A PROSPECTIVE COMPARATIVE STUDY OF A-B GAP IMPROVEMENT IN PURE TONE AUDIOMETRY BETWEEN CSOM CASES UNDERGOING TYPE 1 TYMPANOPLASTY USING TRAGAL PERICHONDRIUM AND TEMPORALIS FASCIA GRAFT

Aim: To ascertain whether the A-B gap improvement of tragal perichondrial grafting is better than TF grafting in CSOM patients undergoing type 1 tympanoplasty by underlay technique. Methodology: A prospective comparative study was done in CSOM patients presenting to a tertiary health care establishment. 60 patients underwent type 1 tympanoplasty, using TF graft in 30 and tragal perichondrial graft in 30 patients. Both groups of patients were compared in terms of A-B gap improvement following surgery. Results: A-B gap improvement of all the 60 patients were analysed. 8(26.67%) patients had A-B gap improvement </= 15dB in both the tragal perichondrium and TF graft group. Rest 22(73.33%) patients had A-B gap improvement of 16-25dB in either group. In cartilage group, 14 out of 15 patients i.e, 93.33%, while in Fascia group, 10 out of 12 pateints i.e, 83.33% patients who had perforation involving anterior quadrant had A-B gap closure between 16-25dB post- operatively. Therefore, cartilage graft showed better A-B gap closure than fascia graft in anterior quadrant. When both the quadrants were taken into consideration, 11 out 17 i.e, 65% patients in fascia group while 8 out of 13 i.e, 61% patients in cartilage group showed AB gap closure between 16-25dB. Therefore, fascia graft showed better result. Conclusions: This study showed that A-B gap improvement is similar in CSOM patients undergoing type 1 tympanoplasty using either TF or tragal perichondrial graft. Either of these can be good for improving the hearing in CSOM patients but tragal cartilage with perichodrium showed better results with perforation involving anterior quadrants.

Quality Evaluation of Health Care Establishment Utilizing Fuzzy AHP

Quality evaluation of healthcare establishment (HCE) is a difficult process as it involves multiple components of quality criteria with various factors and sub-factors therein. Further, the quality criteria are not universally standardized. The subjective evaluation in itself is not reliable as a tool so that available HCEs may be investigated for selecting the best among them. Thus, to avoid vagueness and imprecision due to process of human cognition the need to evolve a useful method for evaluation of quality of HCE was essentially required. To achieve such an objective three well established HCEs from northern cities of India have been studied. An Integrated Quality Model designed for HCE (Azam et al., 2012a, 2012b) and specifically tested previously with the AHP study by the authors (Azam et al., 2015) with its components, parameters and factors sub-factors has been utilized to evaluate the quality aspects of HCEs forming subjects of the current study. Further, the standard formula of Fuzzy AHP methodology with the application of fuzzy set theory was applied to the multiple components of the quality criteria with various factors and sub-factors therein pertaining to various HCEs forming the subject of the study. Quality of the HCEs thus could be evaluated empirically avoiding vagueness due to human cognition factors. Utilizing this methodology respective rankings of HCEs could also be assigned among them with practical utility to maintain the required quality of their services. Quality evaluation of Health Care Establishment utilizing Fuzzy AHP along with fuzzy set theory is a unique method which will benefit the client patients to select the best HCE among the available alternatives of HCEs. It also helps the managers to improve the business by allocating scarce resources wherever critically required to improve various quality components criteria factors and sub-factors of their HCEs.

Maintenance Management in a Health Care Establishment

With the accelerated growth of the health area in Brazil, institutions increasingly seek to optimize the operations by leveraging the results and becoming competitive in the market. Ensuring the high availability of infrastructure and assets provides that the organization is a strategic tool to achieve positive productivity results. However, it is necessary to structure the engineering department of the maintenance and correct administration of the flows that integrate the sector to meet the expected results. The use of computerized maintenance control tools helps in the management of environments and equipment, assuring the operational reliability of the health care establishment. This article presents the stages of implementation of management and maintenance in a health care establishment. The results demonstrate the evolution in the control of the maintenance department with greater efficiency, planning, increased availability of infrastructure and equipment as well as reduced costs for the operation of health sector processes in Brazil.

