Impact of a hospital improvement initiative in Bangladesh on patient experiences and satisfaction with services: two cross-sectional studies

<p>Abstract</p> <p>Background</p> <p>The Bangladesh government implemented a pilot Hospital Improvement Initiative (HII) in five hospitals in Sylhet division between 1998 and 2003. This included management and behaviour change training for staff, waste disposal and procurement, and referral arrangements. Two linked cross-sectional surveys in 2000 and 2003 assessed the impact of the HII, assessing both patients' experience and satisfaction and public views and use of the hospitals.</p> <p>Methods</p> <p>In each survey we asked 300 consecutive outpatients and a stratified random sample of 300 inpatients in the five hospitals about waiting and consultation time, use of an agent for admission, and satisfaction with privacy, cleanliness, and staff behaviour. The field teams observed cleanliness and privacy arrangements, and visited a sample of households in communities near the hospitals to ask about their opinions and use of the hospital services. Analysis examined changes over time in patients' experience and views. Multivariate analysis took account of other variables potentially associated with the outcomes. Survey managers discussed the survey findings with gender stratified focus groups in each sample community.</p> <p>Results</p> <p>Compared with 2000, an outpatient in three of the hospitals in 2003 was more likely to be seen within 10 minutes and for at least five minutes by the doctor, but outpatients were less likely to report receiving all the prescribed medicines from the hospital. In 2003, inpatients were more likely to have secured admission without using an agent. Although patients’ satisfaction with several aspects of care improved, most changes were not statistically significant. Households in 2003 were significantly more likely to rate the hospitals as good than in 2000. Use of the hospitals did not change, except that more households used the medical college hospital for inpatient care in 2003. Focus groups confirmed criticisms of services and suggested improvements.</p> <p>Conclusion</p> <p>Improvements in some aspects of patients' experience may have been due to the programme, but the decreased availability of medicines in government facilities across the country over the period also occurred in these hospitals. Monitoring patients’ experience and satisfaction as well as public views and use of hospital services is feasible and useful for assessing service interventions.</p

Stabilny i niestabilny proces frezowania super stopu niklu obserwowany z wykorzystaniem wykresów rekurencyjnych i entropii wieloskalowej

This paper discusses the stability of high-speed machining processes. The problem of harmful vibrations can usually be detected based on measured signal forces. Nevertheless, the chatter effect may be unrevealed and hence some alternative approaches of signal monitoring must be taken to detect it. In the discussed case of machining, process stability is determined by means of stability diagrams. The measured milling force components are investigated by various signal analysis methods. In addition to this, the analysis also uses recurrence plots, recurrence quantifications, composite multi-scale-entropy and as well the statistical approach. Results obtained by the different methods are presented and discussed.W niniejszym artykule omówiono stabilność procesu obróbki szybkościowej. Problem szkodliwych drgań zwykle może zostać wykryty na podstawie sygnału mierzonych sił. Niemniej jednak drgania samowzbudne mogą nie ujawnić się w sposób wyraźny, a niekiedy do ich wykrycia potrzebne jest alternatywne podejście do monitorowania sygnału. W przedstawionym procesie obróbki stabilność procesu oszacowano za pomocą wykresów stabilności. Zmierzone siły frezowania badano różnymi metodami analizy sygnału. W analizie wykorzystano wykresy rekurencyjne, wskaźniki rekurencyjne, entropię wieloskalową, a także podejście statystyczne. Przedstawiono wyniki różnych metod i omówiono ich porównanie

Segregation of Ruthenium to Edge Dislocations in Uranium Dioxide

Atomic-level simulation methods are used to determine the interaction of a metallic fission product, Ru4+, with the core of a o/2\u3c1 1 0\u3e {1 1 0} and ao/2\u3c1 1 0\u3e {0 0 1} edge dislocations in UO2, experimentally the most active slip systems. Specifically, the segregation behavior of Ru4+ is examined at the cationic substitution site; comparisons are made with both continuum-elastic results and with the results of atomistic simulations on strained single crystals. The results on strained single crystals suggest that segregation behavior is a strong function of the elastic strain field around the detailed atomic structure at the dislocation core. Furthermore, the segregation is affected by the orientation of the dislocation and electrostatic interactions at the atomic defect site

Adverse impact of nocturnal transportation noise on glucose regulation in healthy young adults : effect of different noise scenarios

Background: Epidemiological evidence indicates an association between transportation noise exposure and a higher risk of developing type 2 diabetes. Sleep disturbances are thought to be one of the mechanisms as it is well established that a few nights of short or poor sleep impair glucose tolerance and insulin sensitivity in healthy good sleepers. Objectives: The present study aimed to determine the extent to which exposure to nocturnal transportation noise affects glucose metabolism, and whether it is related to noise-induced sleep alterations. Methods: Twenty-one young healthy volunteers (nine women) participated in a six-day laboratory study starting with a noise-free baseline night, then four nights sleeping with randomly-presented transportation noise scenarios (three road and one railway noise scenario) with identical average sound level of 45 dB but differing in eventfulness and ending with a noise-free recovery night. Sleep was measured by polysomnography. Glucose tolerance and insulin sensitivity were measured after the baseline, the last noise night and the recovery nights with an oral glucose tolerance test using Matsuda and Stumvoll insulin sensitivity indexes. Eleven participants were assigned a less eventful noise scenario during the last noise night (LE-group), while the other ten had a more eventful noise scenario (ME-group). Baseline metabolic and sleep variables between the two intervention groups were compared using a non-parametric Mann-Whitney U test while mixed models were used for repeated measure analysis. Results: All participants had increased glucoseAUC (mean ± SE, 14 ± 2%, p < 0.0001) and insulinAUC (55 ± 10%, p < 0.0001) after the last noise night compared to the baseline night. 2 h-glucose level tended to increase only in the ME-group between baseline (5.1 ± 0.22 mmol·L−1) and the last noise night (6.1 ± 0.39 mmol·L−1, condition: p = 0.001, interaction: p = 0.08). Insulin sensitivity assessed with Matsuda and Stumvoll indexes respectively decreased by 7 ± 8% (p = 0.001) and 9 ± 2% (p < 0.0001) after four nights with transportation noise. Only participants in the LE-group showed beneficial effects of the noise-free recovery night on glucose regulation (relative change to baseline: glucoseAUC: 1 ± 2%, p = 1.0 for LE-group and 18 ± 4%, p < 0.0001 for ME-group; Stumvoll index: 3.2 ± 2.6%, p = 1.0 for LE-group and 11 ± 2.5%, p = 0.002 for ME-group). Sleep was mildly impaired with increased sleep latency of 8 ± 2 min (<0.0001) and more cortical arousals per hour of sleep (1.8 ± 0.6 arousals/h, p = 0.01) during the last noise night compared to baseline. No significant associations between sleep measures and glucose tolerance and insulin sensitivity were found. Conclusion: In line with epidemiological findings, sleeping four nights with transportation noise impaired glucose tolerance and insulin sensitivity. Based on the presented sound exposure, the eventfulness of the noise scenarios seems to play an important role for noise-induced alterations in glucose regulation. However, we could not confirm our hypothesis that transportation noise impairs glucose regulation via deterioration in sleep quality and quantity. Therefore, other factors, such as stress-related pathways, may need to be considered as potential triggers for noise-evoked glucose intolerance in future research.SCOPUS: ar.jinfo:eu-repo/semantics/publishe