Tool for Supervision of Screening for Tuberculosis Patients in District Hospitals.

Setting :  The tuberculosis control programme in Khon Kaen province, North East Thailand.Objective :  To develop a tool for supervisor to easily assess the quality of screening for tuberculosis suspects in peripheral health units.Methods :  Field exploration, tool development and field testing by researchers and health professionals.Results :  A tested supervisor tool measuring the proportion smear positive tuberculosis suspects and the proportions suspects with two and three smears examined, indicative for screening performance.  Defined acceptable levels of performance and remedial action to be taken.Conclusion :  The tool is simple to use by the supervisors, is acceptable to supervisees and stimulates to self assessment and improvement.Key words : tuberculosis, tool, supervision, screening, district hospital 

Tool for Quality Control of Tuberculosis Sputum Smear Examinaiton in Peripheral Laboratories.

Setting :  District hospital laboratories and reference Zonal Tuberculosis Control Centre Laboratory in Khon Kaen Province, Thailand.Objective : To develop a peripheral laboratory quality control tool of tuberculosis sputum smear examinationMethods : Health systems research. First exploratory research and tool design, later analysis of tool application in the routine control programme.Results : A system of laboratory quality control consisting of re-examinaiton of a sample of slides, using the lot quality assurance sampling technique was created. Two indicators are measured : the proportion poorly prepared slides and the jproportion incorreclty read slides.  Difficulties in applying the tool are described.Conclusion : A tool for quality control of tuberculosis sputum smear examination in peripheral laboratories has been developed and tested, and found useful to improve the quality of peripheral laboratories in Khon Kaen, Thailand.Key words : tuberculosis, tool, sputum smear examination, quality control, laboratory

The Performance of Tuberculosis Sputum Examination at District Hospitals, Khon Kaen, Thailand

 Setting : Nineteen  district  hospital  laboratories  and  a  reference  Zonal  Tuberculosis  control  Centre  laboratory  in  Khon  Kaen,  Thailand. Objective : To  assess  the  performance  of  sputum  smear  examinations  by  peripheral  laboratory  technicians  in  their  own  work  setting. Design : Exploratory  study.  19  district  hospital laboratories  were  asked  to  submit  monthly  a  sample  of  sputum  slides that  were  examined  during  1990 and  1991.  These  slides  were  reexamined  by  a  reference  laboratory  technician.  The  reading  results  were  compared and  the  influence  of  slide  preparation  on  the  reading  result  was  analyzed. Results  :  In  a  sample  of  1057  slides  the  agreement  in  reading  results  between  the  reference  and  peripheral  laboratories  was  94%  However,  39%  of  slides  were  not  prepared  well  in  sputum  collection,  smearing  or  staining.  Among  the  slides  with  good  sputum  but  with  poor  smearing  or  staining  a  significantly  different  proportion  of  positive  slides  were  found  compared  with  the  well  prepared  slides  when  examined  by  the  reference  laboratory.  The  authors  speculate  that  technicians  in  the  district  and  reference  laboratories  make  the  same  mistakes  in  reading  these  poorly  prepared  slides,  so  that  a  high  agreement  in  results  does  not  guarantee  good  performance. Conclusion :  Not  only  agreement  in  reading  results  but  also  the  proportion  well   prepared   slides  is  and  important   indicator  for  peripheral  laboratory  performance. Keyword  :  tuberculosis,  performance,  sputum  smear  examination,  district  hospitalRequest  for  reprints :

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.