Birth Prevalence and Risk Factors Associated With CL/P in Thailand.

INTRODUCTION: The objectives of this study were to obtain the birth prevalence of cleft lips and/or cleft palates (CL±P) and to identify potential associated risk factors in the population of the Northeast (NE) region of Thailand. METHODS: The data were collected from October 1, 2012, to September 30, 2013, for infant deliveries with nonsyndromic CL±P in all hospitals of 4 provinces in the region. Workshops were conducted to establish diagnostic criteria, treatment guidelines, referral systems, data collection, and data reporting. All patients included in this study, including a case (the child born with cleft lip and palate [CLP]) and 2 control cases (2 following children born without CLP in the same hospital), completed a questionnaire regarding demographics, cleft characteristics, and factors of interest such as alcohol intake, smoking, vitamin use, and medication. Unadjusted and adjusted odds ratio were presented for the magnitude of associations between proposed risk factors and CL±P along with 95% CIs. RESULTS: The overall birth prevalence of CL±P was 1.93 per 1000 live births. There was a significant difference in percentages of infants with low birth weights (P = .03), family history of CL±P (P = .01) in cases than controls. Mothers who took self-medication or a menstrual regulation supplement were more likely to have the child with CL±P (P = .01 adjusted). CONCLUSIONS: The prevalence of CL±P in the NE Thailand was high. Low infant birth weight, family history of CL±P, and the use of self-medication or menstrual regulation herbal supplement was significant factors.

Adding herbal extracts to silicone gel on post-sternotomy scar: a prospective randomised double-blind study.

OBJECTIVE: Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect. METHOD: After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale. RESULTS: Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (-0.391, p=0.025; -0.435, p=0.013, respectively), and pigmentation scores at three and six months (-0.391, p=0.019; -0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (-0.6609, p=0.000; -0.348, p=0.046, respectively). CONCLUSION: Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts.

Preschool Age Anthropometric Evaluation of the Nose After Bilateral Complete Cleft Lip Repair.

OBJECTIVE: To evaluate the aesthetic outcomes of surgery in preschool-aged bilateral complete cleft lip patients by comparing their nasal aesthetic parameters with those of normal children. SETTING AND SAMPLE POPULATION: Twenty-six 4 to 6-year-old (preschool age) patients with bilateral complete cleft lip who underwent primary cheiloplasty and a control group of 30 children in Northeast Thailand of the same age were enrolled. MATERIALS AND METHODS: Nasal aesthetic parameters were analyzed in terms of 3 ratios and 1 angle using three-dimensional photographs. The data from bilateral cleft lip patients were compared with those from a control group. RESULTS: The nasal parameters of patients in the cleft group were the same as those in the control group in terms of nasal tip height (NTH), columella height (CH), and dome height (DH) (P values were 0.361, 0.494, and 0.086), but nasal width (NW) was greater in the cleft group (P < 0.001). The nasal aesthetic parameters differed significantly between the 2 groups in terms of CLA (P < 0.001) and ratio of NTH and NW (P < 0.001), but not in terms of the CH:NW (P = 0.190) and DH:CH ratios (P = 0.147). CONCLUSION: This treatment protocol for bilateral cleft lip was able to achieve most of the aesthetic goals in terms of NTH, CH, DH, ratio of CH to NW, and ratio of DH to CH. However, more surgical correction of NW and CLAs may be needed.

Case-control study of nutritional and environmental factors and the risk of oral clefts in Thailand.

