Association Between Physician Online Rating and Quality of Care

Background: Patients are increasingly using physician review websites to find &ldquo;a good doctor.&rdquo; However, to our knowledge, no prior study has examined the relationship between online rating and an accepted measure of quality. Objective: The purpose of this study was to assess the association between online physician rating and an accepted measure of quality: 30-day risk-adjusted mortality rate following coronary artery bypass graft (CABG) surgery. Methods: In the US states of California, Massachusetts, New Jersey, New York, and Pennsylvania&mdash;which together account for over one-quarter of the US population&mdash;risk-adjusted mortality rates are publicly reported for all cardiac surgeons. From these reports, we recorded the 30-day mortality rate following isolated CABG surgery for each surgeon practicing in these 5 states. For each surgeon listed in the state reports, we then conducted Internet-based searches to determine his or her online rating(s). We then assessed the relationship between physician online rating and risk-adjusted mortality rate. Results: Of the 614 surgeons listed in the state reports, we found 96.1% (590/614) to be rated online. The average online rating was 4.4 out of 5, and 78.7% (483/614) of the online ratings were 4 or higher. The median number of reviews used to formulate each rating was 4 (range 1-89), and 32.70% (503/1538) of the ratings were based on 2 or fewer reviews. Overall, there was no correlation between surgeon online rating and risk-adjusted mortality rate (P=.13). Risk-adjusted mortality rates were similar for surgeons across categories of average online rating (P&gt;.05), and surgeon average online rating was similar across quartiles of surgeon risk-adjusted mortality rate (P&gt;.05). Conclusions: In this study of cardiac surgeons practicing in the 5 US states that publicly report outcomes, we found no correlation between online rating and risk-adjusted mortality rates. Patients using online rating websites to guide their choice of physician should recognize that these ratings may not reflect actual quality of care as defined by accepted metrics.</p

Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study.

OBJECTIVE: To define early presenting features of bacterial meningitis in young infants in England and to review the adequacy of individual case management as compared with relevant national guidelines and an expert panel review. DESIGN: Retrospective medical case note review and parental recall using standardised questionnaires. SETTING: England and Wales. PARTICIPANTS: Infants aged <90 days with bacterial meningitis diagnosed between July 2010 and July 2013. RESULTS: Of the 97 cases recruited across England and Wales, 66 (68%) were admitted from home and 31 (32%) were in hospital prior to disease onset. Almost all symptoms reported by parents appeared at the onset of the illness, with very few new symptoms appearing subsequently. Overall, 20/66 (30%) infants were assessed to have received inappropriate prehospital management. The median time from onset of first symptoms to first help was 5 hours (IQR: 2-12) and from triage to receipt of first antibiotic dose was 2.0 hours (IQR: 1.0-3.3), significantly shorter in infants with fever or seizures at presentation compared with those without (1.7 (IQR: 1.0-3.0) vs 4.2 (IQR: 1.8-6.3) hours, p=0.02). Overall, 26 (39%) infants had a poor outcome in terms of death or neurological complication; seizures at presentation was the only significant independent risk factor (OR, 7.9; 95% CI 2.3 to 207.0). For cases in hospital already, the median time from onset to first dose of antibiotics was 2.6 (IQR: 1.3-9.8) hours, and 12/31 (39%) of infants had serious neurological sequelae at hospital discharge. Hearing test was not performed in 23% and when performed delayed by ≥4 weeks in 41%. CONCLUSIONS: In young infants, the non-specific features associated with bacterial meningitis appear to show no progression from onset to admission, whereas there were small but significant differences in the proportion of infants with more specific symptoms at hospital admission compared with at the onset of the illness, highlighting the difficulties in early recognition by parents and healthcare professionals alike. A substantial proportion of infants received inappropriate prehospital and posthospital management. We propose a targeted campaign for education and harmonisation of practice with evidence-based management algorithms

Microbiological Effects of Gas Flaring on Agricultural Soil at Izombe Flow-station, Imo State, Nigeria

The microbiological effects of gas flaring on the agricultural soil from Izombe Flow-Station in Imo State were investigated. The physical and microbiological properties of the soil samples were analyzed. The microbiological analysis of the soil samples were conducted by serially diluting and then inoculating the soil samples on different growth media. Several microbiological and biochemical methods were applied in order to isolate and identify the microorganisms accustomed to the soil samples. An unpolluted soil sample from a farmland outside the Flow-Station served as control. The results showed that temperature increased with increase in distance towards the flare while moisture contents decreased as distance increased towards the flare, indicating that flaring exerts adverse ecological effects on the soil. The pH value at the flare site was acidic (4.0) compared with the near neutral obtained from the control (pH 6.8).  Results also showed a decrease in microbial load of the soil samples as distance approaches the Flow-Stack. The total bacterial counts were low (3.0 x 101 cfu/g) when compared with 2.9 x 105 cfu/g obtained from the control. The total coliform counts were also adversely affected by the flare. A value as low as 2.0 x 101 cfu/g was obtained 10m from the flare stack compared with 6.0 x 104 obtained from the control. The bacteria isolated from the soil samples were species of Staphylococcus spp, Bacillus spp, Escherichia coli, Pseudomona spps, Norcadia spp, Micrococcus spp, Enterobacter spp and Streptomyces spp while species of fungi identified were Aspergillus spp, Fusarium spp, Penicillium spp and Mucor spp. Acid deposition and intense heat from the flare likely have deleterious effects on the soil ecosystem and therefore should be discouraged. Keywords: Gas flaring, microbiological effects, physical properties, Microbial load, Flow-Station

