Patients' satisfaction with community treatment: a pilot cross-sectional survey adopting multiple perspectives.

ACCESSIBLE SUMMARY: Patients' satisfaction is scarcely studied within the context of community treatment for adolescents. Thus, this study adopts a multiple perspective on patients' satisfaction (including service users as well as staff members). The results highlighted that all informants (patients, foster carers in foster homes and professional caregivers from community treatment teams) perceived the patients to be satisfied, with foster carers reporting the highest patient satisfaction rate. Considering the patient satisfaction rate from multiple perspectives provides complementary understandings. Clinical outcomes and, specifically, a reduction in emotional difficulties were related to patient's satisfaction, but only from the patients' perspective. ABSTRACT: Community treatment (CT) teams in Switzerland provide care to patients who are unable to use regular child and adolescent mental health services (i.e. inpatient and outpatients facilities). No study has considered patients' self-rated satisfaction alongside with staff members' perspectives on patient satisfaction. Thus, adopting a cross-sectional survey design, we collected patients' satisfaction using the Client Satisfaction Questionnaire (CSQ-8), rated by multiple informants (patients, foster carers in foster homes and professional caregivers from CT teams). Professional caregivers assessed clinical outcomes using the Health of the Nation Outcome Scale for Children and Adolescents. The results indicated that all informants were satisfied with the community treatment teams. The satisfaction scores were not correlated across informants; however, the alleviation of emotional symptoms was correlated with patients' satisfaction. This study indicated that the use of a combined approach including the views of service users and professionals gives important complementary information. Finally, in our sample, lower emotional symptoms were linked to enhanced patient satisfaction. This study demonstrated the importance of considering multiple perspectives to obtain the most accurate picture of patients' satisfaction. Second, focusing on the reduction of emotional symptoms might lead to a higher degree of patients' satisfaction.

Patients' satisfaction with community treatment: a pilot cross-sectional survey adopting multiple perspectives.

ACCESSIBLE SUMMARY: Patients' satisfaction is scarcely studied within the context of community treatment for adolescents. Thus, this study adopts a multiple perspective on patients' satisfaction (including service users as well as staff members). The results highlighted that all informants (patients, foster carers in foster homes and professional caregivers from community treatment teams) perceived the patients to be satisfied, with foster carers reporting the highest patient satisfaction rate. Considering the patient satisfaction rate from multiple perspectives provides complementary understandings. Clinical outcomes and, specifically, a reduction in emotional difficulties were related to patient's satisfaction, but only from the patients' perspective. ABSTRACT: Community treatment (CT) teams in Switzerland provide care to patients who are unable to use regular child and adolescent mental health services (i.e. inpatient and outpatients facilities). No study has considered patients' self-rated satisfaction alongside with staff members' perspectives on patient satisfaction. Thus, adopting a cross-sectional survey design, we collected patients' satisfaction using the Client Satisfaction Questionnaire (CSQ-8), rated by multiple informants (patients, foster carers in foster homes and professional caregivers from CT teams). Professional caregivers assessed clinical outcomes using the Health of the Nation Outcome Scale for Children and Adolescents. The results indicated that all informants were satisfied with the community treatment teams. The satisfaction scores were not correlated across informants; however, the alleviation of emotional symptoms was correlated with patients' satisfaction. This study indicated that the use of a combined approach including the views of service users and professionals gives important complementary information. Finally, in our sample, lower emotional symptoms were linked to enhanced patient satisfaction. This study demonstrated the importance of considering multiple perspectives to obtain the most accurate picture of patients' satisfaction. Second, focusing on the reduction of emotional symptoms might lead to a higher degree of patients' satisfaction.

Satisfaction with pregnancy and delivery services: The quality of maternity care services as experienced by women

Objective: The objective of this study was to investigate the opinions of women regarding the satisfaction about the quality of maternity care received. We hope to establish whether health care technology increases satisfaction or whether it actually interferes with the construction of personal satisfaction in the process of care. Design and setting: Information was gathered using the focus group technique. The area of study comprised the post-natal groups run as part of the Sexual and Reproductive Health Programme of the Catalan Health Authority. (Spain) Participants: Five focus groups were held between May 2006 and July 2007. Findings: Quality of care is a complex concept in which a number of independent core features can be identified. We have grouped these core features into three basic categories. Safety: the hospital and its technological facilities, and the technical expertise of health professionals. The other two main pillars of quality of care are the human dimension of the relationship between the carers and the patient, and finally the structural aspects that determine the context in which the heath care is provided. Key conclusions and implications for practice: The mothers of our study feel satisfied with healthcare technology and view it as a source of security; technology become indispensable features in order to reduce the anxiety provoked by the perceived lack of confidence in their ability as mothers. In this study, women, both during pregnancy and especially when giving birth, believe their feelings and values should be understood by professionals, from whom they seek empathy and a personal commitment, and not just information.

