Satisfaction of nurses and packing personnel with feeding bag compared to normal saline bottle among enteral feeding patients.

Objective: To assess the satisfaction of nurses and packing personnel with the use of a feeding bag compared to a normal saline bottle for patients needing enteral feeding. Methods: Ninety-three nurses in eleven wards who had been using both feeding bags and normal saline bottles and eight packing personnel who had been preparing food in these two containers were recruited. They were asked to give a satisfaction score (0-100) for both the feeding bag and the normal saline bottle. Results: Nurses were happier with the use of feeding bags than with normal saline bottles in 10 out of 11 aspects (p-value < 0.001): type of container, appropriateness of the container, preparation steps, duration of preparation, correct amount of food, convenience in feeding, flow of food, duration of feeding, food storage and patient’s complications. The only unsatisfactory aspect was reheating due to the loss of the patient’s name tag after soaking the feeding bag in warm water. Conversely, the packing personnel were more satisfied with the use of the traditional normal saline bottle in most aspects, except for the correct amount of food and food transportation. In terms of cost for each patient per day, using the normal saline bottle was a little more expensive than using the feeding bag (44.33 vs. 41.67 baht). Conclusion: For patients needing enteral feeding, the feeding bag should be considered for use, instead of the conventional normal saline bottle. However, more preparation skills and space are needed.

Breast cancer: A cost analysis study.

Objective : To compare the unit cost and the reimbursement calculated by Thai Diagnosis Related Group (DRG) version 3 of breast cancer treatments. Methods: thirty nine breast cancer patients who were underwent surgery during1 March 2001 to 30 April 2001 were sequentially selected. Hospital charts were reviewed. History before diagnosis, type of treatments, laboratory details, hormonal therapy and other costs were recorded. Labor cost, material cost and capital cost were calculated as direct cost which also included the cost of doctor visits. Indirect costs included the cost of the facility. Unit cost of each patent was calculated and compared to the reimbursement calculated by Thai DRG version 3 (September 2002). Results : Of 39 breast cancer patients, total Relative Weight (RW) was 54.37 (mean + SD=1.39+0.23) with full cost being 849,377.52 baht (mean + SD = 21,778.91+8,890.46). The total calculated reimbursement was 869,868.80 baht (men + SD 22,304.33 + 3,635.17). Calculation of reimbursement was based on the initial agreement that the university hospital would receive 16,000 baht in payment per 1 RW. Overall reimbursement was slightly higher than cost. Our study resulted in the classification of patients into 4 DRG groups as follows :1) DRG 09010 (Total mastectomy for malignancy, no complication), 2) DRG 09012 (Total mastectomy for malignancy, with mild to moderate complication),3) DRG 09014 (Total mastectomy for malignancy, with severe complication) and 4) DRG 09020 (Subtotal mastectomy for malignancy, no complication or Conservative breast surgery).Reimbursement was lower than cost in groups 2 and 4. In group 2,1 out of 2 patients had a long hospital stay which resulted in a high average cost. Conversely, unit cost of group 4 was not different from other groups but the RW given was lowest, which made the reimbursement much lower than real cost. Conclusion : In conservative breast surgery (group 4), patients must receive both surgical and radiation treatment to decrease the morbidity which increases the cost of treatment. An increased RW should be specially considered for this group.

Risk of breast cancer in post-menopausal women using hormone replacement therapy.

OBJECTIVE: To study the relationship of hormone replacement therapy (HRT) in post-menopausal women and risk of breast cancer. PATIENTS AND METHOD: The authors conducted a case-control study comparing the proportion of HRT used between breast cancer and non-breast-cancer women. Cases were breast cancer patients who had natural menopause (excluded hysterectomy) and aged > or = 50-years-old from the Siriraj Breast Cancer database (1983-1996). Controls were post-menopausal volunteers aged 50 year or older who visited Siriraj Hospital for other purposes such as elderly clinics, health check, etc. After informed consent, well-trained surgeons examined the women in the control group to exclude any potential breast cancer. Patient characteristics and risk factors were collected. RESULTS: Of 1,913 patients in the database, 623 were included as the cases. Data from 679 volunteers were collected for controls from May to December 1999. Among 1,302 of the study population 58 women had ever used HRT (4.5%), which distributed to 3.2 per cent (20/623) in cases and 5.6 per cent (38/679) in controls. From univariate analysis, age, age at menopause, number of children, habitat, education, contraceptive pills, familial history of breast cancer and HRT usage were associated with breast cancer (p-value<0.05). After multivariate forward stepwise logistic regression analysis, there was no association between HRT use and breast cancer (adjusted odds ratio (OR) = 0.61, 95% CI = 0.31-1.20). In subgroups analysis, women who had older age, higher education level, history of taking contraceptive pills, or positive familial history of breast cancer in second degree relatives had a decreased risk of breast cancer, while those living outside Bangkok had an increased risk. CONCLUSION: Hormonal replacement therapy in post-menopausal women was not associated with increased risk of breast cancer.

Publication of projects granted by faculty of medicine Siriraj Hospital during 1992-1997.

To study the success of Siriraj’s grants, awarded from 1992-1997, information about the granted projects was analysed using the number of publications as a success indicator. One hundred and ninety nine questionnaires were sent out ; 48 granted projects (1,440,000 Baht) were to staff and 151 (1,365,200 Baht) were to residents/fellows. The response rate was 74% (148/199). A total of 56 articles have been published (from 28% of the projects), 44% of faculty staff projects (21 out of 48) resulted in a publication, as did 23% of residents/fellows projects (35 out of 151). Factors that could affect the success of granted projects, such as the average time to start and the duration of the research, were not statistically different between faculty staff and residents/fellows (p=0.17 and 0.08, respectively). The results of this study could be used as a guide in the granting process.