Дисертації з теми "Inpatient teaching"

Behavioral science faculty (BSF) who work in family medicine residency education find themselves in inpatient medicine teaching service settings. However, there is limited research on the roles and responsibilities that BSF fill while working in inpatient medicine teaching services within family medicine residencies. The purpose of the present modified sequential explanatory study was to clarify the roles of BSF and how the BSF responsibilities inform training of mental health clinicians. The convenience sample for quantitative analysis included 60 BSF who currently work on an inpatient medicine teaching service and completed a web-based survey on contextual demographics and roles on inpatient medicine teaching service. The convenience sample for qualitative analysis included 24 BSF who participated in a semi-structured interview about the roles and responsibilities on an inpatient medicine teaching service. Results suggest that behavioral science faculty members assume the roles of Educator, Administrator, Patient Care Supporter, Evaluator, Scholar/Researcher, Community Service Liaison, Mentor/Advisor, and Gatekeeper, and perform multiple responsibilities within each role. I will identify the responsibilities within each role that BSF fill in inpatient medicine teaching services using qualitative analysis and explore discrepancies between previous frameworks and this study's outcomes. Implications for this research will help to inform the hiring process for behavioral science faculty, resident education, and comprehensive behavioral science faculty and marriage and family therapy training.
Ph. D.

The present investigation examined characteristic, symptomatic, and familial predictors of long-term symptom severity of eating disorders. The purpose of the study was to determine if, after accounting for a number of known predictors of outcome, familial variables explained a significant amount of additional variance in disordered eating and general well-being scores measured at post-treatment follow-up. The sample included 398 women, ages 13 to 56, who had completed eating disorder treatment at an inpatient facility. Hierarchal multiple regression analysis demonstrated that familial predictors at admission to treatment did significantly predict long-term outcomes, while changes from admission to treatment in symptoms and perceptions of parents did not predict recovery. Patients' relationships with their fathers significantly contributed to the regression model. Recommendations for future investigations are discussed.

The present study examined whether perceptions of parents, peers, romantic partners and God were predictive of eating disorder symptom severity among women in treatment for eating disorders. The sample included 417 women (ages 12 to 56 years) at an inpatient treatment facility for eating disorders. Participants completed a battery of assessment measures at intake and discharge. Change scores were also computed on all measures. Measures included indices of eating disorder symptomology, parental relationships, peer relationships, romantic partner relationships, and religious well-being. Multiple regression analysis showed perceptions of peers and romantic partner to be significant predictors in all analyses; however perceptions of God failed to predict eating disorder symptom severity in all but one analysis. Differences between perceptions of mothers and fathers were also found. Implications and recommendations for future research are discussed.

Current empirical evidence suggests that true recovery from eating disorders is not possible without a corresponding improvement in body image and self-esteem. Ten studies in current literature evaluate this relationship between self-esteem and clinical eating disorders during inpatient treatment or during follow-up studies but do not provide both pre- (baseline) and post-treatment self-esteem scores. As a result, many questions about the nature of the relationship between eating disorders and self-esteem remain unanswered. The purpose of this study was to empirically investigate whether a comprehensive measure of self-esteem, given to women at the beginning of inpatient treatment for eating disorders, reliably predicted treatment outcome. Specific and global levels of self-esteem were determined by the Multidimensional Self-Esteem Inventory (MSEI). Pearson Product Moment Correlations run on SPSS 10 were used to determine significant results. Participants in this study included 246 women experiencing anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified who received inpatient treatment at the Center for Change (CFC), in Orem, Utah, during the years 1996 to 2003. For the purposes of this study, outcome was measured upon termination of treatment at the Center for Change. CFC discharge was based on clinical judgment of progression through the treatment program, medical stability, reduction of purging behaviors, body weight, as well as attainment of additional treatment goals designed by the therapist. The results of the current study replicate earlier research that reports that positive treatment outcome is nearly always associated with high self-esteem at discharge. These findings extend earlier research by suggesting that high levels of self-esteem at admission are associated with positive treatment outcome. This investigation, which is the first to examine self-esteem change scores between admission and discharge, found that women who experience the greatest decrease in eating disorder symptomatology are those who presented at admission with low self-esteem. Further, a significant association was found between improvements in self-esteem and decreases in eating disorder symptomatology. These findings suggest that the women who report high self-esteem at admission, or women who have low self-esteem but make dramatic improvements by discharge, are likely to experience significant reductions in disordered eating behaviors.