Pedagogical conditions of a corporate culture development in a health-improving type of educational institution

Features of a health-care establishment corporate culture are described in the article along with the system of complementary pedagogical conditions for the development of corporate culture in such institutions. The article substantiates the necessity of employees' professional community development, advancement of their competence and expansion of the opportunities for self-realization within the process of dealing with professional tasks. The author perceives the involvement of all the employees in the process as well as the increase in the number of initiatives and aspiration for bettering the quality of their work as substantial pedagogical conditions for the formation of a corporate culture.

Quality Evaluation of Health Care Establishment Utilizing Fuzzy AHP

Quality evaluation of healthcare establishment (HCE) is a difficult process as it involves multiple components of quality criteria with various factors and sub-factors therein. Further, the quality criteria are not universally standardized. The subjective evaluation in itself is not reliable as a tool so that available HCEs may be investigated for selecting the best among them. Thus, to avoid vagueness and imprecision due to process of human cognition the need to evolve a useful method for evaluation of quality of HCE was essentially required. To achieve such an objective three well established HCEs from northern cities of India have been studied. An Integrated Quality Model designed for HCE (Azam et al., 2012a, 2012b) and specifically tested previously with the AHP study by the authors (Azam et al., 2015) with its components, parameters and factors sub-factors has been utilized to evaluate the quality aspects of HCEs forming subjects of the current study. Further, the standard formula of Fuzzy AHP methodology with the application of fuzzy set theory was applied to the multiple components of the quality criteria with various factors and sub-factors therein pertaining to various HCEs forming the subject of the study. Quality of the HCEs thus could be evaluated empirically avoiding vagueness due to human cognition factors. Utilizing this methodology respective rankings of HCEs could also be assigned among them with practical utility to maintain the required quality of their services. Quality evaluation of Health Care Establishment utilizing Fuzzy AHP along with fuzzy set theory is a unique method which will benefit the client patients to select the best HCE among the available alternatives of HCEs. It also helps the managers to improve the business by allocating scarce resources wherever critically required to improve various quality components criteria factors and sub-factors of their HCEs.

AHP Model for Identifying Best Health Care Establishment

The purpose of this study is to develop an analytic hierarchy process (AHP) model utilizing components, parameters, and factors of a specifically designed Integrated Quality Model for Health Care Establishment (HCE). In doing so, the authors have utilized AHP approach to identify the best health care service quality performer among alternatives of HCEs. To select the best HCE, three HCEs of North India namely: HCE-A; HCE-B; and HCE-C were chosen. The criteria components of the integrated quality model for the HCE designed and suggested by and were adopted. Further, this study has undertaken an extensive in-depth literature review about AHP and its applications for HCEs from various aspects. A specifically developed integrated quality model for HCE with its components parameters, factors thereof, duly coded as criteria and sub-criteria have been utilized. It thus, facilitates the development of an AHP model to rank the chosen HCEs helping to identify potentially the best HCE among them. On the basis of the proposed hierarchical model, the findings suggest that the HCE-A may be selected first followed by HCE-C and HCE-B based on overall rating. The study provides a mechanism through AHP model to select potentially best HCE utilizing specifically developed integrated quality model for HCE with impacts both for the clients and the patients to enjoy the service of best HCE as well as for the managers to improve the services of HCE and the business. The study thus, adds a new perspective by developing a selection process to select the best HCE through an AHP model utilizing criteria and sub-criteria of an integrated quality model specifically developed for HCE. It has practical value for maintaining service quality of HCE to benefit the clients and related stakeholders as well as the managers by improving quality, enhancing reputation and business thereof.