Development of intelligent monitoring system based on Internet of Things and wearable technology and exploration of its clinical application mode / 生物医学工程学杂志

Wearable monitoring, which has the advantages of continuous monitoring for a long time with low physiological and psychological load, represents a future development direction of monitoring technology. Based on wearable physiological monitoring technology, combined with Internet of Things (IoT) and artificial intelligence technology, this paper has developed an intelligent monitoring system, including wearable hardware, ward Internet of Things platform, continuous physiological data analysis algorithm and software. We explored the clinical value of continuous physiological data using this system through a lot of clinical practices. And four value points were given, namely, real-time monitoring, disease assessment, prediction and early warning, and rehabilitation training. Depending on the real clinical environment, we explored the mode of applying wearable technology in general ward monitoring, cardiopulmonary rehabilitation, and integrated monitoring inside and outside the hospital. The research results show that this monitoring system can be effectively used for monitoring of patients in hospital, evaluation and training of patients' cardiopulmonary function, and management of patients outside hospital.

Interpretation of outpatient respiratory management of infants, children, and adolescents with post-prematurity respiratory disease: an official American Thoracic Society clinical practice guideline / 中华实用儿科临床杂志

In recent years, the management of respiratory diseases related to preterm birth has received extensive attention.In 2021, the American Thoracic Society brought together multidisciplinary experts in respiratory, neonato-logy, otolaryngology, sleep medicine, radiology and nursing specialties to develop Guidelines for outpatient respiratory management in infants, children, and adolescents with post-preterm respiratory disease (hereinafter referred to as the " Guideline" ), aiming to provide evidence-based medical evidence for standardized outpatient management of respiratory diseases associated with preterm birth at different ages.The Guideline was interpreted and summarized so that pediatric clinicians could correctly diagnose and treat these diseases, and understand and implement standardized outpatient management on the basis of evidence.

Impact of COVID-19 on Out-Patient Services - Physiotherapy s Perspectives

The rapid spread of Coronavirus disease (COVID-19) has led to global pandemic affecting mental and physical well-being of people around the world. Given the highly contagious nature of COVID-19, public authorities in order to restrict the escalation of the virus ordered social lockdown and asked people to self-quarantine at homes if they develop any symptoms. As a result, these new social regulations have changed how individuals live and carry out everyday tasks in the general society. Reduced physical activity during lockdown has enhanced vulnerability to develop infections and non-communicable diseases. While on the other side, due to absence of routine medical surveillance, the condition of people with existing chronic conditions has deteriorated. Re-allocation of health care resources to treat COVID-19 patients put forward unprecedented challenge for the healthcare system in terms of providing medical support to non-infected out-patients. Extended social lockdowns are also causing adverse repercussions for physiotherapy and rehabilitation out-patient services. COVID-19 restrictions have hampered the in-person interaction of therapists and patients for in-person consultations and therapy sessions. Thus, leading to overall delay in the management and recovery of patients, especially those who are at a critical stage of treatment. During these unprecedented times of COVID-19 pandemic, provision of telehealth appeared to be the guiding light to tackle these evolving challenges of public health. Focusing on the out-patients who need close supervision for therapies and counselling, in this piece, “I” am arguing that methods of telemedicine and tele-rehabilitation should be actively adopted in the healthcare services to bridge the gap caused due to COVID-19.

Psychiatric morbidity in children attending child guidance clinic in a tertiary care teaching hospital

Background: Mental health and its related problems are growing concerns over the world. The early onset of emotional and behavioral problem in the young children is related to a variety of health and behavior problems in adolescence and later life as well. Most of these children present to Pediatric outpatient clinics owing to the Stigma and lack of awareness. The aim of the study is to find out the pattern and prevalence of psychiatric morbidity in children presenting to pediatric outpatient clinics.Methods: It is a cross sectional, point prevalence study of children who have attended Child Guidance Clinic of Pediatric Department in a tertiary care teaching hospital October 2019 to January 2020. Clinical and demographic details was collected in a semi-structured proforma and the details were analyzed.Results: A total of 114 children were analyzed during the study period and this study comprised of 62 boys and 52 girls. Most of the children belonged to the age group of 11-15 years (51%) followed by the ages of 6-10(29.8%). Most common reason for consultation was change in behavior, school refusal and poor academic performance. The most common diagnosis made was Dissociative Conversion Disorder (17.6%), Nocturnal enuresis (15.7%), Mild Mental Retardation (10.5%) and Seizure Disorder with Behavioral Problems (10.5%).Conclusions: A significant number of children attending the Paediatric OPD of general hospitals have psychiatric disorders. The emotional and behavioral problems in children often present with physical symptoms. An effective liaison of services will help to identify and treat children with psychiatric morbidity.

