Patients' Satisfaction with Ophthalmology Clinic Services in a Public Teaching Hospital

PURPOSE

To evaluate patients' satisfaction with ophthalmology health services in a teaching clinic of a tertiary public hospital.

PATIENTS AND METHODS

This was a cross-sectional study in ophthalmology clinic of Dr. Sardjito teaching hospital, Yogyakarta, Indonesia conducted in 2019. Patients were surveyed using the Patient Satisfaction Questionnaire-18 (PSQ-18). PSQ-18 subscale score was analyzed based on patients' characteristics. The main outcome was the odds of reaching top satisfaction score (TSS) of 4-5 from a Likert scale 1 to 5.

RESULTS

Our study recorded 269 participants who consisted of 138 males (51.3%) and 131 females (48.7%) with median age of 52 (18-87) years old. Variables with higher odds of reaching TSS on "patient overall satisfaction" was public health insurance (OR: 7.959 [95% CI: 1.989-31.852], p=0.003) while examination time (OR: 0.955 [95% CI: 0.923-0.988], p=0.008) had lower odds. Examination waiting time (OR: 0.992 [95% CI: 0.985-0.999], p=0.027) and examination time (OR: 0.941 [95% CI: 0.908-0.976], p=0.001) had lower odds of reaching TSS in "general satisfaction". Family monthly income (OR: 1.829 [95% CI: 1.038-3.223], p=0.037) had higher odds of reaching TSS in "technical quality" while examination time (OR: 0.961 [95% CI: 0.931-0.993], p=0.017) and education (OR: 0.549 [95% CI: 0.322-0.934], p=0.027) had lower odds. Comorbidities (OR: 0.533 [95% CI: 0.301-0.944], p=0.031) had lower odds of reaching TSS in "financial aspects". Retina subspecialty clinic (OR: 3.436 [95% CI: 1.154-10.232], p=0.027) had higher odds of reaching TSS in "time spent with doctor". Registrar as attending physician (OR: 0.427 [95% CI: 0.205-0.89], p=0.0230) and examination time (OR: 0.957 [95% CI: 0.924-0.991], p=0.013) had lower odds of reaching TSS in "accessibility-convenience".

CONCLUSION

Examination time and examination waiting time should be shortened, specialist doctors should always see the patients whenever possible, and registrars' technical and communication skill should be improved. Alternative funding for patients without health insurance also should be provided to increase satisfaction.

Preparation, Characterization, and Anticancer Effects of Capsaicin-Loaded Nanoliposomes

BACKGROUND

Medicinal plants have proven their value as a source of molecules with therapeutic potential, and recent studies have shown that capsaicin has profound anticancer effects in several types of human cancers. However, its clinical use is handicapped due to its poor pharmacokinetics. This study aims to enhance capsaicin's pharmacokinetic properties by loading the molecule into nanoliposomes model and testing its anticancer activity.

METHODS

Nanoliposomes were prepared using the thin-film method, and characteristics were examined followed by qualitative and quantitative analyses of encapsulation efficiency and drug loading using HPLC at different lipid/capsaicin ratios. Cell viability assay (MTT) was used to determine IC50.

RESULTS

Capsaicin-loaded nanoliposomes showed optimum characteristics of morphology, particle size, zeta potential, and stability. In vitro anticancer activity of capsaicin and capsaicin-loaded nanoliposomes were compared against MCF7, MDA-MB-231, K562, PANC1, and A375 cell lines. Capsaicin-loaded nanoliposomes showed significant improvement in anticancer activity against cancers cell lines studied (p < 0.001), with increased selectivity against cancer cells compared to capsaicin.

CONCLUSION

The encapsulated capsaicin nanoliposomes produced an improvement in pharmacokinetics properties, enhancing the anticancer activity and selectivity compared with capsaicin. This model seems to offer a potential for developing capsaicin formulations for the prevention and treatment of cancer.

Targeted doxorubicin delivery and release within breast cancer environment using PEGylated chitosan nanoparticles labeled with monoclonal antibodies

Breast cancer has been one of the top chronic and life-threatening diseases worldwide. Nano-drug therapeutic systems have proved their efficacy as a selective treatment compared to the traditional ones that are associated with serious adverse effects. Here, biodegradable chitosan nanoparticles (CSNPs) were synthesized to provide selective and sustained release of doxorubicin (DOX) within the breast tumor microenvironment. CSNPs surface was modified using Polyethylene glycol (PEG) to enhance their blood circulation timing. To provide high drug selectivity, CSNPs functionalized with two different types of breast cancer-specific monoclonal antibodies (mAb); anti-human mammaglobin (Anti-hMAM) and anti-human epidermal growth factor (Anti-HER2). Anti-hMAM PEGylated DOX loaded CSNPs and Anti-HER2 PEGylated DOX loaded CSNPs nano-formulations were the most cytotoxic against MCF-7 cancer cells than L-929 normal cells compared to free DOX. Finally, we believe that dose-dependent system toxicity of freely ingested DOX can be managed with such targeted nano-formulated drug delivery platforms.