Compliance to Annual Ivermectin Treatment in Abia State, South Eastern Nigeria

A study with the objective of determining the rate of individual compliance to annual ivermectin treatment was conducted in Abia State, south eastern Nigeria between January and November, 2011. The study captured the Local Government Areas in  Abia State that were assessed by Rapid  Epidemiological Mapping for Onchocerciasis (REMO) as being hyper-endemic for onchocerciasis and which have been receiving ivermectin for over 14 years. A study questionnaire was designed to investigate the rate of compliance and this was distributed to 558 individuals. The result showed that out of 558 individuals, 309 (55.4%) had taken the drug before while 249 (44.6%) claimed they have not been treated before. Despite the treatment over time, only 70 (22.7%) of those treated before were high compliers (that is, those who had been treated eight times and above). The overall percentage of high compliers in the sampled communities was only 12.6%. Reasons for low compliance include “lack of information on the arrival of drug” (27.8%), “no reason for refusal” (22.2%),” absent, away from village” (20.0%) and “no distribution” (19.7%). In testing the reasons for low compliance, the Chi-square analytical technique on the data revealed that the reasons given by the respondents for low compliance were not significant (?2cal = 1.797 &lt; ?2tab = 16.9190), and therefore do not affect general compliance. Key words: Compliance, Annual ivermectin treatment, Onchocerciasi

Determinants of technical efficiency among smallholder dairy farmers in Tanzania

Irish Ai

Where do delays occur when women receive antenatal care? A client flow multi-site study in four health facilities in Nigeria

Objectives: The objective of the study was to identify where delays occur when women present for antenatal care in four Nigerian referral hospitals, and to make recommendations on ways to reduce delays in the course of provision of antenatal care in the hospitals.Design: Prospective observational studySetting: Four Nigerian (1 tertiary and 3 secondary) HospitalsParticipants: Women who presented for antenatal care.Interventions: A process mapping. The National Health Service (NHS) Institute Quality and Service Improvement Tool was used for the assessment.Main outcome measures: The time women spent in waiting and receiving antenatal care in various departments of the hospitals.Results: Waiting and total times spent varied significantly within and between the hospitals surveyed. Mean waiting and total times spent were longest in the outpatients’ departments and shortest in the Pharmacy Departments. Total time spent was an average of 237.6 minutes. χ2= 21.074; p= 0.0001Conclusion: There was substantial delay in time spent to receive care by women seeking routine antenatal health services in the four secondary and tertiary care hospitals. We recommend managers in health facilities include the reduction of waiting times in the strategic plans for improving the quality of antenatal care in the hospitals. This should include the use of innovative payment systems that excludes payment at time of service delivery, adoption of a fast-track system such as pre-packing of frequently used commodities and the use of new tech informational materials for the provision of health education.Funding: The Alliance for Health Policy and Systems Research, World Health Organization, Geneva; Protocol IDA65869.Keywords: Delays; Waiting time; antenatal; Hospitals; Women; Maternity care; Process mapping; Nigeria

Assessment of Zinc Level and its Relationship with Some Hematological Parameters among Patients with Sickle Cell Anemia in Abakaliki, Nigeria

Background: Sickle cell anemia (SCA) is an inherited hemoglobin (Hb) disorder with susceptibility for oxidative damage due to chronic redox imbalance in red blood cells (RBCs) which often results in hemolysis, endothelial injury, recurrent vaso-occlusive episodes, and derangement in hematological parameters. Zinc is an antioxidant which helps to reduce oxidative damage. This study aimed to assess the serum level of zinc and its relationship with some hematological parameters in patients with SCA (HbSS). Materials and Methods: This was a cross-sectional comparative study which involved HbSS patients in steady state with sex‐ and age‐matched HbAA control. Assay of Hb phenotype, serum zinc level, and some haematological parameters were done. Ethical approval was gotten from the institutional review board, and each participant gave informed written consent before recruitment into the study. Analysis of all data obtained was done using SPSS software, version 20. Results: Thirty adult patients with SCA and thirty sex- and age-matched controls with a mean age of 26.7 ± 7.6 years and 27.7± 5.3, respectively, were studied. There was a significant decrease in serum zinc level among patients with HbSS compared to those with HbAA (P = 0.038). Similarly, patients with HbSS had significantly lower Hb level, packed cell volume, and RBC count compared to HbAA control (P &lt; 0.05). On the contrary, patients with HbSS had significantly higher white cell count and platelet count compared to HbAA individuals (P &lt; 0.05). Correlation between serum zinc level and blood counts showed weak positive relationship between zinc level and Hb level (r = 0.04, P = 0.8) and weak negative relationship between serum zinc level and platelet count (r = −0.3, P = 0.1), as well as zinc and white blood cell (WBC) count (r = −0.2, P = 0.4). Conclusion: There was a significantly low level of zinc among patients with HbSS compared with HbAA controls. Patients with HbSS had zinc levels that weakly correlated with Hb level positively but weakly negatively correlated with platelet and WBC counts. Further studies are required on a wider scale to assess whether zinc supplementation may improve blood counts in patients with SCA