinical laborato
ries.
3
Knutson, Matthew D. "Qualification of inspection techniques for detecting leaks in pouched medical devices at Company XYZ." Online version, 2008. http://www.uwstout.edu/lib/thesis/2008/2008knutsonm.pdf.
Full text
4
Mullen, Carrie. "Quality Assurance of forensic investigations in toxicology and traffic safety." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/5465/.
Full textAbstract:
The work described in this thesis deals with three aspects of quality assurance in the field of forensic toxicology: proficiency testing schemes, validation of analytical methods for the piperazine group of abused drugs and validation of the police field impairment test, used at the roadside to test drivers for drug-induced impairment. Proficiency Testing: Long term reviews were performed for two forensic external quality assurance schemes. Rounds 30 (in 2007) to 48 (in 2012) of the UKAS-accredited commercial Quartz Forensic Blood Toxicology Proficiency Testing Scheme (PTS), and a ten year period from 1999 to 2009 of the freely-available United Nations Office on Drugs and Crime (UNODC) International Collaborative Exercises (ICE). Only limited ICE data could be made available as much of the original data had been stored on a database which had become obsolete, hence the data were only available as the original results forms provided to UNODC by the ICE participants. Data was entered to Microsoft Excel® spreadsheets and Microsoft Access® databases from the original forms for the years 1999, 2001 (2 rounds), 2003 (2 rounds) and 2005 (2 rounds), and summary data was extracted from the UNODC round reports for the years 2007, 2008 and 2009. Four methods of scoring quantitative performance were reviewed and the most suitable, a z-score using an assigned ‘true’ value and a percentage of the true value as acceptable deviation, was applied to reanalyse the participants’ results and assess their performance. Methods of scoring proficiency which relied upon participants’ data to determine acceptable variation were found merely to describe the data rather than challenge participants on whether or not they were performing fit-for-purpose analyses. Factors such as participation, analytes tested, participants’ methods of analysis and participants performance were summarised for each scheme before the performance of the two schemes, and that of their participants, were compared. ICE tested more analytes per annum but from a smaller test menu than Quartz. This resulted in more repetitive testing and allowed for some trend analysis and performance monitoring. It was not possible to observe performance trends with Quartz due to the wide variety of analytes tested. The smaller array of potential analytes and more repetitive nature of ICE testing also meant that performance monitoring and detection of bias were easier to perform, and ICE was shown to be more effective as external quality assurance (EQA). Quartz provided a good educational resource as it incorporated the wide range of drugs which a forensic toxicology laboratory could realistically encounter. Following the review, however, it was recommended for QUARTZ that, to provide a safeguard against bias, more repetitive testing was required and this has now been adopted. Piperazines: All piperazine analogues are now illegal in the UK, registered as Class C of the Misuse of Drugs Act (1971) and schedule 2, part III of the Misuse of Drugs Regulations (2001). Piperazines can elicit similar effects to some ATS and methods for their detection should be available in forensic toxicology laboratories. In the present study, methods were developed for the detection of a range of piperazines in blood using LC-MS/MS (p-MeOPP, p-FPP, BZP, o-MeOPP, p-MPP and TFMPP) and GC-MS (p-FPP, BZP, TFMPP, p-MPP, o-MeOPP, m-CPP, p-MeOPP and p-CPP). Quality assurance required both methods to be validated. For all piperazine analytes accuracy was within ±15% (20% at low concentrations) and precision was within 15% (20% at low concentrations). For both methods LLOD of all analytes was 5 ng/ml of blood and upper limit of quantification was 2 µg/ml of blood. For the GC-MS method lower limits of quantification (LLOQs) were in the range 20 to 30 ng/ml of blood. For LC-MS/MS, LLOQs ranged from 50 to 60 ng/ml of blood, although quantification by the LC-MS/MS method was restricted by the lack of availability of appropriate internal standards. There were no apparent significant matrix effects and recovery by both methods was >60 % and, therefore, acceptable. Short term stability of the piperazine analytes was investigated. Piperazines remain sufficiently stable when stored in the fridge for at least one week, and are stable through three freeze-thaw cycles. There was no detectable degradation when blood samples were left on the bench-top or when extracted ‘in-process’ samples were left in the autosampler for up to 72 hours. The LC-MS/MS method could provide a readily applicable screening method. A small aliquot of a basic drug extract could be screened by LC-MS/MS for the presence of piperazines, leaving the majority of the extract for other analyses, for example, piperazines confirmation or amphetamines analysis. The GC-MS method was suitably validated to provide quantification but application to casework samples remains to be evaluated. It is recommended that piperazine testing be performed for all suspected MDMA or ‘club drug’ intoxication cases. The Field Impairment Test: The detection of drugged drivers primarily depends on the current method which is the driver field impairment test (FIT). FIT comprises measurement of pupil diameter and four physical tasks (the Romberg balance test, walk and turn test, one legged stand and finger to nose test) intended to simultaneously test comprehension, short term memory, balance and motor function. Despite FIT having ISO accreditation, it has been recognised that police officers lack confidence with the protocol and do not apply the test as often as is necessary. The main difficulty arises from the requirement to make a subjective judgement of impairment and officers lack confidence in their ability to do so. FIT has never been fully validated. The present study was designed to meet the urgent requirement to develop FIT into an objective measurement, by determining what constitutes “normal” performance in FIT by unimpaired adults of different ages. FIT performance was recorded for 79 individuals, a statistically determined cohort size, confirmed by breath and oral fluid analysis not to be under the influence of impairing substances. Each error made during FIT, as defined by the FIT standard operating procedure, was recorded and collated in a Microsoft Excel® spreadsheet for analysis. It was found that the definition of ‘errors’ was too stringent as many which are required to be recorded are normal physiological or behavioural characteristics, such as body sway, and most subjects would be unable to complete the task without displaying them. A less stringent, evidence-based definition of “error” was developed which allowed statistically more significant analysis to be performed on the FIT results. A statistically significant difference (P=0.00578) was shown to exist between the FIT performance of individuals under the age of forty years and those aged forty and over. Based on the principles of a PTS, robust mean and standard deviation were used to determine what constituted acceptable performance. Those in the younger age group could be considered impaired if the police officer witnessed more than seven errors, or, in the older age group, more than fifteen errors. Using these criteria the frequency of false positives, i.e. unimpaired drivers being assessed as impaired is estimated to be (less than 3%). Also, the ranges of errors observed in both groups was large and overlapped, such that it may be possible for an impaired person to appear unimpaired. This requires further investigation.
5
Adjeiwaah, Mary. "Quality assurance for magnetic resonance imaging (MRI) in radiotherapy." Licentiate thesis, Umeå universitet, Institutionen för strålningsvetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-142603.
Full textAbstract:
Magnetic resonance imaging (MRI) utilizes the magnetic properties of tissues to generate image-forming signals. MRI has exquisite soft-tissue contrast and since tumors are mainly soft-tissues, it offers improved delineation of the target volume and nearby organs at risk. The proposed Magnetic Resonance-only Radiotherapy (MR-only RT) work flow allows for the use of MRI as the sole imaging modality in the radiotherapy (RT) treatment planning of cancer. There are, however, issues with geometric distortions inherent with MR image acquisition processes. These distortions result from imperfections in the main magnetic field, nonlinear gradients, as well as field disturbances introduced by the imaged object. In this thesis, we quantified the effect of system related and patient-induced susceptibility geometric distortions on dose distributions for prostate as well as head and neck cancers. Methods to mitigate these distortions were also studied. In Study I, mean worst system related residual distortions of 3.19, 2.52 and 2.08 mm at bandwidths (BW) of 122, 244 and 488 Hz/pixel up to a radial distance of 25 cm from a 3T PET/MR scanner was measured with a large field of view (FoV) phantom. Subsequently, we estimated maximum shifts of 5.8, 2.9 and 1.5 mm due to patient-induced susceptibility distortions. VMAT-optimized treatment plans initially performed on distorted CT (dCT) images and recalculated on real CT datasets resulted in a dose difference of less than 0.5%. The magnetic susceptibility differences at tissue-metallic,-air and -bone interfaces result in local B0 magnetic field inhomogeneities. The distortion shifts caused by these field inhomogeneities can be reduced by shimming. Study II aimed to investigate the use of shimming to improve the homogeneity of local B0 magnetic field which will be beneficial for radiotherapy applications. A shimming simulation based on spherical harmonics modeling was developed. The spinal cord, an organ at risk is surrounded by bone and in close proximity to the lungs may have high susceptibility differences. In this region, mean pixel shifts caused by local B0 field inhomogeneities were reduced from 3.47±1.22 mm to 1.35±0.44 mm and 0.99±0.30 mm using first and second order shimming respectively. This was for a bandwidth of 122 Hz/pixel and an in-plane voxel size of 1×1 mm2. Also examined in Study II as in Study I was the dosimetric effect of geometric distortions on 21 Head and Neck cancer treatment plans. The dose difference in D50 at the PTV between distorted CT and real CT plans was less than 1.0%. In conclusion, the effect of MR geometric distortions on dose plans was small. Generally, we found patient-induced susceptibility distortions were larger compared with residual system distortions at all delineated structures except the external contour. This information will be relevant when setting margins for treatment volumes and organs at risk. The current practice of characterizing MR geometric distortions utilizing spatial accuracy phantoms alone may not be enough for an MR-only radiotherapy workflow. Therefore, measures to mitigate patient-induced susceptibility effects in clinical practice such as patient-specific correction algorithms are needed to complement existing distortion reduction methods such as high acquisition bandwidth and shimming.
6
Gilyard, Ameer. "Implementation Strategies for Quality Assurance Performance Improvements in Nursing Homes." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5466.
Full textAbstract:
The healthcare industry, and more specifically the nursing home sector, is changing operations and services due to a healthcare mandates and enactment of the 2010 Affordable Care Act. Such changes are termed quality assurance performance improvements (QAPI), to receive government subsidies and indemnification compensations. The purpose of this single case study was to explore effective strategies implemented by 4 healthcare leaders to comply with QAPI regulations. Total quality management theory was the conceptual framework used in this study. Data were collected through semistructured, open-ended, face-to-face interviews with 4 participants who serve in a management capacity at an organization located in northwest Missouri. Member checking was used to strengthen the credibility and trustworthiness of the interpretation of the participants' responses. The emergent themes from the study were (a) quality planning using systematic and strategic approaches, (b) quality control using business instruments and tools to measure performance and progress, (c) quality assurance through internal and external systematic analysis, and (d) quality improvements using an integrated systems approach. The implications for positive social change include the potential optimization of care provided to consumers in nursing homes by identifying best practices and strategies healthcare and business professionals have used to modify their business processes and operations.
7
Daba, Dieudonne Diba. "Quality Assurance of Intra-oral X-ray Images." Thesis, Umeå universitet, Radiofysik, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-171001.
Full textAbstract:
Dental radiography is one of the most frequent types of diagnostic radiological investigations performed. The equipment and techniques used are constantly evolving. However, dental healthcare has long been an area neglected by radiation safety legislation and the medical physicist community, and thus, the quality assurance (QA) regime needs an update. This project aimed to implement and evaluate objective tests of key image quality parameters for intra-oral (IO) X-ray images. The image quality parameters assessed were sensitivity, noise, uniformity, low-contrast resolution, and spatial resolution. These parameters were evaluated for repeatability at typical tube current, voltage, and exposure time settings by computing the coefficient of variation (CV) of the mean value of each parameter from multiple images. A further aim was to develop a semi-quantitative test for the correct alignment of the position indicating device (PID) with the primary collimator. The overall purpose of this thesis was to look at ways to improve the QA of IO X-rays systems by digitizing and automating part of the process. A single image receptor and an X-ray tube were used in this study. Incident doses at the receptor were measured using a radiation meter. The relationship between incident dose at the receptor and the output signal was used to determine the signal transfer curve for the receptor. The principal sources of noise in the practical exposure range of the system were investigated using a separation of noise sources based upon variance. The transfer curve of the receptor was found to be linear. Noise separation showed that quantum noise was the dominant noise. Repeatability of the image quality parameters assessed was found to be acceptable. The CV for sensitivity was less than 3%, while that for noise was less than 1%. For the uniformity measured at the center, the CV was less than 10%, while the CV was less than 5% for the uniformity measured at the edge. The low-contrast resolution varied the most at all exposure settings investigated with CV between 6 - 13%. Finally, the CV for the spatial resolution parameters was less than 5%. The method described to test for the correct alignment of the PID with the primary collimator was found to be practical and easy to interpret manually. The tests described here were implemented for a specific sensor and X-ray tube combination, but the methods could easily be adapted for different systems by simply adjusting certain parameters.
8
Goliath, Elize. "Engaging employees to build a performance culture in Telkom's NCC division." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/1051.
