A model to measure and evaluate the quality of service of healthcare systems in a gynecological clinic : A Case Study

In today’s world, there is a strong competition between companies. In this competition environment, it is accepted that one of the most important elements is quality for companies to be differentiated. The company which can produce high quality products or high quality services can survive in this competition. Nevertheless, the situations of being high quality or low quality depends on the tolerance limits which are determined by customers and it can be changed from person to person. In today’s world, even though, when quality concept is considered, the first thing that comes to the minds is “the quality of products”, the fact of quality is not important for only manufacturing companies but also service companies. To be able to comprehend that if the products or the services which are provided by the company satisfy the customers’ needs, the quality should be measured. Nevertheless, when the process of measuring the quality is carried out by experiments, observations and tangible data in the manufacturing companies, there is no tangible data in the service companies to measure the quality. That’s why there are many different models and qualitative approaches that are developed to be able to measure the quality in service companies. In the scope of this thesis, a model has been developed to measure the current quality and evaluate the perceived quality of a healthcare company. Developed model is consisted of two main parts which are functional quality and technical quality. Besides, for determining the perceived quality, socio-demographic attributes are also considered. To be able to implement the functional quality part of the model, a survey has been created about the clinic and it has been sent to the patients. And the data about the perceived quality has been gathered from the patients. To be able to implement the technical quality part of the model, interviews with the staff of the clinic have been made and the studies to improve the perceived quality of the clinic, permissions and certificates are identified. Developed model has been tested in the case company and it has been found acceptable. The model ensures to measure the current service quality of the clinic and unveils the areas which cause the low quality in the clinic. Thus, the spots that need to be improved are identified

Does Suture Material Affect Uterine Scar Healing After Cesarean Section? Results from a Randomized Controlled Trial

dogan, ozan/0000-0002-0016-8749; ELLIBES KAYA, ASKI/0000-0002-1323-7416WOS: 000498685000012PubMed: 29667541Background: Impaired healing of the uterine scar after cesarean has been associated with adverse gynecological and obstetric outcomes. Although a large number of studies have been conducted on the events leading to this, information obtained from prospective randomized studies examining the role of suture material in the formation of cesarean scar defect (CSD) is lacking. Objective: To evaluate the effects of synthetic suture materials on CSD formation. Study design: We performed a two-arm 1:1 randomized study in women with singleton pregnancies undergoing elective primary cesarean delivery after the 38th week of gestation. Uterine scar closure was performed using synthetic absorbable monofilament and multifilament sutures. The primary outcome was residual myometrial thickness (RMT) in the area of the scar, measured by transvaginal ultrasound 6-9 months after birth. Secondary outcomes included differences in mean operative time, mean estimated blood loss at the time of surgery, and the rates of postoperative gynecological sequelae. Results: Complete follow-up was obtained from 94 (88%) of 107 participants. RMT was thicker in the monofilament compared to the multifilament suture group (5.5 +/- 2.24 vs. 4.18 +/- 1.76, p = 0.01). Hemoglobin delta was higher in the monofilament suture group (1.59 +/- 0.96 vs. 1.25 +/- 0.60, p = 0.04). There was no statistically significant difference between the monofilament suture and multifilament suture groups in terms of gynecological sequelae. Conclusion: Closure of the uterine scar with monofilament suture has a positive effect on scar healing and increases RMT thickness

Cervical Mucus SLPI is a Predictive Biomarker for Timing of Delivery in Nulliparous Term Pregnancies with Unfavorable Cervix