Satisfaction with pregnancy and delivery services: The quality of maternity care services as experienced by women

Objective: The objective of this study was to investigate the opinions of women regarding the satisfaction about the quality of maternity care received. We hope to establish whether health care technology increases satisfaction or whether it actually interferes with the construction of personal satisfaction in the process of care. Design and setting: Information was gathered using the focus group technique. The area of study comprised the post-natal groups run as part of the Sexual and Reproductive Health Programme of the Catalan Health Authority. (Spain) Participants: Five focus groups were held between May 2006 and July 2007. Findings: Quality of care is a complex concept in which a number of independent core features can be identified. We have grouped these core features into three basic categories. Safety: the hospital and its technological facilities, and the technical expertise of health professionals. The other two main pillars of quality of care are the human dimension of the relationship between the carers and the patient, and finally the structural aspects that determine the context in which the heath care is provided. Key conclusions and implications for practice: The mothers of our study feel satisfied with healthcare technology and view it as a source of security; technology become indispensable features in order to reduce the anxiety provoked by the perceived lack of confidence in their ability as mothers. In this study, women, both during pregnancy and especially when giving birth, believe their feelings and values should be understood by professionals, from whom they seek empathy and a personal commitment, and not just information.

Development of an instrument to measure the degree of critical patient's satisfaction with nursing care: research protocol

Aim: To investigate and understand patient's satisfaction with nursing care in the intensive care unit to identify the dimensions of the concept of"satisfaction" from the patient's point of view. To design and validate a questionnaire that measures satisfaction levels in critical patients. Background: There are many instruments capable of measuring satisfaction with nursing care; however, they do not address the reality for critical patients nor are they applicable in our context. Design: A dual approach study comprising: a qualitative phase employing Grounded Theory and a quantitative and descriptive phase to prepare and validate the questionnaire. Methods: Data collection in the qualitative phase will consist of: in-depth interview after theoretical sampling, on-site diary and expert discussion group. The sample size will depend on the expected theoretical saturation n = 27-36. Analysis will be based on Grounded Theory. For the quantitative phase, the sampling will be based on convenience (n = 200). A questionnaire will be designed on the basis of qualitative data. Descriptive and inferential statistics will be used. The validation will be developed on the basis of the validity of the content, the criteria of the construct and reliability of the instrument by the Cronbach's alpha and test-retest approach. Approval date for this protocol was November 2010. Discussion: Self-perceptions, beliefs, experiences, demographic, socio-cultural epistemological and political factors are determinants for satisfaction, and these should be taken into account when compiling a questionnaire on satisfaction with nursing care among critical patients.

Parents of the Gifted in Ontario: An Investigation of Parental Satisfaction with the Education of their Gifted Children

The opinions of parents in relation to the education of their gifted child were examined, with particular attention paid to their satisfaction and the type and amount of programming their child is receiving. This study employed a mixed methods research design that focused on parents’ experiences with gifted education programming and their perceptions and level of satisfaction with these programs. A survey was used to gather the perceptions and opinions of parents of gifted children in Ontario. The data were quantified and used to make observations in relation to differences in parental satisfaction and to provide a more thorough understanding of the experiences of parents in Ontario in regards to the education of gifted children. Information was also gathered regarding the recommendations that parents have for the improvement of education for their gifted child. The results of the study found that parents of gifted children were satisfied with the connections their child made within a gifted placement with like-minded peers and with opportunities for their children to learn in a more individualized and in-depth manner. However, parents expressed dissatisfaction with the timing of the initial gifted identification and the lack of knowledge that teachers, in both regular and specialized classrooms, have about gifted children and the types of programming best suited to these children. The results of the study also showed parental dissatisfaction with the lack of funding allocated to gifted education programs by district school boards and the lack of involvement they were allowed with respect to the education of their child.

