Problème de l'exposition lors d'examens ionisants chez les enfants souffrant de malformations cardiaques au Centre Hospitalier Universitaire Vaudois (CHUV)

Le nombre d'examens fluoroscopiques pratiqués en fluoroscopie est en augmentation constante en cardiologie pédiatrique. Ces examens ont un bénéfice évident pour le diagnostic et la thérapie de pathologies cardiaques complexes mais ils sont également la cause d'exposition à des hautes doses de radiation. Notre étude propose donc d'analyser cette pratique au Centre Hospitalier Universitaire Vaudois (CHUV) ainsi que d'établir des niveaux de référence diagnostiques et de rechercher les moyens possibles de diminution de doses. La base de données que nous avons analysé provient du service de cardiologie pédiatrique du CHUV (Lausanne). Elle contient 873 examens fluoroscopiques pratiqués entre le 1er janvier 2003 et le 31 décembre 2011 et se compose des données démographiques, du temps de scopie en minutes et du dose area product (DAP) en Gycm 2 pour chaque examen. Les examens sont séparés en deux modalités, diagnostique et interventionnel et ont été pratiqués sur l'installation GE jusqu'en juillet 2010 et par la suite sur l'installation Philips. L'analyse s'est faite sur Excel et sur JMP Statistics afin d'établir la distribution démographique de l'échantillon, les moyennes et percentiles 75. Les examens diagnostiques ont été étudié par classes d'âge et les examens interventionnels selon une classification d'intervention (Ranking) établie en collaboration avec le médecin responsable de ces procédures au CHUV. Seuls les groupes d'examens ayant un nombre égal ou supérieur à 20 ont été analysés. Nous avons donc analysé 873 examens, dont 512 diagnostiques et 361 interventionnels. Le temps de scopie moyen pour l'ensemble des examens diagnostiques est de 11.91 minutes et le DAP moyen de 12.04 Gycm2. Concernant les examens interventionnels, les moyennes de temps de scopie et de DAP sont de 17.74 minutes et 9.77 Gycm2 respectivement. En plus des analyses par classes d'âges et par ranking, nous avons étudié les examens selon leurs données démographiques ainsi que par pathologie et par installation. L'ensemble des examens diagnostiques connaissent une diminution significative (p<0.0001) de 30% pour le temps de scopie moyen et de 60% pour le DAP moyen en passant de l'installation la plus ancienne, GE, à la plus récente, Philips. Concernant les examens interventionnels, La différence entre les deux installations est encore plus marquée avec un temps de scopie moyen 55 % inférieur ( Gycm2) et un DAP moyen 73 % (p=0.0002) plus faible sur Philips par rapport à GE. Ces différences sont principalement expliquées par l'apport de nouveaux outils sur l'installation Philips, tels que la digitalisation et le traitement de l'image, de la possibilité de changer le nombre d'images par seconde durant un examen ainsi que de l'amélioration de la pratique des examinateurs. Nous avons pu définir des percentiles 75 pour les examens diagnostiques par classes d'âge et par pathologie et pour les examens interventionnels selon le ranking établi par le Dr Di Bernardo.

Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol.

BACKGROUND: Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN: This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION: The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

Tradução e adaptação cultural do Newcastle Satisfaction with Nursing Scales para a cultura brasileira

Este estudo teve por objetivos traduzir e adaptar o Newcastle Satisfaction with Nursing Scales para a cultura brasileira, bem como verificar seu uso prático. O instrumento contém duas escalas e tem como objetivo avaliar as experiências vivenciadas pelo paciente e a satisfação com o cuidado de enfermagem. Para o procedimento metodológico de adaptação cultural foram seguidas as etapas de tradução, síntese, retro-tradução, avaliação pelo comitê de especialistas e pré-teste. O processo de tradução e adaptação cultural foi considerado apropriado. A avaliação pelo comitê de especialistas resultou em modificações gramaticais simples para a maioria dos itens e, no pré-teste, participaram 40 sujeitos. A versão brasileira do Newcastle Satisfaction with Nursing Scales demonstrou adequada validade de conteúdo e facilidade de compreensão pelos sujeitos. Contudo, este é um estudo que antecede o processo de avaliação das propriedades psicométricas do instrumento, cujos resultados serão apresentados em publicação posterior.

The interaction of ownership structure and customer satisfaction as determinants of brand equity

In this paper we study the interaction between ownership structure and customer satisfaction, and their impact on a firm's brand equity. We find that customer satisfaction has a positive direct effect on brand equity but an indirect negative one, through reductions in ownership concentration. This latter effect emerges when managers are focused mainly on satisfying customers. It gives out a warning signal that highlights the perverse effect of implementing policies focused excessively on satisfying customers at the expense of shareholders, on a firm's brand equity. We demonstrate our theoretical contention, empirically, making use of an incomplete panel data comprising 69 firms from 11 different nations for the period 2002-2005.