Antimicrobial resistance is a significant global health problem. Misuse of antibiotics is associated with antimicrobial resistance which presents clinicians with treatment challenges and increases the complexity of the decision making process related to the selection of appropriate antibiotic therapy. Antibiotic resistant organisms can often lead to nosocomial infections (NIs) and undoubtedly causes patient harm and increases healthcare costs. According to the National Institute of Allergy and Infectious Diseases (NIAID), at least 70% of the nosocomial infections are caused by antibiotic-resistant organisms. In addition to the problem of inappropriate prescribing, the decreased production of antimicrobial agents over the past 25 years has restricted the arsenal of available antimicrobial agents. The combination of inappropriate antibiotic prescribing practices and reduced research and development of new antimicrobial agents have promoted concerns that society may soon return to a pre-antibiotic era. Addressing the attitudes and behaviours that contribute to inappropriate antibiotic prescribing is a potentially effective and immediate solution to the growing antimicrobial resistance problem. Modifying clinicians' prescribing behaviour with antibiotic decision guidelines and highlighting the problematic side of this issue can promote judicious antibiotic prescribing practices. Representing the existing data regarding the use and misuse of antimicrobials in a Lebanese hospital can support and encourage initiating and complying with antibiotic stewardship programs and prescription guidelines. Purpose: The objectives of this study were to determine current levels and trends in prescribing antibiotics to patients in a Lebanese hospital, (2) to identify the factors that physicians considered when deciding to start antibiotics, (3) to explore whether antimicrobial use (empiric, prophylactic, targeted) will change when physicians fill out a form to document why they prescribed antibiotics, (4) to explore whether an increase in bacterial resistance occurs when antimicrobial consumption increases, (5) to explore the clinicians' perception towards antimicrobial use and antimicrobial stewardship program pre- and post- implementation of an antibiotic assessment form, (6) to explore the effect of the implemented antimicrobial stewardship intervention combined with hand hygiene (HH) on healthcare associated infection rate (HAIs) in the hospital. One-year retrospective study in a Lebanese hospital was conducted to determine the percentage of patients who received antimicrobial treatment and to identify the inappropriateness of their use in different hospital departments. A 12-months intervention was then implemented during which all attending physicians were asked to fill an antimicrobial assessment form (AAF) to document their rationale for starting antimicrobial therapy. In addition, this AAF was used to identify factors physicians considered when deciding to prescribe antimicrobials. Data from the AAFs suggested that physicians in the hospital often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start antimicrobial therapy. Data showed that antibiotic consumption and the median duration of empiric and targeted therapies decreased significantly during the intervention period when compared to the pre-intervention period. Antibiotic appropriateness was also increased significantly after the intervention was conducted. In addition, a better understanding of antimicrobial stewardship strategies was also noted by physicians after the implementation of the intervention. On the basis of these results, AAF filling was a successful intervention to reduce antibiotic use and to urge physicians to refer to antibiotic guidelines when initiating an antimicrobial agent. However, additional measures such as automatic stop orders and computer decision support may be easier and useful for reducing the duration of therapy in hospitals.