BACKGROUND: One infant in 700 is born with an oral cleft. Prior studies suggest low micronutrient status is associated with an increased risk of oral clefts. Environmental factors such as passive smoke exposure or supplement use may also affect oral cleft risk. We examined nutrition and environmental related risk factors for oral clefts. METHODS: We conducted a case-control study in Northeast Thailand in 2012 to 2013. We enrolled 95 cases and 95 controls. We recruited cases with a nonsyndromic cleft lip with or without a cleft palate (CL±P) less than 24 months old. Cases were matched to controls on age and place of conception. We collected survey data, a food frequency questionnaire, and measured zinc concentrations in toenail trimmings. We calculated descriptive statistics by case and control status. We used conditional logistic regression to estimate unadjusted and adjusted associations, 95% confidence intervals (CIs), and p-values. RESULTS: Any liver intake (adjusted OR [aOR] for ≥1/week versus none), 10.58; 95%CI, 1.74-64.37, overall p = 0.02) and the presence of food insecurity (aOR, 9.62; 95% CI, 1.52-61.05; p = 0.02) in the periconceptional period increased CL±P risk. Passive smoke exposure increased the risk of CL±P (aOR, 6.52; 95% CI, 1.98-21.44; p < 0.01). Toenail zinc concentrations were not associated with CL±P risk. CONCLUSION: Our findings add to a growing body of knowledge of environmental risk factors for oral clefts from low- and middle-income countries. Our findings on liver are contradictory to prior results. Large multisite studies are needed to identify environmental and genetic risk factors for oral clefts. Birth Defects Research (Part A) 106:624-632, 2016. © 2016 Wiley Periodicals, Inc.

Evidence-Triggers for Care of Patients with Cleft Lip and Palate in Srinagarind Hospital: The Tawanchai Center and Out-Patients Surgical Room.

Background: Cleft lip and palate (CLP) is a congenital anomaly of the lip and palate that is caused by several factors. It was found in approximately one per 500 to 550 live births depending on nationality and socioeconomic status. The Tawanchai Center and out-patients surgical room of Srinagarind Hospital are responsible for providing care to patients with CLP (starting from birth to adolescent) and their caregivers. From the observations and interviews with nurses working in these units, they reported that both patients and their caregivers confronted many problems which affected their physical and mental health. Based on the Soukup's model (2000), the researchers used evidence triggers from clinical practice (practice triggers) and related literature (knowledge triggers) to investigate the problems. Objective: The purpose of this study was to investigate the problems of care for patients with CLP in the Tawanchai Center and out-patient surgical room of Srinagarind Hospital. Material and Method: The descriptive method was used in this study. For practice triggers, the researchers obtained the data from medical records of ten patients with CLP and from interviewing two patients with CLP, eight caregivers, two nurses, and two assistant workers. Instruments for the interview consisted of a demographic data form and a semi-structured questionnaire. For knowledge triggers, the researchers used a literature search. The data from both practice and knowledge triggers were collected between February and May 2016. The quantitative data were analyzed through frequency and percentage distributions and the qualitative data were analyzed through a content analysis. Results: The problems of care gained from practice and knowledge triggers were consistent and were identified as holistic issues, including 1) insufficient feeding, 2) risks of respiratory tract infections and physical disorders, 3) psychological problems, such as anxiety, stress, and distress, 4) socioeconomic problems, such as stigmatization, isolation, and loss of income, 5)spiritual problems, such as low self-esteem and low quality of life, 6) school absence and learning limitation, 7) lack of knowledge about CLP and its treatments, 8) misunderstanding towards roles among the multidisciplinary team, 9) no available services, and 10) shortage of healthcare professionals, especially speech language pathologists (SLPs). Conclusion: From evidence-triggers, the problems of care affect the patients and their caregivers holistically. Integrated long-term care by the multidisciplinary team is needed for children with CLP starting from birth to adolescent. Nurses should provide effective care to these patients and their caregivers by using a holistic approach and working collaboratively with other healthcare providers in the multidisciplinary team.

Study of Treatment Expense of Patients with Congenital Malformations of Craniofacial in Srinagarind Hospital between 2010 and 2014.