Otorhinolaryngology Out-Patient Practice in the “Post”-COVID-19 Era: Ensuring a Balance Between Service and Safety

Objective@#To review available resources and provide evidence-based recommendations that may optimize otorhinolaryngologic out-patient health care delivery in the “post”-COVID-19 era while ensuring the safety of our patients, healthcare workers and staff.@*Data Sources@#Relevant peer-reviewed journal articles; task force, organizational and institutional, government and non-government organization recommendations; published guidelines from medical, health-related, and scientific organizations.@*Methods@#A comprehensive review of the literature on the COVID-19 pandemic as it pertained to “post”-COVID 19 out-patient otorhinolaryngologic practice was obtained from peer-reviewed articles, guidelines, recommendations, and statements that were identified through a structured search of the data sources for relevant literature utilizing MEDLINE (through PubMed and PubMed Central PMC), Google (and Google Scholar), HERDIN Plus, the World Health Organization (WHO) Global Health Library, and grey literature including social media (blogs, Twitter, LinkedIn, Facebook). In-patient management (including ORL surgical procedures such as tracheostomy) were excluded. Retrieved material was critically appraised and organized according to five discussion themes: physical office set-up, patient processing, personal protection, procedures, and prevention and health-promotion.@*Conclusion@#These recommendations are consistent with the best available evidence to date, and are globally acceptable while being locally applicable. They address the concerns of otorhinolaryngologists and related specialists about resuming office practice during the “post”-COVID-19 period when strict quarantines are gradually lifted and a transition to the “new” normal is made despite the unavailability of a specific vaccine for SARS-CoV-2. While they target practice settings in the Philippines, they should be useful to ENT (ear, nose & throat) surgeons in other countries in ensuring a balance between service and safety as we continue to serve our patients during these challenging times.

A Study of drug utilization pattern in gynaecology out-patient department of a tertiary care hospital

Background: Gynaecological diseases are common in India because of socioeconomic, hygienic and literacy problems. Gynaecological drugs are one of the strong selling drugs in pharmaceutical market. Drug utilization research facilitate appropriate use of drugs in patient, minimize the adverse event and lead to better patient outcome. So, the present study was carried out to examine the patterns of drug prescription.Methods: A retrospective, observational study was done by collecting the prescriptions of the patients who attended the Gynaecology out-patient department in our institute for the period of six months. Total 300 prescription were collected and analysed. Patient’s demographic data, total number and category of drugs prescribed, percentage of individual drug and their dosage forms, drugs prescribed by generic name, brand names and percentage of drugs prescribed from essential drug list were analysed.Results: The mean age of presentation was 36.6±10.98 years. Among infective group breast abscess were common and among non-infective cases dysmenorrhea was most common. Out of 754 drugs prescribed, minerals were most commonly prescribed (42.70%) followed by antimicrobials (24.53%). Tablet form were prescribed more commonly (96.02%) followed by capsules (2%) and injections (1.06%). The average no. of drugs per prescription was 2.51±1.26 SD. Percentage of drugs prescribed by generic name were 98.01% and drugs prescribed from essential drug list were 85.41%.Conclusions: The overall drug use pattern in our study correlates with various gynaecological diseases. Majority of the women from rural background depend on primary health services for gynaecological diseases in their areas so, strengthening of gynaecological health care services reduce the morbidity among the women from rural areas.

Time Series Modelling Of Hospital Census: Application On Out Patient Department Data Of An Ayurvedic Secondary Care Hospital

The main objective of this paper is to fitt a curve on OPD data, for predicting the hospital OPD data. Four models were selected for curve fitting. All four models were fitted to old and new OPD patients for male and female separately. Models equations and coefficient of determination were calculated. Second order polynomial model was fitted well in all situations though exponential model was fitted well on old OPD patient data.

