Enhancing accessibility of patients with cleft lip/palate to healthcare services via a cleft birth registration system.

BACKGROUND: Cleft lip/palate is a critical health problem in Thailand; with an incidence rate of 2.49/1,000 live births. To insure the best outcomes, surgery should be performed near the age of three months. However; during the years 1993-2007, only 39.7% of children with a cleft lip/palate underwent an operation by the age of 3-4 months and only 58.18% by the age of 9-12 months. OBJECTIVE: The purpose of the study is to determine if a cleft birth registry might facilitate timely and proper treatment for children with a cleft lip/palate. MATERIAL AND METHOD: A pilot cleft birth registry, developed by the Tawanchai Cleft Center, was made available to hospitals in Khon Kaen, Roi-et, Kalasin, and Mahasarakam provinces, Thailand. Ninety-eight personnel involved in the care of children with a cleft lip/palate were recruited from the participating hospitals to evaluate the system. Assigned to one offour focus groups, participants were asked to evaluate the pilot system in terms of satisfaction and benefit. Following the focus groups, those participants that were traditionally responsible for registration were asked to use the cleft birth registry to register any newborns with a cleft lip/palate that were encountered in the course of their duties. Records were examined to determine how many newborns were properly registered and for those registered, whether proper care was received in a timely manner RESULTS: With 78 focus group participants responding to the satisfaction survey, results indicated mostly high levels of satisfaction with 26 (33%) participants rating satisfaction as very good, 49 (63%) as good and 3 (4%) as fair No participant rated satisfaction below fair. Furthermore, a majority stated that the cleft birth registy would benefit patients and contribute to timely treatment. During two years of active use, one hundred and thirty-seven newborns with a cleft lip/palate were registered into this cleft birth registry. Subsequent examination showed that eighty-eight percent ofregistered cases received proper management in tertiary healthcare settings. CONCLUSION: The fact that most of registered cases received proper care suggests that a cleft birth registry has the potential to facilitate timely and proper care. Howeve,; declining rates of registration over time is cause for concern. One opportunity for improvement in this regard might come from the establishment of an in-service trainingprogram to update knowledge pertaining to current standards of care and effective case management. Further improvements could also be made through better integration with existing referral systems. The researchers also noted that the existing electronic patient records (EPRs) in use by participating hospitals often lacked data structures suitable for effective care of patients with a cleft lip/palate. Thus, to foster useful integration, existing EPRs must also be extended to include data specific to cleft care/management.

Treatment of 4-5 year old patients with cleft lip and cleft palate in Tawanchai center.

BACKGROUND: The occurrence of Cleft Lip/Palate condition in Thailand reaches a rate of 2.49% of child births, with estimates of 800 new cases per year in the Northeastern region. The healthcare process emphasizes interdisciplinary teamwork at each stage of the planning of treatment and services with the primary goal of achieving patient satisfaction and ability to live normally in society. The first 5 years are particularly important, with a focus on quality of care and ability to adapt to the environment before entering school. OBJECTIVE: To study the treatment of patients with cleft lip and palate in Tawanchai center in the 4-5 year age range. MATERIAL AND METHOD: A retrospective study of the clinical records was led, concerning the 123 cleft lip and cleft palate patients aged 4-5 years under treatment in Tawanchai center, Srinagarind Hospital. Data was collected during three months from October to December 2011, using the admission records of the interdisciplinary team. Percentages and mean values were calculated from these data. RESULTS: 120 of the 123 patients were operated, giving a ratio of 97.56%. 108 cases were under government universal health coverage regime, corresponding to 87.80% of cases. 74 cases (60.16%) presented both cleft lip and palate condition, and an average of 5-night stay in hospital per person. Medical services by the interdisciplinary team were provided as follows: (1) of 30 patients with cleft lip aged 3-4 months, 30 (100%) received pre and post-surgery care counseling, 29 (96.67%) received surgery; (2) of 19 patients with cleft palate aged 10-18 months, 17 (89.47%) received treatment information, pre and postsurgery counseling and were operated according to the protocols; (3) of 74 patients with cleft lip and palate, 53 (71.62%) received counseling for pre and post-surgery care for lip repair at the age of 3-4 months, 52 (70.27%) were operated following the protocols, while at the age of 10-18 months 63 patients (85.14%) received treatment information, pre and postsurgery care counseling, and surgical intervention for palate repair. CONCLUSION: Results of cleft lip and palate continuous treatment by interdisciplinary team in Tawanchai center for patients aged 4-5 years are reported. The highest percentage of patients to follow the treatment protocol, with pre and post-surgery care counseling and surgical intervention was achieved for cleft lip only cases, followed by cleft palate cases. Patients with both cleft lip and palate condition achieved the lowest percentage. In all cases, patients accepted within the center were treated at an 85.39% rate.

