Способ профилактики и лечения послеоперационного гипотиреоза путем аутотрансплантации ткани щитовидной железы

Мета роботи - розробка ефективного способу хірургічного лікування й профілактики післяопераційного гіпотиреозу. Запропоновано спосіб профілактики та лікування післяопераційного гіпотиреозу методом аутотрансплантації щитоподібної залози. Наведені результати демонструють простоту, доступність і безпеку цього методу. Результати та обговорення. Ступінь гормональної компенсації після тиреоїдєктомії з аутотрансплантацією тиреоїдної тканини залежить від загальної маси аутографа, ваги пацієнта. Лікування післяопераційного гіпотиреозу методом аутотрансплантації оксігенованої тиреоїдної тканини щитоподібної залози є ефективним, простим, легким у виконанні, економічно доступним та доцільним.The aim - is to develop an affective method of surgical treatment of a postoperation hypothyroidism. Material and methods. The method of prophylaxis and treatment of a hypothyroidism by autotransplantation of a thyroid tissue worked out. For correction of postsurgical hypothyroidism the autotransplantation of oxygenated thyroid gland was performed with the following clinical-laboratory dynamics. Good results after autotransplantation of a thyroid tissue demonstrate the the simplicity,availability,safety and cheapness of this method of prophylaxis and treatment of a postoperation hypothyroidism. Completeness of hormonal compensation after thyroidectomy with autotransplantation of a thyroid tissue depends on weight of autografts, body weight of patient. Treatment of postoperation hypothyroidism by autotransplantation of a thyroid tissue is effective, simple, easy implemented and cost effective

Ендокринний та імунний супровід поліваріантних вегетотонічних ефектів біоактивної води Нафтуся у жінок

Среди женщин репродуктивного возраста с гиперплазией щитовидной железы автоиммунной природы, на которых курсовое питье биоактивной воды Нафтуся оказывало разнонаправленные вегетотонические эффекты, в эндокринном статусе выявлены незначительные различия между начальными уровнями общего трийодтиронина, альдостерона и прогестерона, а также между выразительностью, но не направленностью сопутствующих изменений общего тироксина и эстрадиола. Сопутствующие изменения иммунного статуса можно сгруппировать в три паттерна.Among the women of reproductive age with hyperplasia of thyroide glands of autoimmune nature, on which course drinking of bioactive water Naftussya made differ vegetotonic effects, the insignificant divergences between initial levels common tryiodthyronin, aldosteron and progesteron, and also between expressiveness, but not by an orientation of accompanying changes common thyroxin and estradiol are revealed. Accompanied changes of immune status groupped in three patterns

Is the readmission rate a valid quality indicator? A review of the evidence

Conclusions: Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indi

Using quality measures for quality improvement: The perspective of hospital staff

Research objective: This study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals. Study design: A cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness) indicators. Population studied: 93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran. Principal findings: On average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05). Conclusions: There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and effectiveness indicators is needed to support internal quality improvement processes at hospital level

Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals: a quantitative analysis.

OBJECTIVE: To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. DESIGN: A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits. PARTICIPANTS: One hundred and fifty-five CEOs and 155 quality managers. SETTING: One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s) Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda. RESULTS: Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships. CONCLUSIONS: Having quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters

How to prepare a successful proposal for EU funding?

Both national and international health services and public health researchers are struggling to find appropriate funding for their research ideas. On the one side this due to a scarcity in resources both nationally and internationally, and on the other side this is due to insufficient skills to prepare successful proposals for European Union (EU) finding. The EU provides several mechanisms that fund innovative, state-of-the-art projects with an outstanding added value to the European community. The aim of this presentation is firstly to show researchers which EU funding mechanisms are available, and secondly to explain the process of preparing an EU proposal, and the essential skills that need to be used in the preparation phase. Methods: The presentation will be based on extensive experience in the preparation of both successful and unsuccessful proposals for EU funding. This is the basis for lessons on what to do, and what not to do. Results: The first part of the presentation is spent on providing clarity in the labyrinth of EU funding mechanisms. Researchers will learn the importance of carefully selecting the most relevant funding mechanism to suit your research intentions. The second part of the presentation provides insights into how to manage the preparation of an EU proposal. This will include the translation of EU priorities into your own research interests and vice versa; awareness to award criteria; making a workplan from a to z; how to deal with a low success rate; preparing a feasible though relevant research design; how to select and approach project partners; how to assure a high EU added value; important steps in the writing process; and preparing an appropriate and relevant budget. Conclusions: There is no one recipe for success. There are however a number of skills that each researcher can master if the dedication, interests and enthusiasm are in the right place

The strength of primary care in Europe = De sterkte van de eerste lijn in Europa.