Full textAbstract:
Operating as a commercial company since October 1991, Telkom has grown into the largest communications services provider in Africa based on operating revenue and assets. The Group, consisting of the fixed-line company Telkom and a 50 per cent shareholding in mobile operator Vodacom. Telkom has changed its vision to the following: “To be a leading customer and employee centric ICT solutions service provider”. The company has been retrenching staff since 1999 and the staff numbers have reduced significantly from approximately 65 000 people to 25 575 people in 2006. The focus has been on increasing shareholder value and the staff feel that their value has not been recognised. The research paper focused on the extent that employees engaged to build a performance culture in Telkom’s NCC division. The following research methodology was followed: - A literature survey to determine factors or behaviours that will enhance employee engagement in building a performance culture and what Telkom NCC can do to build the workplace that will foster higher levels of employee engagement. - A survey was conducted to determine what the engagement levels of employees are at Telkom NCC, what stops the employees from doing their best and what Telkom NCC division can do to show they care and value their staff as according to their employees by means of a questionnaire. - The findings from the literature study and empirical study would be used to determine to what extent are employees engaged to build a performance culture in Telkom’s NCC division. A self administered questionnaire was used to collect the data required for this research. In conclusion it was said that employee engagement is a partnership between the company and the employees where everyone works together to achieve the business objectives of the company and the personal aspirations of employees. The organization has the responsibility to create the conditions for this to happen (Understanding Employee Engagement, 2004: 2). It was recommended that in order for NCC to enhance their employees attitudes toward the promoters’ team especially in terms of pride, strong attachment, feeling part of the family and motivating employees to do well promoters must concentrate on building relationships with their teams and individual members of the team. Employees must also be given decision making power for implementing the idea. NCC should educate their leaders on the value of recognition and the best way to go about it. In order for employees to grow and be promoted into higher positions, NCC must consider that if positions become available that they first be advertised in the NCC division before it be made available to the rest of the company.
9
Ly, Huong Q. "Medical Laboratory Managers Success with Preanalytical Errors." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3498.
Full textAbstract:
Clinicians rely heavily on accurate laboratory results to diagnose and treat their patients. Laboratory errors can occur in any area of total testing phases, but more than half of the errors occur in the preanalytical phase. Framed by the total quality management theory, the purpose of this multiple case study was to explore medical laboratory managers' strategies to reduce preanalytical errors. A purposive sample of 2 organizations with laboratories in southern California participated in semistructured face-to-face interviews. Company A had 2 participants and 3 participants participated in the study from Company B. Each participant had at least 5 years of laboratory experience, with a minimum of 2 years of management experience in preanalytical testing, and had completed one project to minimize laboratory errors. Thematic analysis exposed 5 main themes: quality improvement, recognition, reward, and empowerment, education and training, communication, and patient satisfaction. The participants highlighted the need for organizations to concentrate on quality management to achieve patient satisfaction. To achieve quality services, medical laboratory managers noted the importance of employee engagement, education and training, and communication as successful strategies to mitigate preanalytical errors. The recommendation for action is for laboratory leaders to review and apply effective strategies exposed by the data in this study to reduce preanalytical errors in their medical laboratory. Positive implications of this study include reduction of preanalytical errors, increased operational cost, and improved patient experience.
10
Stambaugh, Cassandra. "The Evaluation and Study of Modern Radiation Dosimetry Methods as Applied to Advanced Radiation Therapy Treatments Using Intensity Modulated Megavoltage Photon Beams." Scholar Commons, 2015. https://scholarcommons.usf.edu/etd/5587.
Full textAbstract:
The purpose of this work is to evaluate quasi-3D arrays for use with intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) and to determine their clinical relevance. This is achieved using a Delta4 from Scandidos and ArcCheck from Sun Nuclear and the associated software. While certain aspects of these devices and software have been previously evaluated, the main goal of this work is to evaluate the new aspects, such as reconstructing dose on a patient CT set, and extending the capabilities. This includes the capability to reconstruct the dose based on a helical delivery as well as studying the dose to a moving target using measurement-guided motion simulations.
It was found that Sun Nuclear's ArcCheck/3DVH system exhibited excellent agreement for dose reconstruction for IMRT/VMAT using a traditional C-arm linear accelerator and stringent 2%/2mm comparison constraints. It also is a powerful tool for measurement-guided dose estimates for moving targets, allowing for many simulations to be performed based on one measurement and the target motion data. For dose reconstruction for a helical delivery, the agreement was not as good for the stringent comparison but was reasonable for the clinically acceptable 3%/3mm comparison. Scandidos' Delta4 shows good agreement with stringent 2%/2mm constraints for its dose reconstruction on the phantom. However, the dose reconstruction on the patient CT set was poor and needs more work.
Overall, it was found that quasi-3D arrays are powerful tools for dose reconstruction and treatment plan comparisons. The ability to reconstruct the dose allows for a dose resolution comparable to the treatment plan, which negates the previous issues with inadequate sampling and resolution issues found when just comparing the diodes. The ability to quickly and accurately compare many plans and target motions with minimum setup makes the quasi-3D array an attractive tool for both commissioning and patient specific quality assurance.
11
Li, Tieyu. "Systems Theoretic Accident Model and Process application : quality control in medical device manufacturing." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/90689.
Full textAbstract:
Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, June 2013.<br>Cataloged from PDF version of thesis. "September 2012."<br>Includes bibliographical references (pages 102-103).<br>The goal of medical device industry is to provide patients and healthcare professionals effective, reliable, safe and affordable products. However, due to the dynamic and competitive operation and business environment, most manufacturers did not always attain this goal. It is a challenge to balance the demands of meeting government regulations and containing production costs, in an effort to produce the most effective, reliable and safest medical devices. The increasing complexity on product structures, production process and usage context make this task even more formidable. The increase in serious adverse events has outpaced industry growth by 8 % since 2001[1], which reflects the insufficiency of traditional quality control measures. The disastrous consequences of quality hazards usually have profound impact on customers, manufacturers, and communities. Therefore, it is imperative to look for a better way to achieve effective quality control in medical device industry. The purpose of the thesis is to compare the traditional quality control measures, which are now widely adopted in quality systems of medical device industry for designing and development, process control and non-conformance handling, with the approach of Systems Theoretic Accident Model and Process (STAMP) based System-Theoretic Process Analysis (STPA) method. Through the case study on real quality issue in manufacturing control, this work analyzes the current states of complex manufacturing process controls that are designed by utilizing traditional principles and tools, and demonstrates the improvement after the STPA techniques was applied to the same cases. The advantages of STPA technique is to model the process to system control structure without oversimplifying any possible influencing factors, and then examine the links an interaction among these factors to reveal what constraints need to be installed and are followed to ensure that the system performs in safe zone and deliver the expected outcomes. This approach can effectively reveal hidden defects and dangers in system that the traditional measures are not able to detect, and thus is very helpful to the high-stake industry such as medical device manufacturing to prevent potential serious adverse events and protect patients from injuries caused by accidents of quality hazards.<br>by Tieyu Li.<br>S.M. in Engineering and Management
12
Mpuntsha, Loyiso F. "Continuing professional development in medicine : the inherent values of the system for quality assurance in health care." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52173.
Full textAbstract:
Thesis (MPhil)--Stellenbosch University, 2001.<br>ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a
profession. The focus ranges depending on issues at hand - it may
be on the educational, training, humanistic, economic, professional
ethics and legal aspects.
One area of medicine that is under the spotlight around the world is
that of the maintenance of clinical competency, followed very
closely and almost linked to professional ethics. This study follows
the introduction of a system of Continuing Professional
Development (hereinafter also referred to as CPD), in South Africa
and an overview of how it has been introduced in a few other
countries. The main areas of focus being the extrication of inherent
values of CPD, relating this aspect to quality improvement in
medical health care.
The medical profession as well as most of the interested parties, has
different perspectives regarding the fact that the system is regulated
through legislation. There is also the doubt whether the CPD system
will be effective in achieving the goals that it has been set to
achieve. Although a system of Continuing Medical Education has
been a tradition in all countries, which implies that the CPD system
is not totally new as far as the educational principles are concerned,
the values accruable need to be exploited. It is the possible success
of this kind of evaluations that may foster more understanding of
the inherent values in this CPD system.<br>AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot
belangstelling gelok. Die fokus verskuif na gelang van die
onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding,
humanisme, ekonomie, en professionele etiek tot regsaspekte.
Dwarsoor die wêreld word daar gefokus op die handhawing van
kliniese vaardighede, gevolg deur professionele etiek wat ook daarin
verweef is. Hierdie studie bespreek die instelling van 'n stelsel van
Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO)
in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar
ander lande ingestel is. Die klem lê op die inherente waardes met
betrekking tot die verbetering gehalte in mediese gesondheidsorg.
Die mediese beroep, asook meeste van die belangegroepe het
verskillende opvattings oor die feit dat die stelsel deur wetgewing
gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy
vooropgestelde doelwitte sal slaag. Wat die opvoedkundige
beginsels betref, is die VPO-stelsel nie totaal en al nuut nie.
Alhoewel VPO in ander lande tradisie is, is dit nodig om die
totstandkoming van waardes te ontgin. Die moontlike sukses van
hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die
inherente waardes in die VPO-stelsel bevorder.
13
Metsemakers, Jacobus François Maria. "Unlocking patients' records in general practice for research, medical education and quality assurance the registration network family practices /." Amsterdam : Maastricht : Thesis Publishers ; University Library, Maastricht University [Host], 1994. http://arno.unimaas.nl/show.cgi?fid=6952.
Full text
14
Wasserman, Elizabeth. "Implementation evaluation as a dimension of the quality assurance of a new programme for medical education and training." Thesis, Stellenbosch : University of Stellenbosch, 2004. http://hdl.handle.net/10019.1/16079.
Full textAbstract:
Thesis (DPhil)--University of Stellenbosch, 2004.<br>ENGLISH ABSTRACT: In this thesis, an ‘alignment approach’ to the quality assurance of medical curricula is developed
and practically illustrated in the evaluation of a section of a new curriculum in undergraduate
medical education and training instituted at the Faculty of Health Sciences of the University of
Stellenbosch in 1999.
The background of curriculum innovation at this institution during the 1990s is described, and the
literature on the concepts of quality assurance is explored in higher education in general and in
medical education and training in particular. The current focus on socially responsive curriculum
renewal and accountability illustrates the need for this study.
The empirical part of the study was conducted in two phases. The first phase consisted of a
‘clarification evaluation’. The planning of the new curriculum introduced in 1999 was analysed
retrospectively through a study of the planning documents and interviews with leaders of the
planning process. The results of this clarification evaluation are presented in the form of a ‘Logic
Model’. The implicit theory of the curriculum, as represented by the Logic Model, was then
evaluated regarding its consistency with trends in medical education. These trends were
determined through a study of the literature on the subject published during the time of the
planning of the curriculum. It was found that the planning of the curriculum was in line with most
of the identified trends, but that it lacked detailed information on how the basic sciences and
clinical skills training were to be addressed. This compromised the evaluability of phase I of the
curriculum and of the clinical rotations1 by the method use in this study. Because of this, and also
considering the time frame of this evaluation, phase I of the curriculum and the late clinical
rotations were excluded from the second phase of the study.
The aims identified for the curriculum during the process of clarification evaluation were also
aligned with the document, The Profile of the Stellenbosch Doctor 2 . This indicates that the
planning process of the curriculum was in line with its intended outcome.The second phase of the study consisted of an ‘implementation evaluation’ of phases II and III of
the theoretical components and of the early and middle clinical rotations of the curriculum. Data
for this implementation evaluation were collected from April 2002 to June 2003. Module
chairpersons3, lecturers and students were used as sources of data for the evaluation of the
theoretical phases. The perceptions of these groups regarding the implementation of phases II
and III of the theoretical part of the curriculum were collected by means of questionnaires
designed specifically for this study. For the evaluation of the clinical rotations, the results of the
standard student feedback obtained by the Faculty of Health Sciences were used as a source of
data for a secondary analysis. The study guides provided for each of the theoretical modules and
the clinical rotations were also used as a secondary source for the analysis of data.
The data obtained were then analysed by using the framework provided by the Logic Model.
Following this, a judgment of the quality of the implementation of the curriculum was made. The
planned curriculum was aligned with the practised curriculum by drawing up a ‘curriculum
scoreboard’. It was found that alignment was adequately achieved for six of the identified aims,
while the implementation of four of the aims was not aligned to the planning according to the
criteria used in this study.
The study illustrates that the methods of programme evaluation can be validly applied in the
evaluation of a curriculum in medical education and training. The Logic Model enables an
alignment between the planned and the practised curriculum, which can be used as a measure of
the quality of a curriculum in terms of ‘fitness of purpose’. 1 See Addendum A for a diagrammatic overview of the curriculum. The curriculum was structured into three theoretical
phases (phases I, II and III) and three clinical rotations (early, middle and late).
2 This document was drawn up during the initial phases of the planning process of the curriculum and regarded by the
Faculty as a blueprint for the intended outcomes of the curriculum. 3 A module chairperson in the context of the Faculty of Health Sciences of the University of Stellenbosch is a senior
faculty member responsible for the organisation and management of the modules presented as part of the curriculum in
medical education and training.<br>AFRIKAANSE OPSOMMING: In hierdie tesis word ʼn ‘belyningsbenadering’ tot die gehalteversekering van mediese kurrikula
ontwikkel en prakties op die proef gestel deur ʼn gedeelte van die nuwe kurrikulum vir
voorgraadse mediese onderrig, wat in 1999 aan die Fakulteit Gesondheidswetenskappe van die
Universiteit van Stellenbosch ingestel is, te evalueer.
