Cadaveric fascia lata pubovaginal slings:early results on safety, efficacy and patient satisfaction

Objective To prospectively evaluate and quantify the efficacy of cadaveric fascia lata (CFL) as an allograft material in pubovaginal sling placement to treat stress urinary incontinence (SUI).

Patients and methods Thirty-one women with SUI (25 type II and six type III; mean age 63 years, range 40-75) had a CFL pubovaginal sling placed transvaginally. The operative time, blood loss, surgical complications and mean hospital stay were all documented. Before and at 4 months and 1 year after surgery each patient completed a 3-day voiding diary and validated voiding questionnaires (functional inquiry into voiding habits, Urogenital Distress Inventory and Incontinence Impact Questionnaire, including visual analogue scales).

Results The mean (range) operative time was 71 (50-120) min, blood loss 78.7 (20-250) mL and hospital stay 1.2 (1-2) days; there were no surgical complications. Over the mean follow-up of 13.5 months, complete resolution of SUI was reported by 29 (93%) patients. Overactive bladder symptoms were present in 23 (74%) patients before surgery, 21 (68%) at 4 months and two (6%) at 1 year; 80% of patients with low (<15 cmH (2) O) voiding pressures before surgery required self-catheterization afterward, as did 36% at 4 months, but only one (3%) at 1 year. Twenty-four (77%) patients needed to adopt specific postures to facilitate voiding. After surgery there was a significant reduction in daytime frequency, leakage episodes and pad use (P <0.05). The severity of leak and storage symptoms was also significantly less (P <0.002), whilst the severity of obstructive symptoms remained unchanged. Mean subjective levels of improvement were 69% at 4 months and 85% at 1 year, with corresponding objective satisfaction levels of 61% and 69%, respectively. At 1 year, approximate to 80% of the patients said they would undergo the procedure again and/or recommend it to a friend.

Conclusion Placing a pubovaginal sling of CFL allograft is a highly effective, safe surgical approach for resolving SUI, with a short operative time and rapid recovery. Storage symptoms are significantly improved, and subjective improvement and satisfaction rates are high.

Artificial urinary sphincter implantation in the irradiated patient:safety, efficacy and satisfaction

Objective To compare the long-term outcome of artificial urinary sphincter (AUS) implantation in patients after prostatectomy, with and with no history of previous irradiation.

Patients and methods The study included 98 men (mean age 68 years) with urinary incontinence after prostatectomy for prostate cancer (85 radical, 13 transurethral resection) who had an AUS implanted. Twenty-two of the patients had received adjuvant external beam irradiation before AUS implantation. Over a mean (range) follow-up of 46 (5-118) months, the complication and surgical revision rates were recorded and compared between irradiated and unirradiated patients. The two groups were also compared for the resolution of incontinence and satisfaction, assessed using a questionnaire.

Results Overall, surgical revision was equally common in irradiated (36%) and unirradiated (24%) patients. After activating the AUS, urethral atrophy, infection and erosion requiring surgical revision were more common in irradiated patients (41% vs 11%; P <0.05); 70% of patients reported a significant improvement in continence, regardless of previous irradiation. Patient satisfaction remained high, with >80% of patients stating that they would undergo surgery again and/or recommend it to others, despite previous Irradiation and/or the need for surgical revision.

Conclusions Despite higher complication and surgical revision rates in patients who have an AUS implanted and have a history of previous Irradiation, the long-term continence and patient satisfaction appear not to be adversely affected.

Extending Customer Relationship Management into a Social Context

Informed by the resource-based view, this study draws on customer relationship management (CRM) and value co-creation literature to develop a framework examining the impact of social networking sites on processes to manage customer relationships. Facilitating the depth and networked interactions necessary to truly engage customers, social networking sites act as a means of enhancing customer relationships through the co-creation of value, moving CRM into a social context. Tested and validated on a data set of hotels, the main contribution of the study to service research lies in the extension of CRM processes, termed relational information processes, to include value co-creation processes due to the social capabilities afforded by social networking sites. Information technology competency and social media orientation act as critical antecedents to these processes, which have a positive impact on both financial and non-financial aspects of firm performance. The theoretical and managerial implications of these findings are discussed accordingly.

