Feedback intervention to doctors improves patient satisfaction among outpatients in Inner Mongolia Autonomous Region, China.

OBJECTIVES: The doctor-patient relationship (DPR) in China is known to be tense. We tested whether an intervention program providing individualized feedback to doctors by patients could improve patients' satisfaction in an outpatient setting. STUDY DESIGN: A non-randomized controlled prepost intervention study in a tertiary hospital. Six surgery clinics were chosen as the intervention group and eight internal medicine clinics as the control group. METHODS: Before the program started, patients attending each group of clinics were asked to fill in the Short-Form Patient Satisfaction Questionnaire (PSQ-18). In the experimental period, patients attending the intervention clinics were requested to rate their perception of the doctor's quality of care in various domains on an 8-question feedback card immediately after exiting from the examination room and to drop the completed card into the feedback box for the particular doctor. The cards were then collected by the doctor confidentially at the end of each day. There was no feedback in the control clinics. After the experimental period ended, the doctors in both groups of clinics were reassessed by a new series of patients using PSQ-18. The PSQ-18 scores were compared within the same group of clinics over time, and the changes in satisfaction score compared between intervention and control clinics. RESULTS: There were 189 and 190 responders in the intervention group and 190 and 200 in the control group, before and after the intervention period, respectively. Scores in all domains increased significantly (P < 0.001) in the intervention group but not in the control group. Significant improvement in the patient satisfaction scores in the intervention clinics compared with the control clinics was confirmed by mixed-effects linear regression controlling for the effects of gender, age, marital status, education, and household income in the domains of general satisfaction, technical quality, communication, and accessibility and convenience. CONCLUSIONS: Timely feedback to doctors of patients' perception of quality of care received can improve outpatient satisfaction in a Chinese hospital.

Risk factors for reintubation in the post-anaesthetic care unit: a case-control study.

BACKGROUND: Risk factors for reintubation in post-anaesthetic care units related to anaesthetic processes have not previously been reported. Our goal was to identify risk factors for reintubation in general surgical patients. METHODS: A time-matched, case-control study was conducted on anaesthetic patients between 2001 and 2011. One hundred and sixty-four reintubated patients were compared with 656 randomly selected controls. RESULTS: Independent risk factors for reintubation were age <1 yr vs age 30-49 yr [odds ratio (OR)=16.4, 95% confidence interval (CI)=5.7-47.7], chronic pulmonary disease (OR=2.1, CI=1.1-4.0), preoperative hypoalbuminaemia (OR=4.9, CI=2.4-10), creatinine clearance <24 vs >60 (OR=4.1, CI=1.2-13.4), emergency case (OR=1.8, CI=1.0-3.1), operative time >3 vs <1 h (OR=3.0, CI=1.5-6.2), airway surgery (OR=32.2, CI=13.6-76), head and neck surgery (OR=3.4, CI=1.8-6.2), cardiac surgery (OR=3.8, CI=1.1-13.4), thoracic surgery (OR=6.3, CI=1.9-21.2), cardiac catheterization (OR=2.5, CI=1.1-5.5), ASA physical status III (OR=3.8, CI=1.4-10), and the use of certain types of neuromuscular blocking agent (P<0.001). CONCLUSIONS: Age <1 yr, chronic pulmonary disease, preoperative hypoalbuminaemia, and renal insufficiency were patient factors for reintubation. Emergency case, head and neck, cardiothoracic and airway surgery, and operative time >3 h were operative factors, while certain neuromuscular blocking agents and ASA physical status III were anaesthetic factors for reintubation.

A Thai reference for normal fetal nasal bone length at 11-13(+6) weeks gestation.