Die agtergrond van kurrikulumverandering in hierdie instansie gedurende die 1990’s word
ondersoek, en daar word ’n oorsig gegee van die literatuur oor die konsepte van
gehalteversekering wat op daardie stadium in die hoër onderwys in die algemeen en in mediese
onderrig in besonder in gebruik was. Die huidige fokus op sosiaal responsiewe kurrikula en
verantwoordbaarheid illustreer die noodsaaklikheid van ʼn studie van hierdie aard.
Die empiriese gedeelte van die studie is in twee fases uitgevoer. Die eerste fase het bestaan uit
‘n ‘verklarende evaluasie’. Die beplanning van die 1999-kurrikulum is retrospektief geanaliseer
deur die bestudering van die relevante beplanningsdokumente en deur onderhoude met leiers
van die beplanningsproses te voer. Die resultate van die verklarende evaluasie is in die vorm van
ʼn ‘Logika Model’ voorgestel. Die implisiete teorie van die kurrikulum, soos voorgestel in die
Logika Model, is daarna geëvalueer ten opsigte van die ooreenstemming van die model met die
tendense in mediese onderrig wat op daardie stadium geldig was. Hierdie tendense is nagespeur
in die belangrikste literatuur oor die onderwerp wat in dieselfde tydperk as die beplanning van
die 1999-kurrikulum gepubliseer is. Die bevinding was dat die beplanning van die kurrikulum in
lyn is met die meerderheid geïdentifiseerde tendense, maar dat die basiese wetenskappe en
opleiding in kliniese vaardighede nie in detail aangespreek is nie. Dit het die evalueerbaarheid
van fase I van die kurrikulum en die kliniese rotasies4 deur die metode wat in hierdie studie
gebruik is, gekompromitteer. Om hierdie rede, en met inagneming van die tydsraamwerk van
hierdie evaluasie, is fase I en die laat kliniese rotasies nie in die tweede gedeelte van hierdie
studie ingesluit nie.
Die doelwitte van die kurrikulum wat gedurende die verklarende evaluasie geformuleer is, is ook
met die dokument, Die Profiel van die Stellenbosch dokter 5, belyn. Dít het aangedui dat die
beplanningsproses van die kurrikulum in lyn met die beoogde uitkoms daarvan is.Die tweede deel van die studie het bestaan uit ʼn ‘implementerings-evaluasie’ van fases II en III
van die teoretiese komponente en van die vroeë en middel kliniese rotasies van die kurrikulum.
Data vir die implementerings-evaluasie is vanaf April 2002 tot Junie 2003 ingesamel. Modulevoorsitters6,
dosente en studente is as bronne van data vir die evaluering van die teoretiese fases
gebruik. Die indrukke van hierdie groepe persone betreffende die implementering van die
teoretiese fases is deur middel van vraelyste ingesamel wat spesiaal vir hierdie studie ontwerp is.
Vir die evaluering van die kliniese rotasies is die resultate van die standaard studenteterugvoer
wat deur die Fakulteit ingewin word, gebruik as bron vir sekondêre analise. Die studiegidse wat
vir elke teoretiese module en die kliniese rotasies verskaf word, het ook as ʼn bron vir sekondêre
data-analise gedien.
Die data wat vir hierdie studie ingewin is, is deur middel van die raamwerk wat deur die Logika
Model verskaf is, geanaliseer. Daarna is ʼn oordeel gevel oor die kwaliteit van die implementering
van die kurrikulum. Die kurrikulum-soos-beplan is belyn met die uitgevoerde kurrikulum deur ’n
‘kurrikulumtelbord’ op te stel. Die bevinding was dat hierdie belyning voldoende bereik is vir ses
van die geïdentifiseerde doelstellings van die kurrikulum, terwyl die uitvoering van vier van die
doelstellings nie goed met die beplanning daarvan belyn was volgens die kriteria wat vir hierdie
studie gebruik is nie.
Hierdie studie illustreer dat die metodes van programevaluasie geldig toegepas kan word in die
evaluering van ’n kurrikulum in mediese onderrig en opvoeding. Die Logika Model maak dit
moontlik om die beplande kurrikulum met die uitgevoerde kurrikulum te belyn. Dit kan dan
gebruik word as ’n maatstaf van die kwaliteit van ’n kurrikulum in terme van ‘geskiktheid vir doel’.4 Sien Addendum A vir ʼn diagrammatiese oorsig van die kurrikulum. Die kurrikulum is gestruktureer volgens drie
teoretiese fases (fases I, II en III) en drie kliniese rotasies (vroeg, middel en laat).
5 Hierdie dokument is gedurende die vroeë fases van die beplanningsproses van die kurrikulum saamgestel en word deur
die Fakulteit as ʼn bloudruk vir die beoogde uitkomste van die kurrikulum beskou.6 ’n Module-voorsitter in die konteks van die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch
is ʼn senior lid van die fakulteit wat verantwoordelik is vir die organisasie en bestuur van die modules wat as deel van die
kurrikulum in mediese onderrig en opleiding aangebied word.
15
Swanson, Abby Jo. "Electronic Medical Records in Acute Care Hospitals: Correlates, Efficiency, and Quality." VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/871.
Full textAbstract:
The purpose of this dissertation is to examine the organizational and environmental correlates of hospital EMR use and to examine the relationship between hospital EMR use and performance. Using a theoretical framework that combines resource dependence theory with Donabedian's structure, process, outcome model, a conceptual model is created. To test the hypotheses of this model, logistic regression and Data Envelopment Analysis (DEA) are used. The data included in this analysis come from the AHA, HIMSS, CMS, ARF, and HQA. In the analysis of hospitals correlates of EMR use, three hypotheses were supported, and one was partially supported. Hospital system affiliation, bed size, and environmental uncertainty were found to be positively associated with hospital EMR use. Hospital rurality was found to be associated with EMR use for all categories except one; at every other level of rurality, as the hospital moves on a continuum from least rural to most urban, the likelihood of hospital EMR use also increases. Hospital EMR use was not found to be associated with teaching status, environmental munificence, competition, operating margin, ownership, or public payer mix. In the hospital performance analyses, one hypothesis was supported, and one was partially supported. Regarding quality, hospitals with EMRs were found to provide higher quality than those without EMRs. In efficiency performance, only small hospitals with EMRs were found to be more efficient than hospitals without EMRs. No support was found that hospitals with EMRs improve their efficiency over time more than hospitals without EMRs. Hospital EMR use does vary by certain organizational and environmental characteristics. For this reason, hospitals and policy makers must take action that enables and encourages all hospitals to implement and use EMRs because some hospitals do not have the motivation or resources to begin using EMRs on their own. Hospital EMR use is positively associated with high quality care, thus justifying the practice. Hospital efficiency was not found to be associated with EMR use in medium or large hospitals, but it was found to be associated with EMR use in small hospitals. Interestingly, larger hospitals are more likely to use EMRs than small hospitals. It is possible that the efficiency gains of EMR use in hospitals will not be realized until a standardized, fully interoperable system is developed, allowing health care provides to quickly and easily share the medical charts of their patients.
16
Lindström, Kjell. "Methods for quality development of the primary health care structure /." Linköping : Univ, 2002. http://www.bibl.liu.se/liupubl/disp/disp2002/med719s.pdf.
Full text
17
Toulemon, Léa. "Job quality, health insurance and the price of medical products : essays in applied economics." Thesis, Paris, Institut d'études politiques, 2016. http://www.theses.fr/2016IEPP0041/document.
Full textAbstract:
Cette thèse étudie deux facteurs majeurs pour le bien-être individuel, la qualité de l'emploi et l'accès aux soins. Dans le premier chapitre, nous étudions l'effet de la perte d’emploi suite à une fermeture d’usine sur un large panel d’indicateurs mesurant la qualité de l'emploi retrouvé. Nous utilisons une stratégie d’appariement exact par tranche qui prend en compte les inobservables fixes dans le temps. Nos résultats principaux montrent une dégradation de la qualité de l’emploi suite au licenciement, dont la durée et l’ampleur dépendent de la dimension considérée. Le second chapitre étudie l'impact d'une assurance maladie publique plus généreuse sur la consommation de soins de santé. Nous utilisons la coexistence de deux systèmes d'assurance maladie en France, tous deux publics et obligatoires : le système national, et le régime local d'Alsace Moselle, donc les taux de remboursement sont plus élevés. Nous évaluons comment les personnes déménageant en Alsace Moselle modifient leur consommation de soins, en utilisant les personnes déménageant entre d’autres régions françaises comme groupe de contrôle. En étudiant plusieurs postes de santé, nous trouvons qu’au total, le régime d’Alsace Moselle n’engendre pas de hausse des dépenses. Le dernier chapitre s'intéresse à l'effet de l'achat groupé sur les prix des médicaments dans les hôpitaux français, en utilisant les créations de groupements entre 2009 et 2014. Nos données contiennent les prix d’achat des médicaments innovants dans les hôpitaux publics. Nos résultats montrent que l'achat groupé baisse les prix des médicaments en oligopole, mais n'a aucun impact sur les prix des médicaments qui n'ont pas de concurrents<br>This thesis focuses on two major aspects of individual well-being : job quality and the availability of medical care. We first investigate the long-term effects of job displacement on several dimensions of job quality. We use a coarsened exact matching method that takes into account time-invariant unobservables. Our main findings point to a deterioration of job quality after displacement. The magnitude and duration of the observed negative impact depends on the dimension considered. The second chapter studies the impact of a more generous public health insurance. We use the coexistence of two compulsory public health insurance systems in France, the national system, and the Alsace Moselle local system, which offers higher reimbursement rates. We investigate how moving to Alsace Moselle affects healthcare consumption, taking individuals who move between other French regions as a control group. Overall, we show that the Alsace Moselle local system does not increase healthcare consumption. The third chapter estimates the impact of group purchasing on medicine prices in French hospitals. We take advantage of the creation of regional purchasing groups between 2009 and 2014. We use a unique database that provides information on the average annual prices paid by public hospitals for all innovative medicines. Using a fixed effects model controlling for medicine-specific bargaining abilities of hospitals and medicine-specific price trends, we find that group purchasing reduces prices of medicines in oligopoly markets, but has no impact on prices of medicines for which there exist no competitors
18
Dashti, David. "Improving Quality Assurance of Radiology Equipment Using Process Modelling and Multi-actor System Analysis." Thesis, KTH, Skolan för kemi, bioteknologi och hälsa (CBH), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-302563.
Full textAbstract:
With the introduction of RIS and PACS technologies in clinical radiology, the field has become increasingly technology dependent. The quality assurance in radiology have however yet to catch on. With many quality assurance programs mainly focusing on the clinical side of radiology whilst little attention is paid to the technical aspects. This thesis serves to change that, by investigating quality assurance of radiology equipment in the workflow of hospital physicists and biomedical engineers at Södersjukhuset emergency hospital. To improve said workflows, process modelling and multi-actor system analysis was utilized in combination with the on-site inventory system Medusa. In order to model the workflows, the process modelling technique flowchart was used. To add additional information into the flowcharts, multi-actor system analysis was employed. This was done for the workflow of both scheduled and unscheduled maintenance of radiology equipment. Initially resulting in a pair of pre-study models which modelled the after the existing workflows. From said pair of pre-study models, both redundancies and main objectives for improvement were deduced. This in combination with an extensive semistructured literature review, led to a list of requirements. Two pairs of improved models were then created with the list of requirements in mind. All the models were then evaluated, including the pair of pre-study models, in workshops held with hospital physicists, biomedical engineers and respective leadership staff. These workshops contained both an open discussion and a questionnaire, asking the participants to rate the alignment of the models with the different requirements in the list. Based on the results from the workshops, one of the proposed pairs of improved models were then chosen as the final solution of an improved workflow. A workflow in which redundancies were reduced, traceability capabilities added in form of digital storage, and alignment with legislative demands from SSM assured. A step in the digitalization of Södersjukhuset. Utilizing digital technology to improve quality assurance in the workflow of radiology equipment.<br>I samband med introduktionen av RIS och PACS teknologi i klinisk radiologi, så har fältet blivit mer teknikdrivet. Kvalitetledning av radiologisk utrustning har däremot inte förändrats. Då de flesta kvalitetslednings program har primärt fokus på den kliniska sidan av radiologi och förbiser de tekniska aspekterna. Detta examensarbete försöker bemöta detta, genom att utreda kvalitetsledningen av radiologisk utrustning hos arbetsflödena av sjukhusfysiker och medicintekniska ingenjörer på Södersjukhuset. För att förbättra arbetsflödena, så användes processmodellering och analys av multi-aktörsystem i kombination med det lokala inventariesystemet Medusa. För att skapa en modell av arbetsflödet så användes processmodelleringstekniken flowchart. För att lägga till ytterligare information i flödena så utfördes en multi-aktörsystem analys. Detta utfördes för både förebyggande- och avhjälpande underhåll av radiologisk utrustning. Vilket resulterade i ett par av förstudiemodeller som modellerade det nuvarande arbetsflödet. Baserat på detta par av förstudiemodeller, så kunde både överflödigheter och huvudsakliga förbättringsmål härledas. Detta i kombination med en semistrukturerad litteraturundersökning, ledde till en lista med krav på modellerna. Sedan så skapades två par av modeller som förslag till förbättrat arbetsflöde, baserat på listan med krav. För att utvärdera alla modeller, inklusive förstudiemodellerna, så hölls workshops med sjukhusfysiker, medicintekniska ingenjörer och respektive chefspersonal. Dessa workshops innehöll både en öppen diskussion och ett formulär, som bad deltagarna att utvärdera de olika paren av modeller gentemot de olika kraven som hade formulerats i listan. Baserat på resultaten från dessa workshops, så valdes en av de två förslagna paren av modeller för förbättrat arbetsflöde, som en slutgiltig lösning. Ett arbetsflöde där överflödigheter har motarbetats, spårbarhet förbättrats med hjälp av digital lagring, och sammanstämning med regulatoriska krav från SSM har säkerställts. Ett steg i digitaliseringen av Södersjukhuset, genom att utnyttja digital teknik för att förbättra kvalitetledningen av radiologisk utrustning.
