Does a postoperative visit increase patient satisfaction with anaesthesia care?

BACKGROUND: 'Continuity of personal care by anaesthetist', as defined by a single anaesthetist providing preoperative evaluation, performing anaesthesia, and delivering a postoperative visit to the patient, has been shown to be a major factor for patient satisfaction with anaesthesia care. This prospective randomized study investigated whether a single postoperative visit increased the patient's perception of 'Continuity of personal care by anaesthetist' and hence satisfaction. METHODS: In Group 1, the same anaesthetist who conducted anaesthesia visited the patient on the first postoperative day. In Group 2, a nurse anaesthetist who did not participate in anaesthesia delivery made a postoperative visit to the patient. Patients in Group 3 were not visited. Patients received a previously validated questionnaire after discharge from hospital. RESULTS: The negative patient response created by the perception of not being visited after operation by the attending anaesthetist was 13.5% (95% CI ± 6.9), 69.2% (95% CI ± 10.3), and 77.1% (95% CI ± 9.1) in Groups 1, 2, and 3, respectively, with 1 vs 2 and 1 vs 3 (P < 0.001) being significantly different. The negative patient response for 'Continuity of personal care by anaesthetist' was 40.0% (95% CI ± 5.3), 48.8% (95% CI ± 5.6), and 55.5% (95% CI ± 5.3) in Groups 1, 2, and 3, respectively, with 1 vs 3 (P < 0.001) being significantly different. CONCLUSIONS: Perception of the anaesthetist and satisfaction with 'Continuity of personal care by anaesthetist' were significantly increased by the introduction of a single postoperative visit by the anaesthetist compared with no visit at all. Overall satisfaction with anaesthesia was unchanged.

Duration of wet work in hairdressers.

AIM OF THE STUDY: Occupational contact dermatitis caused by wet work is particularly common in hairdressers. Data on the duration of wet work (DWW) in the hairdresser's trade are not well known until now. A questionnaire or self-reported/estimated skin exposure are not suitable to get accurate information about DWW. According to the guidance of the German Federal Ministry for Labour and Social Affairs, employees with DWW > 2 h per day should get a possibility for targeted occupational-medical health examinations. Targeted occupational-medical health examinations are prescribed for employees with daily duration of wet work longer than 4 h. The aim of the study was to quantify the average daily exposition to wet work in hairdressers. MATERIALS AND METHODS: In our study, we used the direct observation as a standard method to analyse the work steps and to measure DWW in hairdressers. We developed the instrument for the analyses of activities in hairdresser salons and measurement of DWW in hairdressers during their 8-h shift. At the beginning of the study, 60 observers were intensively instructed and trained in the procedure of analysis. RESULTS: The mean of duration of wet work (DWW) in 106 8-h shifts analysed was 8,234 s (approx. 2 h 17 min). The minimum of DWW was 278 s and the maximum 21,135 s (approx. 6 h); the standard deviation was 3,826 s. In 37% of the analysed 8-h shifts, DWW was shorter than 2 h, in 58% between 2 and 4 h and in 5% longer than 4 h. Eighteen per cent of the DWW was caused by wearing water-resistant protective gloves. We found positive correlations between "DWW" and "DWW > 2 h", with the predictors "number of customers total", "number of long-haired people" and "number of female customers". CONCLUSION: According to the guidance of the German Federal Ministry for Labour and Social Affairs, hairdressers should get a possibility for targeted occupational-medical health examinations.

Effect of timing on the response to postal questionnaires concerning satisfaction with anaesthesia care.

BACKGROUND: There is little information on the effect of time on the assessment by the patient of quality of anaesthesia care. This study compared the patient's assessment of anaesthesia care after three different periods of time following discharge from hospital. Materials. Three groups of patients were assigned to receive a standardized, validated psychometric questionnaire either 1, 5, or 9 weeks after discharge from hospital. We measured response rate and the total mean problem score of six dimensions. RESULTS: Groups 1, 2, and 3 received 748, 743, and 723 questionnaires, respectively. The response rates including one reminder were 67.3 (95% confidence interval [CI] 63.9-70.6%), 64.5% (CI 61.1-67.9%), and 58.9% (CI 55.5-62.4%), respectively (Group 1 vs Group 3, P<0.001, and Group 2 vs Group 3, P<0.05). The total mean problem scores were not significantly different with 17 (CI 1.4%), 17 (CI 1.4%), and 15% (CI 1.3%), respectively. In two out of six dimensions ('Continuity of personal care by anaesthetist' and 'Nursing care in recovery room') significantly less problems were reported after 9 weeks. The other dimensions of the questionnaire showed no consistent differences between groups. CONCLUSIONS: The response rate is significantly lower at 9 weeks compared with 1 and 5 weeks after discharge. The total mean problem score remains unchanged but certain fields show fewer problems after 9 weeks compared with 1 and 5 weeks. Questionnaires on patient satisfaction with anaesthesia care should be sent within 5 weeks of discharge.

