Analysis of Factors Influencing Inpatient and Outpatient Satisfaction with the Chinese Military Health Service

Background

Relatively few articles have focused on exploring factors influencing soldiers’ overall satisfaction and differences between inpatients’ and outpatients’ satisfaction, particularly in the Chinese army. Elucidating factors influencing military inpatient and outpatient care separately and analyzing their differences may provide more information for the healthsystem.

Methods

The Revised China National Health Service Survey questionnaire was used in the survey. The questionnaire included 5 sections and 32 items concerning demographic, inpatient, and outpatient characteristics and perception variables for both inpatients and outpatients. Bivariate and multivariate techniques were used to reveal relationships between satisfaction and the variables assessed.

Results

Outpatients’ and inpatients’ overall satisfaction rates were 19.0% and 18.5%, respectively. The strongest determinant of outpatients’ satisfaction was satisfaction with doctor’s communication regarding therapeutic regimen followed by length of military service, level of trust in medical staff, and disease severity. Determinants of inpatients’ satisfactionincludedstaff categories, satisfaction with environment, and satisfaction with medical quality.

Conclusion

The factors influencing military outpatients’ satisfaction differed from those of inpatients. Exploring the causes of satisfaction and dissatisfaction with military health institutions is important in their fulfillment of their responsibility to maintain soldiers’ health.     

Factors Affecting Admission to a Coronary Care Unit

Of 103 patients with suspected myocardial infarction admitted to an intensive care unit in a general hospital half were admitted within four and a half hours of the onset of symptoms. In general, patients who attended the casualty department were under intensive care sooner than patients who sought attention from their general practitioner before admission. Patients who were seen by a locum from the emergency treatment service at night or weekends were more likely to remain at home until seen the next day by their own general practitioner, compared with patients seen by their own general practitioner initially.     

Factors Associated with Participation,Active Refusals and Reasons for Not Taking Part in a Mortality Followback Survey Evaluating End-of-Life Care

Background

Examination of factors independently associated with participation in mortality followback surveys is rare, even though these surveys are frequently used to evaluate end-of-life care. We aimed to identify factors associated with 1) participation versus non-participation and 2) provision of an active refusal versus a silent refusal; and systematically examine reasons for refusal in a population-based mortality followback survey.

Methods

Postal survey about the end-of-life care received by 1516 people who died from cancer (aged ≥18), identified through death registrations in London, England (response rate 39.3%). The informant of death (a relative in 95.3% of cases) was contacted 4–10 months after the patient died. We used multivariate logistic regression to identify factors associated with participation/active refusals and content analysis to examine refusal reasons provided by 205 nonparticipants.

Findings

The odds of partaking were higher for patients aged 90+ (AOR 3.48, 95%CI: 1.52–8.00, ref: 20–49yrs) and female informants (AOR 1.70, 95%CI: 1.33–2.16). Odds were lower for hospital deaths (AOR 0.62, 95%CI: 0.46–0.84, ref: home) and proxies other than spouses/partners (AORs 0.28 to 0.57). Proxies of patients born overseas were less likely to provide an active refusal (AOR 0.49; 95% CI: 0.32–0.77). Refusal reasons were often multidimensional, most commonly study-related (36.0%), proxy-related and grief-related (25.1% each). One limitation of this analysis is the large number of nonparticipants who did not provide reasons for refusal (715/920).

Conclusions

Our survey better reached proxies of older patients while those dying in hospitals were underrepresented. Proxy characteristics played a role, with higher participation from women and spouses/partners. More information is needed about the care received by underrepresented groups. Study design improvements may guide future questionnaire development and help develop strategies to increase response rates.     