Exploration on psychological status of the primipara and gravida with second child / 中国医学装备

Objective:To explore the status and characteristic of psychology for primipara and gravida with second child so as to improve psychological status of them and take them keep positive mentality in whole gestation.Methods: 176 gravidas randomly were selected in this study, and a self-designed questionnaire of psychology was applied to evaluate and compare the psychological status and self-care capacity between primipara and gravida with second child by using method of questionnaire survey. The primipara and gravida with second child were implemented hierarchical management depended on their differently psychological problem, and personalized intervening measurement was adopted to enhance their self-care capacity.Results: The psychological enduring capacity, self-care capacity and the ability of deal with problem about interpersonal relationship of gravidas with second child were obviously better than that of primiparas, while the neglect degree for antenatal care of them was higher than that of primiparas.Conclusion: The whole society should pay attention to the process for gestation of pregnant woman, and give them higher social support so as to promote the maternal and child health and effectively decrease the occurrence rate of delivery risk.

Pharmaceutical Care in Integrated Diabetes Out-patient Participated by Clinical Pharmacists / 医药导报

Objective To introduce the working experience of clinical pharmacists who provide pharmaceutical service in participating integrated diabetes out-patient.Methods Review and analyze the patients' clinical features and the clinical pharmacists' working model and effect in integrated diabetes out-patient of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University.Results Among these patients who got pharmaceutical service in integrated diabetes out-patient, 81.7% were 40 to 70 years old, 51.7% had diabetes for 5 to 10 years, 50.0% were taking oral antidiabetic drugs to control blood glucose, and 90.0% were having complications.After the medication guide by clinical pharmacists,patients' medication compliance was increased from the percentage of 30.0% to 80.0%, the good control rate of blood glucose was increased from the percentage of 8.3% to 41.7%, and the incidence rate of adverse reaction was reduced from 10.0% to 3.3%.Conclusion Clinical pharmacists who actively participate in integrated diabetes out-patient could ensure the effective and safe treatment to diabetic patients.Therefore, this model is worth to be popularized due to professional value of clinical pharmacists.

Practice and Exploration of Service Model of Famous Expert Team in Hospital Out-patient Clinics / 中国医院管理

In order to deepen the reform of public hospitals,Beijing Tongren Hospital has carried out the pilot effort of famous experts team service model in out-patient,established a new mode of interior hierarchical medical services in the hospital.Through the adjustment of outpatient service process and the change of service model,issues of difficult medical treatment and ticket scalpers were solved.The reform has achieved the optimal utilization of outpatient resources inside the hospital,has been the beneficial exploration and practice of hospital internal hierarchical diagnosis and treatment,truly reflected the hospital service concept of taking the patient as the center,and has laid a solid foundation for the future widely hierarchical diagnosis and treatment mode.

A comparative evaluation of parenting styles for children diagnosed with conduct disorder at the out-patient service (OPS) of the National Center for Mental Health (NCMH) and for students studying at Malabon High School, April-Dec 2008

OBJECTIVES: This research aimed at showing the difference in parenting style of parents whose children were out patients diagnosed with conduct disorder at NCMH (clinical group) and those of parents with children studying at Malabon high school (non-clinical group).METHODOLOGY: Using a Parenting Scale translated in Filipino, 11 respondents from each group selected purposively were made to answer a 30 item questionnaire within 10- 15 minutes. The questions were grouped according to laxness, overreactivity and verbosity with corresponding factor loading.RESULTS: There was a mean of 2.66 for laxness, 2.54 for overreactivity and 1.92 for verbosity, with a total of 4.55 for the clinical group while the non clinical group had 2.5, 2.45 and 1.74 respectively for laxness, overreactivity and verbosity with a total of 3.95. Using the T test, it was determined that both clinical and non clinical group data had equal variances; without any significant differences noted between variances.CONCLUSION: Although parenting styles in families with children diagnosed with conduct disorder was dysfunctional, there was no statistical significance compared to that of parents from the non clinical group.   