Applying the motivation-hygiene theory as a means of measuring learner satisfaction with blended learning courses in higher education

This study describes research on a postgraduate blended learning programme within the Department of Education at the University of Aveiro in Portugal. It is based on a multi-philosophical paradigm and examines students‟ satisfaction levels through the application of Herzberg‟s Motivation and Hygiene Theory. The main question being addressed in this research is: “Can the Motivation and Hygiene Theory be adopted as a means to measure student satisfaction with their blended learning environment?” Embedded within this research question are four fundamental questions which set the scene for the development of this research study and are explored in greater detail in Chapters 4 and 5 respectively: 1. What are the factors responsible for bringing about learning satisfaction with their b-Learning course? 2. What are the factors responsible for bringing about learning dissatisfaction with their b-Learning course? 3. Can these factors be represented as Motivation and Hygiene factors? 4. Will this method of measuring learning satisfaction lead to a set of guidelines that could be considered as a framework for the development of b-Learning courses? The results indicate that the Motivation and Hygiene Theory or an adapted version such as the Enricher and Enabler Theory proposed in this study could be considered as a plausible means of analysing an institution‟s b-Learning processes. The opportunity to carry out future research is evident and can be varied depending on the research objectives in mind. Examples where further exploration would be beneficial lay within the application of this theory to the wider sector; the use of larger samples, focusing on the teachers, as well as the learners and the application of Web 2.0 technologies as means of gathering information. The results of this research will be of great significance to those areas of education that are interested in locating quick and efficient means by which to evaluate their b-Learning and to no lesser extent e-Learning environments.

Antecedents of loyalty to a brand : Apple clients vs. non-clients

Apple is undoubtedly a sui generis and remarkable brand in what concerns to its branding and brand experience, and remains an indisputable reference in the consumer electronics and computer industries. The aim of this study encompasses the development and empirical testing of two conceptual models that evaluate and allow to draw a comparison between Apple clients and non-clients’ perceptions, regarding brand experience, brand perceived value, price perceptions and brand trust; and that determine the antecedents of clients’ loyalty to the brand. Therefore, the contribution of this study to the literature relies on the research of the impact of brand experience on brand perceived value and on price perceptions, as well as the influence of price perceptions (positive and negative) on trust, satisfaction, and commitment to the brand. Two surveys were used to test each conceptual model, through a sample collected across the portuguese academic community. The findings prove the strong influence of the sensory and affective aspects of brand experience on both clients and non-clients. They also reveal that the negative role of price is neutralized in the presence of strong brand experience, and that the fact that Apple is viewed as an “expensive brand” may highlight its association to higher quality and prestige. Also, this study reinforces the important role of satisfaction and commitment in building customer loyalty, corroborating the existent literature. Managerial implications derived from the findings are also discussed.

Aplicação de métodos de customer relationship management ao tratamento de dados para o desenvolvimento de negócios

Tese de Doutoramento, Gestão, na especialidade de Marketing, Faculdade de Economia, Universidade do Algarve, 2007

Big data warehouse framework for smart revenue management

Revenue Management’s most cited definitions is probably “to sell the right accommodation to the right customer, at the right time and the right price, with optimal satisfaction for customers and hoteliers”. Smart Revenue Management (SRM) is a project, which aims the development of smart automatic techniques for an efficient optimization of occupancy and rates of hotel accommodations, commonly referred to, as revenue management. One of the objectives of this project is to demonstrate that the collection of Big Data, followed by an appropriate assembly of functionalities, will make possible to generate a Data Warehouse necessary to produce high quality business intelligence and analytics. This will be achieved through the collection of data extracted from a variety of sources, including from the web. This paper proposes a three stage framework to develop the Big Data Warehouse for the SRM. Namely, the compilation of all available information, in the present case, it was focus only the extraction of information from the web by a web crawler – raw data. The storing of that raw data in a primary NoSQL database, and from that data the conception of a set of functionalities, rules, principles and semantics to select, combine and store in a secondary relational database the meaningful information for the Revenue Management (Big Data Warehouse). The last stage will be the principal focus of the paper. In this context, clues will also be giving how to compile information for Business Intelligence. All these functionalities contribute to a holistic framework that, in the future, will make it possible to anticipate customers and competitor’s behavior, fundamental elements to fulfill the Revenue Management

Strategic Human Resource Management of Volunteers and the Link to Hospital Patient Satisfaction

This article uses strategic human resource management theory to consider the ways in which volunteers can potentially enhance hospital patient satisfaction. Results of a structural equation modeling analysis of multi-source data on 107 U.S. hospitals show positive associations between hospital strategy, volunteer management practices, volunteer workforce attributes, and patient satisfaction. Although no causality can be assumed, the results shed light on the volunteer–patient satisfaction relationship and have important implications for hospital leaders, volunteer administrators, and future research.

Fiscal Year 2013-14 Accountability Report

The University of South Carolina Lancaster reports to the Office of State Budget its annual accountability report that includes an executive summary, a description of the leadership system, customer focus and satisfaction and other performance criteria, mission, and program descriptions and budgets.

Fiscal Year 2013-14 Accountability Report

The University of South Carolina at Union reports to the Office of State Budget its annual accountability report that includes an executive summary, a description of the leadership system, customer focus and satisfaction and other performance criteria, mission, and program descriptions and budgets.

Avaliação do impacto da formação profissional : aplicação da técnica cliente mistério

Relatório de estágio de mestrado, Ciências da Educação (Avaliação em Educação), Universidade de Lisboa, Instituto de Educação, 2011