19
Grevillot, Loïc. "Monte Carlo simulation of active scanning proton therapy system with Gate/Geant4 : Towards a better patient dose quality assurance." Phd thesis, INSA de Lyon, 2011. http://tel.archives-ouvertes.fr/tel-00735746.
Full textAbstract:
Hadron Therapy is an advanced radiotherapy technique for cancer treatment. It offers a better irradiation ballistic than conventional techniques and therefore requires appropriate quality assurance procedures. In this work, we upgraded the GEANT4-based GATE Monte Carlo platform in order to recalculate the TPS dose distributions in view of further benchmarking. In a first step, we selected an appropriate simulation environment (physics models and parameters) in order to produce accurate and efficient simulations. GATE simulations were validated using measurements and other Monte Carlo codes for depth-dose and transverse profiles. While a good agreement was found for depth-dose profiles, larger discrepancies were pointed out for transverse profiles. In a second step, we developed a modeling method to simulate active scanning beam delivery systems, which does not require to simulate the components of the treatment nozzle. The method has been successfully applied to an IBA proton therapy system and validated against measurements for complex treatment plans. Interfaces have also been developed in order to link DICOM RT ION PLAN and DICOM RT DOSE with GATE. Finally, we compared in a third step the TPS and Monte Carlo dose distributions in homogeneous and heterogeneous configurations. The beam models of both dose engines were in satisfactory agreement, allowing further evaluation of clinical treatment plans. A two-field prostate plan has been evaluated, showing a satisfactory agreement between the TPS and Monte Carlo, and demonstrating the novel capabilities of the platform for the evaluation of the TPS. To summarize, we selected an appropriate simulation environment for proton therapy, proposed a modeling method for active scanning systems and presented a method to compare the TPS and Monte Carlo dose distributions. All tools developed in GATE were or will be publicly released. A detailed validation stage of the system including absolute dosimetry is still necessary, in order to quantitatively evaluate its accuracy in various homogeneous and heterogeneous configurations. In this thesis, we have demonstrated that the GATE Monte Carlo platform is a good candidate for the simulation of active scanning delivery systems, allowing further TPS benchmarking. Moreover, the GATE platform also handles imaging applications, such as PET or prompt-gamma imaging towards online treatment monitoring and paves the way of interdisciplinary research advances.
20
Noharet, Renaud. "Contribution à l'assurance qualité des dispositifs médicaux en implantologie orale : à propos de la précision du placement implantaire." Thesis, Lyon 1, 2014. http://www.theses.fr/2014LYO10109/document.
Full textAbstract:
L'assurance qualité est une discipline récente dans le domaine médical, d'autant plus en odontologie. Sa mise en oeuvre passe dans notre discipline essentiellement par l'application de règles d'exigences vis-à-vis des dispositifs médicaux utilisés au sein des cabinets dentaires. Les implants, les piliers, les prothèses implantaires mais également les guides chirurgicaux sont des exemples appliqués au domaine implantaire. Cette technique chirurgico-prothétique se doit d'être exécutée dans les meilleurs conditions avec une exigence optimale : chaque acte pouvant avoir des conséquences sur le patient et/ou l'avenir du traitement. Afin de répondre aux exigences d'assurance qualité du traitement implantaire, il semble que les guides chirurgicaux statiques puissent être un moyen afin d'améliorer le placement implantaire impactant donc la qualité de la thérapeutique mise en place. Dans un premier temps, les notions d'assurance qualité et des dispositifs médicaux sont remis en lumière, notamment au travers du filtre de l'implantologie orale. Ensuite, la qualité du traitement implantaire est discutée : des bases historiques jusqu'aux connaissances d'aujourd'hui. Il est important de maitriser l'évolution de cette technique et des outils associées afin de comprendre et donc d'utiliser les outils diagnostics et thérapeutiques à notre disposition aujourd'hui. Le dernier temps de ce travail constitue l'évaluation des outils actuels en implantologie (CFAO, stéréolithographie, chirurgie guide statique, informatique) au travers d'une étude sur sujets anatomiques. Cette étude évalue la précision du positionnement implantaire avec des guides dits conventionnels et des guides de chirurgie guidée statique. Cette précision est évaluée par comparaison des images préalables de planification et des examens tridimensionnels post-opératoires<br>The quality assurance is a recent discipline in the medical domain, all the more in odontology. Its implementation passes in our discipline essentially by the application of rules of requirements towards medical devices used within dental surgeries. Implants, abutments, implant’s prosthesis but also the surgical guides are examples applied to the domain. This surgico-prosthetic technique owes be executed in the best conditions with an optimal requirement: every act which can have consequences on the patient and/or the future of the treatment. To meet the requirements of quality assurance of the treatment, it seems that the static surgical guides can be a way to improve the placement of implants thus impacting on the quality of the organized therapeutics. At first, the notions of quality assurance and medical devices are handed in light, in particular through the filter of the oral implantology. Then, the quality of the treatment is discussed: historic bases until the knowledge of today. It is important to master the evolution of this technique and tools associated to understand and thus use tools diagnoses and therapeutic at our disposal today. The last time of this work establishes) the evaluation of the current tools implantologie (CAD-CAM, stereolithography, surgery guides static, IT) through a study on anatomical subjects. This study estimates the precision of the implant’s positioning with conventional said guides and guides of static guided surgery. This precision is estimated by comparison of the preliminary images of planning and the post operative threedimensional examinations
21
Alopaeus, Eva. "Uppfattningar om kvalitet på medicinska bibliotek." Thesis, Högskolan i Borås, Institutionen Biblioteks- och informationsvetenskap / Bibliotekshögskolan, 1997. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-12204.
Full textAbstract:
This paper presents the background, aim and results of a small empirical study conducted in the setting of a medical hospital library. The background is found both in the quality ambitions of the medical professions and organizations and in the effort of medical libraries to show their importance to the total quality of medical decision making. As a first step in the library's quality process, the aim has been to identify quality performance indicators of value to library users in their contact with a medical hospital library. The second step- to identify satisfaction levels - is not included in this work. Another aim has been to compare the quality categories in this small study with the generally accepted quality categories that emerged in the comprehensive studies of Parasuraman, Zeithaml and Berry in which customers express their expectations and perceptions of services. This study is based on a small number of interviews with representatives from different user groups within a hospital. The analysis is inspired by phenomenography which build on perceptions of phenomena - in this case the phenomenon "quality". In the material from the interviews five quality categories were identified. Compared to generally accepted quality categories from the service sector none of these five categories were unique. Important conclusions were that despite the homogeneity of the user group, expectations and needs are different and vary from time to time. Consequently flexibility and individual treatment of library users are crucial if the library is to meet user expectations. But the material also shows that despite access to modern technology users have very traditional perceptions of the library seeing the library as a room. If libraries were to let only user expectations initiate changes, it would lead to stagnation. It is not realistic to rely only on the knowledge or interest of the users.
22
Hernandez, John B. "Evaluating a multi-hospital quality improvement strategy to implement clinical guidelines for radiographic contrast agents." Santa Monica, CA : Rand, 1998. http://catalog.hathitrust.org/api/volumes/oclc/42204634.html.
Full text
23
Eckermann, Simon Economics Australian School of Business UNSW. "Hospital performance including quality: creating economic incentives consistent with evidence-based medicine." Awarded by:University of New South Wales. School of Economics, 2004. http://handle.unsw.edu.au/1959.4/22011.
Full textAbstract:
This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.
24
Rojas-Candio, Piero, Arturo Villantoy-Pasapera, Jimmy Armas-Aguirre, and Santiago Aguirre-Mayorga. "Evaluation Method of Variables and Indicators for Surgery Block Process Using Process Mining and Data Visualization." Repositorio Academico - UPC, 2021. http://hdl.handle.net/10757/653799.
Full textAbstract:
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.<br>In this paper, we proposed a method that allows us to formulate and evaluate process mining indicators through questions related to the process traceability, and to bring about a clear understanding of the process variables through data visualization techniques. This proposal identifies bottlenecks and violations of policies that arise due to the difficulty of carrying out measurements and analysis for the improvement of process quality assurance and process transformation. The proposal validation was carried out in a health clinic in Lima (Peru) with data obtained from an information system that supports the surgery block process. Finally, the results contribute to the optimization of decision-making by the medical staff involved in the surgery block process.<br>Revisión por pares
25
Celi, Sofia. "Contribution à la radiothérapie adaptative par analyse systématique de la fluence en entrée et de la dose en sortie du patient." Thesis, Toulouse 3, 2016. http://www.theses.fr/2016TOU30037/document.
Full textAbstract:
La radiothérapie moderne combine les techniques complexes et les traitements personnalisés, avec le risque que certaines évolutions et erreurs ayant lieu au cours de traitement passent inaperçues. Ces aléas peuvent entraîner des conséquences graves pour la santé du patient. Dans cette perspective, nous avons étudié le potentiel d'un système de dosimétrie in vivo de transit pour le suivi continu du patient et, par conséquent, la radiothérapie adaptative. L'expérience clinique et des tests de faisabilité ont permis de définir les axes de travail principaux: l'automatisation et la simplification du procédé d'analyse des contrôles. Les développements incluent la création d'une bibliothèque de données standard et une série d'analyses de causes racines, permettant ainsi de renforcer la précision du système, d'améliorer l'automatisation de sa mise en place et d'identifier des pistes pour une analyse efficace des résultats et pour la création d'outils supplémentaires facilitant le suivi et l'adaptation du traitement en routine clinique<br>Modern radiation therapy combines complex techniques and personalized treatments, with the risk that certain evolutions and errors occurring during the course of the treatment might go unnoticed. These fluctuations may cause great damage to the health of the patient. In this perspective, we worked on the potential of a transit in vivo dosimetry system for continuous monitoring of the patient and, hereafter, adaptive radiotherapy. Our clinical experience and feasibility testing determined the main lines of work : automatization and simplification of the results analysis method. The developments included the creation of a golden data library and a series of root cause analyzes, allowing us to strengthen the accuracy of the system, to enhance the automatization of the setup and to identify tracks for an efficient analysis of the results and for the creation of additional analytical tools to facilitate the monitoring and adaptation of the treatments in clinical routine
26
Ververs, James. "A quantitative method for reproducible ionization chamber alignment to a water surface for external beam radiation therapy depth dose measurements." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/2600.
Full textAbstract:
Ionization chambers (ICs) are the most commonly used detectors for radiation therapy dose measurements. Typical IC measurements use cylindrical ICs in a water phantom and therefore require initial IC alignment to the water surface. This alignment has long been ignored and only recently has a qualitative governing recommendation been made. This thesis describes a reproducible methodology for quantitative ionization chamber water surface alignment. Depth-ionization measurements are taken with twenty-eight IC designs under varying conditions including, but not limited to, changes in scan direction, speed, and resolution, radiation beam type, field size, energy, and electron contamination. Measurements are acquired using standard radiotherapy accelerators in the Virginia Commonwealth University Department of Radiation Oncology and at the National Research Council of Canada, where a customized scanning system capable of better than 0.15 mm IC positioning precision is used. Measurements are also performed with standard commercial scanning equipment on the Accuray CyberKnife, a specialized radiosurgery-class accelerator. An analytical model is developed from basic principles to test the theoretical foundations of IC response near a water surface. The theoretical foundation is further validated via Monte Carlo simulation models that fully account for all details of the ICs used to take measurements. It is determined that the dose gradient as a function of depth is maximized when a given IC reaches the water surface when moving from depth in water. This effect is unchanged under all of the measurement scenarios tested. Measurements taken at 0.1 mm resolution for several seconds per point over several millimeters near the surface will yield a gradient peak that can be used for quantitative alignment. Using developed software, multiple scans at variant resolutions can be stitched into typical clinical scans so as not to significantly affect clinical measurement workflow. The recommended measurement method is developed in a format suitable for inclusion into a clinical protocol for depth-ionization measurement acquisition.
27
Asan, Volkan, and Pejman Assadinia. "Sambandet mellan psykisk hälsa och oral hälsa - En journalstudie." Thesis, Malmö universitet, Odontologiska fakulteten (OD), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19742.