Patient Experience and Satisfaction with Inpatient Service: Development of Short Form Survey Instrument Measuring the Core Aspect of Inpatient Experience

Patient experience reflects quality of care from the patients’ perspective; therefore, patients’ experiences are important data in the evaluation of the quality of health services. The development of an abbreviated, reliable and valid instrument for measuring inpatients’ experience would reflect the key aspect of inpatient care from patients’ perspective as well as facilitate quality improvement by cultivating patient engagement and allow the trends in patient satisfaction and experience to be measured regularly. The study developed a short-form inpatient instrument and tested its ability to capture a core set of inpatients’ experiences. The Hong Kong Inpatient Experience Questionnaire (HKIEQ) was established in 2010; it is an adaptation of the General Inpatient Questionnaire of the Care Quality Commission created by the Picker Institute in United Kingdom. This study used a consensus conference and a cross-sectional validation survey to create and validate a short-form of the Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ). The short-form, the SF-HKIEQ, consisted of 18 items derived from the HKIEQ. The 18 items mainly covered relational aspects of care under four dimensions of the patient’s journey: hospital staff, patient care and treatment, information on leaving the hospital, and overall impression. The SF-HKIEQ had a high degree of face validity, construct validity and internal reliability. The validated SF-HKIEQ reflects the relevant core aspects of inpatients’ experience in a hospital setting. It provides a quick reference tool for quality improvement purposes and a platform that allows both healthcare staff and patients to monitor the quality of hospital care over time.     

Companion-Animal Caregiver Knowledge,Attitudes, and Beliefs Regarding End-of-Life Care

Although awareness of end-of-life care is growing within the veterinary field and there appears to be consumer demand for these services, it is unclear exactly what caregivers know about end-of-life options for their companion animals. Are companion-animal caregivers aware of the range of options for their nonhuman animals? What do they value most highly for their nonhuman animals at the end of life? Answers to these and other related questions about caregiver perceptions are important because what they know about end-of-life care and how they approach decision-making for their companion animals will shape the kind of care an animal receives. This article presents the results of a large survey exploring companion-animal caregivers’ knowledge, attitudes, and beliefs about end-of-life care, including in-home euthanasia, hospice and palliative care, financial commitment to end-of-life care, insurance usage, and level of comfort in providing care (e.g., subcutaneous fluids) in the home.     

Challenges in End-of-Life Decisions in the Intensive Care Unit: An Ethical Perspective

When making end-of-life decisions in intensive care units (ICUs), different staff groups have different roles in the decision-making process and may not always assess the situation in the same way. The aim of this study was to examine the challenges Danish nurses, intensivists, and primary physicians experience with end-of-life decisions in ICUs and how these challenges affect the decision-making process. Interviews with nurses, intensivists, and primary physicians were conducted, and data is discussed from an ethical perspective. All three groups found that the main challenges were associated with interdisciplinary collaboration and future perspectives for the patient. Most of these challenges were connected with ethical issues. The challenges included different assessments of treatment potential, changes and postponements of withholding and withdrawing therapy orders, how and when to identify patients’ wishes, and suffering caused by the treatment. To improve end-of-life decision-making in the ICU, these challenges need to be addressed by interdisciplinary teams.     

Towards a ``Good' Death: End-of-Life Narratives Constructed in An Intensive Care Unit

End-of-life decisions regarding the withdrawal and withholding of lifesupporting technology have become commonplace within intensive careunits (ICUs). In this paper, we examine the dialogue between ICU teammembers and families regarding limitation of treatment as a therapeuticnarrative – that is, as a story which frames therapeutic events aswell as the critically ill patient's experience in a meaningful andpsychologically comforting way for families and health care providersalike. The key themes of these end-of-life narratives are discussed, aswell as the qualities that the stories share with other narratives ofthe same genre.     

Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa,Tanzania

Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum.     

Factors Affecting Reproducibility of Numerical Classifications

Results obtained with reference organisms which had been included in each of three different investigations were compared. Positions of the reference organisms in diagrams based on highest-link numerical groupings varied with the composition of the microbial samples studied, but significant correlations were found between the results of different investigations. Correlations between the overall groupings obtained in different studies were often better than the correlations between actual similarity values computed between specific pairs of organisms. Similarity values based on different sets of features showed significant correlations, regardless of the kinds of features involved or of the number of features (above a minimum of about 40). Correlations between values based on totally different features were nearly as good as those between values based on similar features which had been determined by different investigators.     

