Patient complaints as a means to improve quality of hospital care. Results of a qualitative content analysis / Patientenrückmeldung als Möglichkeit die Versorgungsqualität von Spitalpatienten zu verbessern. Ergebnisse einer qualitativen Inhaltsanalyse

Background: Many hospitals have defined procedures for a complaint management. A systematic analysis of patient complaints helps to identify similar complaints and patterns so that targeted improvement measures can be derived (Gallagher & Mazor, 2015). Aim: Our three-month, nurse-led practice development project aimed 1) to identify complaints regarding communication issues, 2) to systemise and prioritise complaints regarding communication issues, and 3) to derive clinic-specific recommendations for improvement. Method: We analysed 273 complaints of patients documented by the quality management (secondary data analysis). Using content analysis and applying the coding taxonomy for inpatient complaints by Reader, Gillespie and Roberts (2014), we distinguished communication-related complaints. By further inductive differentiation of these complaints, we identified patterns and prioritised fields of action. Results: We identified 186 communication-related complaints divided into 16 subcategories. For each subcategory, improvement interventions were derived, discussed and prioritised. Conclusions: Thus, patient complaints provided an excellent opportunity for reflection and workplace learning for nurses. The analysis gave impulse to exemplify the subject "person-centered care" for nurses.

Comportamento da mortalidade por câncer de mama nos municípios brasileiros e fatores associados / Breast cancer mortality in Brazilian municipalities and associated factors / Mortalidad por cáncer de mama en municipios brasileños y factores asociados

RESUMO Objetivo Analisar o comportamento da mortalidade por câncer de mama nos municípios brasileiros e avaliar a influência de fatores socioeconômicos e demográficos sobre as taxas e mortalidade. Métodos Foram calculadas taxas de mortalidade, padronizadas por faixa etária e corrigidas por causas mal definidas, centradas em 1990, 2000 e 2010. Posteriormente, foram estimados modelos de regressão, com dados em painel, que permitiram verificar o grau de associação entre os fatores de interesse e a taxa de mortalidade pela doença. Resultados Verificou-se uma tendência de crescimento da mortalidade no país. Contudo, os modelos indicaram que a mortalidade poderia ter diminuído (tendência negativa), principalmente no Sudeste e Sul, caso alguns fatores associados à doença (por exemplo, nível de renda, educação, longevidade, taxa de fecundidade, gastos em saúde, infraestrutura, entre outros) tivessem permanecido constantes durante o período considerado. Observou-se que a mortalidade por câncer de mama apresentou associação positiva/significativa com a longevidade e negativa/significativa com o nível de gastos públicos em saúde. A mortalidade foi maior nas regiões Sul e Sudeste, nos municípios com mais de 500 000 habitantes e naqueles onde a população é inferior a 5 000. Conclusões O crescimento da renda per capita, a elevação da expectativa de vida e a diminuição da taxa de fecundidade podem estar associados a elevadas taxas de mortalidade por câncer de mama e a uma tendência de crescimento na mortalidade por esse câncer nos municípios brasileiros.

ABSTRACT Objective To analyze breast cancer mortality trends in Brazilian municipalities and assess the influence of socioeconomic and demographic factors on mortality rates. Methods Age-adjusted mortality rates were calculated for the periods centered in 1990, 2000, and 2010 and corrected for ill-defined causes of death. After that, panel data regression models were developed for analysis of the association between the factors of interest and the mortality rate from breast cancer in Brazilian municipalities. Results A growing trend was detected in breast cancer mortality in Brazil. However, the models showed that the mortality could have decreased (negative trend), especially in the Southeast and South regions, if some associated factors (such as income, education, longevity, fertility rate, health spending, and infrastructure, among others) had remained constant during the study period. Breast cancer mortality was positively/significantly associated with longevity and negatively/significantly associated with public health spending. Mortality was higher in the South and Southeast, in municipalities with more than 500 000 inhabitants and in those with population below 5 000. Conclusions The growth in per capita income, the increase in life expectancy, and the decrease in fertility rates may be associated with high breast cancer mortality and a trend towards increased mortality from this cancer in Brazilian municipalities.