Full textAbstract:
Syfte: Studiens syfte var att undersöka om det fanns samband mellan psykisk ohälsa och oral hälsa i en population. Det sekundära syftet var att utföra kvalitetsundersökning av journalföring på avdelningen för Oral diagnostik på Odontologiska fakulteten Malmö Universitet.Material och metod: Materialet bestod av ett frågeformulär samt tillhörande journalhandlingar. Totalt granskades 530 journalhandlingar avseende patientens psykiska hälsostatus, kariologiska fynd, Decayed Missing Filled Teeth (DMFT), betandning samt parodontala fynd.Resultat: Totalt uppgav 15,7% individer psykisk ohälsa. Kariessjukdom var mer frekvent hos män med psykisk ohälsa. Kvinnor som medicinerades mot psykisk ohälsa uppvisades ha mer sällan tandköttsfickor >5 mm än de som inte medicinerade sig mot psykisk ohälsa. Granskningen av journalföringen uppvisade strukturella brister i journalföring av parodontalt status och psykisk ohälsa.Slutsats: Studiens resultat påvisar inga skillnader i populationen som sin helhet men att det finns skillnader i gruppnivå. Signifikanta skillnader observerades mellan könen när kariesprevalens relaterades till psykisk ohälsa. Vidare kunde det konstateras en skillnad mellan könen när tandköttsfickor >5 mm relaterades till medicinering mot psykisk ohälsa. Skillnader i journalföringen förekom särskilt gällande parodontal status och genererade en viss osäkerhet vid journalgranskningen. Brist i den strukturella journalhanteringen kan bidra till signifikanta misstolkningar av situationen. Dock anses denna osäkerhet inte åstadkomma betydande konsekvenser för patienten. För att reda ut denna variation av journalskrivning bör en tydligare mall vara obligatorisk för alla journalförare. Studiens resultat avviker från tidigare utförda studier. Ytterligare studier av prospektiv art skulle sannolikt förtydliga eventuella kausala samband kring orala hälsan av psykiatriska öppenvårdspatienter.<br>Purpose: The purpose of this study was to investigate whether there was a relationship between mental health and oral health in a normal population. The secondary purpose was to carry out a quality assurance of record keeping at the Department of Oral Diagnostics at the Faculty of Dentistry Malmö University.Material and method: The material consisted of a questionnaire and associated journal documents. A total of 530 journal documents were reviewed regarding the patient's mental health status, cariological findings, Decayed Missing Filled Teeth (DMFT) and periodontal findings.Results: A total of 15.7% of individuals reported mental illness. Caries was more frequent in men with mental illness. Women who were medicated for mental illness were found to have less frequent periodontal pockets >5 mm, than those who did not medicate for mental illness. Quality assurance showed that there was a lack of structure for recording periodontal status and mental illness.Conclusion: The study's results show no differences in the population in its entirety, but there are differences in group level. Significant differences were observed between the sexes when caries prevalence was related to mental illness. Furthermore, there was a difference between the sexes when periodontal pockets >5 mm were related to medication for mental illness. Differences in record keeping were particularly prevalent regarding periodontal status and generated some uncertainty in the journal review. Lack of structural journal management can contribute to significant misinterpretations of the situation. However, this uncertainty is not considered to have significant consequences for the patient. To clarify this variation of journal writing, a clearer template should be mandatory for all dental care providers. The study's results differ from previous studies. Further studies of a prospective nature will likely clarify any causal relationships around the oral health of psychiatric outpatients.
28
Stockddale, Cynthia R. "A Comparison of Community-Based Centers versus University-Based Centers in Clinical Trial Performance." [Tampa, Fla] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002472.
Full text
29
Du, Plessis Ulandi. "Explaining the endurance of poverty and inequality : social policy and the social division of welfare in the South African health system." Thesis, Rhodes University, 2013. http://hdl.handle.net/10962/d1002002.
Full textAbstract:
This thesis examines the structure and flow of public funding between the public and private sectors in the South African health system and the consequences thereof for the achievement of equity. The conceptual framework used to undertake the analysis derives from Richard Titmuss’ core theoretical framework, the Social Division of Welfare. The application of the Social Division of Welfare applied to the South African health care context demonstrates how state resources end up benefitting the non-poor and, as a result, reproduce inequality. Those who access public institutions such as public health care are assumed to be ‘dependent’ on the state, whilst those who access private health facilities claim to be ‘independent’ of the state. However, this thesis shows that these assumptions are flawed. Access to the formal labour market, and subsequently the paying of taxes, authorises one to access state subsidies not available to those who do not. The application of the Social Division of Welfare shows that tax-paying private health care patients benefit considerably from state resources. This thesis argues that due to cost escalation in the private health sector, a consequence of the commodification of health care, these private health care ‘consumers’ as well as the private health industry in general are dependent upon state resources. This thesis analyses the role played by the profit motive present in the private health industry and the consequences for equity, quality, access and efficiency in health care provision
30
Ullman, Gustaf. "Quantifying image quality in diagnostic radiology using simulation of the imaging system and model observers." Doctoral thesis, Linköping : Department of Medicine and Health, Linköping University, 2008. http://www.bibl.liu.se/liupubl/disp/disp2008/med1050s.pdf.
Full text
31
BRAMBILLA, TANIA de P. "Estudo de materiais adsorvedores para o preparo de geradores de Ge-68/Ga-68." reponame:Repositório Institucional do IPEN, 2013. http://repositorio.ipen.br:8080/xmlui/handle/123456789/10560.
Full textAbstract:
Made available in DSpace on 2014-10-09T12:41:57Z (GMT). No. of bitstreams: 0<br>Made available in DSpace on 2014-10-09T14:04:43Z (GMT). No. of bitstreams: 0<br>Tese (Doutoramento)<br>IPEN/T<br>Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP
32
Kellström, Anna. "A study of the stability of vitamin 25[OH]D2 and 25[OH]D3." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-95166.
Full textAbstract:
During the industrialization of the 19th century the negative health effects of vitamin D was discovered as children in the cities developed osteomalacia or more commonly known as rickets caused by vitamin D deficiency. Vitamin D is produced in the skin from 7-dehydrocholesterol during sun-exposure and enhances intestinal phosphor and calcium absorption thus enhancing the bone remodeling process. Now, in the 21st century, Vitamin D is still relevant as positive health effects have been recognized and with it an increased number of samples and a demand for accurate analyzing. Vitamin D is commonly believed to be sensitive to ultraviolet radiation in serum and blood samples and therefore have traditionally been kept protected from light exposure from the time of sampling until the finished analyze. However recent studies have proven 25- hydroxyvitamin D (25[OH]D) to be stable in both whole blood and serum. As previous studies have been primarily conducted in research laboratories with the aim to study vitamin D under specific research-laboratory conditions the aim of this study was to study the stability of 25[OH]D in serum and whole blood within both primary care- and hospital laboratories under normal and exaggerated conditions with the purpose to evaluate possible pre-analytical issues with everyday handling processes. The assay used was high pressure liquid chromatography-tandem mass spectrometry, HPLCMS/MS, and the sought analytes 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3, 25[OH]D2 and 25[OH]D3. The results showed that 25-hydroxyvitamin D is stable in serum for 24 hours at room temperature whilst exposed to light both ultraviolet and fluorescent. The analyte is also stable for up to four freeze-thaw cycles rendering the process of light-protection and samples frozen immediately after centrifugation superfluous. The results also ensure reliable results even if samples are accidently left on benchtops or saved refrozen to be reanalyzed at a later date.<br>Under den industriella revolutionen på 1800 talet upptäcktes de negativa hälsoeffekterna av vitamin D-brist då barnen i städerna utvecklade rakit (osteomalaci) eller engelska sjukan som sjukdomen också kallas på grund av brist på sol och D-vitamin. Vitamin D produceras i huden från 7-dehydrokolesterol vid solexponering och ökar upptaget av fosfor och kalcium i tarmen som i sin tur förbättrar återuppbyggnaden av skelettet. Vitamin D är fortfarande aktuell även nu i vår tid men då för dess nyupptäckta hälsofrämjande egenskaper som till exempel förebyggandet av coloncancer. Detta medför även en ökning av antalet analyser och kräver därmed en adekvat analysmetod. Traditionellt har det antagits att vitamin D är ljuskänsligt i alla former därför har blod och serum ljusskyddats, från provtagningstillfället fram tills dess att analysen är utförd. Dock har nya studier visat att 25-hydroxyvitamin D (25[OH]D) är mycket stabilt bundet till vitamindbindande protein i både serum och helblod. Syftet med studien var att utvärdera om 25[OH]D i serum och helblod behöver ljusskddas genom att studera stabiliteten hos 25[OH]D i både serum och helblod under normala primärvårdslaboratorie- och sjukhuslaboratorieförhållanden samt under extrema förhållanden för att utvärdera eventuella preanalytiska problem eller fel relaterade till den vardagliga hanteringen av vitamin D prover. Proverna analyserades med högupplösande vätskekromatografi-tandem masspektrometri, HPLC-MS/MS, och de sökta analyterna var 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3, 25[OH]D2 och 25[OH]D3. Resultat från studien visade att 25-hydroxyvitamin D är stabilt i serum i 24 timmar i rumstemperatur med ljusexponering från både ultraviolett och fluorescerande ljus. 25-hydroxyvitamin D är även stabil i serum upp till fyra frys- och tiningscykler. Detta gör att provhanteringen kan förenklas genom att dessa prover inte behöver ljusskyddas samt att serumet ej behöver frysas in direkt efter centrifugering. Resultatet säkerställer även tillförlitliga resultat om prover lämnas framme på bänken av misstag eller om prover behöver sparas och frysas om för att analyseras vid senare tillfälle.
33
Beck, Andrea Diez. "Avaliação da ocorrência de eventos adversos em um centro de terapia intensiva adulto." Universidade do Vale do Rio dos Sinos, 2014. http://www.repositorio.jesuita.org.br/handle/UNISINOS/4596.
Full textAbstract:
Submitted by William Justo Figueiro (williamjf) on 2015-07-21T23:30:17Z
No. of bitstreams: 1
69c.pdf: 808730 bytes, checksum: 0b75ef037842e0369cd10f11d2db1a0d (MD5)<br>Made available in DSpace on 2015-07-21T23:30:17Z (GMT). No. of bitstreams: 1
69c.pdf: 808730 bytes, checksum: 0b75ef037842e0369cd10f11d2db1a0d (MD5)
Previous issue date: 2014-03-14<br>Nenhuma<br>As organizações de saúde são ambientes que abrigam setores, atividades e processos, cuja complexidade favorece a ocorrência de eventos adversos (EA). Como forma de evita-los, a incorporação de modificações substanciais e adequadas, surge como necessidade básica para melhorar a segurança do paciente. OBJETIVO: Rastrear a ocorrência dos eventos adversos encontrados no Centro de Terapia Intensiva, através da abordagem proposta pelo Institute for Healthcare Improvement, utilizando a ferramenta de rastreamento global. MATERIAL E MÉTODO: Estudo transversal e analítico realizado no CTI adulto de um hospital privado e filantrópico de grande porte do município de Porto Alegre/RS. Foram analisados 128 prontuários por estratificação, proporcional e aleatório, de pacientes que tiveram alta do CTI adulto de abril a outubro de 2012. Foram incluídos os pacientes, maiores de 18 anos, que permaneceram no mínimo 24 horas internados no CTI, independente do desfecho de alta e excluídos pacientes em reabilitação e internação psiquiátrica. Os dados foram coletados por dois enfermeiros e um médico intensivista, que realizou a autenticação dos dados coletados, definiu o evento adverso e o dano. O protocolo de verificação de cada prontuário ocorreu no tempo preconizado de 20 minutos. Os dados foram classificados nos módulos terapia intensiva e cuidado: (a) C1: transfusão sanguínea ou uso de hemocomponentes; (b) C2: parada cardiorrespiratória; (c) C5: RX ou ecografia com doppler para estudo de êmbolos ou trombose venosa profunda (TVP); (d) I3: procedimento; (e) I4: intubação/reintubação; (f) outros. Os danos foram classificados seguindo as categorias de exclusão e inclusão. As variáveis qualitativas foram descritas por frequências absolutas e relativas e as quantitativas por média e desvio padrão. A fim de testar as associações entre as variáveis qualitativas, foi utilizado o teste quiquadrado. Para comparação de médias entre os grupos foi utilizado o teste t. Para todas as análises, considerou-se um nível de significância de 5%. O projeto foi aprovado pelos Comitês de Ética em Pesquisa das instituições. RESULTADO: Em 39,8% dos prontuários foram identificados algum EA, com uma média de 0,8 eventos por prontuário. O principal motivo de internação no CTI foi pós-operatório. Os pacientes que sofreram EA tiveram maior tempo de permanência no CTI (p <0,001). Foram identificados 51 pacientes com EA. Destes, 40 EA foram rastreados nos módulos de cuidado e terapia intensiva, identificados por 241 gatilhos, e 60 EA foram identificados por outros rastreadores propostos pela ferramenta do IHI. Em 56% dos casos, os EA foram classificados como dano temporário e houve necessidade de uma intervenção no paciente. Cerca de 15% tiveram dano que levou a necessidade de intervenção para manutenção da vida ou morreram. Os EA evitáveis ocorreram em 77% dos casos. CONCLUSÃO: O conhecimento de EA pode contribuir e direcionar estratégias de melhoria e busca de resultados, sendo que três alternativas foram elencadas para implantação de curto a médio prazo na terapia intensiva. São elas: (1) lista de verificação (Checklist); (2) criação de um programa de educação continuada e certificação para os profissionais de enfermagem da terapia intensiva; (3) implantar um método de avaliação sistemática de prontuários de pacientes que internaram no CTI Adulto.<br>Health organizations are the settings that host sectors, activities and processes whose complexity favors the occurrences of adverse events (AE). As a way to avoid them, the incorporation of substantial and adequate modifications arises as a basic need to improve patient’s safety. OBJECTIVE: To track the occurrences of adverse events on the Intensive Care Center, applying the suggested approach by the Institute for Healthcare Improvement. MATERIAL AND METHOD: Transversal study and analytical performed at the Intensive Care Center in a big private philanthropic hospital in the city of Porto Alegre/RS. 128 medical records from patients who were discharged from the hospital between april and october in the year 2012 were randomly analyzed by stratification and proportion. It was also included patients who were more than 18 years old and that had been at least 24 hours in the Intense Care Unit, independently from the outcome of discharged and excluded patients who were under rehabilitation and psychiatric hospitalization. The data was collected by two nurses and an intensivist doctor, who authenticated the collected data, defined the adverse events and the damage. The checking protocol of each medical record happened in the recommended time of 20 minutes. The data was classified in the patterns of Intensive Therapy and Care: (a) C1: blood transfusion or the use of hemocomponents; (b) C2: cardiorespiratory arrest; (c) C5: XR or ultrasound with Doppler to study emboli or deep venous thrombosis (TVP); (d) I3 procedure: (e) I4: intubation / reintubation; (f) others. The damages were classified according to the inclusion and exclusion categories. The variable was described by absolute and relative frequencies. The qualitative variables were describe by absolute and relative frequencies and the quantitative by mean and standard deviation. Chi-square test was used in order to test the associations between the qualitative variables. The ttest was employed to compare means between the groups. For all analyses, the significance level was 5%. The project was approved research ethics committee by the institutions. RESULTS: 39,8 of the medical records were identified with some AE within an average of 0,8 events per medical record. The main reason to hospitalization in Intensive Care was the postoperative. The patients who suffered AE had longer time remaining at the ICU (p<0,001). 51 patients were identified with AE whose 40 AE were tracked in the care module and in the intensive therapy, identified by 241 triggers, and 60 AE were identified by other trackers suggested as tools from the IHI. In 56% of the cases, the AE were classified as temporary damage and there was a need of an intervention in the patient. Around 15% of the cases had damage that there was a need of an intervention to keep them alive or they died. The preventable AE happened in 77% of the cases. CONCLUSION: The AE acknowledgment may contribute and direct improvement strategies and search of results, considering that three alternatives were listed to the implementation of short to medium term in the intensive care. They are: (1) checklist; (2) creation of a continued education program and certification to the nursery professionals in the intensive care; (3) Implementation of a method to evaluate systematically the medical records from patients who are hospitalized in the adult IC.