A forma de tratar os pacientes pode ser ensinada não somente pela teoria e prática formais, mas principalmente pelas atitudes do mestre e pela relação médico paciente que ele estabelece. O principal objetivo deste trabalho é avaliar os efeitos positivos ou deletérios da visita médica em grupo ao leito dos pacientes da Enfermaria da Clínica Médica Geral pois ela pode melhorar ou piorar a ansiedade e a depressão já contidas e instaladas no paciente e testar um modelo de visita médica hospitalar que priorize o paciente enquanto sujeito. Estudaram-se 95 pacientes com idades entre 16 e 65 anos, divididos em três grupos: um com 36 pacientes chamado G0 que passa visita na enfermaria mas não discute à beira do leito; outro com 34 pacientes chamado G1 que passa visita na enfermaria e discute à beira do leito e um novo, experimental, com 25 pacientes chamado G2, com visita na enfermaria e nova forma de discutir ao leito, com participação ativa do paciente em seu processo de recuperação . O Método utilizado foi: todos os pacientes, na véspera da visita, foram submetidos à escala HAD para medir ansiedade e depressão e à parte pré-visita do Questionário de Avaliação da Internação do Paciente da Clínica Médica Geral (QAIPCMG). No dia da visita, após a mesma, reaplicou-se aos três grupos a escala HAD, a parte pós-visita do QAIPCMG , a qual contém um quadro de Sentimentos e Sensações a serem escolhidos como tendo sido sentidos pelos pacientes durante a visita médica, o Teste de Apercepção Temática - TAT, pranchas 1 e 15 e o Questionário Desiderativo. Os critérios de inclusão foram: pacientes com doenças crônicas menores e agudas maiores internados há mais de uma semana e não mais do que duas. Para a análise estatística utilizaram-se os testes: Qui quadrado e Kruskal Wallis. As medidas de ansiedade e depressão da escala HAD pré e pós visita não apresentaram diferenças estatisticamente significantes. O grupo experimental G2, que se apresentou, propôs ao paciente que se sentasse, não usou termos técnicos para discutir o caso, explicou quais eram as medidas propostas para continuar o tratamento, pediu sua autorização para realizar novos exames e procedimentos, olhou e ouviu suas colocações, obteve referências de alegria (p= 0,0009) e tranqüilidade (p= 0,0058) por parte dos pacientes, estatisticamente significantes quando comparados às respostas dos outros dois grupos. O grupo G2 referiu um número maior de aspectos positivos observados na visita médica, (p = 0,0186) se comparados aos grupos G0 e G1. Os testes psicológicos projetivos possibilitaram medir e analisar as capacidades de abstração e elaboração mental de 52% da amostra, apontando que, nos 3 grupos 37,68% dos pacientes, mostrou boa capacidade para elaborar o impacto da internação e da doença, porém 40% apresentou pouca capacidade para conter aspectos negativos de suas personalidades. Conclui-se que, se não se cuidar do que e como se fala, não olhando e ouvindo o paciente, considerando-o como sujeito, a visita médica pode ser iatrogênica.
How to treat patients is something that can be taught not merely by theory and formal practices, but mainly through the teacher’s attitudes and how the physician-patient relationship is established. The main goal of this paper is to assess positive or deleterious effects of a group medical visit to patients’ bedsides at Internal Medicine Infirmary, as visits can improve or worsen anxiety and depression already existing in patients and test a model for hospital medical visits which allocates priority to patients as subjects. 95 patients with ages between 16 and 65 were studied, divided into three groups: one with 36 patients called G0, visiting patients with no discussion at the bedside; another with 34 patients called G1, visited in the infirmary with discussions, and a new, experimental group with 25 patients called G2, with infirmary visits and a new mode of discussion by the bedside, with the patient’s active participation in the recovery process. The method used was: the day before the visit, all patients underwent the HAD scale to measure anxiety and depression and the pre-visit part of the Questionnaire to Assess Hospitalization. On the day of the visit, after the call, the HAD scale was once again applied to the three groups, and the after visit part of the Questionnaire, using the chart on Feelings and Sensations that are selected to reflect patients feelings during the visit, the Theme Apperception Test - TAT, diagrams 1 and 15 and the Desiderative Questionnaire. Inclusion criteria included: patients with minor or greater chronic diseases extending for more than a week, not exceeding two weeks. The following tests were used for statistical analysis: chi square and Kruskal Wallis. The HAD scale measurements of anxiety and depression before and after the visits did not present significant statistical differences. The G2 experimental group introduced itself and proposed to the patient that he/she sit, avoided using technical terms to discuss the case, explained the measures being set forth to continue treatment and requested authorization to carry out new tests and procedures, heard the patient’s comments, obtained references on happiness (p= 0,0009) and calmness (p= 0,0058) expressed by patients that were statistically significant when compared to the responses of the other two groups. Group G2 referred to a greater number of positive aspects observed in the medical visits, (p = 0,0186) when compared to groups G0 and G1. The projective psychological enabled the measurement and analysis of the capacity for abstraction and mental elaboration of 52% of the sample, demonstrating that in the 3 groups, 37,68% of the patients had a good ability to elaborate on the impact of hospitalization and the disease, whilst 40% had little capacity when it came to containing or controlling negative aspects in their personalities. The conclusion therefore is that if no caution is taken on how to speak to patients, if physicians do not look at and listen to patients, considering them as subjects, medical visits may be iatrogenic.

碩士
國立中山大學
醫務管理研究所
96
The purpose of this study is to evaluate the satisfaction and performance indicators in discharge planning services at a regional hospital in Taiwan. A structured questionnaire incorporating client databases, services items, performance indicators and satisfaction surveys was employed. A self-constructed structural questionnaire, with content validity of 0.7 which was verified by five experts and examined with Cranbach α, is employed as a key research tool. Data were collected from March 2007 to September 2007. In total, 321 clients accepted discharge planning services and gave their choices among the offered after-discharge caring services. Visit with the phone after coming out of hospital, nine people who is death, eight people who have not contact, total seventeen people was deletes. As a result, a total of 304 respondents or 94.7% response rate, responded their satisfaction levels via telephone interview thereafter. The results show that the respondents suffering from CVA (p<0.05) and head injury (p<0.01) accepted (statistically significantly) more medical transfer services than those with lung diseases; the respondents who were taken care by caring institutions after discharge accepted more nursing teaching services than those live with family members (p<0.01); the respondents living with family members after discharge received more medical transfer services than those staying with caring institutions (p<0.01); satisfaction levels reported higher in respondents living with family members than those with caring institutions (p<0.01); the more nursing teaching, medical transfer and social services are offered, the higher the satisfaction level is achieved (p<0.01); The results could provide the valuable information on the implementation of discharge planning. The study contributes to several significant results such as: (1) The more demand for tubes care, the more days in hospitalization （r＝0.28, p＝0.00）and the more unexpected emergency care within two weeks（r＝0.14, p＝0.02）. (2) Significant difference （F=5.13, p＝0.02）was found between relocation and total days in hospitalization. Post hoc analysis shows clients who live with family had statistically significant less days in hospitalization than those who were relocated to other hospitals (p=0.008) and caring institutions (p=0.008). (3). Significant difference of satisfaction was found among different relocations（F＝3.50, p＝0.01）. Clients who live with family displayed statistically higher satisfaction than those who were relocated to caring institutions. (4). Significant difference of days in hospitalization was found between on nasal-gastric tube（F＝9.64, p＝0.000）and on tracheal tube（F＝30.13，p＝0.000） (5). Different departments show significant difference in unexpected emergency care within two weeks（F＝20.12，p＝0.00）. The unexpected emergency care within two weeks in the Medical Department was statistically higher than the Surgical Department. (6). Positive correlations (p<0.05) were found between days in hospitalization and several satisfaction measurements, indicating the more days in hospitalization, the more time available to provide services and the higher client satisfaction can be achieved. Furthermore, clients with unexpected emergency care within three days displayed statistically low satisfaction. The results are capable of providing us information for improvement so as to ensure that clients can receive sustainable, effective and integrated care.