Objectives: To report the treatment expenses of the congenital malformations of craniofacial of in-patients of Srinagarind Hospital between 2010 and 2014 Material and Method: The expenses of congenital malformations of craniofacial in-patients of Srinagarind Hospital were studied by analyzing the actual amount charged and the reimbursement of treatment expenses. Results: One thousand eight hundred forty five in-patients were treated 2,144 times. The average treatment was about once or twice per person. Male patients were 54.1% and female were 45.9%. About 84% of the patients were under the universal coverage, with an average Relative Weight (RW) between 2010 and 2014 of 1.6988, 1.7059, 1.4847, 1.4165, and 1.5096, respectively. The average of the RW and the treatment expenses differentiated by the patients' eligible medical expenses for self-paid, Government or State Enterprise Officer (OFC), Social Security Scheme (SSS), and universal coverage (UC) were 1.0398, 1.1596, 1.2759, 1.3477, respectively. The average RW calculated under diagnosis-related group (DRG) for each patient was 1.3148. The estimated RW of OFC at 13,378 and UC at 9,600 baht per RW were 18,081, 14,535, 14,259, and 17,118 baht, for an average of 16,842 baht. The average of the treatment expenses charged by the hospital to the OFC was 14,535 baht and to the UC was 17,118 baht for each treatment. The treatment expense under DRG was lower than the cost under the hospital charge by 2,051,072 baht. Conclusion: The present study analyzed the treatment expense by patients' eligible medical expenses between 2010 and 2014. The universal coverage and government or state enterprise officer's charges were reimbursed to the hospital under DRG system for 32,257,000 baht while the hospitals actual charges were 34,308,072 baht. This indicated that Srinagarind Hospital must set up the fund to support congenital malformations of craniofacial patients for a minimum sum of 410,214 baht per year. This is likely to increase in the future.

Dorsalis pedis Perforator Flap: Cadaveric Anatomical Study.

Background: The Dorsalis pedis perforator flap is a thin and pliable fasciocutaneous tissue. No previous study has demonstrated the surgical anatomy among Asians. Material and Method: Demonstrate the surgical anatomy of Dorsalis pedis perforator flap in 12 limbs from Thai cadavers. Results: We found the Dorsalis pedis perforators in all limbs and average the distance of distal perforators was 3.25+0.5 cm proximal to the metatarso-phalangeal joint. The first dorsal metatarsal artery was mainly type 1 (83.3%) while another 16.7% were type 2. Conclusion: Dorsalis pedisperforator flaps were versatile with a constant surgical anatomy and acceptable donor site morbidity.

An Anatomical Study of Vascular Supply of the Distally Based Sural Artery Flap: A Cadaveric Study.

Objective: In this study we conducted the vascular anatomy of sural flap to determine the peroneal artery perforator contribution relative to anatomical landmark of tip of lateral malleolus, include the first peroneal artery perforator to identify safely pivot point of the flap. Material and Method: A retrospective study of an anatomical study of Vascular supply of the Distally Based Sural Artery Flap was performed by dissection on 12 fresh adult cadavers legs. We recorded number of the perforator, location of each perforators in relationship to the tip of lateral malleolus and location of first peroneal artery perforator. Results: The anatomical of vascular supply of the distally based sural artery flap, anatomical of peroneal artery perforators was identified and measured from anatomical landmark is tip of lateral malleolus. The mean number of perforators was 3.4 (range, two to five), grouped in 5 perforators at the following average locations proximal to the tip of lateral malleolus: first, at 6.3+0.9 cm; second, at 8.5+1 cm; third, at 11.17+1.4 cm; fourth, at 12.7+1.2 cm; and fifth, at 14.6+0.2 cm proximal to the tip of the lateral malleolus. Conclusion: Complete vascularization of venoneurofasciocutaneous sural flap was accomplished by peroneal perforator, the blood supply of the distally based sural venoneurofasciocutaneous flap can be pivoted at the lowest perforators in the posterolateral region, which are about 5.4 to 7.2 cm proximal to the tip of lateral malleolus.

Time for Eustachian Tube Function Recovery in Children with Cleft Palate after the 2-Flap Palatoplasty with Intravelarveloplasty.