Quality of life of cancer patients at palliative care units in developing countries: systematic review of the published literature

Purpose

This systematic review aims to summarize factors that influence the quality of life (QOL) of advanced cancer patients in palliative care (PC) in developing countries. Understanding this context in developing countries milieu is necessary; however, this outcome is rarely reported.

Methods

Following the PRISMA guidelines, the electronic databases MEDLINE, Embase, CINAHL, and Web of Science were systematically searched using the search terms: QOL, cancer, PC, and names of all developing countries. Studies with less than ten subjects, qualitative or pilot studies, reviews, conference abstracts, and that reported validation of QOL questionnaires were excluded.

Results

Fifty-five studies from 15 developing countries in the African (n = 5), Latin America and the Caribbean (n = 10), and Asian (n = 40) region were included in the narrative synthesis. 65.4% were cross-sectional, 27.3% were cohort studies, 7.3% were RCTs or quasi-experimental studies. Around 30 QOL factors were studied with 20 different types of QOL instruments. Advanced cancer patients who were older, married/ever married, participated in additional care within PC, used complementary and alternative medicine (CAM), and practiced spirituality/religiosity showed higher QOL score. Low educational level and high depression were associated with a lower QOL.

Conclusion

Various factors affect QOL among cancer patients in PC. Patients valued the use of CAMs; however, the quality and safety aspects should be properly addressed. Important factors that influenced the QOL score were social and spiritual support. While there is a general need to develop PC strategies further, recognizing patients’ needs should be prioritized in national cancer programs.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02633-z) contains supplementary material, which is available to authorized users.

Health-related quality of life in Malaysian gastrointestinal cancer patients and their family caregivers-a comparison study

PURPOSE

Gastrointestinal (GI) cancer has emerged as a major health problem. Cancer patients receive informal care from their families beyond formal care. There has been little evidence showing how the health-related quality of life (HRQOL) of the caregivers differs from that of the GI patients in Malaysia. A cross-sectional study was conducted in three referral hospitals in Malaysia. The objectives of this study were to determine the HRQOL of GI cancer patients and their family caregivers, and assess whether there is any significant relationship between the demographic factors, and the physical component summary (PCS) and mental component summary (MCS) scores for patients and caregivers.

METHODS

A total of 323 dyads of GI cancer patients and their caregivers completed the Medical Outcomes Study 12-item Short Form (MOS SF-12) questionnaire to measure their HRQOL during face-to-face interviews. The analyses were performed using SF-12 scoring software to compute PCS and MCS scores (HRQOL parameters). The independent t test, one-way ANOVA, and the Pearson correlation test were conducted to determine the demographic factors related to the HRQOL of the dyads.

RESULTS

The caregivers had higher scores in all domains for the SF-12 than the patients. There were significant differences found in the MCS scores of the patients according to ethnicity, origin of cancer, duration of cancer, and surgery. None of these factors had a significant relationship with the caregivers' HRQOL.

CONCLUSION

Caregivers had better HRQOL than cancer patients. Early intervention for cancer patients in the form of counselling and personalised pain management may enhance the HRQOL of patients.

The function of patient-centered care in mitigating the effect of nursing shortage on the outcomes of care

BACKGROUND

The shortage of nursing staff is a national and international issue. Inadequate number of hospital nurse staff leads to poor health care services. Yet the effects of patient-centeredness between the relationships of nursing shortage on the quality of care (QC) and patient safety (PS) have not been explored. The aim of this study was to examine the mediating effects of patient-centeredness on the relationship of nursing shortage on the QC and PS in the Medical and Surgical Wards, in Malaysian private hospitals.

METHOD

A descriptive, cross-sectional study was carried out on 12 private hospitals. Data was gathered, through a self- administered questionnaire, from 652 nurses, with a 61.8% response rate. Stratified simple random sampling was used to allow all nurses to participate in the study. Hayes PROCESS macro-regression analyses were conducted to explore the mediating effects of patient-centeredness on the relationships of hospital nurse staffing on the QC and PS.

RESULTS

Patient-centeredness mediated the relationships of hospital nurse staffing on both the QC (F = 52.73 and P = 0.000) and PS (F = 31.56 and P = 0.000).

CONCLUSION

Patient-centeredness helps to mitigate the negative associations of nursing shortage on the outcomes of care. The study provides a guide for hospital managers, leaders, decision-makers, risk managers, and policymakers to maintain adequate staffing level and instill the culture of patient-centeredness in order to deliver high quality and safer care.