碩士
中臺科技大學
醫療暨健康產業管理系碩士班
105
Abstract In recent years, the medical concept of patient-centered and attention of the patient safety care is the mainstream of global medical quality improvement. Falling not only cause physical harm, accompanied by the increase of the number of days in hospital and medical expenses, but also caused the burden to the patient, the patient family and the society. Its psychological and social impact on patients and their families is also difficult to estimate; Therefore, how to make patients to avoid nociceptive falling, and to reduce the disability and death after falling, is an important subject of medical care. This study analyze for the relevant factors in the case of inpatients' nociceptive falling notifications circulate by the patient safety notification system from April 1, 2012 to December 31, 2016, in a teaching hospital in the central Taiwan. The aim of this study is to investigate the current status of falling in the inpatients, to study the factors associated with the fall of the patients, and the high-risk factors of nociceptive fall. Used the retrospective data collection method, the descriptive statistics, chi-square test and logistic regression analysis. The results showed that the age distribution of the patients was 16-64 years old, with the largest number of males and internal medicine. The victims are often with their family while it happens. Often during night swift while it happens, and the patients who were able to get out of bed are the high-risk groups. It mostly happens at the bedside. Most victims are unconstrained and conscious while it happens. The reasons mostly related to patient's health problems. The number of the victims who have hurt is lower than which have not. All personal background variables and fall-related variables did not reach significant levels in the chi-square test (p> .05) .Using binary logistic regression analysis, a falling case with a conscious victim would be at a lower risk of moderate to severe injury (p <.01),the cases with a constrained victim, with a conscious victim or happened in the saloon, would be at a lower risk of moderate to severe injury (p <.05). The results of this study can provide to clinical personnel, to appropriate precautions against the high-risk factors of nociceptive falling, to reduce the incidence and the degree of injury of falling, to improve the patient hospitalization and medical care quality.

碩士
國立成功大學
高階管理碩士在職專班
98
“Do Good, Do Not Harm” is the prime principle of medical ethics. However, patient-safety incidents still occur in hospitalized patients. Ever since 1999, when the Institute of Medicine (IOM) published “To Err is Human: Building a Safer Health System”, patient safety has gained increasing attention all over the world, including Taiwan. In Taiwan, the Department of Health (DOH), Executive Yuan established the National Patient Safety Committee in 2003; DOH, Taiwan Joint Commission on Hospital Accreditation and National Health Research Institutes held a National Health Policy Conference. “Declaration on Patient Safety” was launched at the Meeting, stating that a mechanism to improve medication safety should be implemented in every hospital nationwide. Medication errors are the most common incidents among patient safety issues that require ongoing advocacy efforts. Thus medication safety is the primary principle concern regarding patient safety. Especially, delivery of inpatient chemotherapy that carries high risks requires extra vigilance and attention. To improve the safety of inpatient chemotherapy, Root Cause Analysis(RCA) can be applied after the occurrence of events, or prospective analysis of potential risks, such as HFMEA, can be used to prevent the possibility of errors and mistakes. The study reviews the results of applying HFMEA on the procedure of chemotherapy for hospitalized patients in a teaching hospital in Taiwan. The results revealed 164 failure modes and 199 counterpart causes. Based on the findings, the study suggests strategies for improving the procedure and enhancing drug delivery systems to prevent future medication errors.