RESUMEN Objetivo Analizar las tendencias de la mortalidad por cáncer de mama en municipios brasileños y evaluar la influencia de factores socioeconómicos y demográficos sobre las tasas de mortalidad. Métodos Se calcularon las tasas de mortalidad, ajustadas por grupo etario y corregidas por causas mal definidas, para los años 1990, 2000 y 2010. Posteriormente, se calcularon modelos de regresión, a partir de datos de panel, que permitieron verificar el grado de asociación entre distintos factores de interés y la tasa de mortalidad por esta enfermedad. Resultados Se verificó que había una tendencia al aumento de la mortalidad en el país. Sin embargo, los modelos indicaron que la mortalidad podría haber disminuido (tendencia negativa), principalmente en el sudeste y el sur, si algunos factores asociados (por ejemplo, nivel de ingresos, educación, longevidad, tasa de fecundidad, gastos en salud, infraestructura, entre otros) hubieran permanecido constantes durante el período en estudio. Se observó que la mortalidad por cáncer de mama presentó una asociación positiva y significativa con la longevidad, y negativa y significativa con el nivel del gasto público en salud. La mortalidad fue mayor en las zonas sur y sudeste, en los municipios con más de 500 000 habitantes y en aquellos cuya población es inferior a 5000. Conclusiones El aumento de los ingresos per cápita, el incremento de la esperanza de vida y la disminución de la tasa de fecundidad pueden estar asociados a tasas altas de mortalidad por cáncer de mama y a una tendencia al aumento de dicha mortalidad en los municipios brasileños.

Problem Formulation in Knowledge Discovery via Data Analytics (KDDA) for Environmental Risk Management.

With the growing popularity of data analytics and data science in the field of environmental risk management, a formalized Knowledge Discovery via Data Analytics (KDDA) process that incorporates all applicable analytical techniques for a specific environmental risk management problem is essential. In this emerging field, there is limited research dealing with the use of decision support to elicit environmental risk management (ERM) objectives and identify analytical goals from ERM decision makers. In this paper, we address problem formulation in the ERM understanding phase of the KDDA process. We build a DM³ ontology to capture ERM objectives and to inference analytical goals and associated analytical techniques. A framework to assist decision making in the problem formulation process is developed. It is shown how the ontology-based knowledge system can provide structured guidance to retrieve relevant knowledge during problem formulation. The importance of not only operationalizing the KDDA approach in a real-world environment but also evaluating the effectiveness of the proposed procedure is emphasized. We demonstrate how ontology inferencing may be used to discover analytical goals and techniques by conceptualizing Hazardous Air Pollutants (HAPs) exposure shifts based on a multilevel analysis of the level of urbanization (and related economic activity) and the degree of Socio-Economic Deprivation (SED) at the local neighborhood level. The HAPs case highlights not only the role of complexity in problem formulation but also the need for integrating data from multiple sources and the importance of employing appropriate KDDA modeling techniques. Challenges and opportunities for KDDA are summarized with an emphasis on environmental risk management and HAPs.

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Integration of syndromic surveillance data into public health practice at state and local levels in North Carolina.

OBJECTIVES: We sought to describe the integration of syndromic surveillance data into daily surveillance practice at local health departments (LHDs) and make recommendations for the effective integration of syndromic and reportable disease data for public health use. METHODS: Structured interviews were conducted with local health directors and communicable disease nursing staff from a stratified random sample of LHDs from May through September 2009. Interviews captured information on direct access to the North Carolina syndromic surveillance system and on the use of syndromic surveillance information for outbreak management, program management, and the creation of reports. We analyzed syndromic surveillance system data to assess the number of signals resulting in a public health response. RESULTS: Syndromic surveillance data were used for outbreak investigation (19% of respondents) and program management and report writing (43% of respondents); a minority reported use of both syndromic and reportable disease data for these purposes (15% and 23%, respectively). Receiving data from frequent system users was associated with using data for these purposes (p=0.016 and p=0.033, respectively, for syndromic and reportable disease data). A small proportion of signals (<25%) resulted in a public health response. CONCLUSIONS: Use of syndromic surveillance data by North Carolina local public health authorities resulted in meaningful public health action, including both case investigation and program management. While useful, the syndromic surveillance data system was oriented toward sensitivity rather than efficiency. Successful incorporation of new surveillance data is likely to require systems that are oriented toward efficiency.

Organizing "mountains of words" for data analysis, both qualitative and quantitative.

Qualitative research creates mountains of words. U.S. federal funding supports mostly structured qualitative research, which is designed to test hypotheses using semiquantitative coding and analysis. This article reports on strategies for planning, organizing, collecting, managing, storing, retrieving, analyzing, and writing about qualitative data so as to most efficiently manage the mountains of words collected in large-scale ethnographic projects. Multiple benefits accrue from this approach. Field expenditures are linked to units of work so productivity is measured, many staff in various locations have access to use and analyze the data, quantitative data can be derived from data that is primarily qualitative, and improved efficiencies of resources are developed.