Improvement Practice of the Information System of Out-patient Pharmacy Intravenous Admixture Center in Our Hospital / 中国药房

OBJECTIVE:To improve the information system of Out-patient pharmacy intravenous admixture center (OUIVA) to improve the pharmaceutical service rendered to the transfusion patient and ensure the safety of drug use. METHODS:The defi-ciency in OUIVA information system of our hospital were analyzed,in which improvement was made with respect to ungrouped doctor’s orders,inconsistency between the total doses charged and the prescribed doses and the error of transfusion days that occurred fre-quently. The conformity rate of out-patient fluid transfusion prescriptions and the time of patients’waiting for transfusion before and after the improvement were compared and evaluated. RESULTS:Improvement was made to OUIVA information system through the optimization of transfusion process,the application of condition limit,the adding of logical operation and verification and the other measures. After improvement,the unconformity rate of out-patient prescriptions in our hospital descended from 11.24% in 2013 to 3.69% in 2014,with an obvious increase in the accuracy rate of dispensing for fluid transfusion;and the time of patients’waiting for transfusion was shortened from 30-40 min to 15-20 min,with an increase in the degree of satisfaction of transfusion patients. CONCLUSIONS:The OUIVA information system can reduce the errors of drug dispensing for fluid transfusion and improve pharmaceutical services.

A comparative study on the reasons for non-compliance to outpatient charity appointments of child and adult patients seen as emergency referrals to the Department of Psychiatry and Behavioral Medicine of the UP-Philippine General Hospital from June 1-August 31,2013

OBJECTIVES: This study aims to identify the rate of noncompliance and the reasons for noncompliance to outpatient appointment among child and adult patients who were initially seen as emergency psychiatric referrals from June 1 to August 31,2013 at the UP-Philippine General Hospital.METHODOLOGY: This is a descriptive study. Total enumerative sampling of all patients seen as emergency psychiatric referrals was done. Results included percentage of noncompliance to appointments and a comparison of the rates using z-test. Top reasons for noncompliance were identified based on frequency and percentage. Comparison of reasons between child and adult groups was done using Fisher's exact test.RESULTS: Majority (71.3%) of patients who were seen as emergency referrals to the Section of Psychiatry and Behavioral Medicine during the study period was non-compliant with their outpatient follow-up appointments. There was no statistically significant difference between child and adult groups in terms of rate of compliance and reasons for non-compliance.CONCLUSION: The most common reasons for non-compliance to outpatient charity appointments: were unclear instructions about follow-up date and procedure;conflict with work or school schedule; perceived recovery after initial consult; no available companion; and no budget for transportation.

Survey of out-patient training by junior residents at university hospitals in Japan / 医学教育

<p>　It is necessary to perform out-patient training in order to acquire the basic medical skills of primary care. However, the actual situation of out-patient training has not been clarified in Japan. Therefore, we performed a survey of out-patient training by junior residents at university hospitals throughout Japan.</p><p>　A questionnaire survey was performed on out-patient training for junior residents at 80 university hospitals (main hospitals) nationwide. We received responses from 39 hospitals. The hospitals where out-patient training by junior residents was performed numbered 34, and there were 26 hospitals in which the training in out-patient reception hours is being performed. Hospitals which received training on related hospitals were also noted. There were many hospitals receiving a few patients with common symptoms. It is important to conduct training in university hospitals in cooperation with local hospitals.</p>

Trial of outpatient care experience simulation class using electronic medical chart samples / 医学教育

<p>Background: Few medical education programs provide hands-on classes using electronic medical charts for a large number of students.<br>Methods: To simulate a medical interview, third- and sixth-year medical students viewed electronic medical chart samples on a screen, created by FileMaker, and discussed patient management. Following this, they underwent a questionnaire survey.<br>Results: A total of 63.1 and 76.3% of the third- and sixth-year students responded to the questionnaire, and 87.1 and 78.9% of the responders became interested in the class, respectively, because it focused on hands-on, practical training. A total of 5.6% of third-year students stated that the class was difficult to master but they hoped to continue learning.<br>Discussion: The adoption of a hands-on class using electronic medical charts interested even junior medical students.</p>

The practice of the effect of quality control circle in medicine waiting time reduc-tion of out-patients in Hospital of Traditional Chinese Medicine of Foshan City / 药学实践杂志

Objective To investigate the effect of quality control circle in the reduction of medicine waiting time for out‐patients .Methods Analyze the reason of the increase of medicine waiting time for out‐patients was analyzed .Specific plan was made and carried out .Medicine waiting time for out‐patients before and after the intervention was compared by statistic analy‐sis ,and the effect of quality control circle was assessed .Results The average medicine waiting time for out‐patients after inter‐vention was 14 .47 min ,which was 2 .45 min shorter than the average time before the intervention;67 .78% of the patients got their medicine within 15 min after the intervention ,which was 10 .61% higher than that of before the intervention ;the quality control methods ,abilities of solving problems and working initiative of the quality control circle stuffwere improved .Conclusion Quality control circle is capable of increasing dispensing efficiency ,shortening medicine waiting time for out‐patients ,and promoting the core competitiveness of dispensary of traditional Chinese medicine .

