Adang Bachtiar

Comparison of nasal obstruction symptom evaluation, peak nasal inspiratory flowmeter, and rhinomanometry in patients with nasal deformities

Nasal obstruction is the most common symptom in daily otolaryngology practice that correlates with quality of life. Nasal obstruction etiology is multifactorial and can result from mucosal or structural factors. Subjective and objective evaluation approaches are a significant challenge in its diagnosis. This study aimed to evaluate correlations among the nasal obstruction and symptom evaluation (NOSE) and peak nasal inspiratory flowmeter (PNIF) scores and active anterior rhinomanometry values for nasal obstruction diagnosis in subjects with nasal deformities including crooked nose, saddle nose, nasal valve incompetence, and deviated septum. Furthermore, the correlation of nasal obstruction with sleep-disordered breathing was evaluated. Data in this cross-sectional analytical study in 52 consecutive subjects with nasal deformities and 10 consecutive normal subjects were analyzed with the bootstrapping method. Mean nasal resistance in normal subjects and those with nasal deformities were 0.172 and 0.173 Pa/cm3/s, respectively, on 75 Pa. The NOSE score was not significantly correlated with the PNIF score or the nasal airflow resistance determined by rhinomanometry. However, there was a significant correlation between PNIF and nasal airflow resistance.

Measurement Model of Hospital Performance for Achieving Hospital Mission in Indonesia

Performance measurement is an important issue. This reminds that healthcare industry characteristic is unique rather than others. Health care with its all activities is a “high risk” industry. Performance measurement is the centre of quality improvement. From this, many factors or reasons related to excellent services can be identified. This research aimed to get quality dimensions that could be used as performance measurement in hospital as a health care provider. The direction of this performance measurement is as guidance on achieving hospital mission. With limited resources, Hospital needs priority to achieve its mission, so its need to be known wisely the critical dimension that correlate to a hospital mission. The design of this research was an operational research that using both qualitative and quantitative method in the government and private hospital in Indonesia. The result showed that there is a correlation between Patient Centeredness dimension with Clinical Effectiveness, Efficiency, Staff Orientation, Responsive Governance and Design dimensions, where all of dimension (except Responsive Governance) showed a positive correlation to the hospital mission variable. Hereby its correlation of equation: Hospital Mission = 0.118 Clinical Effectiveness + 0.348 Efficiency – 0.034 Responsive Governance + 0.182 Staff Orientation + 0.268 Design. Where the influence of Patient Centeredness dimension to Clinical Effectiveness is about 0.578, Efficiency is about 0.488, Staff Orientation is about 0.478, Responsive Governance is about 0.609 and Design is about 0.351. From structural model equation test with Partial Least Square was summarized that the big affluence dimension to the mission is Efficiency and Design, while Responsive Governance is not a critical dimension in this model due to it has a negative correlation to the mission. The model consists of quality dimensions for hospital performance on achieving hospital mission. This model is called Mission Achievement Tools in Hospital model (MATH). MATH model could be functioned as a management system, strategic management tools, and as a dashboard on hospital organization’s trip to achieve the mission that can be used by The Ministry of Health to develop policy especially in hospital area. Keywords— Performance Measurement, Hospital Mission,