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Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: a cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals.
BMC Complement Altern Med. 2017 Mar 28;17(1):174
Authors: Kim CE, Shin JS, Lee J, Lee YJ, Kim MR, Choi A, Park KB, Lee HJ, Ha IH
BACKGROUND: Treatment effectiveness holds considerable importance in the association between service quality and satisfaction in medical service studies. While complementary and alternative medicine (CAM) use grows more prominent, comprehensive evaluations of the quality of medical service at CAM-oriented hospitals are scarce. This study assesses the quality of medical services provided at a CAM-oriented hospital of Korean medicine using the service encounter system approach and analyzes the influence of treatment effectiveness on patient loyalty.
METHODS: A survey study using one-on-one interviews was conducted using a cross-sectional design in outpatients visiting one of fifteen Korean medicine facilities located throughout Korea. A total of 880 surveys were completed from June to July, 2014, and 728 surveys were included in the final analysis after excluding incomplete or incorrect questionnaires. The reliability and validity of the surveys was confirmed using Cronbach's alpha coefficient and confirmatory factor analysis, and a structural equation modeling analysis was performed to verify causality and association between factors (quality of medical service, treatment effectiveness, patient satisfaction, and intent to revisit).
RESULTS: The measured factors of physician performance and quality of service procedures had a positive effect on treatment effectiveness. The impression of the facilities and environment directly impacted satisfaction rates for interpersonal-based medical service encounters, while treatment effectiveness positively affected satisfaction regarding quality of medical service. However, treatment effectiveness had a more significant effect on satisfaction compared to facilities and environment, and it indirectly affected satisfaction and directly influenced intent to revisit. Treatment effectiveness and satisfaction both positively influenced intent to revisit.
CONCLUSIONS: The importance of treatment effectiveness should be recognized when examining quality of medical services, and we hope that these findings may contribute to future studies.
PMID: 28351389 [PubMed - indexed for MEDLINE]
The association of a probiotic with a prebiotic (Flortec, Bracco) to improve the quality/quantity of spermatozoa in infertile patients with idiopathic oligoasthenoteratospermia: a pilot study.
Andrology. 2017 May;5(3):439-444
Authors: Maretti C, Cavallini G
The hypothesis that the assumption of a probiotic associated with a prebiotic (Flortec, Bracco; one sachet contains: Lactobacillus paracasei B21060 5 × 10(9) cells + arabinogalctan 1243 mg + oligo-fructosaccharides 700 mg + l-glutamine 500 mg) could improve the quality and quantity of spermatozoa in idiopathic oligoasthenoteratospermia (iAOT) patients to a larger extent than a control substance (starch) was tested. Forty-one patients with no chromosomal aberrations were randomized into two groups: 20 received Flortec, one sachet per day for 6 months, whereas 21 received the control substance. The following data were collected: clinical history, scrotal Doppler scans, Y microdeletion, karyotype and cystic fibrosis screens, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), and prolactin (PRL) levels, and two semen analyses. Both the Flortec and the starch groups underwent two semen analyses and one FSH, LH, T, E2, and PRL measurement in the blood, at the beginning of the study, and after 6 months. The comparisons were carried out using a non-parametric (Wilcoxon signed rank) test. The side effects were assessed and compared using the chi-squared test. Group 1 (Flortec) had their sperm count improved: volume of the ejaculate (median from 2.4 to 3.1 mL; p < 0.01), sperm concentration (median: from 15.2 × 10(6) /mL to 28.3 × 10(6) /39 mL; p < 0.01), progressive motility (median: from 16.2 to 42.0%; p < 0.01), and the percentage of typical forms (median: from 7 to 16.3%; p < 0.01); in addition, their FSH, LH, and T levels improved (p < 0.01), while those of E2 and PRL did not. Group 2 (control substance) had no modification in 42 of the parameters studied. There were no side effects in either group. These data showed that Flortec constitutes a safe therapy for improving the volume of the ejaculate and the quality/quantity of spermatozoa in iOAT patients.
PMID: 28245352 [PubMed - indexed for MEDLINE]
The Impact of a Standardized Oral Multinutrient Supplementation on Embryo Quality in in vitro Fertilization/Intracytoplasmic Sperm Injection: A Prospective Randomized Trial.