碩士
長榮大學
醫務管理學系碩士班
93
As the health insurance expenditures keep rising, all countries are facing the pressure of losing the financial balance on health insurance; therefore, the payment system reforming mechanisms have come into being, such as Global Budget and DRG payment system so as to hold back the medical expenditures. In order to control effectively the medical expenses and allocate reasonably the limited health services resources, the NHI has been phasing in the Global Budget system step by step, and will launch the Diagnosis Related Groups (DRGs) payment system for the inpatient services. To assess the financial risks hospitals will be taking after the implementation of this DRG payment system, this study is to compare the actual medical fee with DRG fixed fee (R), take the difference （ΔR） between the two fees, and calculate the difference to fixed fee ratio for each DRG patient （ΔR/R）. Briefly, the main purposes of this study are to compare the financial risks of medical treatment across clinical departments and major disease category (MDC), and make comparisons on the financial risks across physicians within specific MDC and DRG. This study uses insurance claims data from the National Health Insurance prepared by a regional teaching hospital located in the southern Taiwan. All the inpatient services excluding psychiatric (MDC19 ＆ MDC20) and cancer cases within the time period of July through December 2004 were included. After data screening, appropriate analytical approaches were adopted for analysis which included: (1) descriptive statistics—providing a basic description of sample data; (2) one-way ANOVA—comparing the means of difference to fixed fee ratios between clinical departments, MDCs, and DRGs, respectively, and comparing the means of difference to fixed fee ratios across physicians in specific MDCs and/or DRGs; and (3) Scheffe’s multiple comparisons—identifying the units with statistically significant difference. Briefly speaking, the results show that, among all clinical departments, the department of internal medicine would incur the highest financial risk had the DRG reimbursement system been put in action, followed by department of surgery, and department of pediatrics; in contrast, department of orthopedics and department of obstetrics & gynecology would stand in a more favorable stance. In terms of financial risks for different MDCs, the results show that the MDC01 patients (diseases on nerve system) would cause the highest financial risk and, to the contrary, MDC14 patients (pregnancy, birth & nursing periods) would be at the lowest financial risk. In addition, the financial risks that different physicians would bring forth in treating same type of MDC patients would be significantly different in the categories of MDC01, MDC04, MDC05, MDC06 and MDC08. Further, when inpatient services were examined for physicians treating same DRGs cases, the result shows that the financial risks did not reach significant difference. In summary, there exist significant differences in the financial risks for treating patients in different clinical departments. Therefore, it is suggested hereby that appropriate operations programs be developed and implemented in accordance with the characteristics of different clinical departments and needs of patients so as to meet financial risk balance. As for the financial risks on treatment of different MDC patients, since there also exist significant differences, it is proposed hereby that it would be better to identify those major disease categories in the local community and then make best use of hospital specialty and medical resources to effectively reduce the financial risks on treatment of different types of MDC patients. What deserves closer attentions is the fact that physicians would cause significant differences in the financial risks on treatment of same type of MDC patients. Therefore, from the perspective of operations management, it would be necessary to launch certain programs (e.g., clinical guideline, restrictions on consumption of supplies and medicine, etc.) to help physicians to use medical resources in a more financially efficient way.

碩士
靜宜大學
管理碩士在職專班
102
Since the implementation of national health insurance scheme in Taiwan, because of the keen competition between the medical establishment , how to promote the medical service quality and increase the patient satisfaction has become the important factor in the medical competitive advantage.In the past, there have been many studies about medical service quality and satisfaction; however, there is a lack of study about hospitalization service quality and satisfaction , consideration and intention to return of obstetrics inpatient. The aim of the study is to find out the relationship between hospitalization service quality and satisfaction and intention to return of obstetrics inpatient. We hope this study may gain more information about what they really need so that better medical care can be provided. This study used cross-sectional study design, structured questionnaires to collect data. The sample frame consists of the obstetrics inpatient in a regional teaching hospital in central Taiwan , issued a total of 250 questionnaires , 218 valid questionnaires. By descriptive statistics, t-test and two- parent, regression analysis of the marginal effects, such as for data processing and statistical analysis, the results are as follows: 1. On the degree of importance and satisfaction for hospital hardware devices and medical service quality, respondents are most concerned about maternal or infant safety and comfort and medical care process. 2. The study surveyed high patient satisfaction and intention to return at this regional teaching hospital. 3. The analysis of variance and regression analysis for investigate the relevance among the demography and family medical care choices result showed that obstetrics inpatient in smaller household sizes have higher influence. 4. The result showed that old aged, housewife have higher intention to return to hospital. But obstetrics inpatient in smaller household sizes have lower intention to return to hospital. Because the study in a obstetrics inpatient in a regional Teaching hospital in central Taiwan, may differ with other regional hospital , need to rely on future generations to continue to sophisticated research. Finally, make recommendations to the hospital, as the implementation of service quality management to enhance the competitiveness of the reference.