Compositional Model Repositories via Dynamic Constraint Satisfaction with Order-of-Magnitude Preferences

The predominant knowledge-based approach to automated model construction, compositional modelling, employs a set of models of particular functional components. Its inference mechanism takes a scenario describing the constituent interacting components of a system and translates it into a useful mathematical model. This paper presents a novel compositional modelling approach aimed at building model repositories. It furthers the field in two respects. Firstly, it expands the application domain of compositional modelling to systems that can not be easily described in terms of interacting functional components, such as ecological systems. Secondly, it enables the incorporation of user preferences into the model selection process. These features are achieved by casting the compositional modelling problem as an activity-based dynamic preference constraint satisfaction problem, where the dynamic constraints describe the restrictions imposed over the composition of partial models and the preferences correspond to those of the user of the automated modeller. In addition, the preference levels are represented through the use of symbolic values that differ in orders of magnitude.

Communication that values patient autonomy is associated with satisfaction with care: a systematic review

Question: Which communication factors used by clinicians during patient-clinician interactions are associated with satisfaction with care? Design: Systematic review with meta-analysis of studies investigating the association of verbal or nonverbal factors or interaction styles used by clinicians with patient satisfaction during an encounter between clinician and patient. Participants: Clinicians interacting with patients in primary care or rehabilitation settings. Results: Twenty-seven studies investigated 129 verbal, nonverbal, and interaction style factors. of these, 38 factors were consistently associated with satisfaction. Verbal factors concerning clinicians involving, facilitating, and supporting patients were associated with satisfaction with care. Most communication factors presented a fair correlation (r >= 0.21 but < 0.41) with satisfaction with care. Nonverbal factors such as time spent discussing prevention and time spent reading patient charts had a fair association with satisfaction with care (correlations range from 0.21 to 0.40). A moderate association was found between interaction styles such as caring (pooled r = 0.51, 95% CI 0.42 to 0.60) and satisfaction with care. Over half (58%) of the 129 identified factors never associated with satisfaction with care and the remainder associated inconsistently. Conclusion: The number of potential modifiable communication factors associated with satisfaction with care and the magnitude of their association partially support interventions to train clinicians in communication skills that value patient autonomy. [Oliveira VC, Refshauge KM, Ferreira ML, Pinto RZ, Beckenkamp PR, Negrao Filho RF, Ferreira PH (2012) Communication that values patient autonomy is associated with satisfaction with care: a systematic review. Journal of Physiotherapy 58: 215-229]

Work conditions and occupational health of dentists in Brazilian public health system

Conselho Nacional de Desenvolvimento Ciêntífico e Tecnológico (CNPq)

Family satisfaction with critical care: measurements and messages

PURPOSE OF REVIEW: Family satisfaction in the ICU reflects the extent to which perceived needs and expectations of family members of critically ill patients are met by healthcare professionals. Here, we present recently developed tools to assess family satisfaction, with a special focus on their psychometric properties. Assessing family satisfaction, however, is not of much use if it is not followed by interpretation of the results and, if needed, consecutive measures to improve care of the patients and their families, or improvement in communication and decision-making. Accordingly, this review will outline recent findings in this field. Finally, possible areas of future research are addressed. RECENT FINDINGS: To assess family satisfaction in the ICU, several domains deserve attention. They include, among others, care of the patient, counseling and emotional support of family members, information and decision-making. Overall, communication between physicians or nurses and members of the family remains a key topic, and there are many opportunities to improve. They include not only communication style, timing and appropriate wording but also, for example, assessments to see if information was adequately received and also understood. Whether unfulfilled needs of individual members of the family or of the family as a social system result in negative long-term sequels remains an open question. SUMMARY: Assessing and analyzing family satisfaction in the ICU ultimately will support healthcare professionals in their continuing effort to improve care of critically ill patients and their families.