Gynecol Obstet Invest. 2017;82(1):8-14
Authors: Nouri K, Walch K, Weghofer A, Imhof M, Egarter C, Ott J
The role of micronutrients in fertility has recently gained increased attention. We aimed to test the impact of a standardized, multinutrient supplementation on outcomes after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in a pilot study. One hundred women undergoing IVF/ICSI were prospectively included and randomized to receive either a multinutrient supplementation named PROfertil® female that included folic acid, selenium, vitamin E, catechins, glycyrrhizin, diosgenin, damiana and omega-3-fatty acids (study group; n = 50), or 400 µg folic acid (control group; n = 50). Outcome parameters were embryo quality on day 3 after oocyte retrieval (good quality vs. poor quality) and the clinical pregnancy rate. In an intention-to-treat analyses, a higher rate of women with at least one good quality embryo (with at least 6 cells and a fragmentation rate <20%) were found for the study (29/50, 58.0%) compared to the control group (18/50, 36.0%; p = 0.045 in chi-square test; relative risk 1.611, 95% CI 1.009-2.597). In conclusion, a multinutrient supplementation that includes folic acid, selenium, vitamin E, catechins, glycyrrhizin, diosgenin, damiana and omega-3-fatty acids seems beneficial in terms of embryo quality.
PMID: 27832646 [PubMed - indexed for MEDLINE]
Evaluation of Sleep Quality in Patients With Nasal Septal Deviation via the Pittsburgh Sleep Quality Index.
J Craniofac Surg. 2016 Oct;27(7):1738-1740
Authors: Kara M, Erdoğan H, Güçlü O, Sahin H, Dereköy FS
OBJECTIVE: To investigate the effect of nasal septum deviation, without obstructive sleep apnea, on sleep quality.
METHODS: The present case-controlled study enrolled patients older than 16 years with nasal septum deviation who attended the Otorhinolaryngology Clinic between December 2013 and July 2014. The control group was selected from patients attending the clinic for another complaint. Sleep quality was evaluated via the Pittsburgh Sleep Quality Index, and differences between the groups were compared using the Mann-Whitney U test.
RESULTS: During the study period, 55 patients with nasal septum deviation were included in the study group, and the control group consisted of 51 patients with no complaints of nasal obstruction. Compared with the control group, patients with nasal septum deviation were found to be significantly higher (P <0.05) in all parameters of Pittsburgh Sleep Quality Index.
CONCLUSION: The presence of nasal septum deviation with nasal obstruction should be investigated in patients with sleep disorders. If any pathology is present, opening the nasal passages should be ensured and sleep disorders reevaluated.
PMID: 27536915 [PubMed - indexed for MEDLINE]
Liver Transplant Registry in Poland: Web-Netted Quality Tool in Liver Transplantation From Deceased and Living Donors.
Transplant Proc. 2016 Jun;48(5):1347-9
Authors: Czerwiński J, Lewandowska D, Małkowski P, Danielewicz R
BACKGROUND: Poltransplant managed a national transplant registry with the use of the Web tool www.rejestry.net. It collects information about all organ transplantations in the country along with outcomes. This article presents a formal analysis of data collected in the registry for the years 1998 to 2014.
MATERIALS AND METHODS: Results presented are actual, not extrapolated, numbers; these were calculated only for the events for which the observation was complete, meaning that a given term of follow-up had passed and the information on recipient's and graft survivals were available.
RESULTS: All liver transplant procedures were registered from the years 1998 to 2014, with follow-up data completeness of 89% to 99%. Detailed statistical descriptions of liver transplant results were significantly better for transplants from living donors, in comparison to deceased donors, for pediatric recipients. Results for pediatric and adult recipients did not vary if the organ was from a deceased donor. Elective and primary transplantations have significantly better results in comparison to urgent and re-transplanted cases. Results depend on indications for transplantation. Significantly better results were obtained in the case of cholestatic diseases and cirrhosis other than hepatitis C virus. Significantly worse results were obtained in acute liver failure, independently of etiology. Results in the case of hepatitis C virus cirrhosis, metabolic diseases, and neoplasms do not vary significantly.
CONCLUSIONS: The strength of these findings are based on the registry's reliability and completeness. The registry fulfills its aims related to collecting records and monitoring graft function, and recipient survival. The data are an important source of information, to be used by transplantation institutions and referred to in the literature.
PMID: 27496402 [PubMed - indexed for MEDLINE]
Multicentre cohort study 'Rehabilitation of Occupational Skin Diseases - Optimization and Quality Assurance of Inpatient Management (ROQ)': results from a 3-year follow-up.
Contact Dermatitis. 2016 Oct;75(4):205-12
Authors: Brans R, Skudlik C, Weisshaar E, Scheidt R, Ofenloch R, Elsner P, Wulfhorst B, Schönfeld M, John SM, Diepgen TL, ROQ Study Group
BACKGROUND: A tertiary individual prevention programme (TIP) is offered to patients with severe occupational skin disease (OSD) in Germany. Previously, it was shown that the burden of OSDs is considerably reduced in patients up to 1 year after the TIP.