碩士
中華醫事科技大學
生物科技系暨生物醫學研究所
106
The Ministry of the Interior has announced that the elderly population in Taiwan officially reached 14%, of the aging society in April 2018. And National Development Council R.O.C. estimates that Taiwan’s elderly population will reach 20%, the super-aged society, in 2025. The friendly environment for the elderly has become a global concern following the arrival of aging society. In 2010, the Health Promotion Administration, MOHW, began to promote the "Aging Friendly Health Care Institution Certification" which could make the elderly has a dignified and friendly medical care environment. In addition, the national health insurance policy that has led to major changes in Taiwan’s medical care has gone through nearly a quarter of a century. The improvement and demand for medical quality is an important policy of National Health Insurance Administration, Ministry of Health and Welfare of Taiwan. The hospitals could not meet with the correct, high-quality services, and to get the patient's inner satisfaction unless the medical institutions could understand what the patients really need. The medical treatment process and the patient’s feelings are some important parts of the medical outcome in addition to the healing of the disease under the basic concept of patient-centered medical care. Among them, the evaluation of hospitalization satisfaction is often one of the indispensable methods for improving medical quality. The purpose of this study was to explore the case hospital and attempt to compare the evaluation of hospitalization satisfaction before and after obtaining the friendly environment for the elderly health care certification. Whether it is subject to change through the certification of an elderly friendly health agency, or whether it is relevant. The results of the research could be used as a reference for the case hospital and continue to carry out the aging friendly health care certification policy. This research cited the secondary data analysis of hospitalization satisfaction with a Taiwan southern public hospital as a case study. The data period was between 2011 to 2012（before certification）and 2013-2014（after certification）. The secondary data was a systematic questionnaires based on the purpose of hospital surveys. The range of the survey included the environmental facilities, the attitude of the staffs, the patient's waiting time, the medical process, and the overall service etc. Questionnaires and analysis were conducted while the patients were discharged from the hospital. The data of this study was analyzed by SPSS 22.0 for descriptive statistics, chi-square test, and statistical analysis of t-test. The number of samples was 1,125. The study results showed that: 1. The case hospitals did not differ in satisfaction due to before and after certification. 2. The administrative efficiency satisfaction before certification of the case hospitals was the lowest. The results also showed that the administrative efficiency was the lowest among the three sections after certification. 3. Concerning the analysis of the patients who was 51 and over showed a declined satisfaction after certification. However, excluding fluidity and instability ward, the satisfaction was in an ascent condition in comprehensive ward. In fact, it cannot be shown by this study regarding the causal relationship between the former and the elder friendly environment. 4. According to the analysis of ward characteristics, the comprehensive ward which with a higher stability had a significant impact on the overall feeling after certification (p<0.01), complaint handling (p<0.05), and hospital environmental facilities (p<0.1). 5. There was no significant difference on the medical wards before and after passing the elder friendly certification. 6. The score of satisfaction showed a decline condition on the surgical wards after passing the elder friendly certification. For the further analysis, the construction plan of the case hospital which has been as a public hospital for more than sixty years was based originally on senior citizens treatments. However, there was no significant difference in the comparative analysis including the holistic environmental space after two years of obtaining the health care certification. Because the hospital's aims is to promote patients' health care for both the quality of medical care and the aging health care policy. Therefore, there was no remarkable difference no matter whether it was to promote the patient's health care or the case of the aging hospital. It could be used as a topic for following research and as a reference for the future elderly friendly hospitals if there are other related factors. Some suggestions are recommended for the future aging friendly health hospital certification including the dedicated units should strengthen the curriculum education and publicity on aging-related issues which could make the accredited units to do the 14 performance indicators such as promote, review, and analyze the care process. It is also recommended to use team resources to manage the accurate operations, effectively reshape the process, improve the effectiveness and satisfaction of friendly services, and thus increase the effectiveness of the aging friendly health hospital certification.