Nursing care system development for patients with cleft lip-palate and craniofacial deformities in operating room Srinagarind Hospital.

BACKGROUND: For a successful surgical outcome for patients with cleft lip/palate (CLP), the attending nurses must continuously develop their potential, knowledge, capacity and skills. The goal is to meet international standards of patient safety and efficiency. OBJECTIVE: To assess and improve the nursing care system for patients with CLP and craniofacial deformities at the operating room (OR), Srinagarind Hospital, Khon Kaen University. MATERIAL AND METHOD: Data were collected for two months (between March 1, 2011 and April 30, 2011). Part I was an enquiry regarding the attitude of OR staff on serving patients with CLP; and, Part 2.1) patient and caregiver satisfaction with service from the OR staff and 2.2) patient and caregiver satisfaction with the OR transfer service. RESULTS: The authors interviewed 28 staff in OR unit 2 of the OR nursing division and 30 patients with CLP and his/her caregiver. The respective validity according to the Cronbach's alpha coefficient was 0.87 and 0.93. The OR staff attitude visa-vis service provision for patients with CLP service was middling. Patient and caregiver satisfaction with both OR staff and the transfer service was very satisfactory. DISCUSSION AND CONCLUSION: Active development of the nursing care system for patients with CLP and craniofacial deformities in the operating room, Srinagarind Hospital improved staff motivation with respect to serving patients with CLP. The operating theater staff was able to co-ordinate the multidisciplinary team through the provision of surgical service for patients with CLP.

The development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital, Khon Kaen, Thailand.

BACKGROUND: The highest incidence of cleft lip-palate and craniofacial deformities in Thailand occur in the Northeastern Region. There is the necessity for an interdisciplinary care team as well as the specialized care center with systematic coordinated care, thus "Tawanchai Cleft Center" is becoming a superior medical center for patients with cleft lip-palate and craniofacial deformities. Therefore, the development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital is extremely important and necessary. OBJECTIVE: To develop the nursing care system appropriate for a super tertiary hospital (Tawanchai Cleft Center). MATERIAL AND METHOD: It is a participation study which has 3 steps as follows, 1) Analyzing the situations and collecting the opinions of the 22 Out-patient Surgery Department staff and Tawanchai Cleft Center staff by using 6 questions, 2) Summarizing of the situation analysis from the meetings and the questionnaires, then using such summary as the guidelines for developing the nursing care system from January 2011 onwards, 3) evaluating the satisfaction after the 4 month development period (May-August 2011) with 106 caregivers by using 8 questions and being analyzed by the average value, percentage and standard deviation. RESULTS: 1) The nursing care system consisted of psychosocial care, breast feeding, counseling and other assistance as required. This various assistance responded to the patient/family problems by following the treatment guideline of the multidisciplinary team which uses the continuous evaluation processes for the holistic patient/family care. 2) The patients with complete cleft lip-palate were the most common type, found in 44 cases or 41.53 percent. The highest number of caregivers were mothers which were 68 percent; the average age of those mothers was 36 years old. The highest number of them finished elementary school at 43 percent and 40 percent were farmers. The satisfaction for the services of Tawanchai Cleft Center showed the average for each satisfaction subject all at very good level (x = 3.56, SD = 0.13). CONCLUSION: The care for patients with CLP and craniofacial deformities at Tawanchai Cleft Center Srinagarind Hospital has been developed in order to have the appropriate nursing care system to provide superior quality care, which provides patient-holistic care, as well as improving effective accessibility to the services. Thus, the patients/caregivers who are satisfied with given services, get continuing monitoring and treatment and are able to live their lives in the society happily.