AIM: The purpose of this study was to establish a Thai reference for normal fetal nasal bone length (NBL) at 11-13(+6) weeks gestation. METHODS: The fetal nasal bone was measured by sonography in pregnant women at 11-13(+6) weeks gestation. All neonates who showed normal karyotypes were examined after delivery to confirm the absence of congenital abnormalities. RESULTS: A total of 255 pregnant women were recruited. Forty-seven pregnant women were excluded from the analysis because of technically unsatisfactory examination or absent nasal bone and chromosomal abnormalities. The mean ± SD of NBL was 1.79 ± 0.33 mm and increased significantly with crown-rump length (CRL) and gestational age (p < 0.001). The best-fit equation for NBL in euploid fetuses in relation to CRL was: NBL (mm) = (0.030 × CRL (mm)) - 0.016. CONCLUSION: NBL in Thai fetuses at 11-13(+6) weeks was found to be on average shorter than that in Caucasian, African-American and Chinese populations, but similar to those reported in Korean and Latin-American populations.

The effect of maximum bite force on alveolar bone morphology.

OBJECTIVES: To investigate to what extent maximum bite force contributes to alveolar bone morphology parameters, i.e. alveolar thickness, shape and arch width. DESIGN: An observational cross-sectional survey. SETTING AND SAMPLE POPULATION: One hundred and fifty one 12- to 14-year-old students from a secondary school in Hatyai City, Songkhla Province, Thailand. MATERIAL AND METHODS: Height, weight and maximum bite force of each subject were recorded. Alveolar bone morphology parameters were measured from study models. RESULTS: Maximum bite force moderately correlated with alveolar thickness and shape (r = 0.31-0.44, p < 0.001), but weakly correlated with arch width (r = 0.03-0.05, p > 0.05). After adjusting for gender and body mass index (BMI), the maximum bite force significantly determined alveolar thickness and shape (p < 0.001), accounting for 10-20% of the variations. Boys were associated with larger posterior arch width (p < 0.01), where BMI was not associated with alveolar bone morphology parameters (p > 0.01) after Bonferroni correction for multiple testing. CONCLUSION: Maximum bite force had a selective influence on alveolar thickness and shape, but not on arch width.

Infant death rates and animal-shed delivery in remote rural areas of Nepal.

This article outlines a community-based retrospective study in a remote area of Nepal and describes local birth practices and their impact on infant mortality. Data collection was carried out in two steps, a household survey from September to October 1996 and a qualitative research phase. Data collected include socio-economic background, reproductive history, birth practices and child survival. Among 3007 live-born children, 660 (22%) died before their first birthday. In keeping with local customs, approximately half of the children were delivered in an animal shed and the other half in the home. Children born in an animal shed were at significantly higher risk of dying than were those born in the home even after adjusting for socio-economic status and biological variables. The association was stronger in the neonatal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period (OR= 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was inadequate and thereby facilitated infection of both the newborn and the mother. Traditional norms and animal-shed delivery practices are common in the Jumla community. The reasons addressed for giving birth in the animal shed included (1) Household Deity's anger if delivery takes place in the home and (2) easy to clean the shed following the birth.

High-risk childbirth practices in remote Nepal and their determinants.

This study describes birth-related practices and their determinants among women in the Jumla district of Nepal. Data were derived from a household survey in 1996. Of 939 married women of reproductive age, 657 who had given birth to their last child during the previous five years were included in the analysis. Qualitative information was further obtained from traditional birth attendants (TBAs), mothers-in-law, community leaders and pregnant women. High-risk practices were common and related to local custom and lack of knowledge on the importance of cleanliness. Husband's level of education greater than fifth grade significantly reduced the high-risk practices in all stages of childbirth, independent of other socio-economic, biological and village variables.

Factors associated with coverage of iodine deficiency disorders by control programs in an endemic area in West Sumatra, Indonesia.