碩士
高雄醫學大學
公共衛生學研究所碩士在職專班
92
Objective: In 1999, American Institute of Medicine pointed out that the preventable medical errors in America caused the death rolls of 98000 each year. There were two vital medical errors successively happening in Taiwan in 2002 and made people astonished. However, according to experiences from the advanced Western countries, medical personnel can considerably minimize the occurrence of wrong medical treatments as long as they have correct understandings to medical errors and draw up strategies of improvement, based on different factors. The research, through experiences of a regional teaching hospital, is to discuss the rate of potential medical errors in process of medicine-administrating and risks of medicine safety. We investigated whether the patients and medical personnel affect the results. Moreover, we deliberated whether the situation of medical errors has been improved after carrying out the strategies of medicine-administrating management. Besides, we inquired inpatients of different competency in the regional hospital and researched into the safety of medicine-administrating along with current situation in applied risk management, referential for other medical institutions on these issues. Material and Method: After referring to relevant bibliographies, a “checklist of safe medicine-administrating for inpatients” was edited as the tool for this research to investigate safety of medicine usage by making structural observation. The research is targeted to inpatients, attending doctors, nursing staff, pharmacists and office clerks of the sample hospital; the investigation was divided into two phases. Since we came up with the results, we applied to Software of “SPSS10.0 edition” to do the “Descriptive Statistics”, “Nonparametric Statistics Analysis”, “One-Way ANOVA ”, “Logistic Regression Analysis”, “Multiple-Regression Analysis”. Furthermore, a single-group of inpatients was chosen to make comparison between before/after practice of risk management by way of quasi-experiments. Consequence and Discussion: The research has shown that the potential errors can probably happen in every process of administrating medicine. The probability is 61%, similar to results of Brennan, 58% (1991), Wilson, 54% (1992), and Thomas, 51.2% (1999). For the nursing staff, the probability is 45% whereas 25% in pharmacists and 16% in office clerks— the result is similar to Bates (1995). The potential errors applied by “Logistic-Regression Analysis” came up with the fact that the probability of errors increases 55% as long as the inpatients take one more injection. Those who are above 65 years old are exposed themselves to 1.7 times of potential errors than those who are under 65 years old. This consequence is similar to Brenann’s (1991). Conclusion and Suggestions: No matter what the consequences are, it is a fact that the patients play innocent and fragile roles in the process of medical treatments, for there is a very high ratio of potential medical errors in which the inaccuracy of medicine-administrating even reaches 61%. It is an unshirkable responsibility for every medical institution to better safety systems in medicine-administrating and guarantee the security of patients. To sum up, we suggest as the following: 1. The hygienic agencies should set up localized specific goals for patient safety and customs of safety notification. 2. The superintendents of medical institutions should provide complete facilities for medicine-administrating and develop systems of safety notification. For the follow-up researchers, we suggest that they ask the doctors to recheck case histories and medical records, planning longer time frame for executing risk managements and expanding ranges of researches, in order to extrapolate the consequences of the research.

碩士
高雄醫學大學
公共衛生學研究所碩士在職專班
91
Objectives：This study was intended to examine the predictors for long-stay schizophrenic inpatients by using the information collected in admission assessments.The expected results may be helpful for the development of case management indicators and quality improvement program of schizophrenia of National Health Insurance. Methods：The study design was retrospective secondary data analysis. A sample of 626 schizophenic inpatients who were admitted to a public psychiatric teaching hospital during a one-and-half year stay period (from July 2001 to December 2002) were studied and classified into long-stay and short-stay groups according to their length of stay (LOS). The data source was derived form chart review which included demographic data, family support strength, past psychiatric history and clinical severity within 48 hours of admission (BPRS total scores, self care scale total scores, violence, suicide). Chi-squre, t- test, desciminant analysis and stepwise logistic regression analysis were conducted to identify the determinants of length of stay and predictors of long-stay schizophrenic inpatients. Results：Signficant differences in marital status, family support strength, violence, employment history, previous admission and medical utilization were found between the two groups. Age, previous admissions, employment history, violence and family support strength were desciminant predictors for long-stay schizophrenic inpatients as confirmed by the results of descriminant analysis and stepwise logistic regression analysis. There were 73.0% and 83.8% of schizophrenic inpatients correctly identified by each analysis. Conclusions：To identify predictive factors of long-stay schizophrenic inpatients within 48 hours of admission is critical to clinical care and resources allocation. In order to meet the purposes of quality improvement program, the establishment of case management model and an integrated system of resources is equally important.

碩士
高雄醫學大學
公共衛生學研究所碩士在職專班
92
Purpose：The main group of inpatients in mental hospital are schizophrenics. The rate of discharged against medical advice (DAMA) is one of the important quality indexes of medical service. This project was intended to examine the predictors of DAMA on acute schizophrenic inpatients, the influence of the consequent utility of medical service and the outcome. The results may be helpful for the clinicians to prevent DAMA and improve the quality of medical care. Methods：The subjects were the schizophrenic inpatients who were discharged from the acute wards of a public psychiatric teaching hospital on south area of Taiwan, from Jan. 1, 1999 to Dec. 31, 2002. There were102 DAMA cases included as the study group. There were 826 cases discharged by permitted (DBP), and 206 cases were chosen by a systematic sampling as the comparing group. A retro-prospective design to review the chart to analyze the basic data, the characters on disease, and the utility on medical service after discharged. Results：The past DAMA history, substance abused history, and age could predict DAMA of schizophrenic acute inpatients, and the odds ratio (OR) were 26.373, 2.195, and 0.961 respectively. The returning rate of outpatient after discharged one-month was lower on the group of DAMA. The duration between date of discharged and readmission was shorter on the group of DAMA. Conclusion：To identify predictive factors of DAMA on acute schizophrenic inpatients is critical to clinical care. The early intervention, and well prepare discharge planning, could increase the compliance, and decrease the DAMA rate.