Study of care for patients with cleft lip/palate (CLP) in Lao People's Democratic Republic.

OBJECTIVE: The objectives of the study were to determine basic information, understand health-related problems and examine problem-solving strategies among patients with cleft lip/palate (CLP) residing in Lao People's Democratic Republic (PDR). MATERIAL AND METHOD: This was a cross-sectional, descriptive study. The research team interviewed 24 patients with CLP who underwent surgery at the Khammouan Hospital between October 16-20, 2010 and their caregivers. A questionnaire was developed by the research team to collect information on demographics, health-related problems and problem-solving strategies. Content validity was reviewed by five experts. RESULTS: Sixty-two percent (15/24) of the patients were boys with an average age of 6.3 years. Fifty percent of the patients had both a cleft lip and cleft palate. Heredity played a major role in causing the CLP among the majority of patients (58%). Most of caregivers resided in either Khammouan (33%) and Bolikhamxai Province (33%). With respect to the caregivers, their average age was 36 years, 50% were fathers and mothers, 87% had a family income lower than one million Kip/month (124 USD); all were satisfied with the treatment provided, 96% had sufficient knowledge for helping or publicizing the proper treatment to other patients and 87% knew of the healthcare resources for patients with CLP (i.e., Khammouan Hospital provides free-of-charge surgery). The caregivers also understood the need for regular, life-long follow-up care of cleft lip. However, 87% of the caregivers did not know the causes of CLP, 75% did not know that the patients with ridges cleft must have a ridges bone graft surgery, while 66% did not know about post operative care, wound care, audiometry and speech therapy. CONCLUSION: Although timely receipt of primary cleft surgery is essential to the physical and psychosocial well-being of patients with CLP, those residing in Lao PDR did not receive surgery until the age of 6 years. The main reasons for this are the lack of awareness regarding diagnosis and treatment, limited availability of health services, and insufficient financial resources; therefore, both technical and financial support from external stakeholders is crucial. The establishment of a local medical infrastructure, training local surgeons and free access are also critical for the development of a sustainable and effective multidisciplinary management program for patients with CLP and their families.

Internet-Based Interactive Support for Cancer Patients: Are Integrated Systems Better?

To compare the benefits of the Internet generally versus a focused system of services, 257 breast cancer patients were randomly assigned to a control group, access to the Internet with links to high-quality breast cancer sites, or access to an eHealth system (Comprehensive Health Enhancement Support System, CHESS) that integrated information, support, and decision and analysis tools. The intervention lasted 5 months, and self-report data on quality of life, health-care competence, and social support were collected at pretest and at 2-, 4-, and 9-month posttests. CHESS subjects logged on more overall than Internet subjects and accessed more health resources, but the latter used non health-related sites more. Subjects with access to the Internet alone experienced no better outcomes than controls at any of the 3 time points, compared to pretest levels. Subjects with CHESS experienced greater social support during the intervention period and had higher scores on all 3 outcomes at 9 months, 4 months after the intervention ended. CHESS subjects also scored higher than those with Internet access during the intervention period but not significantly after the intervention ended. Thus, CHESS (with one simple interface and integrated information, communication, and skills services) helped newly diagnosed breast cancer patients even after computers were removed. In contrast, patients received little benefit from Internet access, despite having links to a variety of high-quality sites.

