Ileocecal interpositional graft for gastric replacement after total gastrectomy

The aim of this study is to evaluate the technique of ileocecal segment interpositional graft after total gastrectomy for gastric cancer with assessment of its advantages and disadvantages. This is a prospective study carried out at the National Cancer Institute, Cairo University. Twenty four patients with gastric carcinoma were identified from December 1998 to February 2003. All of them were submitted to surgery after preoperative clinical, radiological and endoscopic diagnosis. Total gastrectomy with ileocecal interpositional graft were done [19 subdiaphragmatic reconstruction and 5 intrathoracic reconstruction]. Patients were followed up for at least 12 months for postoperative morbidity, body weight, reflux and dumping symptoms. Gastrografin swallow, barium swallow, upper GIT endoscopy were routinely done in all patients and pouch emptying time by Tc-99m sulpher colloid was done in 11 patients only. Perioperative mortality was 8.3% [2/24]. No patient reported reflux symptoms-or showed endoscopic findings of reflux esophagitis in the subdiaphraematic reconstruction group and mild reflux was noted in only one patient in the intrathoracic reconstruction group. No patient reported dumping symptoms. Emptying time showed good capacity as a reservoir of food. Postoperative decrease in body weight averaged less than 10% of preoperative weight. ileocecal interposition graft after total gastrectomy has the advantages of preventing reflux esophagitis and providing functional replacement of the stomach as a reservoir for ingested food. It can be done with acceptable morbidity and mortality. It is simpler than some of the pouch reconstructions and deserves more attention

Structure assessment in a neonatal intensive care unit

The aim of this study was to asses the quality of the nursing care provided at the Neonatal Intensive Care Unit [NICU] at Princess Badia Teaching Hospital, Jordan, as regards the various components of structure domain within the context of quality. A checklist for structure assessment was developed including criteria classified under three main areas; namely, material resources, human resources and organizational structure. The results revealed certain deviations from the recommended compliance scores for each area. Recommendations were proposed to stress the importance of the NICU being specifically built to reflect the practice, environment and cultural needs as well as continuous education activities of NICU staff. Documented policy and procedure manuals were also recommended for assuring maintained quality care at the NICU

Quality of nursing care provided in a neonatal intensive care unit. Structure assessment

Structure is considered one of the three major approaches in the evaluation of quality; the other two being process and outcome. Appraisal of structure involves the attributes of the settings in which care is delivered that includes the material resources, the human resources and the organizational structure. The aim of the study was to assess the quality of nursing care provided at the neonatal intensive care unit [NICU] at Princess Badia Teaching Hospital, Jordan, as regards the various components of structure domain within the context of quality. A checklist for structure assessment was developed which included criteria classified under three main areas; namely, material resources, human resources and organizational structure. The results revealed certain deviations from the recommended compliance scores for each area. Recommendations were proposed to stress the importance of the NlCU being specifically built to reflect practice, environment and cultural needs as well as continuous education activities of NICU staff. Documented policy and procedure manuals were also recommended for assuring maintained quality care at the NICU

Job satisfaction and stress among MCH physicians in Alexandria

Physician satisfaction with their job is a topic of importance to physicians in practice, physicians in training, health administrators and health executives. Stress among physicians arises due to inadequate demands of the job in relation to worker's abilities, frustrated aspirations and dissatisfaction with regard to aimed goals. The cross-sectional study design was conducted at 7 randomly selected Maternal and Child Health [MCH] centres affiliated to seven medical zones in Alexandria. The study sample consisted of all physicians working at the studied MCH centres. A questionnaire designed for data collection was distributed to all physicians available and who accepted to participate in the study. The questionnaire included 4 sections measuring, sociodemographic characteristics, overall satisfaction and global satisfaction, an eight-dimension satisfaction scale and a four dimension stress scale. The questionnaire was distributed to 100 physicians out of whom 77% responded. Satisfaction scale was on a scale ranging from 6 [greatly satisfied] to 1 [greatly dissatisfied]. Stress was on a scale ranging from 6 [greatly stressed] to 1 [greatly unstressed]. The total mean satisfaction score for the sample under study was 3.3 +/- 0.6 with a significant difference among zones and the total mean stress score for the sample under study was 3.8 +/- 0.7 with a significant difference among zones. It is recommended that decision makers at the MOHP find ways to raise the physicians' pay, efficient planning of resources and find opportunities for future promotion

Validation of a patient satisfaction scale for primary care settings

The objective of this study was to develop and validate an instrument pertinent for the Egyptian culture and situation suitable for use by health centres administrators as a complementary tool for assessing the quality of outcome of care rendered. The study describes an attempt to develop and validate an instrument of patient satisfaction with primary health settings in Alexandria. A systematic randomized sample [227] of patients attending the outpatient clinics at 4 primary health centres in Alexandria were included in the study. The instrument included a section for respondents characteristics, and the other section was a 5-point Likert-type scale ranging from highly satisfied [5] to highly dissatisfied [1] was developed by adapting items from other measures of patient satisfaction in the literature. The internal consistency of the instrument was determined, and the Cronbach's alpha coefficient for all scales was 0.80. Using the principal components factor analysis factor loadings for the scale items were high on seven factors. The factors were named technical care, accessibility, structure, humaneness, respect, in return for cost, and the waiting time. The study supports that the instrument is a reliable and valid measure for patient satisfaction suitable for Egyptian primary health settings