碩士
中國醫藥大學
醫務管理學系碩士班
106
In recent years, as medical disputes have continued to occur with increased frequency and severity, doctor-patient relationships have also deteriorated, resulting in the gradual loss of critical care health care professionals. However, most medical disputes can be prevented by strengthening communication between doctors and patients. Effective communication has the positive value of establishing good doctor-patient relationships, improving medical compliance, and increasing the overall level of patient satisfaction. However, it is not uncommon for doctors and patients to hold different perceptions and opinions even after the communication process. These differences in perception can lead to a discrepancy in medical expectations, a decline in the quality of medical care, skepticism with regards to patient safety, and the occurrence of medical disputes. The purpose of this study is to investigate various aspects and levels of differences perceived by doctors and patients for the duration of hospital stay. In order to develop effective “patient-centered” medical care practice, it is vital to examine the differences in perception experienced by doctors and patients during their communication process, and to find effective solutions that can help remedy various situations. In this study, a cross-sectional questionnaire was given to discharged patients over 20 years old from both the internal medicine and surgical departments in a teaching hospital in central Taiwan, with the aim to assess the patient’s perception of the interaction between doctors and patients. A questionnaire containing the same set of questions was then given to the patients’ attending physicians to assess the doctor’s perception of the interaction between doctors and patients. A total of 132 patient questionnaires and 132 attending doctor questionnaires were collected. Doctor-patient pairing methods were used to compare the differences in perception in the interaction between doctors and patients. At the same time, factors such as the patient’s age, gender, education level, marital status, and the attending doctor’s specialization and duration of practice were also analyzed to account for differences in perception between the doctor and the patient. The data in the questionnaire was processed and statistical analysis was conducted by SPSS software. The results of the study show that there are statistically significant differences in perception between doctors and patients with regards to the transmission of information, mutual interaction, and participation in decision-making during hospitalization. The average scores obtained by doctors in each category are lower than those obtained by the patients. Particularly, in terms of whether the patient wants to be more involved in the medical decision-making process, the doctor''s perception is significantly lower than the patient''s expectation. The differences in perception between patients and doctors during the process of medical care are important and worthy of further discussion. If the doctor lacks understanding and awareness of the differences in perception between doctors and patients, this would reduce the hospital’s ability to provide patient-centered medical care, and thereafter increase the risks of medical disputes.

碩士
輔英科技大學
護理系碩士班
103
Purpose: This study was designed to explore the effectiveness of TB knowledge, medication adherence, and completed treatment for the tuberculosis inpatients receiving integrated instruction of the DOTS care. Methods: The research was used retrospectively methodology. The second data basis was applied into secondary analysis. Sample database from a teaching hospital in southern Taiwan from January 2011 to December 2012, the initially diagnosis of TB patients were admitted to the isolation ward in hospital DOTS case management care, the integrated instruction given by the results of the TB knowledge questionnaire, a second questionnaire tested after the intervention 3-5days (before discharge), then tracked the clinic 12 month their medication adherence and completed treatment situation by case managers, but excluded the patients with the status of dead, referred other hospital and changed diagnosis by doctors. The integrated TB instruction is the clinical nurses and case managers mutually instructed the TB-related knowledge of the patients by using the multi-teaching method. Results: Results identified 95 samples with average age 50.8 and male was 3.75 times than women, complete treatment rate 88.4% that reached WHO indicator of the cohort follow up. The knowledge levels of the initial diagnosed TB patients were only in the middle levels, and the lowest levels on risk factors, transmitting way, and the cognition of illness onset. The effectiveness for the integrated TB instruction was indicated that the TB knowledge levels, including five structure of knowledge, have promoted the accuracy from 66.80% to 96.68% before and after by compared t test, approaching the significant difference (p<.05). Additionally, results found that the correlation between medication adherence, and complete treatment rates was around 31.0～49.9% by the analysis of Point-biserial correlation and Chi-Square, especially presented a significantly positive correlation from 4 to 7 months (p<.05). Conclusion: To complete treatment, the TB patients must continue to take Anti-TB drugs more than180s days. In the initial diagnosed of TB,early to provid the integrated TB instruction by the cooperation of clinical nurses and case managers, can significantly increase patient’s the TB knowledge levels, to understand the importance of treatment, and also to enhances the medication adherence and complete treatment rate of the patients in continues under the DOTS management. The research findings could provide medical and nursing members as the reference for TB case management and suggested government should be advocate self-screening the symptoms of TB in the commtunity, to finding and treat TB patients early.