Patient satisfaction with anaesthesia care: development of a psychometric questionnaire and benchmarking among six hospitals in Switzerland and Austria.

BACKGROUND: We describe the development and comparison of a psychometric questionnaire on patient satisfaction with anaesthesia care among six hospitals. METHODS: We used a rigorous protocol: generation of items, construction of the pilot questionnaire, pilot study, statistical analysis (construct validity, factor analysis, reliability analysis), compilation of the final questionnaire, main study, repeated analysis of construct validity and reliability. We compared the mean total problem score and the scores for the dimensions: 'Information/Involvement in decision-making', and 'Continuity of personal care by anaesthetist'. The influence of potential confounding variables was tested (multiple linear regression). RESULTS: The average problem score from all hospitals was 18.6%. Most problems are mentioned in the dimensions 'Information/Involvement in decision-making' (mean problem score: 30.9%) and 'Continuity of personal care by anaesthetist' (mean problem score: 32.2%). The overall assessment of the quality of anaesthesia care was good to excellent in 98.7% of cases. The most important dimension was 'Information/Involvement in decision-making'. The mean total problem score was significantly lower for two hospitals than the total mean for all hospitals (significantly higher at two hospitals) (P<0.05). Amongst the confounding variables considered, age, sex, subjective state of health, type of anaesthesia and level of education had an influence on the total problem score and the two dimensions mentioned. There were only marginal differences with and without the influence of the confounding variables for the different hospitals. CONCLUSIONS: A psychometric questionnaire on patient satisfaction with anaesthesia care must cover areas such as patient information, involvement in decision-making, and contact with the anaesthetist. The assessment using summed scores for dimensions is more informative than a global summed rating. There were significant differences between hospitals. Moreover, the high problem scores indicate a great potential for improvement at all hospitals.

Attitudes of homoeopathic physicians towards vaccination.

Vaccinations are one of the most effective preventive procedures in modern medicine. However, earlier studies have indicated that homoeopathic physicians do not recommend or apply vaccinations as frequently as their allopathic colleagues. Few studies have been undertaken to clarify this question and most of these have not distinguished between medically and non-medically qualified homoeopathic practitioners. Therefore, misunderstandings have arisen concerning this question. In the study presented only medically qualified colleagues were included. In the course of this study, 219 medically qualified homoeopathic and 281 non-homoeopathic physicians in Germany (response rate 30.4%) returned a questionnaire about the application and recommendation of 17 different vaccinations in their practices. The answers show that the responding homoeopathic physicians do not generally refuse vaccines but rather view them with a specific hierarchy. The 'classical' vaccines against tetanus, diphtheria and poliomyelitis are applied to nearly the same degree as by non-homoeopathic colleagues. Vaccines against childhood diseases, risk group vaccinations and vaccinations judged as ineffective are applied and accepted with more restraint by homoeopathic physicians.

Task profile and risk of occupational hepatitis A infection in sewerage workers.

OBJECTIVE: The aim of the study was to assess to what extent parameters of task-related occupational exposure influence anti-hepatitis A virus (anti-HAV) seroprevalence in sewerage workers, using a new instrument for classification of exposure. METHODS: A new instrument for the assessment of work-related infection hazards was developed based on expert interviews, evaluation of literature and theoretical considerations. It was included in a questionnaire for collecting detailed information on occupational exposure, safety awareness, safety behaviour and socio-demography. Anti-HAV status was assessed for all (n = 343) (non-vaccinated) study participants. RESULTS: Marked differences in task profile and task-related exposure within the group of sewerage workers were found, underlining the necessity of a detailed exposure analysis. In a multivariate model three risk factors that were related significantly to anti-HAV positivity were identified: age, country of origin and task-related exposure. CONCLUSIONS: Since task profiles and occupational exposure differ strongly within the job category of sewerage workers. evaluation of endangerment has to reflect individual task-related exposure. The task-exposure matrix developed and presented in this study is a practicable and valid instrument for exposure assessment and may be used for the exposure analysis of further biological agents in this working environment. Besides the known risk parameters age and origin, our study demonstrates a dose-response relationship between the degree of occupational exposure and the anti-HAV seroprevalence. Therefore, an effective worksite HAV-prevention programme should consider all technical, structural and educational measures that help to reduce individual exposure.