Measuring Patient Satisfaction in Primary Care: a Joint Project of Community Representatives, Clinic Staff Members and a Social Scientist

We describe the process of planning and developing a questionnaireand conducting a patient satisfaction survey in a neighbourhoodclinic in Beer-Sheva, Israel. The project was conducted by theclinic staff members, patient representatives and a medicalsociologist. The satisfaction survey was conducted in patients'homes, with a 67% response rate. General satisfaction and satisfactionwith specific components of service are described. Patient satisfactionwas higher among men than among women, and negatively correlatedwith family size. The strongest predictor of general satisfactionwas satisfaction with physicians' services. Implications ofthe survey results were decided upon by active collaborationbetween the clinic staff and the patient representatives. Theinferences drawn from the patients' replies and the changesintroduced as a result of them, are discussed. Health care consumersshould be active participants in carrying out surveys of satisfactionon a regular basis.     

Evaluation of a burn prevention program in Israeli schools

The study describes an educational burn injuries preventionprogram for schoolchildren, and its short and long term effectson knowledge, attitudes and the wish to learn more about preventivebehaviors. The data were collected by self-administered questionnairesin two sampled groups of 10–14 year olds: a study groupof children who were exposed to the program, and a similar controlgroup. All children filled out the questionnaire three times.prior to the introduction of the program, at the end of it,and 10 weeks later. The results show an increase in knowledgein both groups. Yet, a significantly higher level of knowledge was achievedin the study group. Six out of ten attitudes studied changedin the expected direction after the program in the study group,and none in the control group. The expressed willingness tolearn more about prevention of injuries increased significantlyonly in the study group. The results indicate that this programachieved its immediate goals, and suggest that burn preventioneducation programs can be successfully implemented among schoolchildren.     

Laser Florence 2008

Patients sustaining acute myocardial infarction (AMI) often require urgent percutaneous revascularization within the first 24 h from onset of the infarction due to continuous ischemia and hemodynamic instability. Upon arrival to the cardiac catheterization, the electrocardiogram of AMI patients may exhibit acute ST-elevation (STEMI) with or without accompanying Q-wave or depression of the ST segment (non-STEMI or non-Q-wave infarction). Data comparing acute outcome of device application in patients presenting for urgent revascularization with established Q-wave myocardial infarction (QWMI) versus those with non-STEMI (NQMI) are sparse. Excimer laser is a revascularization modality applied for debulking of atherosclerotic plaque and vaporization of associated thrombus in the setting of AMI. One hundred fifty-one AMI patients with continuous chest pain and ischemia who enrolled into a multicenter study and underwent urgent revascularization were divided for the purpose of a retrospective analysis into two groups. One group presented with established electrocardiographic Q-wave, whereas the other had ST-depression (NQMI). In comparison with the NQMI group, the QWMI patients had a higher incidence of failed thrombolytic therapy (17% vs 3, p = 0.006), cardiogenic shock (20 vs 6%, p = 0.01), left anterior descending as a culprit infarct-related vessel (46 vs 14%, p < 0.0001), a higher incidence of TIMI 0 flow (48 vs 24%, p = 0.04), a heavier thrombus burden (grade 4 TIMI thrombus, 58 vs 23%; p = 0.0001), and higher CPK (1272 ± 2180 vs 404 ± 577, p = 0.001) and troponin levels (62 ± 95 vs 14 ± 48, p = 0.0003). Both groups underwent laser angioplasty and stenting for relief of continuous chest pain and ischemia within 24 h of infarction onset. Quantitative coronary arteriography in an independent core laboratory measured similar improvement in baseline minimal luminal diameter and percent diameter stenosis by application of laser energy in both groups. Among the QWMI patients, a significantly higher acute gain was recorded with the laser treatment in lesions containing a large/extensive thrombus burden as compared with lesions containing only a small clot burden (1.2 ± 0.7 vs 0.8 ± 0.5, p = 0.01). Such a phenomenon was not detected among the NQMI patients (1.0 ± 0.5 vs 0.8 ± 0.6, p=ns). Baseline TIMI flow grade (0.9 ± 1.0 for QWMI vs 1.5 ± 1.2 for NQMI, p = 0.0001) increased with laser emission to 2.8 ± 0.5 and subsequently reached a final level of TIMI 3 in both groups. In comparison with the QWMI patients, there was a trend toward a reduced rate of major adverse coronary events among the NQMI patients (12% QWMI vs 4% NQMI, p = 0.09). Significant differences in baseline clinical characteristics, extent of myocardial damage, location of infarct related vessel, thrombus burden, and TIMI flow exist between QWMI and NQMI patients who require urgent intervention. However, application of excimer laser results in similar high procedural success and low complication rates in both groups. Maximal acute laser gain is achieved among QWMI patients whose lesions are laden with a heavy thrombus burden.     

Change in live donor characteristics over the last 25 years: A single centre experience

Aim: While deceased donor kidney transplantation rates have remained stagnant, live donor kidney transplantation (LDKT) rates have increased significantly over the last decade, and are now a major component of renal transplantation programmes worldwide. Additionally, there has been an increased utilization of more marginal donors, including donors who are obese, older and subjects with well-controlled hypertension. Method: A retrospective audit of all live donors at the Princess Alexandra Hospital Renal Transplantation unit was performed from 24 August 1982 to 29 May 2007 to assess any change in donor characteristics over time. Results: There were 373 live donor operations. Over the last 25 years there has been a significant increase in the number of donors who are either older or obese. Furthermore, there is a greater proportion of spousal and emotionally related LDKT. Conclusion: It is imperative that donors, in particular marginal donors, are followed up long-term to determine their risk of kidney and cardiovascular disease and initiation of appropriate treatment if required.     

Health, transport and the environment Does European and UK policy support effective joint action?

Background: There is growing recognition of the importance oflinks between health, transport and the environment. Complexinterrelationships demand effective intersectoral collaborationand community participation and policy should therefore supportthis. The UK has a number of key policy documents representingpublic health, environmental health and transport perspectives.The purpose of this review is to assess how well these policiesare integrated and the extent to which joint action and participationare supported. Review: Reviewing global and European influenceson UK policy identifies two main themes: the new public healthagenda arising from the Health for All (HFA) Strategy and amore traditional environmental health approach. However, thereare fundamental aspects in common, in particular the underlyingtheme of sustainable development. To date, public health andenvironmental health ‘traditions’ have been inadequatelyintegrated. This is demonstrated in a number of ways, includingapproaches to implementation, the choice of indicators and targetsand a general failure to define the roles that different sectorscan best play in tackling transport, environment and healthissues. The revised national health strategy, ‘Our HealthierNation’, places emphasis on local planning through interagencypartnership and joint responsibilities, but it remains to beseen how well this will work in practice. Conclusions: Recentyears have seen convergence of environmental and public healthpolicies, but further integration is required. National policycould do more to facilitate explicitly local joint action andcommunity participation. Because of the influence that environmentand transport issues have on health, national health strategyhas a particularly important part to play in achieving this.     

Identifying with the patient: an intensive programme for medical students

An intensive programme called 'Hospitalization Week' was developed at the medical school of the Ben-Gurion University of the Negev in Israel. The main goal of the programme is to give first-year medical students an opportunity to understand the complexity of the needs and problems of hospitalized patients. To achieve this goal each student accompanies two patients from their arrival at the emergency room throughout their stay in the hospital. The goals and methods of the programme are described and evaluated.