A study on drug prescribing pattern in psychiatry out-patient department from a tertiary care teaching hospital.

Background: The burden of illness resulting from psychiatric and behavioral disorders is enormous; although, it remains grossly under represented by conventional public health statistics, which focus on mortality rather than the morbidity or dysfunction. Therefore, the study was carried out to find out morbidity pattern of psychiatric diseases and prescribing trends of psychotropic drugs. Methods: A prospective observational study was conducted in psychiatry out-patient department of a tertiary care hospital for 3 months. Diagnosis was made according to ICD-10 criteria. Prescription pattern was analyzed using World Health Organization (WHO) drug indicators. Results: Of 520 patients analyzed, 52.31% were males and 47.69% were females, 72.31% were <45 years. Depression 42.88%, schizophrenia 23.08%, bipolar mood disorders 17.88%, and anxiety 9.04% accounted for 92.88% of cases. Among the total of 1092 psychotropic drugs prescribed, 1056 (96.7%) were oral formulations. Average number of psychotropic drugs per prescription was 2.1 ± 0.8. 20.58% of the prescriptions contained fixed dose combinations. About 28.75% drugs were prescribed by generic name. Utilization from the WHO and National essential medical list were 28.57% and 38.64%, respectively. The prescribing frequency of anxiolytics, anti-depressants, anti-psychotics, anti-cholinergics, and anti-mania drugs was 30.04% (328/1092), 25.46% (278/1092), 25.37% (277/1092), 11.54% (126/1092), and 7.6% (83/1092), respectively. Clonazepam, olanzapine, escitalopram, carbamazepine and trihexyphenidyl were the most commonly prescribed benzodiazepines (BZD), antipsychotic, antidepressants, mood stabilizer and anti-cholinergics, respectively. Conclusion: Utilization pattern of the psychotropic drugs were in accordance to the recommendations of various treatment guidelines. BZD were the most commonly prescribed psychotropic drugs.

Trend of psychiatric disorders among out-patients and in-patients of a tertiary care center of India.

Background: Pattern of psychiatric disorders found among patients visiting the hospital helps in understanding the epidemiology, heath seeking behavior as well as strategic service planning and development. Methods: A retrospective health record review, of all the patients visiting out-patient care and in-patient care of psychiatry department of a tertiary care hospital in a period of two years, was conducted to assess the prevalence and trend of most common psychiatric disorders among them. Results: Major depressive disorder and Alcohol use disorder were the most common conditions found in out-patient and in-patient settings respectively. Out-patient consultations were consistently increasing whereas in-patient admissions were variable and decreasing with time. Conclusion: Current scenario and trends of psychiatric disorders among this group of patients is in line with epidemiological patterns and reflects a healthy trend of community oriented (out-patient based) care.

Controle da anticoagulação com Varfarina realizada em ambulatório especializado / Control of anticoagulation with Warfarin in a specialized outpatient clinic

Fundamentos: Em várias cardiopatias a anticoagulação previne eventos tromboembólicos. Varfarina é o anticoagulante oral mais utilizado, entretanto sua eficácia e segurança dependem do monitoramento do tempo de protrombina (TP) e sua padronização pelo INR. Manter INR adequado é um desafio, especialmente em população de baixos níveis educacional e socioeconômico. Ambulatório especializado em anticoagulação representa importante aliado.Objetivo: Avaliar o controle do INR em pacientes acompanhados em ambulatório de anticoagulação.Métodos: Durante dois meses foram selecionados pacientes que utilizavam varfarina e eram acompanhados em ambulatório especializado no controle de TP. Os pacientes são assistidos em intervalo máximo de quatro semanas, recebem orientação sobre riscos e benefícios da anticoagulação e têm carteira específica para o acompanhamento. Foi considerado INR adequado valores entre 2,0 e 3,5. Utilizado o teste t de Student e considerado significativo p<0,05. Resultados: Avaliados 96 pacientes, sendo 50 (56,25 %) homens; média de idade 59±14,9 anos. A indicação para anticoagulação foi fibrilação/flutter atrial em 55,21 %; prótese valvar em 26,04 %; tromboembolismo prévio em 9,38 % e trombo intracardíaco em 9,37 %. O tempo de acompanhamento médio foi 361,26±216,34 dias, e 66 (68,75 %) pacientes apresentaram INR adequado. A dose média diária de varfarina foi 4,93±3,13 mg/dia. A média de idade, o tempo de acompanhamento e a dose média diária foram semelhantes nos dois grupos: com INR adequado e com INR inadequado. Conclusão: A anticoagulação orientada por equipe especializada é efetiva e segura em pacientes com baixa renda e baixo nível educacional, permitindo que seja prescrita para esses pacientes.

