Result of the poor - grade student file rotation in KKU Medical School in nineteen ninety.

 A  file  for  each  student  who  had  a  poor  study  result  in  1989  was  created.  The  file  contained  the  student’s  background  data  related information.  There  was  a   tatal  of  75  files.  Half  of  theem  were  randomly  selected  to  be  he  study  group  and  the  rest  were the  control  group.  The  files  of  the  study  group  were  distributed to  the  study  group  and  the  rest  were  the control  group.  The  files  of  the  A  set  of  quedtionnaires  for  the  staff  was  went  to  the  department  as  son  as  the  students  left  the  department.  Students’  opinions  were  collected  by  questionnaires  at  the  beginning  and  the end  of  the  academic  year.  The  numbers  of  re – examinations   of  each  student  in  1989  and  1990  were  collected  and  served  as  indicator  for  the  sudent’s  study  achievements.  This  randomized  control  study  revealed  that  there  was  no  significant  difference  in  staff  attitudes  to  both  groups.  The  students  in  both  group  had  no  difference  in  the  number  of  re – examination.  The  opinions  of  both  groups  as  a  result  of  the  response  to  32  questions,  are  not  statistically  different.  The  major  problem  in  this  study  was  the  low  response  rate.  Only  one – hied  of  he  staff  used  the  circulated  file,  and  61.5%  of  them  responded  to  the  questionnaires. No  negative  effect  was  found   in this  study .  Most  of  the  staff  who  replied  to  questions   supported  the continuation  of  the  file  rotation.  To  improve  the  effectiveness,  we  suggest  that  the  file  should  be  sent  to  the  staff  who  are  really  interested  in  student’s  problems.

Computerized Audit for Surgical Patients

Objective: 1. To audit the management of surgical patients by computer system. 2. To collect the problems of data analysis for auditing the management of surgical patientsDesign: Retrospective, descriptive study.Setting: Department of surgical, Faculty of Medicine, Khon Kaen UniversitySubject: All in-patients of Department of Surgical within 1998.Data collection: Review from computer database.Measurement: Descriptive statistics.Result: Important factor, which can be retrieved from computer database, include age, sex, diagnosis, operation, result, hospital stay, and mortality rate. A total of 6,821 patients was admitted in Department of Surgery during January and December 1998. The male: female ratio was 0.98:1 (3,375:3,446). The mean age of male and female patients was 43.17 and 43.76 years, respectively. The average hospital stay was 9.53 days. There were 1,224 patients (17.94%) who had complications and 6,048 patients (88.67%) had good discharge status. The average hospital mortality was 1.92%Conclusions: Computerized audit of surgical patients can be done much faster than manual audit. The result is highly accurate but may have some mistakes. Misunderstanding, inappropriate coding, unclear wording and input error cause mistakes in the computerized patient records. Some important factors for auditing are not collected in the computer system.Keyword: (1) Computer (2) Audit (3)Surgical patients

Neonatal Cholestasis : Biliary Atresia, the Possible Solution

Bachground : Neonatal cholestasis is defined clinically abs the accumulation in the blood conjugated bilirubin higher than 2 mg/dl or a fraction greater than 20 % of an elevated total bilirubin level. The clinical features of any form of cholestasis are similar, including jaundice, dark yellow urine and pale stools. The correct diagnosis of biliary atresia and neonatal hepatitis is important because the clinical course of these two diseases are different. In biliary atresia if Kasai operation would not be performed within 2 months of age, the child will end up with biliary cirrhosis and die at average age of one and a haff year.Objective :\  To assess the problem of diagnosis and result of treatment in order to improve management guildline for neonatal cholestasis.Study design : Retrospective descriptive study. The medical records of patients with neonatal cholestasis during Jury 1997 to July 2000 were used in this study.Results : There 33 cases of patients, 20 males, 13 females with average age was 82.69  34.39 days. A Conbination of blood test for congenital infection, imaging by ultrasound, DISIDA scan, exploratory laparotomy with intraoperative cholangiography (IOC) and histological study aided in establishing the diagnosis and differentiating biliary atresis from other causes of neonatal cholestasis. There were 13 cases of biliary atresia, 5 cases were neonatal hepatitis and 15 cases were cholestasis with non specific causes. The mean age was 78.07,57.0,97.73 days in group of libiary atresia, neonatal hepatitis, and cholestasis group respectively, The most reliable investigation was exploratory laparotomy and IOC. Kasai operation was done in only 8 cases. Only 2 had good result and liver transplantation was required in one of these. The others had cirrhosis. There were 3 cases in the neonatal hepatitis group and 7 cases in cholestasis group had results.Conclusions : The early definite diagnosis of neonatal cholestasis is the most important especially biliary atresia which the early operative treatment is crucial. There for, the parents are given advise that jaundice with pale stools after age of 2 \– 3 weeks should be regarded as abnormal. The first wellbaby examination should be happens at 4 weeks of age. The appropriate investigations should be performed for detection of biliary atresia which surgical procedure can safe their lives.Key words : neonatal cholestasis, biliary atresia, neonatal hepatitis.