34
Lima, Débora Astolfo de. "A satisfação da criança e da família acerca do manejo da dor em um pronto-socorro infantil." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/7/7141/tde-05112018-124035/.
Full textAbstract:
Introdução: A dor da criança é uma das queixas de maior procura pelos serviços de urgência e de emergência e seu manejo tem sido um motivo de preocupação pelos profissionais de saúde. Para avaliar os cuidados prestados aos pacientes, são utilizados indicadores de qualidade, dentre eles, a satisfação. Objetivo: Compreender a satisfação da criança e de seu familiar acerca do manejo da dor no pronto-socorro infantil. Metodologia: Estudo qualitativo exploratório e descritivo. Para a discussão dos dados foi utilizado o modelo de Donabedian. Os participantes deste estudo foram constituídos por crianças entre seis e 12 anos de idade e seus familiares. As entrevistas foram gravadas e os dados analisados à luz da análise temática. Resultados: Foram entrevistados 19 crianças e 19 familiares entre outubro de 2016 a maio de 2017. Os resultados sobre a percepção da satisfação acerca do manejo da dor no pronto-socorro infantil compuseram o Tema 1: A satisfação percebida pelas crianças e familiares, composto por três subtemas: Atendimento prioritário, alívio rápido da dor e Acolhimento pela equipe A satisfação percebida pelas crianças composto por um subtema: Necessidades básicas atendidas. A satisfação percebida pelos familiares, composto por um subtema: Investigação dos sintomas. E a insatisfação percebida acerca do manejo da dor no pronto-socorro infantil compuseram o Tema 2: A insatisfação percebida pelas crianças e familiares, composto por um subtema: Demora em aliviar a dor A insatisfação percebida pelas crianças composto por dois subtemas: Procedimentos dolorosos e Ambiente desconfortável. A insatisfação percebida pelos familiares composto por um subtema: Demora pelos resultados dos exames\". Conclusão: Observou-se que a satisfação da criança e de seus familiares foi muito mais do que o alívio da dor, ou o atendimento prioritário. Englobou também o ambiente e o acolhimento pela equipe. É recomendado que o cuidado do profissional de saúde seja direcionado às singularidades das crianças e de suas famílias.<br>Introduction: Child pain is one of the most pressing complaints of emergency services and its management has been a cause of concern for health professionals. To assess the care provided to patients, quality indicators are used, among them, the satisfaction. Objective: To understand the satisfaction of the child and his/her family with pain management in the emergency room. Methodology: A qualitative, exploratory and descriptive study. To discuss our data was used the Donabedian model. The study population consisted of children between six and 12 years age and their family. Interviews were recorded and data analyzed in the light of the thematic analysis. Results: We interviewed 19 children and 19 family members between october 2016 and may 2017. The results on the perception of satisfaction with pain management in the emergency room constituted theme 1: Children\'s and their families perceived satisfaction, composed of three sub-themes: \"Priority in care\", \"quick pain relief\" and \"warm welcome at the hospital\". Children\'s perceived satisfaction, composed of one sub-theme: \"Basic needs met\". Families perceived satisfaction, composed of one sub-theme: \"Investigation of symptoms\". And the results on the perception of dissatisfaction with pain management in the emergency room constituted theme 2: Children\'s and their families perceived satisfaction, composed of one sub-theme: \"Delays in relieving pain\". Children\'s perceived dissatisfaction composed of with two sub-themes: Painful Procedures \"and\" Uncomfortable Environment\". Families perceived dissatisfaction composed of one sub-theme: \"Delays in the results of the exams\". Conclusion: We observed that the satisfaction of the child and his/her family with pain management was beyond pain relief or priority care. Also included the environment and the warm welcome given by the healthcare team. We recommend that the care provided by the health professional be directed to the singularities of each child and their family.
35
Remes, J. (Jukka). "Method evaluations in spatial exploratory analyses of resting-state functional magnetic resonance imaging data." Doctoral thesis, Oulun yliopisto, 2013. http://urn.fi/urn:isbn:9789526202228.
Full textAbstract:
Abstract Resting-state (RS) measurements during functional magnetic resonance imaging (fMRI) have become an established approach for studying spontaneous brain activity. RS-fMRI results are often obtained using explorative approaches like spatial independent component analysis (sICA). These approaches and their software implementations are rarely evaluated extensively or specifically concerning RS-fMRI. Trust is placed in the software that they will work according to the published method descriptions. Many methods and parameters are used despite the lack of test data, and the validity of the underlying models remains an open question. A substantially greater number of evaluations would be needed to ensure the quality of exploratory RS-fMRI analyses. This thesis investigates the applicability of sICA methodology and software in the RS-fMRI context. The experiences were used to formulate general guidelines to facilitate future method evaluations. Additionally, a novel multiple comparison correction (MCC) method, Maxmad, was devised for adjusting evaluation results statistically. With regard to software considerations, the source code of FSL Melodic, popular sICA software, was analyzed against its published method descriptions. Unreported and unevaluated details were found, which implies that one should not automatically assume a correspondence between the literature and the software implementations. The method implementations should rather be subjected to independent reviews. An experimental contribution of this thesis is that the credibility of the emerging sliding window sICAs has been improved by the validation of sICA related preprocessing procedures. In addition to that, the estimation accuracy regarding the results in existing RS-fMRI sICA literature was also shown not to suffer even though repeatability tools like Icasso have not been used in their computation. Furthermore, the evidence against conventional sICA model suggests the consideration of different approaches to analysis of RS-fMRI. The guidelines developed for facilitation of evaluations include adoption of 1) open software development (improved error detection), 2) modular software designs (easier evaluations), 3) data specific evaluations (increased validity), and 4) extensive coverage of parameter space (improved credibility). The proposed Maxmad MCC addresses a statistical problem arising from broad evaluations. Large scale cooperation efforts are proposed concerning evaluations in order to improve the credibility of exploratory RS-fMRI methods<br>Tiivistelmä Aivoista toiminnallisella magneettikuvantamisella (engl. functional magnetic resonance imaging, fMRI) lepotilassa tehdyt mittaukset ovat saaneet vakiintuneen aseman spontaanin aivotoiminnan tutkimuksessa. Lepotilan fMRI:n tulokset saadaan usein käyttämällä exploratiivisia menetelmiä, kuten spatiaalista itsenäisten komponenttien analyysia (engl. spatial independent component analysis, sICA). Näitä menetelmiä ja niiden ohjelmistototeutuksia evaluoidaan harvoin kattavasti tai erityisesti lepotilan fMRI:n kannalta. Ohjelmistojen luotetaan toimivan menetelmäkuvausten mukaisesti. Monia menetelmiä ja parametreja käytetään testidatan puuttumisesta huolimatta, ja myös menetelmien taustalla olevien mallien pätevyys on edelleen epäselvä asia. Eksploratiivisten lepotilan fMRI-datan analyysien laadun varmistamiseksi tarvittaisiin huomattavasti nykyistä suurempi määrä evaluaatioita. Tämä väitöskirja tutki sICA-menetelmien ja -ohjelmistojen soveltuvuutta lepotilan fMRI-tutkimuksiin. Kokemuksien perusteella luotiin yleisiä ohjenuoria helpottamaan tulevaisuuden menetelmäevaluaatioita. Lisäksi väitöskirjassa kehitettiin uusi monivertailukorjausmenetelmä, Maxmad, evaluaatiotulosten tilastolliseen korjaukseen. Tunnetun sICA-ohjelmiston, FSL Melodicin, lähdekoodi analysoitiin suhteessa julkaistuihin menetelmäkuvauksiin. Analyysissa ilmeni aiemmin raportoimattomia ja evaluoimattomia menetelmäyksityiskohtia, mikä tarkoittaa, ettei kirjallisuudessa olevien menetelmäkuvausten ja niiden ohjelmistototeutusten välille pitäisi automaattisesti olettaa vastaavuutta. Menetelmätoteutukset pitäisi katselmoida riippumattomasti. Väitöskirjan kokeellisena panoksena parannettiin liukuvassa ikkunassa suoritettavan sICA:n uskottavuutta varmistamalla sICA:n esikäsittelyjen oikeellisuus. Lisäksi väitöskirjassa näytettiin, että aiempien sICA-tulosten tarkkuus ei ole kärsinyt, vaikka niiden estimoinnissa ei ole käytetty toistettavuustyökaluja, kuten Icasso-ohjelmistoa. Väitöskirjan tulokset kyseenalaistavat myös perinteisen sICA-mallin, minkä vuoksi tulisi harkita siitä poikkeavia lähtökohtia lepotilan fMRI-datan analyysiin. Evaluaatioiden helpottamiseksi kehitetyt ohjeet sisältävät seuraavat periaatteet: 1) avoin ohjelmistokehitys (parantunut virheiden havaitseminen), 2) modulaarinen ohjelmistosuunnittelu (nykyistä helpommin toteutettavat evaluaatiot), 3) datatyyppikohtaiset evaluaatiot (parantunut validiteetti) ja 4) parametriavaruuden laaja kattavuus evaluaatioissa (parantunut uskottavuus). Ehdotettu Maxmad-monivertailukorjaus tarjoaa ratkaisuvaihtoehdon laajojen evaluaatioiden tilastollisiin haasteisiin. Jotta lepotilan fMRI:ssä käytettävien exploratiivisten menetelmien uskottavuus paranisi, väitöskirjassa ehdotetaan laaja-alaista yhteistyötä menetelmien evaluoimiseksi
36
Nordesjö, Olle, Victor Pontén, Stephanie Herman, Joel Ås, Sabri Jamal, and Alona Nyberg. "Ett sannolikhetsbaserat kvalitetsmått förbättrar klassificeringen av oförväntade sekvenser i in situ sekvensering." Thesis, Uppsala universitet, Institutionen för biologisk grundutbildning, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-225999.