Awareness and current knowledge of breast cancer

Breast cancer remains a worldwide public health dilemma and is currently the most common tumour in the globe. Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact on recognition and screening of breast cancer. Breast cancer is life-threatening disease in females and the leading cause of mortality among women population. For the previous two decades, studies related to the breast cancer has guided to astonishing advancement in our understanding of the breast cancer, resulting in further proficient treatments. Amongst all the malignant diseases, breast cancer is considered as one of the leading cause of death in post menopausal women accounting for 23% of all cancer deaths. It is a global issue now, but still it is diagnosed in their advanced stages due to the negligence of women regarding the self inspection and clinical examination of the breast. This review addresses anatomy of the breast, risk factors, epidemiology of breast cancer, pathogenesis of breast cancer, stages of breast cancer, diagnostic investigations and treatment including chemotherapy, surgery, targeted therapies, hormone replacement therapy, radiation therapy, complementary therapies, gene therapy and stem-cell therapy etc for breast cancer.

[Mental Health Determines the Quality of Life in Patients With Cancer-Related Neuropathic Pain in Quito, Ecuador]

OBJECTIVE

To identify the main factors determining the health related quality of life (HRQL) in patients with cancer-related neuropathic pain in a tertiary care hospital.

METHODS

A cross-sectional analytical study was performed on a sample of 237 patients meeting criteria for cancer-related neuropathic pain. Clinical and demographic variables were recorded including, cancer type, stage, time since diagnosis, pain intensity, physical functionality with the Palliative Performance Scale (PPS), and anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Their respective correlation coefficients (r) with HRQL assessed with the SF-36v2 Questionnaire were then calculated. Linear regression equations were then constructed with the variables that showed an r≥.5 with the HRQL.

RESULTS

The HRQL scores of the sample were 39.3±9.1 (Physical Component) and 45.5±13.8 (Mental Component). Anxiety and depression strongly correlated with the mental component (r=-.641 and r=-.741, respectively) while PPS score correlated with the physical component (r=.617). The linear regression model that better explained the variance of the mental component was designed combining the Anxiety and Depression variables (R=77.3%; P<.001).

CONCLUSIONS

The strong influence of psychiatric comorbidity on the HRQL of patients with cancer-related neuropathic pain makes an integral management plan essential for these patients to include interventions for its timely diagnosis and treatment.

Quality of life and satisfaction with care among palliative cancer patients in Saudi Arabia

OBJECTIVE

This study aimed to determine the relationship between quality of life and satisfaction with care among cancer patients in palliative care in Saudi Arabia.

METHODS

A total of 130 palliative cancer patients were invited to participate in our cross-sectional study. Patients were recruited from a large tertiary hospital within the Ministry of Health in Saudi Arabia. All eligible participants answered a three-part questionnaire that included demographic data and the validated European Organization for Research and Treatment of Cancer (EORTC QLQ-C15-PAL) and (EORTC IN-PATSAT32) questionnaires.

RESULTS

Participants were mostly female (103/130, 79%) and married (93/130, 71%), and more than half had breast cancer (69/130, 53%). They were between 17 and 86 years of age (mean = 46.7, SD = 16.50). The correlation test showed that the relationship with physical function was weak, while emotional function and global health status had a moderate relationship with general satisfaction (r = 0.21, p < 0.01; r = 0.32, p < 0.001; r = 0.26, p < 0.01, respectively). Our results suggest that emotional function is the more important factor in predicting satisfaction with care among palliative cancer patients. An increase in emotional function leads to increased general satisfaction.

SIGNIFICANCE OF RESULTS

The emotional function of palliative cancer patients was more closely associated with overall satisfaction with care than physical function or global health status. All palliative care team members are thus required to provide adequate psychosocial support. It is recommended that interdisciplinary and collaborative approaches be integrated in palliative care of cancer patients.

Awareness and Attitude of Nurses in Regard to Providing Hospice Care

BACKGROUND

Awareness and attitudes of nurses regarding end of life care are important factors in providing hospice care. In an extensive literature review, we found no related articles investigating Iranian nurses awareness and attitudes about providing such care.

OBJECTIVES

The aims of this study were to investigate the awareness and attitudes of Iranian nurses in providing hospice care.

MATERIALS AND METHODS

In this descriptive-correlational study, 240 nurses employed in six educational centers were selected by non-randomized stratified sampling. The data collection instruments included an awareness test and attitudes regarding providing end of life care in hospice questionnaire. The data were analyzed using descriptive statistics and independent sample t-tests, one-way ANOVA, and Pearson correlation tests.

RESULTS

The nurses' awareness score was 14.3 out of 29 and 55.7% of them stated that they had not received any education in providing end of life care. Also, by obtaining the score of 91.7 out of 120 the attitudes of participants in providing end of life care in hospices were positive. In addition, the highest attitudes score of nurses were in the dimensions of benefits of implementation and health care team.