[Parent satisfaction with a child and family-centered treatment program for primary headache in childhood and adolescence]

Patient satisfaction represents a significant outcome criterion in the context of systemic psychotherapeutic therapy research. This study investigated parent satisfaction with a psychosocial treatment program (comprising three components: child group therapy, parents' evenings, systemic family sessions) for pediatric primary headache (diagnosed according to IHS criteria). 10 weeks after the end of the treatment program, the parents were sent a questionnaire containing open questions and ten-point numerical rating scales. The sample comprised n=48 families. The return rate was 89%. The qualitative content analysis showed a hierarchical category system consisting of 3 major categories, 7 main groups and 69 sub-categories. The parents stated that they were satisfied with (1.) the effects of the treatment program, (2.) the specific treatment techniques and the medical and psychosocial headache-related information provided, and (3.) the therapeutic relationship. The mean satisfaction for all three therapy components on the ten-point numerical rating scale was 8.1 with a standard deviation of 2.0 (child headache group: 8.5; parents' evenings: 8.2; family sessions: 7.5). The results are discussed with reference to methodological aspects: avoidance of ceiling effects and social desirability in measuring customer satisfaction, order effects of items, weighting of the significance of satisfaction levels as an outcome criterion.

Integration of a data acquisition system based on FlexRIO technology with EPICS

EPICS (Experimental Physics and Industrial Control System) lies in a set of software tools and applications which provide a software infrastructure for building distributed data acquisition and control systems. Currently there is an increase in use of such systems in large Physics experiments like ITER, ESS, and FREIA. In these experiments, advanced data acquisition systems using FPGA-based technology like FlexRIO are more frequently been used. The particular case of ITER (International Thermonuclear Experimental Reactor), the instrumentation and control system is supported by CCS (CODAC Core System), based on RHEL (Red Hat Enterprise Linux) operating system, and by the plant design specifications in which every CCS element is defined either hardware, firmware or software. In this degree final project the methodology proposed in Implementation of Intelligent Data Acquisition Systems for Fusion Experiments using EPICS and FlexRIO Technology Sanz et al. [1] is used. The final objective is to provide a document describing the fulfilled process and the source code of the data acquisition system accomplished. The use of the proposed methodology leads to have two diferent stages. The first one consists of the hardware modelling with graphic design tools like LabVIEWFPGA which later will be implemented in the FlexRIO device. In the next stage the design cycle is completed creating an EPICS controller that manages the device using a generic device support layer named NDS (Nominal Device Support). This layer integrates the data acquisition system developed into CCS (Control, data access and communication Core System) as an EPICS interface to the system. The use of FlexRIO technology drives the use of LabVIEW and LabVIEW FPGA respectively. RESUMEN. EPICS (Experimental Physics and Industrial Control System) es un conjunto de herramientas software utilizadas para el desarrollo e implementación de sistemas de adquisición de datos y control distribuidos. Cada vez es más utilizado para entornos de experimentación física a gran escala como ITER, ESS y FREIA entre otros. En estos experimentos se están empezando a utilizar sistemas de adquisición de datos avanzados que usan tecnología basada en FPGA como FlexRIO. En el caso particular de ITER, el sistema de instrumentación y control adoptado se basa en el uso de la herramienta CCS (CODAC Core System) basado en el sistema operativo RHEL (Red Hat) y en las especificaciones del diseño del sistema de planta, en la cual define todos los elementos integrantes del CCS, tanto software como firmware y hardware. En este proyecto utiliza la metodología propuesta para la implementación de sistemas de adquisición de datos inteligente basada en EPICS y FlexRIO. Se desea generar una serie de ejemplos que cubran dicho ciclo de diseño completo y que serían propuestos como casos de uso de dichas tecnologías. Se proporcionará un documento en el que se describa el trabajo realizado así como el código fuente del sistema de adquisición. La metodología adoptada consta de dos etapas diferenciadas. En la primera de ellas se modela el hardware y se sintetiza en el dispositivo FlexRIO utilizando LabVIEW FPGA. Posteriormente se completa el ciclo de diseño creando un controlador EPICS que maneja cada dispositivo creado utilizando una capa software genérica de manejo de dispositivos que se denomina NDS (Nominal Device Support). Esta capa integra la solución en CCS realizando la interfaz con la capa EPICS del sistema. El uso de la tecnología FlexRIO conlleva el uso del lenguaje de programación y descripción hardware LabVIEW y LabVIEW FPGA respectivamente.