Full textAbstract:
In situ sekvensering är en metod som kan användas för att lokalisera differentiellt uttryck av mRNA direkt i vävnadssnitt, vilket kan ge viktiga ledtrådar om många sjukdomstillstånd. Idag förloras många av sekvenserna från in situ sekvensering på grund av det kvalitetsmått man använder för att säkerställa att sekvenser är korrekta. Det finns troligtvis möjlighet att förbättra prestandan av den nuvarande base calling-metoden eftersom att metoden är i ett tidigt utvecklingsskede. Vi har genomfört explorativ dataanalys för att undersöka förekomst av systematiska fel och korrigerat för dessa med hjälp av statistiska metoder. Vi har framförallt undersökt tre metoder för att korrigera för systematiska fel: I) Korrektion av överblödning som sker på grund avöverlappande emissionsspektra mellan fluorescenta prober. II) En sannolikhetsbaserad tolkningav intensitetsdata som resulterar i ett nytt kvalitetsmått och en alternativ klassificerare baseradpå övervakad inlärning. III) En utredning om förekomst av cykelberoende effekter, exempelvisofullständig dehybridisering av fluorescenta prober. Vi föreslår att man gör följande saker: Implementerar och utvärderar det sannolikhetsbaserade kvalitetsmåttet Utvecklar och implementerar den föreslagna klassificeraren Genomför ytterligare experiment för att påvisa eller bestrida förekomst av ofullständigdehybridisering<br>In situ sequencing is a method that can be used to localize differential expression of mRNA directly in tissue sections, something that can give valuable insights to many statest of disease. Today, many of the registered sequences from in situ sequencing are lost due to a conservative quality measure used to filter out incorrect sequencing reads. There is room for improvement in the performance of the current method for base calling since the technology is in an early stage of development. We have performed exploratory data analysis to investigate occurrence of systematic errors, and corrected for these by using various statistical methods. The primary methods that have been investigated are the following: I) Correction of emission spectra overlap resulting in spillover between channels. II) A probability-based interpretation of intensity data, resulting in a novel quality measure and an alternative classifier based on supervised learning. III) Analysis of occurrence of cycle dependent effects, e.g. incomplete dehybridization of fluorescent probes. We suggest the following: Implementation and evaluation of the probability-based quality measure Development and implementation of the proposed classifier Additional experiments to investigate the possible occurrence of incomplete dehybridization
37
Oliveira, Carlos Augusto Cardim de. ""Prática de medicina baseada em evidências em um centro de tratamento intensivo pediátrico"." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-13082005-173825/.
Full textAbstract:
Objetivos: Estimar a concordância entre as práticas e as evidências disponíveis em uma unidade de terapia intensiva pediátrica. Métodos: Estudo retrospectivo de todos os pacientes internados durante 2001. As práticas foram classificadas em adequadas ou não-adequadas de acordo com recomendações. Esperava-se para as práticas recomendadas 90% de concordância, para as contra-indicadas, discordância de até 10% e para aquelas onde havia incertezas, 50%. Resultados: Foram selecionadas 114 publicações e avaliadas 253/275 internações (92%). O uso foi considerado apropriado para albumina em 47,6% (IC 95% 39% 55%); dopamina <3mg/kg/min 87,9% (83% 92%); sedação e analgesia 88,6% (87% 90%); transfusões de concentrado de hemácias 95,2% (92% 97%); profiliaxia de úlcera de estresse 89,7% (88% 91%).<br>Objectives: Estimate the concordance between the practices and the evidence available in a pediatric intensive care unit. Methods: Retrospective study of all admitted patients during 2001. The practices were classified as adequate or non-adequate according to recommendations. It was expected 90% concordance for the recommended practices, while for non-adequate practices, discordance until 10% and for those where there was doubt, 50%. Results: 114 publications were selected and 253/275 admissions (92%) were evaluated. Use was considered appropriate for albumin in 47.6% (IC 95% 39% 55%); dopamine <3mg/kg/min 87.9% (83% 92%); sedation and analgesia 88.6% (87% 90%); red blood cell transfusions 95.2% (92% 97%); stress ulcer prophylaxis 89.7% (88% 91%).
38
Wallace, William Emory, and James Louis Dillard. "Quality Assurance/Risk Management in the Naval Medical Command." Thesis, 1985. http://hdl.handle.net/10945/21515.
Full text
39
Ho, Jui-Min, and 何瑞明. "The Study of Medical Device GMP and Medical Device Quality Assurance in Hospital." Thesis, 2000. http://ndltd.ncl.edu.tw/handle/46552416038076615512.
Full textAbstract:
碩士<br>中原大學<br>醫學工程學系<br>88<br>Everybody has a close relationship with medication in his/her process of growth and fading. The medical device is a leading player in diagnosis & therapy of the process of medication. The quality of medical device projects direct influence on the users. The inferior quality of medical device affects the safety of consumers, even threatens the life. The consequence can be fatal. As the consequence of technological advancement, the varieties & functions of medical device are becoming more and more sophisticated. The utilization ratio increases, too. Without strict control in the process of production, the medical device will create permanent injuries.
The ultimate goal of manufacturing medical device is for clinical application in diagnosis & therapy for human body’s health. However, the success of medical device’s development merely represents 1/3 of R&D. The subsequent clinical investigation & validation and the monitor & correction during post-market are the most important port in the overall research and development of medical devices.
Pursuant to the regulation of Federal Register of U.S., the Food and Drug Administration (FDA) announced the enforcement of medical device GMP in 1978. Since then, all medical devices market into the United Stated are required to comply with the GMP requirements. The Department of Health (DOH) and the Ministry of Economic Affairs (MOEA) announced “Notice for Execution of Medical Device GMP” on August 10, 1998, effective from February 10, 1999.
The Medical Device GMP signifies our country’s medical device management system’s movement toward global harmonization with International Standard ISO 13485: 1996 which was initiated based on FDA’s experience of current GMP inspection. Now ISO 9001/2 have become the minimum requirements of quality for all industries. On the other hand, the Medical Device GMP is a regulation initiated specifically for local and foreign manufacturers who market medical devices into R.O.C.
The utilization of medical device affects patient’s lives directly. Therefore, the requirements for quality and safety are much higher than other industrial products. The specific requirements for the safety and functions of medical devices have reconciled the administration systems and products inspections of the United Stated and European countries. Now, the inspection of medical device entails product life-cycle management, including all phases of R&D, production, utilization and recycling.
This research project is made with the hope that the quality of medical device and the clinical application can be warranted in line with the Medical Device GMP announced by government, thus provides the quality-assured medical services to the general public.
40
Su, Chih-Fen, and 蘇志棻. "Applying IDEF0 Models to Studies of Quality Assurance System of Medical Device Industry." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/9k65q2.
Full textAbstract:
碩士<br>朝陽科技大學<br>工業工程與管理系碩士班<br>91<br>The manufacturers of medical products should ensure that their products are of a high standard in order to not endanger the health of their patients. If flaws in the product occurred, and these were found to be the result of lack of inspections during the manufacturing process, the result could be disastrous for the manufacturers and the entire industry as a whole. In this study, all researches and analyse have been made by the IDEF0 models, resulting in the proposed quality system as a hypothesis of this study. ISO documents have been drawn up from the flow chart models.The subjects of this study include the Membership Factories of Taiwan Medical Industry Association. This study explores how quality systems have been carried out among domestic medical device manufacturers and their current situation through industrial interviews and questionnaire investigations. Furthermore, the study makes evaluations on the outcomes after IDEF0 flow chart models have been applied to medical device industries. The main subjects of the evaluations are those who are willing to carry into execution, those who are executing, and those who have already passed ISO 9000, EN 46000, QSR 21CFR Part820, ISO 13485, Medical Device GMP, CE MDD, FDA 510K, the certification standards of medical device.
In light of references relative to this study, the diversities among a series of verification standards have been made by means of comparing the above standards and medical device manufacturers. The findings from questionnaires, investigations and other gathered information shows the current situation of how qualification certifications and product verifications are executed by domestic medical device manufacturers. The analyses of the situation also incorporate the experiences of those who have passed the above certification standards. The outcome of this study is coherent with the researcher’s expectation which can be established as a flawless quality management system, equipped with structure models.
We look forward to providing enterprises with a flawless model, IDEF0, quality assurance system, to analyze, plan and integrate their products, and to ensure the products’ coherence and integration in every operational process. Besides, the quality assurance, drawn by IDEF0 models, can also be used to evaluate the tools of the IDEF0 models and to see if it could be effectively applied to QA system in all medical device manufacturers. If the system is applied, not only will the quality of medical device products be heightened, but the regulations in our country will be acceptable to the European and American markets.
41
Kumar, Saravana. "Health service quality in Australian private sector physiotherapy and chiropratics :." 2005. http://arrow.unisa.edu.au:8081/1959.8/81678.
Full textAbstract:
The decreasing Australian health dollar requires closer scrutiny on what outcome is purchased for it. Quality outcomes are produced by quality services, it is important to identify the constructs of quality care from individual stakeholders' perspectives. Empirical research on quality constructs is limited to medical and nursing literature. Within Physiotherapy and Chiropractics, little research has been undertaken to examine the constructs of quality care from individual stakeholder perspectives, or to develop monitoring systems that reflect the nature and philosophy of Physiotherapy and Chiropractic care<br>This research explored and expanded upon current knowledge on the constructs of quality and current quality monitoring standards within Physiotherapy and Chiropractic private sector services in Australia. This research explored individual primary stakeholder perspectives of quality (patients, providers and funders). The study identified factors that acted as barriers and incentives in the provision of quality care. This research generated a model of innovative quality monitoring strategies, which reflected stakeholders' perspectives, and could be utilised across private and public funding sectors<br>This research utilised a mixed method approach of qualitative and quantitative research paradigms. The main methods comprised of interviews with key stakeholders, surveys of patient's perspectives of quality care and an educational outreach program for providers<br>The findings highlight the multi-dimensional and multifactorial nature of health care quality and its constructs from the perspectives of different stakeholders. Patients and providers' expectations of quality were congruent and contained quality constructs ranging across structure, process and outcome dimensions. This research identified that patient expectations of quality are underpinned by patient-centred care and effective communication between patient and provider. In contrast, funders' perspectives of quality were unidimensional with predominant emphasis on cost of services. This study found funders' monitoring standards were inadequate in identifying poor practices or providing incentives to improve practice. This research provided ways in which funding agencies could continue to use traditional methods of monitoring (such as costs) as well as employing innovative strategies such as patient perspectives on the quality of care they would receive<br>This research provides the first known evaluation approach for patients to provide feedback on their expectations of quality of Physiotherapy and Chiropractic services. The unique evaluation instrument is profession-specific and it considers patients' expectations using an episode-of-care model rather than the traditional occasion-of-service model. The findings from the survey of Physiotherapy and Chiropractic patients identified the importance of meeting patient expectations prior to, during, and after, the first occasion-of-service with the provider in the episode, and then at three subsequent service points in the episode<br>This research identified providers' perspectives of an educational outreach program, which aimed to inform and educate them regarding the quality of care they provided. The findings indicated that providers were genuinely interested in uptake of patient feedback into clinical practice. Numerous dissemination strategies were possible within their practices and within their profession<br>This explanatory research is the first of its kind in providing foundational research evidence on the constructs of quality within private practice Physiotherapy and Chiropractics from different stakeholders' perspectives. It has also established that patients can be effectively engaged in monitoring quality of care. The findings highlight that patient expectations of quality vary throughout an episode-of-care and this needs to be recognised by other stakeholders in quality monitoring and quality improvement initiatives. The findings from this research can form the basis for future research in examining relationships of constructs of quality across other patient populations with other Allied Health disciplines, and in testing innovative quality improvement initiatives<br>Thesis (PhD)--University of South Australia, 2005
42
Quental, Ana Raquel de Pinho Sousa. "Quality assurance applied to biotechnology products mostly used for clinical studies." Dissertação, 2019. https://hdl.handle.net/10216/124428.
Full text
43
Quental, Ana Raquel de Pinho Sousa. "Quality assurance applied to biotechnology products mostly used for clinical studies." Master's thesis, 2019. https://hdl.handle.net/10216/124428.
Full text
44
YANG, WEN-YUAN, and 楊雯媛. "A study of establishing quality assurance indicators in medical centers with a special referance to cataract extractions." Thesis, 1992. http://ndltd.ncl.edu.tw/handle/52805983011989532846.
Full text
45
Alshammari, Meshari Turki. "Treatment planning and dosimetric verification of cyberknife prostate SBRT (stereotactic body radiation therapy) on an MR-based 3D prostate model imaging insert in a pelvis phantom." Thesis, 2016. https://hdl.handle.net/2144/16805.
Full textAbstract:
Purpose of this study was to validate a novel CyberKnife stereotactic body radiotherapy (SBRT) treatment planning on an MRI-based 3D prostate model insert in an anthropomorphic pelvis phantom using Gafchromic EBT3 films to perform dosimetric measurements. The methodology of this study is based on a pelvis phantom and a physical printed 3D model of the prostate with dominant intra-prostatic-lesion and surrounding organs at risk segmented from a patient MR images. Cyberknife prostate treatment planning was performed to have at least 95% the planning target volumes (PTV: prostate expanded with margins of 5 mm in all directions except 3 mm posteriorly) covered by 3625 cGy (725x5) and a simultaneous dose escalation to 4750 cGy on the dominant intra-prostatic-lesion. Plan dosimetry verification was performed using Gafchromic EBT3 films on a Stereotactic Dose Verification Phantom. First, film calibration was done on Gafchromic EBT3 films exposed to various doses of 0-2500 cGy based on a LINAC (Trilogy) and CyberKnife monthly quality assurance (QA) for machine output calibration. Second, absolute dose measurements were taken by using films within the dose range 0-2250 cGy. Third, Gafchromic EBT3 films were placed in coronal and sagittal planes on the standard “blue phantom” or Stereotactic Dose Verification Phantom (SDVP) on which one fraction of the treatment plan is delivered for verification measurements. Then, on the prostate-pelvis phantom, a dosimetry inserts were used with films through the DIL region. After the calibration, the accuracy of absolute dose measurements with EBT3 was verified to be ≤ 1% in the dose range of interest (500-1500 cGy). On the SDVP phantom, comparison of films vs. plan for the coronal plane yielded ≥ 99.7% passing rates while for sagittal plane yielded ≥ 95.3% passing rates under the gamma criteria of ≤ 2% in dose and ≤ 2mm in distance to agreement (DTA). This study demonstrated that it is feasible to plan and deliver a SBRT treatment to prostate with a simultaneous dose escalation to the dominant intra-prostatic lesion.