Use and Impact of eHealth System by Low-income Women With Breast Cancer.

This article is the second of a two-part series reporting on a population-based study intended to use an eHealth system to examine the feasibility of reaching underserved women with breast cancer (Gustafson, McTavish et al., Reducing the digital divide for low-income women with breast cancer, 2004; Madison Center for Health Systems Research and Analysis, University of Wisconsin; Comprehensive Health Enhancement Support System [CHESS]) and determine how they use the system and what impact it had on them. Participants included women recently diagnosed with breast cancer whose income was at or below 250% of poverty level and were living in rural Wisconsin (n = 144; all Caucasian) or Detroit (n = 85; all African American). Because this was a population-based study all 229 participants received CHESS. A comparison group of patients (n = 51) with similar demographics was drawn from a separate recently completed randomized clinical trial. Use rates (e.g., frequency and length of use as well as type of use) as well as impact on several dimensions of quality of life and participation in health care are reported. Low-income subjects in this study logged on and spent more time on CHESS than more affluent women in a previous study. Urban African Americans used information and analysis services more and communication services less than rural Caucasians. When all low-income women from this study are combined and compared with a low-income control group from another study, the CHESS group was superior to that control group in 4 of 8 outcome variables at both statistically and practically significant levels (social support, negative emotions, participation in health care, and information competence). When African Americans and Caucasians are separated the control group's sample size becomes 30 and 21 thus reducing power. Statistical significance is retained, however, in all four outcomes for Caucasians and in two of four for African Americans. Practical significance is retained for all four outcomes. We conclude that an eHealth system like CHESS will be used extensively and have a positive impact on low-income women with breast cancer.

Predicting the likelihood of falls among the elderly using likelihood basis pursuit technique.

This study reports on the application of the knowledge discovery in database process to generate models that can predict the likelihood of falls among the elderly who reside in long-term care facilities. This process was applied to data held in the Minimum Data Set, a comprehensive resident assessment instrument being used in all Medicare and Medicaid supported nursing homes in the United States. For this study, we incorporated a new data mining technique, Likelihood Basis Pursuit, into the process. Using this technique, we were able to correctly identify which of the variables in this data set were associated with falls and generate models that could make fall likelihood predictions based upon those variables. Because the model provides probabilities based upon the exact combination of variables present in a particular resident, models constructed using this new data mining technique have the potential to be more useful for assessing fall risk.

Nursing Minimum Data Set development and implementation in Thailand.

BACKGROUND: In 1997, the Thai Ministry of Public Health began planning to implement a national health information system. Development of the nursing component of this system is an ongoing process. The first step in developing a nursing information system is to identify an essential Nursing Minimum Data Set (NMDS). AIM: To describe the development of a NMDS in Thailand and explore the challenges of implementing it, including the issue of the comparability with data sets in other countries, primarily the United States of America. METHODS: The process of developing a NMDS specific to Thailand is reviewed. Strategies for implementing this data set and important issues related to it are then discussed. FINDINGS: Although a preliminary Thai NMDS has been identified, challenges associated with its development and implementation within the Thai National health information system remain. CONCLUSION: A Thai NMDS and its elements have been identified. The International Classification of Nursing Practice was translated and is to be used to implement the data set describing the nursing care of patients and their families. However, many issues, such as the need for conceptual translation and increasing nurses' involvement in the process, still need to be addressed in order to implement the data set successfully.

Applying Knowledge Discovery in Databases in public health data set: challenges and concerns.

We are investigating the use of axiomatic design (AD) as a principled approach to the revision of guidelines. AD models guidelines in a modular and hierarchical manner and captures interactions be-tween modules. To test this approach we applied AD to encode segments of three guidelines and their revised versions. Guideline encodings for the original versions were modified to incorporate changes made in the revised documents. The results indicate that AD is a promising approach for guideline modeling.