CONCLUSIONS

Considering low awareness of nurses about end of life care in hospices, continuing education should be provided for them in this regard. Especially, by considering the positive attitude of nurses, providing such programs could help develop hospice care in Iran.

Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

BACKGROUND & OBJECTIVE

Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia.

DESIGN

Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed.

RESULTS

The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme "1 Care for 1 Malaysia" in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors.

CONCLUSIONS

There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.

Influence of offspring on quality of life among cancer patients and survivors: results from the Korean longitudinal study of aging (KLoSA), 2008-2011

BACKGROUND

To examine whether offspring improve or reduce quality of life (QOL) among cancer patients and survivors.

MATERIALS AND METHODS

We used data from the Korean Longitudinal Study of Aging (KLoSA) from 2008 to 2011. There were 490 research subjects in our study: 245 cancer patients and survivors and 245 controls matched using propensity scores.

RESULTS

For cancer patients and survivors with no offspring, the QOL estimate was -2.831 lower (SE: 5.508, p-value: 0.623) than that of those with two offspring, while for those with five or more offspring, the QOL estimate was 7.336 higher (SE: 2.840, p-value: 0.036). For non-cancer patients and survivors with one child, the QOL estimate was -11.258 lower (SE: 2.430, p-value: 0.002) than that of those with two offspring, while for those with five or more offspring, the QOL estimate was -4.881 lower (SE: 2.484, p-value: 0.090).

CONCLUSIONS

This article provides evidence for a beneficial effect of offspring upon QOL in cancer patients and survivors, indicating that offspring are important for them.

Prevalence and predicting factors for anxiety in thai women with abnormal cervical cytology undergoing colposcopy

AIM

To compare prevalence of anxiety in women with abnormal cervical cytology (Pap) undergoing colposcopy to that of women attending the outpatient clinic for check-up and to examine predicting factors.

MATERIALS AND METHODS

In this cross-sectional analytical study, 100 women with abnormal cervical cytology (abnormal Pap group) and 100 women who attended our outpatient clinic for check-up (control group) were recruited from June 2013 to January 2014. The Hospital Anxiety and Depression Scale (HADS) was employed to determine anxiety in the participants with the score of ≥ 11 suggestive of clinically significant anxiety. The prevalence of anxiety and the mean HADS scores for anxiety were compared between the groups. For those with abnormal Pap, association between clinical factors and anxiety was assessed. A p-value of < 0.05 was considered significant.

RESULTS

Median age was different between the groups, 44.0 years in the abnormal Pap group and 50.0 years in the control group (p=0.01). The proportion of participants who had more than one sexual partner was higher in the abnormal Pap group, 39.2% vs. 24.7% (p=0.03) and the prevalence of anxiety was significantly higher 14/100 (14.0%) vs. 3/100 (3.0%) (p < 0.01). The prevalence of depression was comparable between the groups. The mean HADS scores for anxiety and depression subscales were significantly higher in the abnormal Pap group, 6.6 vs. 4.8 (P < 0.01) and 3.9 vs. 3.1 (p=0.05), respectively. For the abnormal Pap group, no definite association between clinical factors and anxiety was demonstrated.

CONCLUSIONS

The prevalence of anxiety in women with abnormal Pap awaiting colposcopy was significantly higher than that of normal controls. Special attention including thorough counselling, with use of information leaflets and psychological support, should be directed to these women.

Quality of life by stage of cervical cancer among Malaysian patients

Stage of cervical cancer may adversely affect the quality of life (QOL) among patients. The objective of this study was to predict the QOL among cervical cancer patients by the stage of their cancer. A cross-sectional study from September 2012 until January 2013 was conducted among cervical cancer patients who completed treatment. All patients completed a interviewer-guided questionnaire comprising four sections: (A) socio- demographic data, (B) medical history, (C) QOL measured by general health status questionnaire (QLQ-30) and (D) cervical cancer specific module CX-24 (EORTC) was used to measured patient's functional, symptom scale and their global health status. Results showed that global health status, emotional functioning and pain score were higher in stage III cervical cancer patients while role functioning was higher in stage I cervical cancer patients. Patients with stage IV cancer have a lower mean score in global health status (adjusted b-22.0, 95 CI% -35.6, -8.49) and emotional functioning (adjusted b -22.5, 95 CI% -38.1, -6.69) while stage III had lower mean score in role functioning (adjusted b -14.3, 95 CI% -25.4, -3.21) but higher mean score in pain (adjusted b 22.1, 95 CI% 8.56, 35.7). In conclusion, stage III and IV cervical cancers mainly affect the QOL of cervical cancer patients. Focus should be given to these subgroups to help in improving the QOL.