Stand-alone groundwater desalination system using reverse osmosis combined with a cooled greenhouse for use in arid and semi-arid zones of India

In many areas of northern India, salinity renders groundwater unsuitable for drinking and even for irrigation. Though membrane treatment can be used to remove the salt, there are some drawbacks to this approach e.g. (1) depletion of the groundwater due to over-abstraction, (2) saline contamination of surface water and soil caused by concentrate disposal and (3) high electricity usage. To address these issues, a system is proposed in which a photovoltaic-powered reverse osmosis (RO) system is used to irrigate a greenhouse (GH) in a stand-alone arrangement. The concentrate from the RO is supplied to an evaporative cooling system, thus reducing the volume of the concentrate so that finally it can be evaporated in a pond to solid for safe disposal. Based on typical meteorological data for Delhi, calculations based on mass and energy balance are presented to assess the sizing and cost of the system. It is shown that solar radiation, freshwater output and evapotranspiration demand are readily matched due to the approximately linear relation among these variables. The demand for concentrate varies independently, however, thus favouring the use of a variable recovery arrangement. Though enough water may be harvested from the GH roof to provide year-round irrigation, this would require considerable storage. Some practical options for storage tanks are discussed. An alternative use of rainwater is in misting to reduce peak temperatures in the summer. An example optimised design provides internal temperatures below 30EC (monthly average daily maxima) for 8 months of the year and costs about €36,000 for the whole system with GH floor area of 1000 m2 . Further work is needed to assess technical risks relating to scale-deposition in the membrane and evaporative pads, and to develop a business model that will allow such a project to succeed in the Indian rural context.

A novel neural network based system for assessing risks associated with information technology security breaches

Security remains a top priority for organizations as their information systems continue to be plagued by security breaches. This dissertation developed a unique approach to assess the security risks associated with information systems based on dynamic neural network architecture. The risks that are considered encompass the production computing environment and the client machine environment. The risks are established as metrics that define how susceptible each of the computing environments is to security breaches. ^ The merit of the approach developed in this dissertation is based on the design and implementation of Artificial Neural Networks to assess the risks in the computing and client machine environments. The datasets that were utilized in the implementation and validation of the model were obtained from business organizations using a web survey tool hosted by Microsoft. This site was designed as a host site for anonymous surveys that were devised specifically as part of this dissertation. Microsoft customers can login to the website and submit their responses to the questionnaire. ^ This work asserted that security in information systems is not dependent exclusively on technology but rather on the triumvirate people, process and technology. The questionnaire and consequently the developed neural network architecture accounted for all three key factors that impact information systems security. ^ As part of the study, a methodology on how to develop, train and validate such a predictive model was devised and successfully deployed. This methodology prescribed how to determine the optimal topology, activation function, and associated parameters for this security based scenario. The assessment of the effects of security breaches to the information systems has traditionally been post-mortem whereas this dissertation provided a predictive solution where organizations can determine how susceptible their environments are to security breaches in a proactive way. ^

Satisfaction with the healthcare provided of women who had undergone a mastectomy

Abstract Introduction: Breast cancer is the most common form of cancer among women worldwide and, therefore, deserves the highest attention and assistance from medical services. Considering patients’ satisfaction as an indication of healthcare quality, women who have undergone a mastectomy will assess the medical care received. This assessment will be based on what is expected from that medical care and on the expected improvement of her health condition. . Objective: To determine the level of satisfaction of women who have undergone a mastectomy with the medical care provided by nurses, doctors and by the way hospital services are organized. Design: A descriptive and cross-sectional study, developed in Portugal. Participants: A non-probabilistic sample formed by 153 women who underwent a mastectomy with an average age of 55, married (67.3%), unemployed (56.2%), living in a rural area (71.2%) and living on minimum wage (54.9%). Measurement instrument: European Organization for Research and Treatment of Cancer (EORTC) IN-PATSAT32 questionnaire. Results: 113 (73.85%) of the 153 women are satisied with the medical care provided and 40 (26.14%) of them show their lack of satisfaction. A highly signiicant percentage of women (49.01%) feel fairly satisied with the medical care provided by nurses and with the way services are organized (37.9). On the other hand (37.9%) show their dissatisfaction towards doctors. The family network proved to be a predictor of the satisfaction with doctors (β = 0.163; P = .044) and the period of hospitalization predicts the satisfaction with the organization (β = 0.171; P = .011). Both predictors will be useful to explain the 3% variability in patients’ satisfaction. Conclusions: Monitoring the satisfaction with the medical care received is a fundamental strategy to promote the well-being of women who underwent a mastectomy.