Introduction:The aim of the present study was to evaluate cervical mucus secretory leukocyte protease inhibitor (SLPI) levels for the prediction of delivery time in uncomplicated term nulliparous pregnancies with an unfavorable cervix.Material and methods:In this prospective study, a total of 88 nulliparous singleton pregnant women with a gestational age between 370/7and 376/7 weeks were included. Bishop Score was determined and unfavorable cervix was defined as a Bishop Score &lt;5. Cervical mucus SLPI levels were collected from pregnant women with an unfavorable cervix between 370/7and 376/7gestational weeks. Patients were divided into two groups according to gestational age at delivery after cervical mucus SLPI sampling: delivery within 2 weeks group (n: 48) and delivery after 2 weeks group (n: 40).Results:Maternal demographic characteristics, mean Bishop Score, transvaginally measured cervical length, and cervical dilatation at cervical mucus SLPI sampling were similar between the two groups. The mean cervical mucus SLPI level was 52.4±52.6 ng/mL in the delivery after 2 weeks group and 253.2±220.0 ng/mL in the delivery within 2 weeks group and statistically different. The optimal SLPI cutoff value was 32 ng/mL for predict labor induction requirement due to absence of spontaneous labor before 410/7 (sensitivity, 0.65; specificity, 0.93; positive predictive value, 0.52; negative predictive value, 0.95).Conclusions:Our results suggest that measuring the SLPI levels in the cervical mucus can be a useful biomarker for predicting spontaneous delivery time in uncomplicated term nulliparous pregnancies with an unfavorable cervix.</p

Kronik karaciğer hastalıklarında karaciğerde Helicobacter türlerinin araştırılması

Helicobacter pylori is the major etiologic agent in gastritis and duodenal ulcer. Helicobacter pylori and some other Helicobacter species have been found in extragastric tissues as well. Some reports suggested a relation between Helicobater infection and various liver diseases, such as liver cancer, and primary biliary cirrhosis. Aim: to investigate the genetic elements of Helicobacter pylori and other Helicobacter species in liver tissues of the patients with various liver diseases by PCR. Materials and Methods: a part of the urease gene of Helicobacter pylori, and 16S ribosomal DNA of Helicobacter species were determined from the liver tissues of patients with chronic liver disease by PCR. Results: 185 patients with various liver disease (45 had crip-togenic liver disease, 30 had chronic HBV infection, 21 HCV infection, 17 steatosis hepatis, 15 primary biliary cirrhosis and 12 had nonalcoholic steatohepatitis, and 45 other liver diseases) were included in the study. Only 1 patient with PBC and autoimmune hepatitis overlap syndrome had Helicobacter 16S ribosomal DNA in her liver tissue. None of the patients was found to be positive for the PCR of H. pylori urease gene. Conclusions: In this study, genetic elements of Helicobacter species were not detected in the liver tissues of the patients with chronic liver diseases. These results suggested that Helicobacter infections in the liver have almost no role in the pathogenesis of chronic liver diseases in our population.Helicobacter pylori gastrit ve duodenum ülserinin en önemli sebebidir. Bunun yanında Helicobacter pylori ve diğer bazı Helicobacter türlerine mide dışı dokularda da rastlanmaktadır. Karaciğer kanseri ve primer biliyer siroz gibi çeşitli karaciğer hastalıklarında da Helicobacter türlerinin rolü olabileceğine dair çalışmalar yayınlanmıştır. Amaç: Bu çalışmada çeşitli karaciğer hastalıklarında karaciğer dokusunda Helicobacter pylori ve diğer Helicobacter türlerinin varlığının araştırılması planlanmıştır. Materyal ve Metod: Farklı etyolojilere sahip kronik karaciğer hastalarında iğne biyopsisi ile elde edilen karaciğer biyopsilerinde PCR yöntemi ile Helicobacter pylori'nm üreaz genini ve Helicobacter türlerinin 16S ribozomal DNA'sını hedefleyen amplifikasyonlar yapılmıştır. Bulgular: Kırkbeşi kriptojenik karaciğer hastalığı, 30'u kronik HBV infeksiyonu, 21'i kronik HCV infeksiyonu, 17'si alkole bağlı olmayan karaciğer yağlanması, 15'i primer biliyer siroz, 12'si alkol dışı steatohepatit tanısı alan, 45'i diğer karaciğer hastalıklarına sahip 185 hastanın sadece "otoimmün hepatit+primer biliyer siroz overlap sendromu" tanısı alan birinde karaciğerde Helicobacter 16S ribozomal DNA'stna rastlanmıştır. Üreaz gen amplifikasyonu tüm hastalarda negatif bulunmuştur. Sonuç: Kronik karaciğer hastalıklarında karaciğer dokusunda Helicobacter türlerine ait genetik elemanlara rastlanmamış, bu nedenle kronik karaciğer hastalıklarının etyolojisinde Helicobacter türleriyle oluşan infeksiyonunun bir rolü olmadığı düşünülmüştür