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importance-performance analysis method (IPA) is used in market research in
order to measure the level of customer satisfaction. The aim of this study was
to evaluate and highlight the use of IPA as a management tool to measure
quality of dental services. We suggest that this method can be easily
implemented in a dental educational setting, as a performance outcome measure
that includes patient input. The study was conducted in a dental service
through a valid questionnaire, SERVQUAL.
This instrument explores levels of service quality perceived by
patients. It was conducted in four companies in Brazil in 2011 (derived from
different industry segments; two from textiles, one from hospital care and the
other from the manufacturing industry) in two States (S?o Paulo and Minas Gerais).
These companies were covered by the same dental managed care organization which
contracted with independent dentists to provide care. The study was divided
into two stages: the first, in which beneficiaries answered the questionnaire
prior to receiving dental treatment, and the second when the same beneficiaries
answered after completing their dental treatment. Data obtained from SERVQUAL generated graphs
that were used to characterize the IPA matrix using
several dimensions of care. The Assurance Dimension had the highest average in
both expectation and perception. The Reliability dimension showed the value of
the most negative GAP among the dimensions, and the best value occurred in the
Responsiveness dimension. The IPA tool may be effective in Dental Medicine
since it highlights the key points to be improved in the delivery of dental
services in a clinical setting.
resuscitation (CPR) persists as the best practice to maintain cerebral and coronary perfusion after cardiac arrest. Due to the chest compressions and ventilation maneuvers during resuscitation, there
are common complications reported. Abdominal organs injuries occur in
approximately 30% of patients, although studies show that they are under diagnosticated.
The aim of this article is to report a case of massive digestive hemorrhage by
gastric laceration after cardiopulmonary resuscitation, due to the event severity and rare clinic diagnostic. A
75-year-old Caucasian man suffered a sudden malaise and cardiac arrest and transferred
to an Emergency Unit (EU). The set of measures recommended by Advanced Cardiac
Life Support (ACLS) was performed. Despite no resistance to the passage
of nasogastric survey and spontaneous healing of fresh blood exteriorization,
an endoscopy showed ulcers in gastric notch with clots adhered and active
blood. There was no track record of liver or gastrointestinal diseases on this
patient, identifying a gastric laceration after cardiopulmonary resuscitation.
The mechanism by which the gastric laceration after CPR occurred is
uncertain. Nevertheless, some precipitating factors are considered such as
positioning of the patient during CPR, ideal point of compressions and ventilation pressure. In conclusion, this event is rare
with a hard diagnostic however that could be avoided and minimized with preventive