In order to ascertain the coverage and to identify factors determining the success of an iodine deficiency disorders (IDD) control program in West Sumatra, Indonesia, a cross-sectional study among 495 school children aged 6-15 years in a subdistrict of an endemic goitre area was conducted. Coverage of iodine capsule distribution was 27%. Forty-eight percent of the households used iodized salt with an appropriate concentration (>= 40 p.p.m.). Factors associated with not taking idodine capsules among children were: mother's lack of knowledge about the iodine capsule (OR 13.3, 95% CI 7.4-24.1) and mother's education level (OR 1.89, 95% CI 1.05-3.39). For unsatisfactory use of iodized salt in a household, the only predictor was family monthly income. Odds ratios and 95% CI for moderate and high family income were 2.42 (1.39-4.21) and 2.22 (1.4-3.54), respectively. We concluded that for coverage in an IDD control program, supplementation and fortification alone were not enough. Education had an impact on coverage of the supplementation. Furthermore, iodization of salt needs further improvement in relation to quality control. Finally, the program neglected high-income groups. These pitfalls should be corrected.

Risk factors for childhood obesity in a transitional society in Thailand.

OBJECTIVE: To identify factors associated with childhood obesity among the population of Hat Yai municipality, a transitional society in Thailand. DESIGN: Cross-sectional study. SUBJECTS: 2161 primary schoolchildren, aged 6-13 completed years. MEASUREMENTS: Weight-for-height of children by measurement, parental weight and height, parental income, family history of disease and children's activities by questionnaire. RESULTS: Prevalence of obesity was 14.1%. Using polytomous logistic regression, statistically significant associations with obesity were found for family history of obesity (relative rate ratio, RRR = 3.1), low exercise level (RRR = 2.6 vs normal), obesity in mother and father (RRR = 1.9 and 2.2, respectively vs normal weight status). Significant trends of increased risk were associated with higher family income and smaller family size. The highest population attributable fraction was that for family history of obesity (34%), followed by those for low exercise level (12%) and an obese or overweight mother (10%). CONCLUSION: As the parental and family factors identified in this study cannot be readily modified, increasing exercise may be the most appropriate intervention to prevent obesity in childhood.

Experience with oesophageal carcinoma in Songklanagarind Hospital.

Clinical data from 175 patients with squamous cell carcinoma of the oesophagus or cardia admitted to Songklanagarind Hospital between 1982 and 1988 were analysed to evaluate the effects on survival of various tumour and treatment variables. Most tumours (greater than = 86%) were in stage III or IV. Forty-seven percent of stage-IV tumours and 99 per cent of those in stages I, II or III were resectable. One-year and 3-year survival rates of resected stage-III patients (57.3% and 27.5%) were significantly higher than those of resected stage-IV patients (33.3% and 0%). Resection conferred no benefit over radiotherapy chemotherapy or no treatment on the survival of stage-IV cases beyond one year. Combined chemotherapy/radiotherapy/resection of stage-III and stage-IV patients gave no statistically significant improvement in survival. Among resected patients, only lymph node involvement was associated with significantly lower survival (relative risk compared to no involvement = 2.3, 95% CL: 1.2, 4.6), while the fungating type of tumour was possibly associated with improved survival (relative risk compared with all other types = 0.24, 95% CL: 0.05, 1.1).

Early detection of oesophageal carcinoma in southern Thailand.

The use of balloon cytology technique for detection of oesophageal carcinoma has been tested in 73 non-symptomatic patients and 53 patients with symptoms of oesophageal carcinoma from the high incidence of Southern Thailand. Cytological findings were compared with findings of esophagoscopy and oesophageal biopsy. Among symptomatic patients, scope/biopsy revealed 29 positive for carcinoma, against which balloon cytology yielded 9 false negatives (sensitivity 69%), but no false positives. All false negatives were of the stenosing type of tumour. One of 3 early cases of carcinoma revealed by the balloon technique among asymptomatic patients could not be detected by oesophagoscopy, biopsy or oesophagogram, but was confirmed by repeated cytological examination. The basic properties of the balloon cytology technique appear to justify its use as a routine diagnostic tool among high-risk patients for oesophageal carcinoma in Southern Thailand.