46
Skull, John. "Quality assurance for pig carcasses: a study of bacterial contamination at domestic abattoirs in South Australia." 2004. http://arrow.unisa.edu.au:8081/1959.8/28284.
Full textAbstract:
This study of four domestic abattoirs in South Australia with Quality Assurance programmes in place established the size of bacterial populations that could be expected on pig carcasses on entry to abattoir dressing floors at pre-evisceration, the extent of contamination occurring during carcass dressing, and the effect of chilling on these populations. Analysis was conducted for salmonellae, Escherichia coli, Total Viable Count, and pseudomonads. Exterior swabbing was compared to swabbing of corresponding interior sites which are sterile initially. The interior swabbing sites were found to be a more reliable measure of contamination during the dressing process than the swabbing of already contaminated exterior sites. During the identification of some of the points of carcass contamination, the effectiveness of end-of-work foam cleaning programmes used at abattoir dressing floors and their relationship to the potential for airborne contamination of carcasses was examined and found to be positive. Operators' work tools and hands were identified as sources of interior carcass contamination combined with failure of operators to adhere to Standard Operating Procedures (SOPs) during carcass dressing, especially those related to hand and forearm washing at appropriate times. Foot-operated full-immersion hot water units for operators' knives and steels were designed and installed at two abattoirs to give operators access to physically and biologically clean work tools throughout carcass dressing.<br>PhD Doctorate
47
Maynard, Evan David. "Evaluation of a Helical Diode Array and Planned Dose Perturbation Model for Pretreatment Verification of Volumetric Modulated Arc Therapy." Thesis, 2013. http://hdl.handle.net/1828/4932.
Full textAbstract:
The ArcCHECK dosimeter is a novel dosimetry tool that uses a helical array of silicon diode detectors to measure dose in a cylindrical plane. 3DVH is an associated software that can use ArcCHECK diode measurements along with treatment planning system (TPS) data to guide a full 3D dose reconstruction. The ArcCHECK phantom, along with 3DVH software was evaluated as a volumetric modulated arc therapy (VMAT) pretreatment verification tool. The comprehensive evaluation of the ArcCHECK and 3DVH system involved a comparison of measured dose to both ECLIPSE and Monte Carlo calculated dose for open fields and intensity modulated radiation therapy (IMRT) plans. System based confidence limits for gamma-pass rate and dose difference metrics were established through the measurement of prostate and head and neck VMAT plans. Using the system based confidence limits and clinically accepted tolerances, the sensitivity of the ArcCHECK and 3DVH system to VMAT errors was determined. Dose measured by the ArcCHECK and reconstructed in 3DVH agreed very well with dose calculated in ECLIPSE and Monte Carlo for both open fields and IMRT plans. The only results that fell outside of clinically accepted tolerances were a set of head and neck IMRT plans, however it was determined that a major factor in this result was suboptimal modelling of MLC effects in the TPS, in combination with changes in linac performance since commissioning of the TPS model. VMAT measured by the ArcCHECK and 3DVH system were in excellent agreement with ECLIPSE results and system based confidence limits were determined to be tighter than commonly used limits. ArcCHECK and 3DVH were sensitive to clinically relevant VMAT errors and insensitive to errors with little dosimetric impact, although diode measurements alone required tighter tolerances than are typically used. The ArcCHECK phantom and 3DVH software when used together have been shown to provide useful dosimetric information when used for VMAT pretreatment verification.<br>Graduate<br>0756
48
Yang, Tsung-han, and 楊宗翰. "Quality assurance in medical laboratory which is being guided to ISO 15189 - the case study of south area in Taiwan." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/72893058471048380001.
Full textAbstract:
碩士<br>淡江大學<br>管理科學研究所企業經營碩士在職專班<br>93<br>The purpose of this study is to understand the current status of the Taiwan south area public and private hospitals laboratory, which are being guided by ISO 15189 (International Organization for Standard 15189). The methodology of this research is including documents analysis and questionnaire which random from Yunlin County, Chiayi City, Chiayi County, Tainan City, and Tainan County will be the samples. The questionnaire is analysed to understand problems and relevant methods proposed by the hospitals medical technologist being guided to ISO 15189.
The findings of this research are as follows: First, the general opinion of the whole elementary for IOS 15189 application for hospitals laboratory is leveled as upper degree. Second, difficulty that may meet is in order to practice ISO 15189 in the medical laboratory: lack the professional technical adviser and offer consultation; the staffs of the laboratory is insufficient; staff''s cognition degree in the laboratory is not enough; difficulty that the standard documents is made; the staff are difficult in education and training; the funds are too high; staff''s psychology is resisted; the leaders of hospital are determined to be insufficient; other suggestions. Third, what has been practice ISO 15189 in the medical laboratory is because of in conformity with the measure is in order: handling education and training to improve the staff’s knowledge; set up the procedure within the laboratory and plan the consistency with the quality administrative system; the administrative department of the hospital compiles the budget to subsidize; increase the staff of the laboratory; overall computerization of inspection information; engage and employ specialized management / coach in the consultant firm of authentication; set up the assessment criteria of the performance, condense common understandings of staff; Increase and employ the part-time staff; other suggestions .
The suggestions of this research are as follows: First, suggestion on the medical laboratory: (1) Strengthen the personnel''s cognition for ISO 15189, and fully understand its intension and application. (2) To promote the personnel''s identification with system of laboratory accreditation, concentrate the resources, whole participation promotes the quality in laboratory medicine. (3) Set up the laboratory quality system and improve continuously, in order to promote the quality in laboratory medicine. (4) Fully grasp the demands of medical personnel and patient, offer appropriate medical technological quality and service. (5) Expanding the medical laboratory becomes the learning type organization, to promote medical technological quality continuously. (6) Collect and analyse the medical laboratory information extensively, as the objective basis that is improved continuously. Second, suggestion on the administrative department of hospital and the colleges of medical technology: (1) The administrative department of hospital should compile the budget and support to help the medical laboratory accreditation by ISO 15189. (2) The colleges of medical technology should Institute the clinical laboratory management course.
49
Eckermann, Simon. "Hospital performance including quality : creating economic incentives consistent with evidence-based medicine /." 2004. http://www.library.unsw.edu.au/~thesis/adt-NUN/public/adt-NUN20051018.135506/index.html.
Full text
50
Li, Taoran. "Towards the Clinical Implementation of Online Adaptive Radiation Therapy for Prostate Cancer." Diss., 2013. http://hdl.handle.net/10161/7154.
Full textAbstract:
<p>The online adaptive radiation therapy for prostate cancer based on re-optimization has been shown to provide better daily target coverage through the treatment course, especially in treatment sessions with large anatomical deformation. However, the clinical implementation of such technique is still limited primarily due to two major challenges: the low efficiency of re-optimization and the lack of online quality assurance technique to verify delivery accuracy. This project aims at developing new techniques and understandings to address these two challenges. </p><p>The study was based on retrospective study on patient data following IRB-approved protocol, including both planning Computer Tomography (CT) and daily Cone-Beam Computer Tomography (CBCT) images. The project is divided in to three parts. The first two parts address primarily the efficiency challenge; and the third part of this project aims at validating the deliverability of the online re-optimized plans and developing an online delivery monitoring system. </p><p><bold>I. Overall implementation scheme.</bold> In this part, an evidence-based scheme, named Adaptive Image-Guided Radiation Therapy (AIGRT), was developed to integrate the re-optimization technique with the current IGRT technique. The AIGRT process first searches for a best plan for the daily target from a plan pool, which consists the original CT plan and all previous re-optimized plans. If successful, the selected plan is used for the daily treatment with translational shifts. Otherwise, the AIGRT invokes re-optimization process of the CT plan for the anatomy-of-the-day, which is added to the plan pool afterwards as a candidate plan for future fractions. The AIGRT scheme is evaluated by comparisons with daily re-optimization and online repositioning techniques based on daily target coverage, Organ-at-Risk (OAR) sparing and implementation efficiency. Simulated treatment courses for 18 patients with re-optimization alone, re-positioning alone and AIGRT shows that AIGRT offers reliable daily target coverage that is highly comparable to re-optimization everyday and significantly improves compared to re-positioning. AIGRT is also seen to provide improved organs-at-risk (OARs) sparing compared to re-positioning. Apart from dosimetric benefits, AIGRT in addition offers an efficient scheme to integrate re-optimization to current re-positioning-based IGRT workflow.</p><p><bold>II. Strategies for automatic re-optimization.</bold> This part aims at improving the efficiency of re-optimization through automation and strategic selections of optimization parameters. It investigates the strategies for performing fast (~2 min) automatic online re-optimization with a clinical treatment planning system; and explores the performance with different input parameters settings: the DVH objective settings, starting stage and iteration number (in the context of real time planning). Simulated treatments of 10 patients were re-optimized daily for the first week of treatment (5 fractions) using 12 different combinations of optimization strategies. Options for objective settings included guideline-based RTOG objectives, patient-specific objectives based on anatomy on the planning CT, and daily-CBCT anatomy-based objectives adapted from planning CT objectives. Options for starting stages involved starting re-optimization with and without the original plan's fluence map. Options for iteration numbers were 50 and 100. The adapted plans were then analysed by statistical modelling, and compared both in terms of dosimetry and delivery efficiency. The results show that all fast online re-optimized plans provide consistent coverage and conformity to the daily target. For OAR sparing however, different planning parameters led to different optimization results. The 3 input parameters, i.e. DVH objectives, starting stages and iteration numbers, contributed to the outcome of optimization nearly independently. Patient-specific objectives generally provided better OAR sparing compared to guideline-based objectives. The benefit in high-dose sparing from incorporating daily anatomy into objective settings was positively correlated with the relative change in OAR volumes from planning CT to daily CBCT. The use of the original plan fluence map as the starting stage reduced OAR dose at the mid-dose region, but increased 17% more monitor units. Only < 2cc differences in OAR V50% / V70Gy / V76Gy were observed between 100 and 50 iterations. Based on these results, it is feasible to perform automatic online re-optimization in ~2 min using a clinical treatment planning system. Selecting optimal sets of input parameters is the key to achieving high quality re-optimized plans, and should be based on the individual patient's daily anatomy, delivery efficiency and time allowed for plan adaptation. </p><p><bold>III. Delivery accuracy evaluation and monitoring.</bold> This part of the project aims at validating the deliverability of the online re-optimized plans and developing an online delivery monitoring system. This system is based on input from Dynamic Machine Information (DMI), which continuously reports actual multi-leaf collimator (MLC) positions and machine monitor units (MUs) at 50ms intervals. Based on these DMI inputs, the QA system performed three levels of monitoring/verification on the plan delivery process: (1) Following each input, actual and expected fluence maps delivered up to the current MLC position were dynamically updated using corresponding MLC positions in the DMI. The difference between actual and expected fluence maps creates a fluence error map (FEM), which is used to assess the delivery accuracy. (2) At each control point, actual MLC positions were verified against the treatment plan for potential errors in data transfer between the treatment planning system (TPS) and the MLC controller. (3) After treatment, delivered dose was reconstructed in the treatment planning system based on DMI data during delivery, and compared to planned dose. FEMs from 210 prostate IMRT beams were evaluated for error magnitude and patterns. In addition, systematic MLC errors of ±0.5 and ±1 mm for both banks were simulated to understand error patterns in resulted FEMs. Applying clinical IMRT QA standard to the online re-optimized plans suggests the deliverability of online re-optimized plans are similar to regular IMRT plans. Applying the proposed QA system to online re-optimized plans also reveals excellent delivery accuracy: over 99% leaf position differences are < 0.5 mm, and the majority of pixels in FEMs are < 0.5 MU with errors exceeding 0.5 MU primarily located on the edge of the fields. All clinical FEMs observed in this study have positive errors on the left edges, and negative errors on the right. Analysis on a typical FEM reveals positive correlation between the magnitude of fluence errors and the corresponding leaf speed. FEMs of simulated erroneous delivery exhibit distinct patterns for different MLC error magnitudes and directions, indicating the proposed QA system is highly specific in detecting the source of errors. Based on these results, it can be concluded that the proposed online delivery monitoring system is very sensitive to leaf position errors, highly specific of the error types, and therefore meets the purpose for online delivery accuracy verification. Post-treatment dosimetric verification shows minimal difference between planned and actual delivered DVH, further confirming that the online re-optimized plans can be accurately delivered.</p><p>In summary, this project addressed two most important challenges for clinical implementation of online ART, efficiency and quality assurance, through innovative system design, technique development and validation with clinical data. The efficiencies of the overall treatment scheme and the re-optimization process have been improved significantly; and the proposed online quality assurance system is found to be effective in catching and differentiating leaf motion errors.</p><br>Dissertation