[Patient satisfaction in the outpatient department--a pilot study for customer satisfaction in ENT]. / Patientenzufriedenheit in der ambulanten Versorgung--Eine Pilotstudie zum Kundenmanagement in der HNO.

BACKGROUND: Customer satisfaction in German hospitals is becoming more important because of increasing competition in the healthcare market. Because the majority of patients with ear-nose-throat (ENT) problems are treated in an outpatient setting, this competition is not only taking place among hospitals but also among specialists in private practices. To assess patient preferences, reliable and valid questionnaires are necessary, which so far exist only for inpatients. The aim of the study was to develop an instrument with which to discover areas for potential improvement of the outpatient department. MATERIAL AND METHODS: The questionnaire was developed according to the guidelines of the EORTC and tested in a prestudy. During the time of observation, 98 patients were available, of whom 79 could be included in the study. The return rate was 71%. Of these patients, 18 were female and 38 male; the median age was 56 years. There were no differences between the study group and the yearly clinic average in terms of age, gender, or ratio of tumor patients. RESULTS: Patients mainly complained about waiting times in the outpatient department and diagnostic units as well as high patient turnover. Concerning positive aspects, patients mentioned the medical competence of the treating physicians; concerning negative aspects, the building infrastructure was noted. CONCLUSION: The questionnaire showed sufficient psychometric properties and helped find areas for improvement in the outpatient department. However, a complete picture of the department will be feasible only with repeated measures, especially when taking steps to improve the department's processes.

Differentiation of sympathetic and enteric neurons of the fowl embryo in grafts to the chorio-allantoic membrane.

Sympathetic cells (adrenergic neurons, SIF cells and chromaffin cells) and enteric neurons differentiate from migratory cells derived from the neural crest. The development of these cell types was studied in chorio-allantoic membrane (CAM) grafts, using combinations of tissue from domestic fowl embryos. Neural anlagen (neural tube and crest) of the vagal, cervico-thoracic and lumbo-sacral axial levels were equally capable of sympathetic differentiation, but this required somitic tissue for its significant expression. However, the vagal somites possessed only slight sympathogenic activity, thereby accounting for the negligible contribution of the vagal neural crest to the sympathetic nervous system. The same three levels of the neural anlage could furnish enteric neurons when combined directly with the aneuronal colo-rectum. However, the scale of this line of differentiation varied with the level of origin of the neural anlage, in contrast to the apparent equivalence in the ability to diffentiate as sympathetic cells. The density of enteric neurons in combinations with the vagal neural anlage was estimated as 60 times greater than the neuron density in combinations with the cervico-thoracic neural anlage. The lumbo-sacral neural anlage gave results similar to those of the cervico-thoracic level. Moreover, neural crest-derived pigment cells, positioned ectopically in the wall of the colo-rectum, were rare in combinations with the vagal neural anlage, but common in grafts with the other levels. When tested physiologically, the colo-rectum grown with the vagal neural anlage showed non-adrenergic, non-cholinergic inhibitory nervous activity in addition to the expected cholinergic excitatory responses. The neurons derived directly from vagal neural anlagen were similar to those that had reached the colo-rectum via their normal migratory pathways, when studied in terms of histological appearance, density of distribution and physiological responses.