Some Factors Affecting Undergraduate Academic Achievement

A related series of studies, most of which have been published previously, is described. These studies form a coherent whole and demonstrate the development of a theme, namely, the identification of factors in the student and the medical school which, in their interaction, influenced undergraduate academic performance at one medical school. In the population concerned no reliable positive or negative correlation could be demonstrated between cognitive ability and academic performance, when the former was measured by the Wechsler Adult Intelligence Scale and the Medical College Admission Test, and the latter by the current assessment methods of the medical school. Other factors, including socioeconomic and individual personality variables, are at present under investigation as to their effect on academic achievement. It is emphasized that the results of these studies cannot be regarded as valid for all medical schools, but the methods employed can be generalized.     

Factors Affecting Transformation of Pasteurella novicida

The requirements and characteristics of Pasteurella novicida transformations in liquid suspensions were studied. Transformation frequencies of 0.1 to 0.3% were routinely obtained when recipient cells were harvested from 16-hr agar plates and higher than 1% when logarithmic-phase broth-grown cells were used. Calcium ions were essential for transformations. The deoxyribonucleic acid dose response curve, kinetics of transformation, and pH optimum for transformations were similar to those of other bacterial transformation systems. The genetic relatedness of P. novicida and P. tularensis was established by transforming P. novicida mutants with deoxyribonucleic acid extracted from P. tularensis.     

Factors Affecting Transformation of Micrococcus lysodeikticus

Relatively high transfo mation frequencies were obtained with Micrococcus lysodeikticus cells, previou[ill]sly grown in defined broth, with a tris(hydroxymethyl)-aminomethane-glutamate b uffer containing Mg(++), Ca(++), Ba(++), or Sr(++).     

Factors Affecting Egg-ratio in Planktonic Rotifers

Edmondson’s egg ratio (number of amictic eggs per female) is an important life history variable, which has been in wide use to understand and predict patterns of population growth in planktonic rotifers under field conditions. It is also useful as an indicator of the health of rotifers under culture conditions. Generally, an inverse relationship exists between the egg ratio and the density of females in a population. A number of abiotic and biotic factors influence the egg ratio. For example, temperature can cause marked changes in the egg ratio by influencing the frequency of egg production and the hatching times of parthenogenetic eggs. Also, preferential feeding on ovigerous females of rotifers by invertebrate predators such as Asplanchna will lower the egg ratios of the population. The easy detachment of eggs, as may be the case in some members of the Brachionidae especially during enhanced reproduction when food levels are high, may also cause an underestimation of the egg ratio. In this review, we discuss the egg ratio of selected rotifer species in relation to the role of diel changes in egg production, the frequency or the intensity of feeding, the problems of distinguishing between different egg types and the negative effect of stressors such as toxicants and diet quality.     

Factors Affecting Grain Enlargement in Wheat

When most of the grains were removed from wheat ears the remaininggrains developed increased numbers of aleurone and endospermcells, and the increased grain volume was accompanied by anenlarged endosperm cavity. The giant grains usually synthesizedstarch more rapidly than normal grains. Flag leaf photosynthesiswas unaffected and additional sugar was retained in the culmand glumes. Total nitrogen and free amino acid content increased.Gibberellin and auxin concentrations were greater in the glumesof the partly degrained ears, and auxin in the grains was alsogreater than in equivalent grains from intact ears.     

Factors Affecting Transfection in Bacillus stearothermophilus

The conditions for the infection of Bacillus stearothermophilus 4S with TP-1C phage deoxyribonucleic acid (DNA) are described. Cells from log-phase cultures are the most susceptible to phage DNA infection (transfection). A cellular component (competence factor) which enhances transfection is released into the culture medium during the transition period between the log and stationary phase of growth. Transfection is stimulated in the order of decreasing effectiveness, by Fe(3+), Mn(2+), and Mg(2+). The efficiency of transfection is the highest in cells growing at 60.5 C and does not occur in cells growing at 67 C although the cells are growing normally. A cellular component (competence factor) of this organism, which is released into the culture medium, advances by 40 min some step in the uptake of phage DNA.