Estatísticas nas Américas: por uma agenda de estudos históricos comparados / Statistics in the Americas: an agenda for historical studies compared

Esta publicação reúne artigos de vários autores. Parte foi elaborada para uma das sessões na Latin American Studies Association - LASA, realizada no Rio de Janeiro, e parte para uma sessão ocorrida no próprio IBGE, ambas em 2009, cujos debates realçaram o estado atual das pesquisas históricas da atividade estatística, sejam elas realizadas em instituições estatísticas ou em ambiente acadêmico. Quatro países – Argentina, Brasil, Canadá e México – revelaram suas realidades históricas, e os textos, elaborados em seus respetivos idiomas de origem – Espanhol, Português e Francês – reportam tais experiências. (...) A introdução foi traduzida para o Inglês, estando também neste idioma, ao final do livro, os resumos de todos os textos. A publicação está estruturada em quatro seções: uma em que se faz abordagens historiográficas, com revelação de métodos de análise; duas outras com narrativas socio-históricas, ora focando os estados e as instituições, ora a ciência e a técnica; por último, uma que se destina a refletir sobre como seguir adiante, dando curso, em futuro próximo, num espaço regional, a estudos comparados, pelos quais sejam realçadas as possíveis proximidades e os inevitáveis afastamentos nas histórias nacionais. Ao final, duas entrevistas revelam trajetórias intelectuais exemplares: a de Hernán Otero e a de Jean-Pierre Beaud, dois estudiosos da história da atividade estatística, em perspectiva sociológica, e suas produções bibliográficas, sob a escolha dos próprios autores. Que este livro, resultante dos recentes debates ocorridos sobre a pesquisa histórica das estatísticas, no âmbito das sessões da LASA e do IBGE, seja recepcionado como um convite à comunidade acadêmica brasileira no sentido de trabalhar este tema junto ao IBGE, e em agenda própria de pesquisa. Que seja visto, sobretudo, como um exemplo às instituições estatísticas de outros países, estimulando-as à prática de tais pesquisas, como forma de ampliar sua aceitação como organizações necessárias às sociedades democráticas. Que todos, então, pesquisadores acadêmicos e pesquisadores nas instituições estatísticas, e elas próprias, em seus programas de atividades, se irmanem na pesquisa histórica da atividade estatística (e, sempre que próprio, também da atividade geográfica, como no caso do IBGE). Nossos países só terão a ganhar, tornando nossas histórias pátrias melhor escritas. O CD-ROM que acompanha a publicação reproduz o conteúdo impresso.

[Epidemiology and epidemiologists: a survey on the presence, structure and training of epidemiologists and medical statisticians in the Veneto region]. / Epidemiologia ed epidemiologi: indagine sulla presenza, or- ganizzazione e formazione di epidemiologi e statistici medici nella Regione Veneto.

The present study aims at assessing the role of epidemiology on health decision-making processes in the public administrations of the Veneto region, north-eastern Italy. In 2003 a questionnaire was mailed to chief-executives of local public health organizations (21 Local Health Units, 2 Public Hospitals), and 18 responded. All public health organizations were practicing Epidemiology, but only 4 had dedicated services. Sixty-two people were working as epidemiologists in public health, but only half played the role for most of their Full Time Employment. Personal educational qualifications were mainly degree in Medicine (62%) and Statistical Sciences (23%). Among physicians, 78% was specialized in Hygiene and Preventive Medicine. The head office of most public health organizations (15 out of 18) appraised epidemiology as fundamental with regard to the health decision-making process, however two thirds of them reported that the epidemiological informative needs were only little or not at all satisfied. To improve the situation, most Public Health Organizations intended to perform educational activities and to use external advisors. In conclusion, Public Health Organizations of the Veneto region appreciated the importance of epidemiology in the health decision-making process. However, few resources were devoted to this field so that informative needs were only partly satisfied.

Pesquisa histórica das estatísticas: temas e fontes / Historical study of statistics: topics and sources

Tomando as estatísticas como objeto de estudo (e não como meio de análise) e fazendo-o a partir de uma dimensão histórica no quadro teórico de uma sociologia das estatísticas, propõem-se temas e indicam-se fontes para possíveis pesquisas históricas. Os temas e as fontes aqui sugeridos desdobram a abordagem realizada na coleção História das Estatísticas Brasileiras: 1822-2002 (em quatro volumes), que vem sendo editada pelo Instituto Brasileiro de Geografia e Estatística. Trata-se, em última instância, de se fazer uma história do Brasil pelo prisma do querer e do fazer as estatísticas, ou, dito de outra forma, do se governar utilizando-as.

By taking statistics as an object of study (rather than a means of analysis) and taking a historical perspective from within the theoretical framework of the sociology of statistics, topics and sources are put forward for possible historical research. The topics and sources suggested here are a development of the approach adopted in the four-volume collection História das Estatísticas Brasileiras: 1822-2002 brought out by the Instituto Brasileiro de Geografia e Estatística. Ultimately, the aim is to write a history of Brazil from the perspective of the purpose and practice of statistics, or in other words, their use in the practice of government.

The competitive value of healthcare IT.

The competitive advantage that an IT system provides for healthcare organizations does not result from the application system itself; rather, it depends on three factors: How the organization implements the system. Whether the organization is able to develop means to implement IT faster or cheaper than its competitors. The strengths of the organization's IT staff and technical platform.