Europese landen met een goed ontwikkelde eerstelijnsgezondheidszorg hebben een gezondere bevolking. Dit blijkt uit NIVEL-onderzoek dat de prestatie van Europese eerstelijnsgezondheidszorgsystemen in kaart brengt, waarop Dionne Kringos maandag 12 november promoveert aan de Universiteit Utrecht. Het is voor het eerst dat Europees onderzoek aantoont dat een sterke, goed functionerende eerstelijnsgezondheidszorg leidt tot gezondere inwoners van een land. Ze verliezen minder levensjaren door bijvoorbeeld hart- en vaatziekten of astma wanneer zij behandeld zijn in een land met een sterke eerstelijnsstructuur, een goede coördinatie van zorg en een breed eerstelijns zorgpakket, zoals Finland, Denemarken, Nederland, het Verenigd Koninkrijk, Spanje en Portugal. European Primary Care Monitor Dionne Kringos en collega’s vergeleken de eerstelijnsgezondheidszorg in 31 landen met een door het NIVEL (Nederlands instituut voor onderzoek van de gezondheidszorg) ontwikkeld meetinstrument: de European Primary Care Monitor. Dit meetinstrument brengt de sterke en zwakkere punten van eerstelijnszorgsystemen in kaart met tientallen indicatoren zoals beleid en wet- en regelgeving, financiële middelen en de opleidings- en werkcondities voor eerstelijnszorgverleners. Ook worden de toegankelijkheid van de eerste lijn bekeken, of deze op een coördinerende en continue wijze zorg verleent, en de beschikbare zorgdiensten in een land. Aanknopingspunten Dionne Kringos: “Europese landen variëren in de sterkte van de eerste lijn. De informatie die wij op deze manier over de eerste lijn in een land krijgen, biedt beleidsmakers aanknopingspunten voor strategieën om de zorg te verbeteren. Zij moeten vooral kijken naar de dimensies en indicatoren waarop hun land minder goed scoort.” Kosten Uit het onderzoek blijkt dat het loont om te investeren in een betere eerstelijnszorg. Een sterke eerste lijn vermindert vermijdbare ziekenhuisopnamen, verkleint sociaaleconomische verschillen in ervaren gezondheid en draagt bij aan de volksgezondheid. Dat de zorgkosten hierdoor lager worden is vooralsnog niet aangetoond. “De stijgende kosten in de gezondheidszorg de afgelopen jaren in Europa”, stelt Dionne Kringos, “lijken eerder het gevolg te zijn geweest van economische bloei en nationale beleidsagenda’s dan van de sterkte van de eerste lijn.” Informatie-infrastructuur “Het was een uitdaging om in 31 landen complete, betrouwbare en valide eerstelijnszorg gegevens te verzamelen”, vervolgt ze. “Een belangrijk aandachtspunt voor de toekomst is daarom het verbeteren van de informatie-infrastructuur over het functioneren van de eerstelijnszorg in Europa. Een goed informatiesysteem vergroot de mogelijkheden om beter te sturen in de zorg.” Financiering DG SANCO (Europese Commissie), Wereldgezondheidsorganisatie, NIVEL, samenwerkingspartners van NIVEL in 9 landen en het Ministerie van Onderwijs, Cultuur en Wetenschap

The strength of primary care in Europe

This thesis aimed to get insight into the elements that form (the strength of) primary care (PC) in Europe, their determinants and their impact on health care system outcomes. The results strengthen the evidence-base for policymakers to prioritise PC strengthening on the health policy agenda and invest in improving the quality and completeness of PC information infrastructures, for funding agencies to invest in PC research, for researchers to further improve our understanding of the functioning of PC at macro, meso and micro level, and for PC professionals for the importance of their work for improving population health, reducing socio-economic inequality in self-assessed health and reducing avoidable hospitalizations. More specifically, we developed a Primary Care Monitoring Instrument measuring the strength of 9 key PC dimensions with in total 99 indicators. The strength of PC is determined by the degree in which its key dimensions are developed in a health care system. The structure of PC consists of: 1. governance; 2. economic conditions; and 3. workforce development. The PC process is determined by: 4. accessibility; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of PC includes at least: 8. quality of PC; 9. efficiency of PC. By applying all indicators in 31 European countries it became clear that the theoretical notion of ‘PC strength’ cannot be captured by one (summary) measure or score. It is possible to summarize the strength of PC at structure level by one score for each country, but the strength of PC at process level can only by measured by analysing each of the 4 process dimensions separately. We have shown variation in PC strength across Europe, indicating a discrepancy in the responsibility given to PC in (inter)national policy initiatives and the needed investments in PC to solve e.g. future workforce shortages. To improve PC performance management there is a need for countries to improve their PC information infrastructure. We found that the national political agenda, economy, prevailing values, and type of health care system are all important factors that can both favour and hamper the development of strong PC. For example, countries that have been governed by a predominantly left-wing government over the past years have a stronger PC structure, accessibility and coordination of PC. Strengthening PC is in the end a political decision which can only be taken if it is in line with prevailing values in a country. In terms of outcomes, we showed that currently, countries with relatively strong PC have higher total health care expenditures than countries with relatively weak PC in Europe. In financially flourishing times, the total health care expenditures will increase despite strong PC. The results confirm that strong PC has a positive impact on population health, reducing disparity in health, and avoiding unnecessary hospitalizations in Europe. This thesis shows that in the beginning of the twenty-first century strong PC in Europe seems to be conducive to reaching important health care system goals