Objective: Evaluate the clinical outcomes regarding the time needed for Eustachian tube recovery and evaluate associated factors for the recovery in children with cleft palate undergoing primary 2-flap palatoplasty with intravelarveloplasty at Srinagarind Hospital. Material and Method: This was a retrospective descriptive study of 82 consecutive non-syndromic cleft palate patients with/without cleft lip, who underwent primary palatoplasty at Srinagarind Hospital between January 2007 and December 2010. Demographic data were collected including sex, cleft type, age of palatoplasty, operating surgeon, type of tympanogram, oronasal fistula, ventilation tube insertion, age of ventilation tube insertion, and number of ventilation tube insertion. Results: Forty-five boys and 37 girls were included in the study for a total sample of 82 patients. The majority of cleft types was Veau IIIb (37.8%), followed by Veau IV (21.95%), Veau IIIa (20.73%), Veau I (9.76%), and Veau II (9.76%). Mean age of palatoplasty was 11.4 months (range, 9-23). There were three plastic surgeons and plastic surgery residents. The average time for Eustachian tube recovery was 37.5 months. Oronasal fistula was 15.9%. Ventilation tube insertion was 58.5% (one time: 40.2%, two and three times: 18.3%). Average age of ventilation tube insertion was 16 months (range, 9-64). There was no statistically significant difference in sex, age of palatoplasty, operating surgeon, ventilation tube insertion, or number of ventilation tube insertions in Eustacian tube recovery, but there was a statistically significant difference in cleft type, oronasal fistula, and mean age for ventilation tube insertion in Eustachian tube recovery. Conclusion: The median recovery time for Eustachian tube function after primary 2-flap palatoplasty with intravelarveloplasty at Srinagarind Hospital was 37.5 months. Eustachian tube recovery was associated with severity of cleft types, oronasal fistula formation, and age of ventilation tube insertion.

Assessment of Chromosome 22q11.2 Deletion in Patients with Isolated Cleft Palate: A Systematic Review of Prospective Studies.

Background: The prevalence of 22q11.2 deletion in patients presenting with isolated cleft palate has not been systematically assessed. Objective: To assess the evidence in the literature for the prevalence of 22q11.2 deletion in patients who were presenting with isolated cleft palate. Material and Method: A systematic literature search was conducted through PubMed between 1992 and June 2016 using search terms of 22q11.2 deletion OR 22q11 deletion AND cleft palate. Results: Of the six prospective studies reported, 328 patients with isolated cleft palate had been screened with FISH (Fluorescence In Situ Hybridization) test for 22q11.2 deletion. Among the 328 patients, there was one (0.3%) patient with positive FISH test for 22q11.2 deletion. This patient was clinically assessed and did not have an associated malformation or clinically recognized syndrome. Conclusion: The prevalence of 22q11.2 deletion among patients with isolated cleft palate is rather low. Of more than 400 genetic disorders involving occurrences of isolated cleft palate, FISH testing for 22q11.2 deletion in a patient with isolated cleft palate is recommended on clinical suspicion of additional clinical presentations of 22q11.2 deletion syndrome such as conotruncal congenital heart diseases, dysmorphic facies, velopharyngeal insufficiencies, immune deficiencies, hypoparathyroidisms, and neuropsychiatric disorders.

Birth Prevalence of Chromosome 22q11.2 Deletion Syndrome: A Systematic Review of Population-Based Studies.