Background: In several cardiopathies anticoagulation prevents thromboembolic events. Although warfarin is the most widely used oral anticoagulant, its efficacy and safety depend on monitoring the prothrombin time (PT) and its standardization by INR. Maintaining adequate INR is challenging, especially in populations with low educational, social and economic levels. Clinics specializing in anticoagulation are important allies.Objective: To evaluate INR control among patients monitored at an anticoagulation clinic. Methods: For two months, patients taking warfarin were selected and monitored at a PT control clinic, seen at least every four weeks and receiving guidance on the risks and benefits of anticoagulation, with specific monitoring cards. Appropriate INR values were taken as between 2.0 and 3.5, using the Student t test and a significance of p<0.05.Results: Having evaluated 96 patients, with 50 men (56.25 %) and a mean age of 59±14.9 years, the indication for anticoagulation was atrial fibrillation / atrial flutter for 55.21 %; prosthetic valve for 26.04 %; previous thromboembolism for 9.38 % and intracardiac thrombus for 9.37 %. The median follow-up time at the clinic was 361.26±216.34 days, and 66 (68.75 %) of the patients had an appropriate INR. The mean daily dose of warfarin was 4.93±3.13 mg/day. The average age, monitoring time and mean daily dose were similar for both groups, with adequate and inadequate INR. Conclusion: Anticoagulation guided by specialized staff is effective and safe for patients with lower income and educational levels, allowing it to be prescribed for these patients.

Satisfação e responsividade em serviços de atenção à saúde da Fundação Oswaldo Cruz / User satisfaction and responsiveness in the healthcare services at Fundação Oswaldo Cruz

O artigo discute resultados de uma pesquisa sobre satisfação dos usuários com o atendimento em três unidades assistenciais da Fundação Oswaldo Cruz na Cidade do Rio de Janeiro, tomando como base as categorias satisfação do usuário e responsividade. Pesquisou-se as percepções e as opiniões de pacientes ambulatoriais sobre o atendimento no Instituto de Pesquisa Clínica Evandro Chagas, Instituto Fernandes Figueira e Centro de Saúde Escola Germano Sinval Faria. Foram aplicados questionários a partir de amostras intencionais para cada unidade, em um total de 1.339 questionários válidos. A pesquisa encontrou uma alta satisfação entre os usuários, principalmente com o atendimento dos profissionais de saúde. Porém, itens específicos, tais como limpeza dos banheiros e privacidade durante as consultas, não foram bem avaliados. A melhoria desses aspectos depende não somente de investimentos em recursos financeiros e tecnológicos, mas de mudanças na cultura organizacional. Inicialmente é feita uma discussão da literatura sobre satisfação do usuário, identificando os conceitos que nortearam a pesquisa. Em seguida, descrevem-se as etapas metodológicas, as quatro dimensões dos serviços avaliadas - dignidade, agilidade, instalações e informação - e se analisa os resultados da pesquisa.

The paper discusses the results of research into user satisfaction in three healthcare facilities at Oswaldo Cruz Foundation in Rio de Janeiro. The analysis is based on the concepts of user satisfaction and responsiveness. Perceptions and opinions of outpatients from Instituto de Pesquisa Evandro Chagas, Instituto Fernandes Figueira and Centro de Saúde Escola Germano Sinval Faria were investigated. Intention samples were drawn for each institution and a total of 1.339 valid questionnaires were obtained. The study found that patients are satisfied with healthcare at Fiocruz, especially with health professionals. Nevertheless, restroom hygiene and privacy during consultations were less well evaluated. The improvement of these aspects depends not only on financial and technological investments but on changes in organizational culture. The first part of the paper discusses the literature on user satisfaction and responsiveness, with the definition of the categories that guided the study. The methodology is then presented as well as the four health services dimensions assessed - dignity, agility, facilities and communication - and the results are analyzed.