Consumer Satisfaction with Websites of Banks - The Moderating Effect of Consumer Technology Attractiveness

The websites are becoming the firms’ first contact interface with their clients. Hence, understanding customers’ online attitudes and behaviors have been capturing increased research attention. The extant research has pointed customers’ satisfaction with the websites as the main reason for customers’ online behaviors. This research has used mostly variables related to the characteristics of the websites as the predictors of customers’ website satisfaction. However, recent research shows that groups of individuals displaying distinctive characteristics react differently to the same context. Therefore, behavior may be considerably different among groups of customers. In this study, we develop a conceptual model of the influence of individual characteristics on the traditional website quality – website satisfaction relationship. We propose a model based on the construct of consumer technology attractiveness (CTA) to represent the genuine positive propensity of individuals toward technology. We further test the moderating effect of this construct on the commonly used predictors of customer’s website satisfaction using Hierarchical Multiple Regression. The empirical study was based on websites of banks operating in Portuguese market. The commercial banking industry is one of the Portuguese industries that better uses the Internet to establish relationships with clients. Data were collected through an online website satisfaction survey, participated by the lecturers and postgraduate students from four Portuguese Universities and Polytechnic Institutes. Our final sample comprised 276 valid questionnaires. Our study permits to conclude that the most commonly used antecedents of website overall satisfaction are still relevant for analyzing consumer’s satisfaction with the banks websites. We also conclude that CTA has a significant moderating effect on almost all customers’ website satisfaction variables used in the study. This study contributes to highlight the theoretical importance and significant influence of consumers’ personal characteristics on their online behavior. Moreover, for the practitioners, a better understanding of these individual characteristics will assist them in developing customized websites that will meet customers’ expectations. O estudo dos comportamentos dos consumidores em ambientes online tem vindo a ter um crescente interesse, uma vez que os websites estão a transformar-se num importante ponto de contacto entre as empresas e os seus clientes. A satisfação dos clientes com os websites tem sido apontada pela Literatura como o principal condicionante dos comportamentos online dos consumidores. No entanto, a investigação científica tem conseguido provar que grupos de indivíduos com características distintas reagem de forma diferente quando submetidos a contextos idênticos, o que poderá levar a diferenças significativas no comportamento online de consumidores pertencentes a diferentes grupos. Neste estudo desenvolvemos um modelo conceptual que reflecte a influência de características individuais na relação entre a qualidade e a satisfação com os websites. Propomos um modelo assente na atractividade tecnológica do consumidor (CTA), que representa a propensão genuína que os indivíduos possuem em relação à tecnologia. Testamos o efeito moderador deste conceito sobre as variáveis mais utilizadas nos estudos sobre a satisfação dos consumidores com os websites, utilizando a Regressão Múltipla Hierárquica. O estudo empírico baseou-se nos websites dos bancos que operam no mercado português, uma vez que este sector é um dos que melhor utiliza a Internet na sua relação com os clientes. Os dados foram recolhidos através de um questionário sobre satisfação com os websites, colocado online e dirigido a docentes e estudantes de programas de pós-graduações, mestrados e doutoramentos de quatro universidades e instituto politécnico portugueses, tendo resultado numa amostra final de 276 questionários validados estatisticamente. Este estudo permitiu concluir que as variáveis que são mais utilizadas como antecedentes da satisfação dos consumidores com os websites, continuam a ser igualmente válidas para a análise dos websites dos bancos. Também concluímos que a CTA tem efeitos moderadores significativos na grande maioria das variáveis utilizadas neste estudo. Assim, conseguimos realçar a importância teórica das características pessoais dos consumidores no seu comportamento online. Para os gestores, uma melhor compreensão destas características individuais permitir-lhes-á desenvolver websites customizados que irão satisfazer as expectativas dos seus clientes.

Measuring professional satisfaction and nursing workload among nursing staff at a Greek Coronary Care Unit

ABSTRACT Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP) in Greek Coronary Care Units (CCUs). Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7). The most highly valued component of satisfaction was “Pay”, followed by “Task requirements”, “Interaction”, “Professional status”, “Organizational policies” and “Autonomy”. NAS, CNIS and TISS-28 were negatively correlated (p≤0.04) with the following work components: “Autonomy”, “Professional status”, “Interaction” and “Task requirements”. Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.