Background: A birth prevalence of chromosome 22q11.2 deletion syndrome among population-based reports has been documented to vary, however, a systematic assessment is lacking. Objective: To assess the evidence in the literature for the birth prevalence of chromosome 22q11.2 deletion syndrome. Material and Method: A systematic literature search was conducted through PubMed between 1992 and June 2016 using search terms of 22q11.2 deletion OR 22q11 deletion and prevalence. Results: Of the six studies reported, there were 156 patients with 22q11.2 deletion syndrome found in total study populations of 1,111,336 live births. According to countries, the birth prevalence of this deletion syndrome (95% confidence interval) from United States, Belgium, Sweden, United Kingdom, France, and Singapore were 1.68 (1.22-2.26), 1.56 (1.33-1.72), 1.36 (0.91-2.08), 1.30 (0.45-2.15), 1.03 (0.53-2.23), and 1.02 per 10,000 live births, respectively. Estimates of minimum prevalence rates on the basis of the presence of this syndrome in cohorts of patients with cardiovascular malformations were from one in 4,000 to one in 7,092 live births. Conclusion: This systematic review indicates that the 22q11.2 deletion syndrome is rather common. The findings can help physicians, health care planners and other health professionals to plan and manage better care of these patients.

Three Decades of History and Perspectives of Khon Kaen University's Plastic Surgery.

Plastic surgery consists of two major fields: reconstructive surgery and cosmetic surgery with its roots lie in the reconstruction aspect. In Thailand, the plastic surgery procedures, performed during the initial period, included cleft lip and cleft palate repairs and skin graftings: In 1987, the Plastic Surgery Unit was established in the Department of Surgery, Srinagarind Hospital in Khon Kaen, which is the city in the Center of the northeast Thailand. In 1991, the partnership training of resident in plastic surgery with Siriraj Hospital was established and continued until the present time. All fields of plastic surgery were managed and educated in the Plastic Surgery Unit. Since the first batch of plastic surgery training program in 2009, the unit has many advanced in interdisciplinary management, the management of cleft center burn center postgraduate training program, research, community services, and national, regional and international coloration. The future perspectives involve educationfor 21st century skills, integration of teaching, research and community services, and a focus on evidence-based medicine and benchmarked outcomes are the future perspectives.

Development and Monitoring the Key Performent Index of The Quality of Care for Patients with Cleft/Palate in Tawanchai Center and Out-Patient Surgical Room Srinagarind Hospital Thailand.

BACKGROUND: Cleft lips and cleft palates have the most incidences in the Northeast of Thailand (2.49/1,000 newborns). Cleft lips and cleft palates (CLP) can affect patients and families both physically and mentally. It takes critical long-term medical treatment starting when prenatal, newborn, and fully grown until 19 years old by a multidisciplinary team; therefore, it was effective to have collaboration with patients, families, and a multidisciplinary team in order to build up the same objective and create key performance index to monitor the treatment outcome also to develop the quality of care. OBJECTIVE: 1) to create the key performance index and 2) to develop the index system by using information technology. MATERIAL AND METHOD: After the research received ethics approval from Khon Kaen University, qualitative and quantitative data were collected. There were two periods in this study. The 1st period as following list below: 1) Field research was performed by conference meetings and problem-learning process, which participants participated in each step. There were two example groups: (1) Patients and families cooperated 2 times and (2) Nursing care cooperated 4 times in October-December 2013 (3) Combining the conclusions to set the key performance index and develop the index system in January-February 2014 (4) Recording the system in March-June 2014. Content analysis and percentage were used in this study. RESULTS: Nine organizations were engaged in this study; eight key performance indexes were established and the research recorded continuously for 4 months. There were three key performance indexes, which performed successfully: 1) Patients/caregivers received follow-up treatment continuously, 92.06%, 2) Patients/caregivers reported 89.69% satisfaction after asking the information, 3) Patients/families reported overall satisfaction of 92.11%. CONCLUSION: It is shown that recording the key performance index for the 1st period covered every quality of care. The Tawanchai Center and Out-patient Surgical Room under Srinagarind Hospital applied eight key performance indexes and found that three key performance indexes were feasibly implemented. For the 2nd period, the 1st outcome of key performance indices will be analyzed and developed including improving the software in order to record data and analyze the percentages automatically.

Prevalence of Congenital Heart Diseases in Patients with Orofacial Clefts: A Systematic Review.