OBJECTIVES: To evaluate the long-term effects of the TIP.
PATIENTS AND METHODS: In a prospective multicentre cohort study, the clinical and patient-reported outcome data 3 years after the TIP were evaluated.
RESULTS: Of the 1788 patients initially included in the study, 1410 were available for the 3-year follow-up analysis. The severity of OSD, the use of topical corticosteroids and days of absence from work were significantly reduced 3 years after the TIP, and the quality of life and skin protective behaviour were significantly improved. Of the patients, 96.9% were able to resume work. One thousand one hundred and sixty-six patients (82.7%) were still working 3 years after the TIP, 874 of them (75.0%) in the same occupational field. Hairdressers had the lowest rate of remaining in their original profession (41.3%).
CONCLUSIONS: The follow-up during 3 years of this unique cohort of patients with OSDs shows that the TIP is associated with sustained improvements in terms of disease severity, ability to work, quality of life, and prognosis.
PMID: 27356809 [PubMed - indexed for MEDLINE]
Hospital Quality and Performance of a Complex Surgical Procedure after Traumatic Digit Amputation.
Plast Reconstr Surg. 2016 Jul;138(1):141-51
Authors: Swiatek PR, Pandit A, Chung KC, Mahmoudi E
BACKGROUND: Traumatic digit amputations are prevalent injuries that have long-term disabling consequences. Although replantation after traumatic digit amputation is a complex procedure, the aesthetic, functional, and long-term economic benefits of replantation render it preferable to revision amputation when clinically indicated. The authors adapted the Donabedian quality-of-care conceptual framework to examine the association between hospital outcome quality measured by observed-to-expected mortality ratio and the treatment received after traumatic digit amputation. The authors hypothesized that the probability of undergoing replantation is higher in hospitals with lower observed-to-expected mortality ratios.
METHODS: Data from 106 qualified Level I and II trauma centers included in the 2007 to 2012 National Trauma Data Bank were used to estimate hospital-specific observed-to-expected mortality ratio. The authors then used a two-level logistic hierarchical model, adjusting for patient, clinical, and hospital characteristics, to examine whether observed-to-expected mortality ratio, as one of the commonly used hospital quality measures, is a predictor of the treatment received for 4169 patients with traumatic digit amputation.
RESULTS: Compared with trauma centers with high observed-to-expected mortality ratios, the probability of undergoing replantation was substantially higher in trauma centers with low observed-to-expected mortality ratios (OR, 5.09; 95 percent CI, 2.51 to 10.30; p < 0.001). Seeking care at hospitals with more than 400 beds increased the probability of digit replantation (OR, 2.08; 95 percent CI, 1.08 to 4.01; p = 0.029). Having no insurance decreased the odds of undergoing replantation (OR, 0.70; 95 percent CI, 0.53 to 0.91; p = 0.009).
CONCLUSIONS: Hospital observed-to-expected mortality ratio was the greatest predictor of undergoing replantation after digit amputation injury. The observed-to-expected mortality ratio, as an outcome measure of hospital quality, is an important predictor of the treatment received.
PMID: 26986989 [PubMed - indexed for MEDLINE]
The Effect of Experience on Response Time When Judging Synthesized Voice Quality.
J Voice. 2016 Jul;30(4):394-7
Authors: Kisenwether JS, Prosek RA
OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine the effect of level and type of experience on response time and the number of replays needed when judging voice quality.
STUDY DESIGN: This was a within-subjects group design.
METHODS: Speech-language pathologists, singing voice teachers, speech-language pathology graduate students with and without experience with a voice client, graduate students who have completed a voice pedagogy course, and inexperienced listeners (n = 60) rated stimuli with systematically altered measurements of jitter, shimmer, and noise-to-harmonics ratio (NHR) on a visual analog scale ranging from mild to severe for overall severity, roughness, breathiness, strain, and pitch. Response time (in seconds) and number of replays were recorded during the experiment.
RESULTS: Results showed that experienced listeners took the most time when rating the stimuli. Stimuli with two altered acoustical components also yielded longer response times compared with the stimuli with one altered acoustical component. Finally, level and type of experience had some effect on the number of replays for each stimulus during the rating task.
CONCLUSIONS: In conclusion, experience does affect response time when judging voice quality and the number of replays during voice quality rating tasks. Continued research is needed regarding the reasons for extended time and replays as per experience so as to enhance future training protocols.
PMID: 26474719 [PubMed - indexed for MEDLINE]