BACKGROUND: The reports on prevalence rates of congenital heart diseases (CHDs) in patients with orofacial clefts (OFCs) have varied widely. OBJECTIVE: To systematically review the prevalence rates of CHDs in patients with OFCs. MATERIAL AND METHOD: A computer search was conducted through the PubMed from 1950 to June 2015 using key words or search terms of congenital heart diseases, orofacial clefts, cleft lip/palate and prevalence. RESULTS: The search resulted in nine studies with 598 CHDs cases identified in 5,707 patients with OFCs. The prevalence of CHDs in patients with OFCs ranged from 3.9% to 23.9%. The five prospective studies had prevalence rates of 12.0% (95% confidence interval [CI]: 10.9 to 13.2) whilst the four retrospective studies had prevalence rates of 8.6% (95% CI: 7.5 to 9.8). Concerning the prospective studies, the newborn study had a higher prevalence than those of other childhood studies [23.9% vs. 11.5% (95% CI: 10.4 to 12.7)]. The newborn study with the use of echocardiography had a higher prevalence than those without using echocardiography (23.9% vs. 12.8%). Atrial septal defect was the most frequent CHD found. CONCLUSION: CHD is commonly found in a patient with OFC. Echocardiography should be used to assess CHD in patients with OFCs.

Global Birth Prevalence of Orofacial Clefts: A Systematic Review.

BACKGROUND: A birth prevalence of orofacial clefts (OFCs) worldwide has been documented to vary. However a systematic assessment is lacking. OBJECTIVE: To assess the evidence in the literature for the birth prevalence of OFCs. MATERIAL AND METHOD: A systematic literature search was conducted using electronic databases through PubMed between 1950 and June 2015 using key words and search terms of cleft lip palate OR orofacial cleft AND prevalence. RESULTS: There were 45,193 patients with OFCs found in a study population of 30,665,615 live births. According to continents, the OFC birth prevalence (95% confidence interval)from Asia, North America, Europe, Oceania, South America, and Africa were 1.57 (1.54-1.60), 1.56 (1.53-1.59), 1.55 (1.52-1.58), 1.33 (1.30-1.36), 0.99 (0.96-1.02), and 0.57 (0.54-0.60) per 1,000 live births, respectively. The American Indians had the highest prevalence rates of 2.62 per 1,000 live births, followed by the Japanese, the Chinese, and the Whites of 1.73, 1.56, and 1.55 per 1,000 live births, respectively. The Blacks had the lowest rate of 0.58 per 1,000 live births. CONCLUSION: Observed differences may also be of ethnic origin, genetic, environmental factors, and methods of ascertainment. Further investigations are needed to manage this global health problem.

Empowering Volunteers at Tawanchai Centre for Patients with Cleft Lip and Palate.

BACKGROUND: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team's understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment. OBJECTIVE: To examine the impact of the empowering volunteer project, established in the northeast Thailand. MATERIAL AND METHOD: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family's general information, treatment, the group brainstorming, and satisfaction with the project were analysed. RESULTS: Participants were 12 children with CLP their families and five volunteers with CLP; the participating patients were predominantly females and the mean age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding, instructions' needs for care at birth, difficulty in access information and society impact, and needs in having a network of volunteers. CONCLUSIONS: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Evaluation of Facial Appearance among Patients With Repaired Unilateral Cleft Lip and Palate: Comparison of Patient- and Clinician-Ratings of Satisfaction.

The objective of this study was to determine the levels of patient-satisfaction on facial and dental appearance compared with clinician ratings. Participants included 61 patients with repaired unilateral cleft lip and palate (UCLP), aged 14-25 years. Raters comprised three cleft team clinicians. A Likert scale was used to assess the levels of satisfaction of the patients themselves and the clinicians. The results revealed that the patients were moderately satisfied with their appearance. Nose was the least satisfactory feature, followed by lip appearance. When compared to the clinician ratings, the patients were less satisfied with their own nose and lip, but more satisfied with teeth. Concerning age, self-assessment did not differ between adolescents and young adults. Females were less likely to be satisfied compared to males, but the difference was not statistically significant. In conclusion, patients with repaired UCLP were moderately satisfied with their facial and dental appearance. Clinician- and patient-opinions were different in some aspects. This study highlights the importance of patient satisfaction as a meaningful treatment outcome assessment, which could lead to an improvement in cleft care to meet the patient expectations.

Development and Monitoring the Key Performance Indicators of the Quality of Care for Patients with Cleft Lips/Palates at Srinagarind Hospital.

BACKGROUND: Congenital deformities, such as cleft lips and/or cleft palates (CLP), have high incidences in the Northeast of Thailand. These birth defects can affect patient's quality of life. CLP patients need crucial and long-term treatments by a multidisciplinary team starting from prenatal stage to late adulthood. Patients and their families should involve in their own care, and their care objectives should correspond with healthcare providers. Besides the clinical outcome of interdisciplinary team, key performance indicators (KPIs) need to be developed in the hospital service unit in order to improve quality of care and treatment outcomes. OBJECTIVE: 1) to establish KPIs in hospital service units, and 2) to develop the information system to collect, analysis and improve the quality of CLP care. MATERIAL AND METHOD: A nurse coordinator was appointed in the Tawanchai Center to coordinate care. The three periods were conducted for the nurse coordinator to work with nine service units in Srinagarind Hospital for consensus on both qualitative and quantitative data to be used as service unit quality measurement. RESULTS: Thirty one KPIs from nine service units were established, collected and analyzed during a four-month period in 2014. The 20 KPIs achieved the unit targets. Two PKIs of the rates of complication with anesthesia during/after surgery in the first 24 hours and the rates of patient/caregiver's satisfaction in acquiring information from the officer were improving. There were 11 KPIs that did not achieve the targets. The coordinator nurse of the Tawanchai Center discussed with the service unit for the cause and how to improve the outcome. CONCLUSION: The monitoring KPIs will lead to improvement of outcome for better patient quality as well as benchmarking with other hospitals of Cleft Center. The KPIs from hospital service units with the monitoring and analysis of information by the nurse coordinator will enhance and lead to improvement of the quality of the patients and family centered care process.

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.

Clinical outcomes of primary palatoplasty in preschool-aged cleft palate children in Srinagarind Hospital and comparison with other standard cleft centers.

BACKGROUND: The purpose of this study was to evaluate the clinical outcomes regarding the rate of hypernasality and oronasal fistula formation in patients with cleft palate who underwvent primaly palatoplasty at our center and under our management protocol. MATERIAL AND METHOD: A Cross-sectional study of 40 consecutive non-syndromnic cleft palates with/or without cleft lips, born between February 2007 and December 2008, who underwent primaty palatoplasty at Srinagarind Hospital, Thailand. Demographic data that were recorded inclutdes: patients with cleft types, age atpalatoplasty, operating surgeons and surgical techniques. RESULTS: 40 consecutive patients. There were 23 boys and 17 girls. Three patients had associated disease; one patient had amniotic band syndrome and clubfeet, two patients had G-6-PD deficiency. Mean age at time of evaluation was 5.7 years (5.0-6.9 years). Mean age atpalatoplasty was 14.1 months (9-64 months). There were three plastic surgeons and plastic surreiy residents. The predominiant cleft lip type was Veau 3 (52.5%) followed by Veau 4 (27.5%) and Veau 1 (20%). Twvo-flap palatoplasty was used in all patients. The rate of hypernasality was 37.5% (15 out of 40 patients). Mild hypernasality was 25% and moderate hypernasality was 12.5%. Oronasalfistula occurred in 10 patients, fistula rate was 25%. Oronasal fistula closure was relformed on nine patients (90%). Two patients (5%) had residual oronasal fistula at the time of the study. There were no statistically significant differences in the cleft types, age at palatoplasty and operating surgeons in hypernality rates and oronas alfistula fomation. CONCLUSION: The rate of hypernasality and oronas alfistu laformation was comparable to resultsfirom other standard cleft.